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  1. Article ; Online: Unmet needs, quality of life and support networks of people with dementia living at home

    Oomman Sabu / Galboda Kumari / Woods Bob / Miranda-Castillo Claudia / Olojugba Charles / Orrell Martin

    Health and Quality of Life Outcomes, Vol 8, Iss 1, p

    2010  Volume 132

    Abstract: Abstract Background There is lack of evidence about the unmet needs of people with dementia (PWD) living at home and the predictors of high levels of unmet needs. The main aim of this study was to identify the relationship between unmet needs, social ... ...

    Abstract Abstract Background There is lack of evidence about the unmet needs of people with dementia (PWD) living at home and the predictors of high levels of unmet needs. The main aim of this study was to identify the relationship between unmet needs, social networks and quality of life of PWD living at home. Methods One hundred and fifty two community dwelling PWD and 128 carers were interviewed about PWD's needs, social networks, quality of life and other functional and psychological factors. All the interviews with PWD were carried out at their homes. Interviews with carers were undertaken either at PWD's home, their own home or at the health centre. Whenever possible, PWD and carers were interviewed separately. The data collection took place between November 2005 and July 2007. The majority of participants (129, 84.9%) were recruited from National Health Services (NHS) and the rest (23, 15.1%) were recruited from other organisations such as social services and voluntary organizations in the UK. Results The most frequent unmet needs for PWD were daytime activities (77, 50.7%), company (60, 39.5%), and help with psychological distress (47, 30.9%). Higher number of behavioural and psychological symptoms, low-community involvement social networks, having a younger carer and higher carer's anxiety were found to be predictors of higher unmet needs in PWD. Social networks and behavioural and psychological symptoms had an indirect effect on PWD's self-rated quality of life through unmet needs. Conclusions Interventions aiming to reduce unmet needs, through the treatment of behavioural and psychological symptoms and the involvement of PWD in the community, would potentially improve PWD's quality of life.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 360 ; 300
    Language English
    Publishing date 2010-11-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Unmet needs, quality of life and support networks of people with dementia living at home.

    Miranda-Castillo, Claudia / Woods, Bob / Galboda, Kumari / Oomman, Sabu / Olojugba, Charles / Orrell, Martin

    Health and quality of life outcomes

    2010  Volume 8, Page(s) 132

    Abstract: Background: There is lack of evidence about the unmet needs of people with dementia (PWD) living at home and the predictors of high levels of unmet needs. The main aim of this study was to identify the relationship between unmet needs, social networks ... ...

    Abstract Background: There is lack of evidence about the unmet needs of people with dementia (PWD) living at home and the predictors of high levels of unmet needs. The main aim of this study was to identify the relationship between unmet needs, social networks and quality of life of PWD living at home.
    Methods: One hundred and fifty two community dwelling PWD and 128 carers were interviewed about PWD's needs, social networks, quality of life and other functional and psychological factors. All the interviews with PWD were carried out at their homes. Interviews with carers were undertaken either at PWD's home, their own home or at the health centre. Whenever possible, PWD and carers were interviewed separately. The data collection took place between November 2005 and July 2007. The majority of participants (129, 84.9%) were recruited from National Health Services (NHS) and the rest (23, 15.1%) were recruited from other organisations such as social services and voluntary organizations in the UK.
    Results: The most frequent unmet needs for PWD were daytime activities (77, 50.7%), company (60, 39.5%), and help with psychological distress (47, 30.9%). Higher number of behavioural and psychological symptoms, low-community involvement social networks, having a younger carer and higher carer's anxiety were found to be predictors of higher unmet needs in PWD. Social networks and behavioural and psychological symptoms had an indirect effect on PWD's self-rated quality of life through unmet needs.
    Conclusions: Interventions aiming to reduce unmet needs, through the treatment of behavioural and psychological symptoms and the involvement of PWD in the community, would potentially improve PWD's quality of life.
    MeSH term(s) Activities of Daily Living/psychology ; Aged ; Aged, 80 and over ; Alzheimer Disease/complications ; Dementia/therapy ; Female ; Health Services Needs and Demand ; Homebound Persons ; Humans ; London ; Male ; Mental Status Schedule ; Middle Aged ; Psychometrics ; Quality of Life ; Residence Characteristics/classification ; Social Support ; Socioeconomic Factors ; Surveys and Questionnaires
    Language English
    Publishing date 2010-11-12
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1477-7525
    ISSN (online) 1477-7525
    DOI 10.1186/1477-7525-8-132
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Antipsychotic treatment of very late-onset schizophrenia-like psychosis (ATLAS): a randomised, controlled, double-blind trial.

    Howard, Robert / Cort, Elizabeth / Bradley, Rosie / Harper, Emma / Kelly, Linda / Bentham, Peter / Ritchie, Craig / Reeves, Suzanne / Fawzi, Waleed / Livingston, Gill / Sommerlad, Andrew / Oomman, Sabu / Nazir, Ejaz / Nilforooshan, Ramin / Barber, Robert / Fox, Chris / Macharouthu, Ajay Verma / Ramachandra, Pranathi / Pattan, Vivek /
    Sykes, John / Curran, Val / Katona, Cornelius / Dening, Tom / Knapp, Martin / Gray, Richard

    The lancet. Psychiatry

    2018  Volume 5, Issue 7, Page(s) 553–563

    Abstract: Background: Very late (aged ≥60 years) onset schizophrenia-like psychosis occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy and risks of antipsychotic treatment. We investigated whether low-dose amisulpride (100 ... ...

    Abstract Background: Very late (aged ≥60 years) onset schizophrenia-like psychosis occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy and risks of antipsychotic treatment. We investigated whether low-dose amisulpride (100 mg daily) is superior to placebo in reducing psychosis symptoms over 12 weeks and whether any benefit is maintained by continuing treatment after 12 weeks.
    Methods: The ATLAS double-blind controlled trial enrolled participants from 25 old age psychiatry services in the UK. Eligible participants (ie, those with a diagnosis of very late-onset schizophrenia-like psychosis and a Brief Psychiatric Rating Scale [BPRS] score of ≥30, without cognitive impairment) were randomly assigned (1:1:1) to one of three groups in a two-stage trial: amisulpride in stage 1 and 2 (group A), amisulpride then placebo (group B), or placebo then amisulpride (group C). Treatment (100 mg oral amisulpride daily vs placebo) was given for 12 weeks in stage 1 and, initially, 24 weeks then reduced to 12 weeks in stage 2. Participants, investigators, and outcome assessors were masked to treatment allocation. Primary outcomes were psychosis symptoms assessed by the BPRS at 4, 12, and 24, or 36 weeks, and trial treatment discontinuation for non-efficacy. The primary, secondary, and safety endpoints were all analysed in participants given at least one dose of study treatment in modified intention-to-treat analyses. This study is registered with EudraCT, number 2010-022184-35, and ISRCTN, number ISRCTN45593573.
    Findings: Between Sept 27, 2012, and June 28, 2016, we recruited 101 participants. 92 (91%) of 101 participants took trial medication, of whom 59 (64%) completed stage 1 and 34 (58%) of these 59 participants completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7·7 points (95% CI 3·8-11·5, p=0·0002) greater with amisulpride (mean 11·9 points [SE 1·3]) than with placebo (4·2 points [1·0]). In stage 2, BPRS scores improved by a mean of 1·1 points (1·6) from 12 weeks to the final assessment in those who continued amisulpride but deteriorated by 5·2 points (2·0) in those who switched from amisulpride to placebo (difference 6·3 points [95% CI 0·9-11·7], p=0·024). Fewer participants who were allocated amisulpride than placebo stopped treatment because of non-efficacy in stage 1 (p=0·010) and stage 2 (p=0·031). Serious adverse events were reported more frequently in the amisulpride group than in the placebo group in stage 1 (p=0·057) and stage 2 (p=0·19). The most common serious adverse events were infection (five patients in the amisulpride group, three in the placebo group) and extrapyramidal side-effects (three patients in the amisulpride group, none in the placebo group). Five patients died during the study, one from a gastric ulcer bleed before treatment started (group B), two while taking stage 2 treatment (one in group A and one in group C), and two who stopped trial treatment in stage 1 and died many weeks later (one in group B and one in group C). No deaths were related to treatment.
    Interpretation: Low-dose amisulpride is effective and well tolerated as a treatment for very late-onset schizophrenia-like psychosis, with benefits maintained by prolonging treatment.
    Funding: UK National Institute for Health Research.
    MeSH term(s) Age of Onset ; Aged ; Aged, 80 and over ; Amisulpride/administration & dosage ; Amisulpride/adverse effects ; Antipsychotic Agents/administration & dosage ; Antipsychotic Agents/adverse effects ; Double-Blind Method ; Female ; Humans ; Male ; Middle Aged ; Psychiatric Status Rating Scales ; Psychotic Disorders/drug therapy ; Treatment Outcome ; United Kingdom
    Chemical Substances Antipsychotic Agents ; Amisulpride (8110R61I4U)
    Language English
    Publishing date 2018-06-04
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Pragmatic Clinical Trial ; Research Support, Non-U.S. Gov't
    ISSN 2215-0374
    ISSN (online) 2215-0374
    DOI 10.1016/S2215-0366(18)30141-X
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT.

    Howard, Robert / Cort, Elizabeth / Bradley, Rosie / Harper, Emma / Kelly, Linda / Bentham, Peter / Ritchie, Craig / Reeves, Suzanne / Fawzi, Waleed / Livingston, Gill / Sommerlad, Andrew / Oomman, Sabu / Nazir, Ejaz / Nilforooshan, Ramin / Barber, Robert / Fox, Chris / Macharouthu, Ajay / Ramachandra, Pranathi / Pattan, Vivek /
    Sykes, John / Curran, Valerie / Katona, Cornelius / Dening, Tom / Knapp, Martin / Romeo, Renee / Gray, Richard

    Health technology assessment (Winchester, England)

    2018  Volume 22, Issue 67, Page(s) 1–62

    Abstract: Background: Very late-onset (aged ≥ 60 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment. ...

    Abstract Background: Very late-onset (aged ≥ 60 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment.
    Objectives: The study investigated whether or not low-dose amisulpride is superior to placebo in reducing psychosis symptoms over 12 weeks and if any benefit is maintained by continuing treatment thereafter. Treatment safety and cost-effectiveness were also investigated.
    Design: Three-arm, parallel-group, placebo-controlled, double-blind, randomised controlled trial. Participants who received at least one dose of study treatment were included in the intention-to-treat analyses.
    Setting: Secondary care specialist old age psychiatry services in 25 NHS mental health trusts in England and Scotland.
    Participants: Patients meeting diagnostic criteria for VLOSLP and scoring > 30 points on the Brief Psychiatric Rating Scale (BPRS).
    Intervention: Participants were randomly assigned to three arms in a two-stage trial: (1) 100 mg of amisulpride in both stages, (2) amisulpride then placebo and (3) placebo then amisulpride. Treatment duration was 12 weeks in stage 1 and 24 weeks (later reduced to 12) in stage 2. Participants, investigators and outcome assessors were blind to treatment allocation.
    Main outcome measures: Primary outcomes were psychosis symptoms assessed by the BPRS and trial treatment discontinuation for non-efficacy. Secondary outcomes were extrapyramidal symptoms measured with the Simpson-Angus Scale, quality of life measured with the World Health Organization's quality-of-life scale, and cost-effectiveness measured with NHS, social care and carer work loss costs and EuroQol-5 Dimensions.
    Results: A total of 101 participants were randomised. Ninety-two (91%) participants took the trial medication, 59 (64%) completed stage 1 and 33 (56%) completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7.7 points (95% CI 3.8 to 11.5 points) greater with amisulpride than with placebo (11.9 vs. 4.2 points;
    Limitations: The original recruitment target of 300 participants was not achieved and compliance with trial medication was highly variable.
    Conclusions: Low-dose amisulpride is effective and well tolerated as a treatment for VLOSLP, with benefits maintained by prolonging treatment. Potential adverse events include clinically significant extrapyramidal symptoms and falls.
    Future work: Trials should examine the longer-term effectiveness and safety of antipsychotic treatment in this patient group, and assess interventions to improve their appreciation of potential benefits of antipsychotic treatment and compliance with prescribed medication.
    Trial registration: Current Controlled Trials ISRCTN45593573 and EudraCT2010-022184-35.
    Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in
    MeSH term(s) Aged ; Amisulpride/therapeutic use ; Antipsychotic Agents/therapeutic use ; Brief Psychiatric Rating Scale ; Double-Blind Method ; England ; Female ; Humans ; Late Onset Disorders ; Male ; Middle Aged ; National Health Programs ; Psychotic Disorders/drug therapy ; Schizophrenia/drug therapy ; Scotland ; Technology Assessment, Biomedical ; Treatment Outcome
    Chemical Substances Antipsychotic Agents ; Amisulpride (8110R61I4U)
    Language English
    Publishing date 2018-12-03
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2006765-3
    ISSN 2046-4924 ; 1366-5278
    ISSN (online) 2046-4924
    ISSN 1366-5278
    DOI 10.3310/hta22670
    Database MEDical Literature Analysis and Retrieval System OnLINE

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