PhD Student projects
Title: Maintenance CST implementation in practice
Supervisors: Prof Martin Orrell & Dr Aimee Spector
Start & end dates: June 2010 – November 2013
PhD outline :
Background: Cognitive Stimulation Therapy (CST) is an evidence based psychosocial intervention for people with mild to moderate dementia. CST is currently recommended as part of the NICE guidelines (2006) for people to have the opportunity to participate in a structured group activity. Previous research has shown benefits in cognition and quality of life for the person with dementia, however there is little research in to CST implementation in to practiceAims & Objectives: To study the long-term implementation of CST within two linked trials and conduct a phase IV trial which will evaluate the effects of training, and the effects of outreach support, the long-term effects of CST in practice, and will help to understand the barriers and facilitators related to implementing CST in practice. The aim of this study is to determine whether groups are running in practice and demonstrate the positive findings for cognition and quality of life of life for the person with dementia
Methods: This study includes three projects. The staff training
and outreach (STANDOUT) trial and the monitoring and outreach (MONOU) trial
differ in how staff members are recruited and in their previous exposure to
training in CST. For the STANDOUT trial staff will have no previous experience
of CST, whereas in the MONOU trial staff will have previously purchased the
‘Making a difference’ manual or attended the CST training day. Staff will be
cluster randomized to receive outreach support consisting of online forum,
local supervision and email support and complete outcome measures before randomization and at 6 and 12 months. Centres will also record the level of
attendance and adherence to the programme. The observational study recruits
people with dementia only and cognition and quality of life are measured before
during and after the CST and maintenance CST programme.
Progress to date: Recruitment is complete. Both staff and people with dementia are between their follow up 1 and follow up 2 assessment. The upgrade from MPhil to PhD status will occur in July of this year. The protocol for the study has been published in a peer reviewed journal.
Title: The risk of cardiovascular disease (CVD; including coronary heart disease and stroke) amongst people with a severe mental illness
Supervisors: Dr David Osborn and Dr Irene Petersen
Start & end dates: September 2012 – July 2015
Background: The risk of cardiovascular disease (CVD;
including coronary heart disease and stroke) amongst people with a severe
mental illness (SMI) such as bipolar disorder or schizophrenia is at least
twice that of the general population. CVD is currently the leading cause
of death in people with SMI and contributes substantially to the substantial
deficit in life-expectancy of this group relative to the general
population. There is evidence of substantial inequality in the provision
of both preventative and reactive cardiac care, with people with SMI being 40%
less likely to be prescribed a statin than people without SMI. However,
little is known about the factors determining prescription of statins to people
with SMI and how this compares with the general population. Furthermore, very
few studies have examined statin medication adherence in people with SMI and
the evidence assessing differences in adherence relative to the general
population is inconclusive. Given the high CVD mortality rate amongst people
with SMI, it is of great importance to understand the unmet cardiovascular
needs of this population and identify where treatment gaps exist.
Aims: This study aims to describe the differences in the prescribing of statins in people with and without SMI who do not have a pre-existing CVD condition and to evaluate whether adherence rates differ by SMI status (i.e. comparison of patients with, or without, an SMI diagnosis).
Methods: I will analyse data from The Health Improvement Network’s (THIN) Primary Care database, which is populated by data arising from GP consultations in over 500 UK practices. THIN captures longitudinal data on; patient demographics, morbidity, prescriptions, lifestyle and health indicators and consultation dates (including referral). These data will be used to measure and evaluate differences in statin prescribing between people with and without SMI, who are comparable in terms of their CVD risks.
The development and evaluation of individual Cognitive Stimulation Therapy (individual CST) for dementia.
Supervisors: Professor Martin Orrell & Dr. Vasiliki Orgeta
Start date: June 2011
Aims & objectives
To investigate whether individual CST benefits cognition and quality of life in people with dementia over 6 months compared to a control (treatment as usual, TAU) group. To assess the cost effectiveness of individual CST vs. TAU.
To produce and disseminate a standardised therapy package for individual CST
This is a multi centre, pragmatic, single blind randomised 2 treatment arm (individual CST vs TAU) controlled clinical trial over 26 weeks. The intervention consists of iCST sessions delivered by a carer for 30 minutes, 3 times a week over 25 weeks. The primary outcome measures include quality of life of people with dementia assessed by QoL-AD, and cognition assessed by the ADAS-Cog. For carers, quality of life is the primary outcome measure. The trial includes a cost-effectiveness analysis from a public sector perspective.
Progress to date
We are currently in the development phase of the project. We have produced the first draft of the individual CST manual and are running a series of focus groups, interviews and having participants field test the materials to inform the final draft of the package ready for the main RCT.
Medicalisation of sadness, depression and spiritual distress
Supervisors: Prof Gerard Leavey and Prof Roland Littlewood
Start & end dates: June 2010 – June 2013
Background: Critiques of the validity of the current diagnostic criteria for depressive disorder argue that it fails to differentiate between dysfunctional sadness and normal sadness as they do not take into account the phenomenological and existential context in which the depressive symptoms occurred. My previous ethnographic field work conducted in a community of contemplative nuns revealed that symptoms that otherwise might have been described as pathological and likely to meet diagnostic criteria for a depressive disorder, were considered by the nuns a normal and valued experience and understood within the framework of the so-called Dark Night of the Soul narrative: an active process of transforming emotional distress into a process of self-reflection, attribution of religious meaning and spiritual growth (Durà-Vilà et al., 2010).
Aims & objectives: I aim to examine emotional distress and its corresponding explanatory models amongst a highly religious sample. I intend to test and deepen the findings of my initial fieldwork considerably expanding the number of participants as well as significantly increasing the diversity of the religious sample including monastic and secular contexts. A detailed depiction of the Dark Night of the Soul narrative will be obtained from those who conceptualise suffering using this idiom. Furthermore, notions of what constitutes spiritual pathology and the understanding and expression of depressive disorder in a fervent Catholic sample will be sought in an attempt to explore universal concepts of disordered sadness transcending this particular context. Finally, an in-depth exploration of the management of suffering among the participants will be sought, paying particular attention to the role that the clergy play in helping their parishioners and other religious people to cope with times of intense emotional suffering.
Methods: The following four samples were interviewed (semi-structured interviews) giving a total of 60 interviews: 10 contemplative nuns (these nuns were different from those interviewed in the initial research), 10 contemplative monks, 20 lay adults with religious beliefs attending a Catholic theological college, 20 priests.
Progress to date: all the interviews have been done. I have just upgrade fromMPhil to PhD.
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