Browsing by Author "Young, Hannah M. L."
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Item Metadata only Acute intradialytic exercise does not affect the phenotype or pro-thrombotic nature of microparticles but alters their function(Wiley, 2018-10-07) Martin, Naomi; Dungey, Maurice R.; Burton, James O.; Young, Hannah M. L.; Smith, Alice C.; Bishop, Nicolette C.Haemodialysis patients have a dysfunctional and activated immune system, with comorbidity-associated risks of thrombosis, cardiovascular disease and infection. Microparticles are biologically active nanovesicles shed from activated cells and are a novel biomarker of inflammation. Exercise is anti-inflammatory and advocated in haemodialaysis, yet the effect on microparticles is unknown. We assessed the acute effect of intradialytic exercise on microparticle number, phenotype, ability to induce endothelial cell reactive oxygen species and activate leukocytes in vitro. 11 patients were studied during a routine haemodialysis session and one where they exercised. Irrespective of exercise microparticle number increased during haemodialysis (2064 to 7071 MP/µl, P<0.001) as did phosphatidylserine+ (P<0.05), platelet-derived (P<0.01) and percentage pro-coagulant neutrophil-derived microparticles (P<0.05) and leukocyte-activating ability (P<0.01). Microparticles collected 0 and 60 min post-exercise induced greater reactive oxygen species generation from cultured endothelial cells than when resting (P<0.05). In summary moderate intensity intradialytic exercise had no effect on the circulating MP response or their leukocyte-activating ability. However, those collected after exercise induced greater reactive oxygen species from endothelial cells, suggesting an acute, transient pro-inflammatory response. This may stimulate a longer lasting anti-inflammatory adaptation which needs to be confirmedItem Open Access The development and pilot testing of the Self-management Programme of Activity, Coping & Education (SPACE FOR COPD)(Dove Press Ltd, 2013-07-09) Mitchell, Katy E.; Harrison, S. L.; Williams, J. E.; Steiner, M.; Apps, L. D.; Sewell, L.; Young, Hannah M. L.; Morgan, M.; Singh, S. J.Purpose: There is no independent standardized self-management approach available for chronic obstructive pulmonary disease (COPD). The aim of this project was to develop and test a novel self-management manual for individuals with COPD. Patients: Participants with a confirmed diagnosis of COPD were recruited from primary care. Methods: A novel self-management manual was developed with health care professionals and patients. Five focus groups were conducted with individuals with COPD (N = 24) during development to confirm and enhance the content of the prototype manual. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed as the focus of a comprehensive self-management approach facilitated by health care professionals. Preference for delivery was initial face-to-face consultation with telephone follow-up. The SPACE for COPD manual was piloted with 37 participants in primary care. Outcome measures included the Self-Report Chronic Respiratory Questionnaire, Incremental Shuttle Walk Test, and Endurance Shuttle Walking Test (ESWT); measurements were taken at baseline and 6 weeks. Results: The pilot study observed statistically significant improvements for the dyspnea domain of the Self-Report Chronic Respiratory Questionnaire and ESWT. Dyspnea showed a mean change of 0.67 (95% confidence interval 0.23–1.11, P = 0.005). ESWT score increased by 302.25 seconds (95% confidence interval 161.47–443.03, P , 0.001). Conclusion: This article describes the development and delivery of a novel self-management approach for COPD. The program, incorporating the SPACE for COPD manual, appears to provoke important changes in exercise capacity and breathlessness for individuals with COPD managed in primary care.Item Open Access Development of a training program to support health care professionals to deliver the SPACE for COPD self-management program(Dove Press Ltd, 2017-06-07) Blackmore, C.; Johnson-Warrington, V. L.; Williams, J. E. A.; Apps, L. D.; Young, Hannah M. L.; Bourne, C. L. A.; Singh, S. J.Background: With the growing burden of COPD and associated morbidity and mortality, a need for self-management has been identified. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed to support self-management in COPD patients. Currently, there is no literature available regarding health care professionals’ training needs when supporting patients with COPD on self-management. Aim: This study sought to identify these needs to inform, design and develop a training program for health care professionals being trained to deliver a self-management program in COPD. Methods: Fourteen health care professionals from both primary and secondary care COPD services participated in face-to-face semistructured interviews. Thematic analysis was used to produce a framework and identify training needs and views on delivery of the SPACE for COPD self-management program. Components of training were web-based knowledge training, with pre- and posttraining knowledge questionnaires, and a 1-day program to introduce the self-management manual. Feedback was given after training to guide the development of the training program. Results: Health care professionals were able to identify areas where they required increased knowledge to support patients. This was overwhelming in aspects of COPD seen to be outside of their current clinical role. Skills in goal setting and behavioral change were not elicited as a training need, suggesting a lack of understanding of components of supporting self-management. An increase in knowledge of COPD was demonstrated following the training program. Conclusion: Both knowledge and skill gaps existed in those who would deliver self-management. Analysis of this has enabled a training program to be designed to address these gaps and enable health care professionals to support patients in self-management. Keywords: self-management, COPD, health care professionals, trainingItem Open Access Important, misunderstood, and challenging: a qualitative study of nurses and allied health professionals’ perceptions of implementing self-management for patients with COPD(Dove Press Ltd, 2015-06-03) Apps, L. D.; Harrison S. L.; Johnson-Warrington, V. L.; Hudson, Nicky; Young, Hannah M. L.; Singh, S. J.Background: In light of the growing burden of COPD, there is increasing focus on the role of self-management for this population. Currently, self-management varies widely. Little is known either about nurses’ and allied health professionals’ (AHPs’) understanding and provision of self-management in clinical practice. This study explores nurses’ and AHPs’ understanding and implementation of supported COPD self-management within routine clinical practice. Materials and methods: Nurses and AHPs participated in face-to-face semistructured interviews to explore their understanding and provision of COPD self-management, as well as their perceptions of the challenges to providing such care. Purposive sampling was used to select participants from a range of professions working within primary, community, and secondary care settings. Three researchers independently analyzed each transcript using a thematic approach. Results: A total of 14 participants were interviewed. Nurses and AHPs viewed self-management as an important aspect of COPD care, but often misunderstood what it involved, leading to variation in practice. A number of challenges to supporting self-management were identified, which related to lack of time, lack of insight regarding training needs, and assumptions regarding patients’ perceived self-management abilities. Conclusion: Nurses and AHPs delivering self-management require clear guidance, training in the use of effective self-management skills, and education that challenges their preconceptions regarding patients. The design of health care services also needs to consider the practical barriers to COPD self-management support for the implementation of such interventions to be successful.Item Metadata only Intradialytic cycling does not exacerbate microparticles or circulating markers of systemic inflammation in haemodialysis patients(Springer, 2021-12-02) Highton, P. J.; March, D. S.; Churchward, D. R.; Grantham, C. E.; Young, Hannah M. L.; Graham-Brown, M. P. M.; Estruel, S.; Martin, N.; Brunskill, N. J.; Smith, A. C.; Burton, J. O.; Bishop, N. C.Purpose Patients receiving haemodialysis (HD) display elevated circulating microparticle (MP) concentration, tissue factor (TF) expression and markers of systemic inflammation, though regular intradialytic cycling (IDC) may have a therapeutic effect. This study investigated the impact of regular, moderate-intensity IDC on circulating MPs and inflammatory markers in unit-based HD patients. Methods Patients were cluster-randomised to intervention (n = 20, age: 51.4 ± 18.1 years, body mass: 77.6 ± 18.3 kg, mean ± SD) or no-exercise control (n = 20, 56.8 ± 14.0 years, 80.5 ± 26.5 kg). Intervention participants completed 30 min of moderate intensity (rating of perceived exertion [RPE] of 12–14) IDC, thrice weekly for 6 months. Pre-dialysis venous blood samples were obtained at 0, 3 and 6 months. Circulating MP phenotypes, cytokines, chemokine and MP TF expression were quantified using flow cytometry and cytometric bead array assays. Results Despite high exercise compliance (82%), no IDC-dependent effects were observed for any MP, cytokine or chemokine measure (p ≥ 0.051, ηρ 2 ≤ 0.399) other than TNF-α (p = 0.001, ηρ 2 = 0.186), though no significance was revealed upon post hoc analysis. Conclusion Six months of regular, moderate-intensity IDC had no effect on MPs, cytokines or chemokines. This suggests that the exercise did not exacerbate thrombotic or inflammatory status, though further functional assays are required to confirm this.Item Metadata only Motivations and barriers to exercise in chronic kidney disease: a qualitative study.(Oxford University Press, 2015) Clarke, Amy; Young, Hannah M. L.; Hull, Katherine; Hudson, Nicky; Burton, James; Smith, Alice C.