Papers by Michelle Bryans
Dementia presents multiple challenges for primary care. Recently, the advent of new therapeutic o... more Dementia presents multiple challenges for primary care. Recently, the advent of new therapeutic options has highlighted the need to improve its detection so that early decisions about medication and service use can be made. As the gateway to specialist health and social services, it is suggested that efforts at earlier diagnosis should be targeted at primary care. This paper describes the development of an educational curriculum for improving dementia diagnosis and management in general practice. Approaches to learning and the factors influencing continuing medical education are reviewed and discussed. The methods adopted for development of the curriculum are described as well as the educational pathway devised. The curriculum is being tested in a randomised controlled trial of different educational methods in general practice.
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controlled study dementia in primary care: cluster randomised improving detection and management ... more controlled study dementia in primary care: cluster randomised improving detection and management of Effectiveness of educational interventions in
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PsycTESTS Dataset, 2004
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Methods of Information in Medicine, 2002
Summary Background: Diagnosis and management of dementia is a complex process and primary care ph... more Summary Background: Diagnosis and management of dementia is a complex process and primary care physicians are under-equipped to deal with uncertainties in the provision of optimal care for the patient. Objective: To develop a computer decision support system (CDSS) which could assist physicians with diagnosis and management and improve patient care. Methods: A design group including general practitioners derived logic pathways for diagnosis and management of dementia and validated them with a multi-professional expert group. Logic pathways were used to construct a comprehensive CDSS rendered as a series of expert consultations. The CDSS was inserted into commercially available GP systems and bench and field-tested. Results: The complexity of dementia diagnosis and management can be captured in logic pathways which can be expressed as decision trees within existing electronic patient records. The resulting CDSS appears useable in routine practice. Conclusion: The impact of this CDSS ...
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PsycTESTS Dataset, 2004
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Nursing times
ABSTRACT It is estimated that Alzheimer's disease and the other dementias affect approxim... more ABSTRACT It is estimated that Alzheimer's disease and the other dementias affect approximately 650,000 people in the UK. It is predicted that this figure will rise in the next twenty years to almost 1 million, as the older population increases (Alzheimer's Disease Society, 1995). Dementia is a condition that has physical, psychological, social and emotional consequences for both the person with dementia and their family. It is a complex condition that requires careful and rigorous assessment to rule out treatable causes and to formulate appropriate diagnostic and management strategies that will optimise care for the person with dementia. There are also wider social and financial implications for health and social care systems, and for voluntary and community agencies, which aim to care for and support people with dementia and their carers. This picture is further complicated by the availability of therapeutic interventions for Alzheimer's disease in the last few years which has meant that people with dementia and their carers may have higher expectations regarding investigation and treatment than previously, as early diagnosis is essential to gain access to such interventions. The increasing demands on the health care system posed by dementia have led to greater consideration of the complexities involved in caring for people with dementia and a greater interest in their needs. The extent to which health care professionals can respond to these needs has also come under greater scrutiny.
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This paper introduces findings from the first phase of a randomised-controlled trial of education... more This paper introduces findings from the first phase of a randomised-controlled trial of educational interventions in primary care. The focus of this paper is the knowledge, attitudes and confidence of primary care nursing staff to the diagnosis and ongoing management of dementia. A total of 78 nurses with a mean age of 46.4 years and a mean time since qualification of 23.0 years were recruited within 36 practices in Central Scotland and in London. Disciplines represented by this sample were predominantly district nurses, health visitors, practice nurses and community staff nurses. Each practitioner was administered an extensive self-completion questionnaire before the educational interventions were introduced to measure baseline knowledge, confidence and perceived difficulties in dementia care management and attitudes. Results indicate lower levels of knowledge about epidemiology and diagnosis, but slightly higher levels about management strategies. Self-reported ratings of confiden...
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Primary Health Care Research and Development, 2007
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Dementia, 2002
Dementia presents a challenge for primary care and the advent of new therapeutic options has high... more Dementia presents a challenge for primary care and the advent of new therapeutic options has highlighted the need to improve its detection so that early decisions about medication use can be made. Efforts at earlier diagnosis should be targeted at primary care as the gateway to specialist health and social services. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice throughout the world. This article reviews the obstacles to early recognition of dementia and the factors causing sub-optimal management in the community, and discusses educational approaches to enhancing professional skills in the recognition of and response to dementia. Three educational interventions with different characteristics and methods of delivery are described.
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BMJ, 2006
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Aging & Mental Health, 2009
Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is l... more Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care. To determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia. Unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK. Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated. We reviewed 450 records of patients aged 75 and over with a diagnosis of dementia and found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing. The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records.
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Aging & Mental Health, 2003
Dementia, which affects a large and growing number of older people, presents particular challenge... more Dementia, which affects a large and growing number of older people, presents particular challenges to primary care. There is an acknowledged need to develop interventions that address practitioners' needs for information and guidance regarding the diagnosis and management of dementia. This paper examines the potential usefulness and constraints of a Computer Decision Support System (CDSS) to assist practitioners in diagnosing and managing dementia. Questionnaire information was obtained from 97 primary care practitioners regarding their current practice and views on dementia care, priority given to training and familiarity with computer use. Implications of these findings for the relevance and value of CDSS are discussed. The paper is part of a larger ongoing study, the aim of which is the evaluation of three educational interventions for primary care practitioners.
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Age and Ageing, 2004
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British Journal of Nursing, 2003
This article introduces findings from the first phase of a randomized controlled trial of educati... more This article introduces findings from the first phase of a randomized controlled trial of educational interventions in primary care. The focus of the article is the knowledge, attitudes and confidence of primary care nursing staff to the diagnosis and ongoing management of dementia. A total of 78 nurses with a mean age of 46.4 years and a mean time since qualification of 23.0 years were recruited in 36 practices in central Scotland and in London. Disciplines represented by this sample were predominantly district nurses, health visitors, practice nurses and community staff nurses. Each practitioner was administered an extensive self-completion questionnaire before the educational interventions were introduced to measure baseline knowledge, confidence and perceived difficulties in dementia care management and attitudes. Results from the quiz indicate lower levels of knowledge about epidemiology and diagnosis, but slightly higher levels about management strategies. Self-reported rating...
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Papers by Michelle Bryans