29 results on '"Bray, Emma P."'
Search Results
2. Do patients actually do what we ask: patient fidelity and persistence to the Targets and Self-Management for the Control of Blood Pressure in Stroke and at Risk Groups blood pressure self-management intervention
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Schwartz, Claire L., Seyed-Safi, Ashkon, Haque, Sayeed, Bray, Emma P., Greenfield, Shelia, Hobbs, F.D. Richard, Little, Paul, Mant, Jonathan, Williams, Bryan, and Mcmanus, Richard J.
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- 2018
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3. Etiologic workup in cases of cryptogenic stroke: protocol for a systematic review and comparison of international clinical practice guidelines
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Bray, Emma P., McMahon, Naoimh E., Bangee, Munirah, Al-Khalidi, A. Hakam, Benedetto, Valerio, Chauhan, Umesh, Clegg, Andrew J., Georgiou, Rachel F., Gibson, Josephine, Lane, Deirdre A., Lip, Gregory Y. H., Lightbody, Elizabeth, Sekhar, Alakendu, Chatterjee, Kausik, and Watkins, Caroline L.
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- 2019
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4. Blood Pressure Self Monitoring: Questions and Answers from a National Conference
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McManus, Richard J., Glasziou, Paul, Hayen, Andrew, Mant, Jonathan, Padfield, Paul, Potter, John, Bray, Emma P., and Mant, David
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- 2009
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5. Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with suboptimal control and established cardiovascular disease or additional cardiovascular risk diseases (TASMIN-SR)
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Penaloza-Ramos, Maria Cristina, Jowett, Sue, Mant, Jonathan, Schwartz, Claire, Bray, Emma P, Haque, Sayeed M, Hobbs, Richard FD, Little, Paul, Bryan, Stirling, Williams, Bryan, and McManus, Richard J
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- 2016
- Full Text
- View/download PDF
6. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial
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McManus, Richard J, Mant, Jonathan, Bray, Emma P, Holder, Roger, Jones, Miren I, Greenfield, Sheila, Kaambwa, Billingsley, Banting, Miriam, Bryan, Stirling, Little, Paul, Williams, Bryan, and Hobbs, FD Richard
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- 2010
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7. Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis
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Kaambwa, Billingsley, Bryan, Stirling, Jowett, Sue, Mant, Jonathan, Bray, Emma P, Hobbs, Richard FD, Holder, Roger, Jones, Miren I, Little, Paul, Williams, Bryan, and McManus, Richard J
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- 2014
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8. Effect of Self-monitoring and Medication Self-titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease: The TASMIN-SR Randomized Clinical Trial
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McManus, Richard J., Mant, Jonathan, Haque, Sayeed M., Bray, Emma P., Bryan, Stirling, Greenfield, Sheila M., Jones, Miren I., Jowett, Sue, Little, Paul, Penaloza, Cristina, Schwartz, Claire, Shackleford, Helen, Shovelton, Claire, Varghese, Jinu, Williams, Bryan, and Hobbs, Richard F.D.
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- 2014
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9. Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis
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Tucker, Katherine L., Sheppard, James P., Stevens, Richard, Bosworth, Hayden B., Bove, Alfred, Bray, Emma P., Earle, Kenneth, George, Johnson, Godwin, Marshall, Green, Beverly B., Hebert, Paul, Hobbs, F. D. Richard, Kantola, Ilkka, Kerry, Sally M., Leiva, Alfonso, Magid, David J., Mant, Jonathan, Margolis, Karen L., McKinstry, Brian, McLaughlin, Mary Ann, Omboni, Stefano, Ogedegbe, Olugbenga, Parati, Gianfranco, Qamar, Nashat, Tabaei, Bahman P., Varis, Juha, Verberk, Willem J., Wakefield, Bonnie J., and McManus, Richard J.
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Hypertension -- Health aspects ,Meta-analysis ,Blood pressure -- Health aspects -- Control ,Biological sciences - Abstract
Background Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension. Methods and findings Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (-3.2 mmHg, [95% CI -4.9, -1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg [-3.3, 1.2]), to a 6.1 mmHg (-9.0, -3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic -0.2 mmHg [-2.2, 1.8]; ambulatory 1.1 mmHg [-0.3, 2.5]). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies. Conclusions Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions., Author(s): Katherine L. Tucker 1, James P. Sheppard 1, Richard Stevens 1, Hayden B. Bosworth 2, Alfred Bove 3, Emma P. Bray 4, Kenneth Earle 5, Johnson George 6, Marshall [...]
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- 2017
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10. Protocol for a randomised controlled trial of telemonitoring and self-management in the control of hypertension: Telemonitoring and self-management in hypertension. [ISRCTN17585681]
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Little Paul, Jones Miren I, Bryan Stirling, Greenfield Sheila, Holder Roger, Mant Jonathan, Bray Emma P, McManus Richard J, Williams Bryan, and Hobbs FD Richard
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Controlling blood pressure with drugs is a key aspect of cardiovascular disease prevention, but until recently has been the sole preserve of health professionals. Self-management of hypertension is an under researched area in which potential benefits for both patients and professionals are great. Methods and design The telemonitoring and self-management in hypertension trial (TASMINH2) will be a primary care based randomised controlled trial with embedded economic and qualitative analyses in order to evaluate the costs and effects of increasing patient involvement in blood pressure management, specifically with respect to home monitoring and self titration of antihypertensive medication compared to usual care. Provision of remote monitoring results to participating practices will ensure that practice staff are able to engage with self management and provide assistance where required. 478 patients will be recruited from general practices in the West Midlands, which is sufficient to detect clinically significant differences in systolic blood pressure between self-management and usual care of 5 mmHg with 90% power. Patients will be excluded if they demonstrate an inability to self monitor, their blood pressure is below 140/90 or above 200/100, they are on three or more antihypertensive medications, have a terminal disease or their blood pressure is not managed by their general practitioner. The primary end point is change in mean systolic blood pressure (mmHg) between baseline and each follow up point (6 months and 12 months). Secondary outcomes will include change in mean diastolic blood pressure, costs, adverse events, health behaviours, illness perceptions, beliefs about medication, medication compliance and anxiety. Modelling will evaluate the impact of costs and effects on a system wide basis. The qualitative analysis will draw upon the views of users, informal carers and professionals regarding the acceptability of self-management and prerequisites for future widespread implementation should the trial show this approach to be efficacious. Discussion The TASMINH2 trial will provide important new evidence regarding the costs and effects of self monitoring with telemonitoring in a representative primary care hypertensive population. Trial Registration ISRCTN17585681
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- 2009
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11. Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with sub-optimal control and established cardiovascular disease or additional CV risk diseases (TASMIN-SR)
- Author
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Penaloza-Ramos, Maria Cristina, Jowett, Sue, Mant, Jonathan, Schwartz, Claire, Bray, Emma P, Haque, Sayeed, Hobbs, F.D. Richard, Little, Paul, Bryan, Stirling, Williams, Bryan, and McManus, Richard J
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B900 - Abstract
Background: A previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive mediation evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease (CKD) and/or previous cardiovascular disease.\ud \ud Design and methods: A Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year old ‘high risk’ patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost-utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years (QALYs). A sub-group analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management.\ud \ud Results: Base-case results indicated that self-management was cost-effective compared with usual care, resulting in more QALYs (0.21) and cost savings (-£830) per patient. There was a 99% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 per QALY gained. Similar results were found for separate cohorts of men and women. The results were robust to sensitivity analyses, provided that the blood pressure lowering effect of self-management was maintained for more than a year.\ud \ud Conclusion: Self-management of blood pressure in ‘high risk’ people with poorly controlled hypertension not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of health care resources.
- Published
- 2016
12. Schedules for Self-monitoring Blood Pressure: A Systematic Review.
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Hodgkinson, James A, Stevens, Richard, Grant, Sabrina, Mant, Jonathan, Bray, Emma P, Hobbs, F D Richard, Martin, Una, Schwartz, Claire, McCartney, David, O'Mahony, Rachel, Perera-Salazar, Rafael, Roberts, Nia, Stevens, Sarah, Williams, Bryan, and McManus, Richard J
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BLOOD pressure ,META-analysis - Abstract
BACKGROUND Self-monitoring of blood pressure better predicts prognosis than clinic measurement, is popular with patients, and endorsed in hypertension guidelines. However, there is uncertainty over the optimal self-monitoring schedule. We therefore aimed to determine the optimum schedule to predict future cardiovascular events and determine "true" underlying blood pressure. METHODS Six electronic databases were searched from November 2009 (updating a National Institute for Health and Care Excellence [NICE] systematic review) to April 2017. Studies that compared aspects of self-monitoring schedules to either prognosis or reliability/reproducibility in hypertensive adults were included. Data on study and population characteristics, self-monitoring regime, and outcomes were extracted by 2 reviewers independently. RESULTS From 5,164 unique articles identified, 25 met the inclusion criteria. Twelve studies were included from the original NICE review, making a total of 37 studies. Increasing the number of days of measurement improved prognostic power: 72%–91% of the theoretical maximum predictive value (asymptotic maximum hazard ratio) was reached by 3 days and 86%–96% by 7 days. Increasing beyond 3 days of measurement did not result in better correlation with ambulatory monitoring. There was no convincing evidence that the timing or number of readings per day had an effect, or that ignoring the first day's measurement was necessary. CONCLUSIONS Home blood pressure should be measured for 3 days, increased to 7 only when mean blood pressure is close to a diagnostic or treatment threshold. Other aspects of a monitoring schedule can be flexible to facilitate patient uptake of and adherence with self-monitoring. [ABSTRACT FROM AUTHOR]
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- 2019
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13. Self-monitoring blood pressure in patients with hypertension: an internet-based survey of UK GPs.
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Fletcher, Benjamin R., Hinton, Lisa, Bray, Emma P., Hayen, Andrew, Richard Hobbs, F. D., Mant, Jonathan, Potter, John F., McManus, Richard J., and Hobbs, Fd Richard
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REGULATION of blood pressure ,BARORECEPTORS ,BLOOD diseases ,BLOOD pressure testing machines ,HEMODYNAMICS ,CARDIOVASCULAR disease diagnosis ,CARDIOVASCULAR disease prevention ,HYPERTENSION ,AMBULATORY blood pressure monitoring ,ATTITUDE (Psychology) ,FAMILY medicine ,INTERNET ,MEDICAL personnel ,RESEARCH evaluation ,RESEARCH funding ,HEALTH self-care ,SURVEYS - Abstract
Background: Previous research suggests that most GPs in the UK use self-monitoring of blood pressure (SMBP) to monitor the control of hypertension rather than for diagnosis. This study sought to assess current practice in the use of self-monitoring and any changes in practice following more recent guideline recommendations.Aim: To survey the views and practice of UK GPs in 2015 with regard to SMBP and compare them with a previous survey carried out in 2011.Design and Setting: Web-based survey of a regionally representative sample of 300 UK GPs.Method: GPs completed an online questionnaire concerning the use of SMBP in the management of hypertension. Analyses comprised descriptive statistics, tests for between-group differences (z, Wilcoxon signed-rank, and χ2 tests), and multivariate logistic regression.Results: Results were available for 300 GPs (94% of those who started the survey). GPs reported using self-monitoring to diagnose hypertension (169/291; 58%; 95% confidence interval (CI) = 52 to 64) and to monitor control (245/291; 84%; 95% CI = 80 to 88), the former having significantly increased since 2011 (from 37%; 95% CI = 33 to 41; P<0.001) with no change in monitoring for control. More than half of GPs used higher systolic thresholds for diagnosis (118/169; 70%; 95% CI = 63 to 77) and treatment (168/225; 75%; 95% CI = 69 to 80) than recommended in guidelines, and under half (120/289; 42%; 95% CI = 36 to 47) adjusted the SMBP results to guide treatment decisions.Conclusion: Since new UK national guidance in 2011, GPs are more likely to use SMBP to diagnose hypertension. However, significant proportions of GPs continue to use non-standard diagnostic and monitoring thresholds. The use of out-of-office methods to improve the accuracy of diagnosis is unlikely to be beneficial if suboptimal thresholds are used. [ABSTRACT FROM AUTHOR]- Published
- 2016
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14. Patient self-monitoring of blood pressure and self-titration of medication in primary care: the TASMINH2 trial qualitative study of health professionals' experiences.
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Jones, Miren I, Greenfield, Sheila M, Bray, Emma P, Hobbs, Fd Richard, Holder, Roger, Little, Paul, Mant, Jonathan, Williams, Bryan, and McManus, Richard J
- Abstract
Background: Self-monitoring with self-titration of antihypertensives leads to reduced blood pressure. Patients are keen on self-monitoring but little is known about healthcare professional views.Aim: To explore health professionals' views and experiences of patient self-management, particularly with respect to future implementation into routine care.Design and Setting: Qualitative study embedded within a randomised controlled trial of healthcare professionals participating in the TASMINH2 trial of patient self-monitoring with self-titration of antihypertensives from 24 West Midlands general practices.Method: Taped and transcribed semi-structured interviews with 13 GPs, two practice nurses and one healthcare assistant. Constant comparative method of analysis.Results: Primary care professionals were positive about self-monitoring, but procedures for ensuring patients measured blood pressure correctly were haphazard. GPs interpreted home readings variably, with many not making adjustment for lower home blood pressure. Interviewees were satisfied with patient training and arrangements for blood pressure monitoring and self-titration of medication during the trial, but less sure about future implementation into routine care. There was evidence of a need for training of both patients and professionals for successful integration of self-management.Conclusion: Health professionals wanted more patient involvement in hypertension care but needed a framework to work within. Consideration of how to train patients to measure blood pressure and how home readings become part of their care is required before self-monitoring and self-titration can be implemented widely. As home monitoring becomes more widespread, the development of patient self-management, including self-titration of medication, should follow but this may take time to achieve. [ABSTRACT FROM AUTHOR]- Published
- 2013
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15. Patient self-monitoring of blood pressure and self-titration of medication in primary care:the TASMINH2 trial qualitative study of health professionals' experiences.
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Jones, Miren I., Greenfield, Sheila M., Bray, Emma P., Richard Hobbs, F. D., Holder, Roger, Little, Paul, Mant, Jonathan, Williams, Bryan, and McManus, Richard J.
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PATIENT self-monitoring ,BLOOD pressure ,RANDOMIZED controlled trials ,CLINICAL trials ,FAMILY medicine - Abstract
Background Self-monitoring with self-titration of antihypertensives leads to reduced blood pressure. Patients are keen on self-monitoring but little is known about healthcare professional views. Aim To explore health professionals' views and experiences of patient self-management, particularly with respect to future implementation into routine care. Design and setting Qualitative study embedded within a randomised controlled trial of healthcare professionals participating in the TASMINH2 trial of patient self-monitoring with self-titration of antihypertensives from 24 West Midlands general practices. Method Taped and transcribed semi-structured interviews with 13 GPs, two practice nurses and one healthcare assistant. Constant comparative method of analysis. Results Primary care professionals were positive about self-monitoring, but procedures for ensuring patients measured blood pressure correctly were haphazard. GPs interpreted home readings variably, with many not making adjustment for lower home blood pressure. Interviewees were satisfied with patient training and arrangements for blood pressure monitoring and self-titration of medication during the trial, but less sure about future implementation into routine care. There was evidence of a need for training of both patients and professionals for successful integration of self-management. Conclusion Health professionals wanted more patient involvement in hypertension care but needed a framework to work within. Consideration of how to train patients to measure blood pressure and how home readings become part of their care is required before self-monitoring and self-titration can be implemented widely. As home monitoring becomes more widespread, the development of patient self-management, including self-titration of medication, should follow but this may take time to achieve. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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16. Targets and self-management for the control of blood pressure in stroke and at risk groups (TASMIN-SR): protocol for a randomised controlled trial.
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O'Brien, Claire, Bray, Emma P., Bryan, Stirling, Greenfield, Sheila M., Sayeed Haque, M., Richard Hobbs, F. D., Jones, Miren I., Jowett, Sue, Kaambwa, Billingsley, Little, Paul, Mant, Jonathan, Penaloza, Cristina, Schwartz, Claire, Shackleford, Helen, Varghese, Jinu, Williams, Bryan, and McManus, Richard J.
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HYPERTENSION ,BLOOD pressure ,CLINICAL trials ,HEALTH outcome assessment ,DISEASE risk factors - Abstract
Background: Self-monitoring of hypertension with self-titration of antihypertensives (self-management) results in lower systolic blood pressure for at least one year. However, few people in high risk groups have been evaluated to date and previous work suggests a smaller effect size in these groups. This trial therefore aims to assess the added value of self-management in high risk groups over and above usual care. Methods/Design: The targets and self-management for the control of blood pressure in stroke and at risk groups (TASMIN-SR) trial will be a pragmatic primary care based, unblinded, randomised controlled trial of selfmanagement of blood pressure (BP) compared to usual care. Eligible patients will have a history of stroke, coronary heart disease, diabetes or chronic kidney disease and will be recruited from primary care. Participants will be individually randomised to either usual care or self-management. The primary outcome of the trial will be difference in office SBP between intervention and control groups at 12 months adjusted for baseline SBP and covariates. 540 patients will be sufficient to detect a difference in SBP between self-management and usual care of 5 mmHg with 90% power. Secondary outcomes will include self-efficacy, lifestyle behaviours, health-related quality of life and adverse events. An economic analysis will consider both within trial costs and a model extrapolating the results thereafter. A qualitative analysis will gain insights into patients' views, experiences and decision making processes. Discussion: The results of the trial will be directly applicable to primary care in the UK. If successful, self-management of blood pressure in people with stroke and other high risk conditions would be applicable to many hundreds of thousands of individuals in the UK and beyond. [ABSTRACT FROM AUTHOR]
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- 2013
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17. Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials.
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Bray, Emma P., Holder, Roger, Mant, Jonathan, and McManus, Richard J.
- Abstract
Introduction. Self-monitoring of blood pressure (BP) is an increasingly common part of hypertension management. The objectives of this systematic review were to evaluate the systolic and diastolic BP reduction, and achievement of target BP, associated with self-monitoring. Methods. MEDLINE, Embase, Cochrane database of systematic reviews, database of abstracts of clinical effectiveness, the health technology assessment database, the NHS economic evaluation database, and the TRIP database were searched for studies where the intervention included self-monitoring of BP and the outcome was change in office/ambulatory BP or proportion with controlled BP. Two reviewers independently extracted data. Meta-analysis using a random effects model was combined with meta-regression to investigate heterogeneity in effect sizes. Results. A total of 25 eligible randomized controlled trials (RCTs) (27 comparisons) were identified. Office systolic BP (20 RCTs, 21 comparisons, 5,898 patients) and diastolic BP (23 RCTs, 25 comparisons, 6,038 patients) were significantly reduced in those who self-monitored compared to usual care (weighted mean difference (WMD) systolic −3.82 mmHg (95% confidence interval −5.61 to −2.03), diastolic −1.45 mmHg (−1.95 to −0.94)). Self-monitoring increased the chance of meeting office BP targets (12 RCTs, 13 comparisons, 2,260 patients, relative risk = 1.09 (1.02 to 1.16)). There was significant heterogeneity between studies for all three comparisons, which could be partially accounted for by the use of additional co-interventions. Conclusion. Self-monitoring reduces blood pressure by a small but significant amount. Meta-regression could only account for part of the observed heterogeneity. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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18. Protocol for a randomised controlled trial of telemonitoring and self-management in the control of hypertension: Telemonitoring and self-management in hypertension. [ISRCTN17585681].
- Author
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McManus, Richard J., Bray, Emma P., Mant, Jonathan, Holder, Roger, Greenfield, Sheila, Bryan, Stirling, Jones, Miren I., Little, Paul, Williams, Bryan, and Richard Hobbs, F. D.
- Subjects
CARDIOVASCULAR diseases ,PATIENT monitoring ,HYPERTENSION ,PRIMARY care ,BLOOD pressure - Abstract
Background: Controlling blood pressure with drugs is a key aspect of cardiovascular disease prevention, but until recently has been the sole preserve of health professionals. Self-management of hypertension is an under researched area in which potential benefits for both patients and professionals are great. Methods and design: The telemonitoring and self-management in hypertension trial (TASMINH2) will be a primary care based randomised controlled trial with embedded economic and qualitative analyses in order to evaluate the costs and effects of increasing patient involvement in blood pressure management, specifically with respect to home monitoring and self titration of antihypertensive medication compared to usual care. Provision of remote monitoring results to participating practices will ensure that practice staff are able to engage with self management and provide assistance where required. 478 patients will be recruited from general practices in the West Midlands, which is sufficient to detect clinically significant differences in systolic blood pressure between self-management and usual care of 5 mmHg with 90% power. Patients will be excluded if they demonstrate an inability to self monitor, their blood pressure is below 140/90 or above 200/100, they are on three or more antihypertensive medications, have a terminal disease or their blood pressure is not managed by their general practitioner. The primary end point is change in mean systolic blood pressure (mmHg) between baseline and each follow up point (6 months and 12 months). Secondary outcomes will include change in mean diastolic blood pressure, costs, adverse events, health behaviours, illness perceptions, beliefs about medication, medication compliance and anxiety. Modelling will evaluate the impact of costs and effects on a system wide basis. The qualitative analysis will draw upon the views of users, informal carers and professionals regarding the acceptability of self-management and prerequisites for future widespread implementation should the trial show this approach to be efficacious. Discussion: The TASMINH2 trial will provide important new evidence regarding the costs and effects of self monitoring with telemonitoring in a representative primary care hypertensive population. Trial Registration: ISRCTN17585681 [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
19. Telemonitoring—or better follow-up? – Authors' reply
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McManus, Richard J, Mant, Jonathan, Bray, Emma P, Little, Paul, and Hobbs, FD Richard
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- 2010
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20. Patients' experiences of self-monitoring blood pressure and self-titration of medication: the TASMINH2 trial qualitative study.
- Author
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Jones, Miren, Greenfield, Sheila M., Bray, Emma P., Baral-Grant, Sabrina, Hobbs, Richard, Holder, Roger, Little, Paul, Mant, Jonathan, Virdee, Satnam K., Williams, Bryan, and McManus, Richard J.
- Subjects
REGULATION of blood pressure ,SELF-management (Psychology) ,HYPERTENSION ,THERAPEUTICS ,BLOOD pressure measurement ,PATIENT self-monitoring - Abstract
The article focuses on the views and experiences of patients who undertake blood pressure self-management. An interview was conducted among 527 participants in the Telemonitoring and Self Management in the Control of Hypertension (TASMINH2) trial with poorly controlled treated hypertension. The result of the study found that hypertensive patients are not eager on titrating their medication on the basis of the readings and in continuing self-monitoring after completing the study.
- Published
- 2012
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21. Why can't they just apologise?
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Jennifer Bray; Emma Jane Hade
- Abstract
BANKING chiefs were scolded by the Finance Minister over the tracker scandal yesterday - but two lenders are still refusing to apologise for the controversy which has cost 100 people their homes and left thousands out of pocket. [ABSTRACT FROM PUBLISHER]
- Published
- 2017
22. Go to Labour Court and quit striking, urges Leo.
- Author
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Jennifer Bray; Emma Jane Hade
- Abstract
UNIONS should go back to the Workplace Relations Commission and Labour Court instead of holding further crippling rail strikes, the Government has ordered. [ABSTRACT FROM PUBLISHER]
- Published
- 2017
23. Telemonitoring--or better follow-up?
- Author
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Schiff, Adam, McManus, Richard J., Mant, Jonathan, Bray, Emma P., Little, Paul, and Richard Hobbs, F. D.
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LETTERS to the editor , *HYPERTENSION , *SELF-management (Psychology) - Abstract
A letter to the editor is presented in response to the article "Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomized controlled trial," by Richard McManus and colleagues in the July 17, 2010 issue.
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- 2010
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24. Psychological interventions for weight reduction and sustained weight reduction in adults with overweight and obesity: a scoping review.
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Hamer O, Kuroski JA, Bray EP, Harris C, Blundell A, Schneider E, and Watkins C
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- Humans, Adult, Exercise psychology, Obesity therapy, Obesity psychology, Overweight therapy, Overweight psychology, Weight Loss, Psychosocial Intervention methods
- Abstract
Introduction: Overweight and obesity are growing public health problems worldwide. Both diet and physical activity have been the primary interventions for weight reduction over the past decade. With increasing rates of overweight and obesity, it is evident that a primary focus on diet and exercise has not resulted in sustained obesity reduction within the global population. There is now a case to explore other weight management strategies such as psychological therapies. However, there is a dearth of literature that has mapped the types of psychological interventions and the characteristics of these interventions as a means of achieving weight reduction., Objectives: The key objectives focused on mapping the types and characteristics of psychological interventions versus usual care for weight reduction and sustained weight reduction in adults with overweight or obesity. The study followed the scoping review methodology by Arksey and O'Malley and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines., Eligibility Criteria: Intervention studies were included if participants were 18 years and over, classified as overweight or obese (body mass index ≥25 kg/m
2 ) and had received a psychological therapy intervention. Studies were excluded if they included a comparison with other active lifestyle interventions (unless classified as usual care), were not available in English, were not full-text articles or were non-peer-reviewed articles., Sources of Evidence: Six electronic databases were searched from inception to April 2023 to identify relevant articles., Charting Methods: The study employed a systematic charting method and narrative synthesis to organise and synthesise the data., Results: A total of 31 studies met the eligibility criteria and were included in the review. 13 unique psychological interventions for weight reduction in adults with overweight or obesity were identified, with cognitive-behavioural therapy and motivational interviewing being the most common. Eight types of usual care were identified, which largely included education and training on nutrition and physical activity. Gaps in the current research were also identified., Conclusion: The findings highlighted several gaps within the existing literature, largely due to a lack of evidence relating to adults with low socioeconomic status, non-white participants, individuals under 40 years of age and the integration of digital health technologies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)- Published
- 2024
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25. Social media influencers in the space of pregnancy and parenting: a scoping review protocol.
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Hives L, Bray EP, Nowland R, and Thomson G
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- Female, Humans, Pregnancy, Research Design, Review Literature as Topic, Parenting, Social Media
- Abstract
Introduction: Social media influencers (SMIs) are popular sources of online information on various topics, including many aspects of health. Recently, there has been an upsurge in SMIs creating content about pregnancy and parenting, including from midwives, pregnant women and parents. Despite its popularity, SMI content on pregnancy and parenting is not currently regulated, which allows for misinformation and potential harm to women and their children. Research has also found that most women do not discuss the information they access online with their healthcare providers.This is the first scoping review to map the existing evidence on SMIs in the context of pregnancy and early parenting., Methods and Analysis: The scoping review will be conducted from May to December 2024 and reported using guidance from Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. 10 academic databases will be searched for relevant studies, using keywords and subject headings for the concepts of "social media", "influencers", "pregnancy" and "parenting." All primary and secondary research studies of pregnancy and early parenting SMIs will be included. Two authors will screen the identified studies for eligibility. The risk of bias of the included studies will not be assessed. Extracted data will be presented in tables and will be described narratively., Ethics and Dissemination: Ethical approval was not needed for this scoping review. Results will be published in a peer-reviewed journal, presented at conferences, posted on social media and presented to relevant groups., Registration Details: The review is registered with the Open Science Framework (https://osf.io/7v4qb https://osf.io/7v4qb)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2024
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26. Non-pharmacological interventions for the reduction and maintenance of blood pressure in people with prehypertension: a systematic review protocol.
- Author
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Bray EP, Georgiou RF, Hives L, Iqbal N, Benedetto V, Spencer J, Harris C, Clegg A, Williams N, Rutter P, and Watkins C
- Subjects
- Humans, Blood Pressure, Systematic Reviews as Topic, Physical Examination, Prehypertension therapy, Hypertension therapy
- Abstract
Introduction: Prehypertension is defined as blood pressure that is above the normal range but not high enough to be classed as hypertension. Prehypertension is a warning of development of hypertension as well as a risk for cardiovascular disease, heart attack and stroke. In the UK, non-pharmacological interventions are recommended for prehypertension management but no reviews have focused on the effectiveness of these types of interventions solely in people with prehypertension. Therefore, the proposed systematic review will assess the clinical effectiveness and cost-effectiveness of non-pharmacological interventions in reducing or maintaining blood pressure in prehypertensive people., Methods and Analysis: This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases/trial registries that will be searched to identify relevant randomised controlled trials (RCTs) and economic evaluations include Medline, EMBASE, CINAHL, PsycINFO, CENTRAL, the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Cochrane Library, Scopus and the International HTA Database. Search terms have been identified by the team including an information specialist. Three reviewers will be involved in the study selection process. Risk of bias will be evaluated using the Cochrane risk-of-bias tool for RCTs and the Consensus Health Economic Criteria list for economic evaluations. Findings from the included studies will be tabulated and synthesised narratively. Heterogeneity will be assessed through visual inspection of forest plots and the calculation of the χ
2 and I2 statistics and causes of heterogeneity will be assessed where sufficient data are available. If possible, we plan to investigate differential effects on specific subgroups and from different types of interventions using meta-regression. Where relevant, the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) will be used to assess the certainty of the evidence found., Ethics and Dissemination: Ethical approval is not needed. Results will be published in a peer-reviewed journal, disseminated via the wider study website and shared with the study sites and participants., Registration Details: The review is registered with PROSPERO (CRD420232433047)., Competing Interests: Competing interests: VB, CH, AC, JS and CW are partly funded by the National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2024
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27. Psychological interventions for weight reduction and sustained weight reduction in adults with overweight and obesity: a scoping review protocol.
- Author
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Hamer O, Bray EP, Harris C, Blundell A, Kuroski JA, Schneider E, Watkins C, and Clegg A
- Subjects
- Adolescent, Adult, Humans, Body Mass Index, Obesity therapy, Obesity psychology, Weight Loss, Review Literature as Topic, Overweight therapy, Overweight psychology, Psychosocial Intervention
- Abstract
Introduction: Overweight and obesity are growing public health problems worldwide. Both diet and physical activity have been the primary interventions for weight reduction over the past decade. With increasing rates of overweight and obesity, it is evident that a primary focus on diet and exercise has not resulted in sustained obesity reduction within the global population. There is now a case to explore other weight management strategies, focusing on psychological factors that may underpin overweight and obesity. Psychological therapy interventions are gaining recognition for their effectiveness in addressing underlying emotional factors and promoting weight loss. However, there is a dearth of literature that has mapped the types of psychological interventions and the characteristics of these interventions as a means of achieving weight reduction and sustained weight reduction in adults with overweight or obesity., Methods and Analysis: The review will combine the methodology outlined by Arksey and O'Malley with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A total of six databases will be searched using a comprehensive search strategy. Intervention studies will be included if participants are 18 years and over, classified as overweight or obese (body mass index ≥25 kg/m
2 ), and have received a psychological therapy intervention. The review will exclude studies that are not available in English, not full text, none peer reviewed or combine a lifestyle and/or pharmacological intervention with a psychological intervention. Data will be synthesised using a narrative synthesis approach., Ethics and Dissemination: Ethical approval is not required to conduct this scoping review. The findings will be disseminated through journal publication(s), social media and a lay summary for key stakeholders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)- Published
- 2023
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28. Risk reduction intervention for raised blood pressure (REVERSE): protocol for a mixed-methods feasibility study.
- Author
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Hives L, Georgiou RF, Spencer J, Benedetto V, Clegg A, Rutter P, Watkins C, Williams N, and Bray EP
- Subjects
- Adult, Humans, Blood Pressure physiology, Feasibility Studies, Prospective Studies, Risk Reduction Behavior, Prehypertension
- Abstract
Introduction: Around 40% of adults have pre-hypertension (blood pressure between 120-139/80-89), meaning they are at increased risk of developing hypertension and other cardiovascular disease-related conditions. There are limited studies on the management of pre-hypertension; however, guidance recommends that it should be focused on lifestyle modification rather than on medication. Self-monitoring of blood pressure could allow people to monitor and manage their risk status and may allow individuals to modify lifestyle factors. The purpose of this study is to determine the feasibility and acceptability, to both healthcare professionals and people with pre-hypertension, of blood pressure self-monitoring., Methods and Analysis: A prospective, non-randomised feasibility study, with a mixed-methods approach will be employed. Eligible participants (n=114) will be recruited from general practices, pharmacies and community providers across Lancashire and South Cumbria. Participants will self-monitor their blood pressure at home for 6 months and will complete questionnaires at three timepoints (baseline, 6 and 12 months). Healthcare professionals and participants involved in the study will be invited to take part in follow-up interviews and a focus group. The primary outcomes include the willingness to engage with the concept of pre-hypertension, the acceptability of self-monitoring, and the study processes. Secondary outcomes will inform the design of a potential future trial. A cost-analysis and cost-benefit analysis will be conducted., Ethics and Dissemination: Ethics approval has been obtained from London-Fulham NHS Research Ethics Committee, the University of Central Lancashire Health Ethics Review Panel and the HRA. The results of the study will be disseminated via peer-reviewed publications, feedback to service users and healthcare professionals, and to professional bodies in primary care and pharmacy., Trial Registration Number: ISRCTN13649483., Competing Interests: Competing interests: NW is a GP principal in Plas Menai Health Centre, Llanfairfechan, LL33 0PE. He is the deputy chair of the NIHR HTA Programme funding committee (commissioned research) and the chief investigator of two NIHR HTA Programme funded trials. VB, AC and CW are funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration North West Coast., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2023
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29. Individual patient data meta-analysis of self-monitoring of blood pressure (BP-SMART): a protocol.
- Author
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Tucker KL, Sheppard JP, Stevens R, Bosworth HB, Bove A, Bray EP, Godwin M, Green B, Hebert P, Hobbs FD, Kantola I, Kerry S, Magid DJ, Mant J, Margolis KL, McKinstry B, Omboni S, Ogedegbe O, Parati G, Qamar N, Varis J, Verberk W, Wakefield BJ, and McManus RJ
- Subjects
- Comorbidity, Humans, Life Style, Meta-Analysis as Topic, Quality of Life, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Hypertension drug therapy, Self Care methods
- Abstract
Introduction: Self-monitoring of blood pressure is effective in reducing blood pressure in hypertension. However previous meta-analyses have shown a considerable amount of heterogeneity between studies, only part of which can be accounted for by meta-regression. This may be due to differences in design, recruited populations, intervention components or results among patient subgroups. To further investigate these differences, an individual patient data (IPD) meta-analysis of self-monitoring of blood pressure will be performed., Methods and Analysis: We will identify randomised trials that have compared patients with hypertension who are self-monitoring blood pressure with those who are not and invite trialists to provide IPD including clinic and/or ambulatory systolic and diastolic blood pressure at baseline and all follow-up points where both intervention and control groups were measured. Other data requested will include measurement methodology, length of follow-up, cointerventions, baseline demographic (age, gender) and psychosocial factors (deprivation, quality of life), setting, intensity of self-monitoring, self-monitored blood pressure, comorbidities, lifestyle factors (weight, smoking) and presence or not of antihypertensive treatment. Data on all available patients will be included in order to take an intention-to-treat approach. A two-stage procedure for IPD meta-analysis, stratified by trial and taking into account age, sex, diabetes and baseline systolic BP will be used. Exploratory subgroup analyses will further investigate non-linear relationships between the prespecified variables. Sensitivity analyses will assess the impact of trials which have and have not provided IPD., Ethics and Dissemination: This study does not include identifiable data. Results will be disseminated in a peer-reviewed publication and by international conference presentations., Conclusions: IPD analysis should help the understanding of which self-monitoring interventions for which patient groups are most effective in the control of blood pressure., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2015
- Full Text
- View/download PDF
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