Search

Your search keyword '"Zambellas, Rhea"' showing total 16 results
Start Over Author "Zambellas, Rhea"
16 results on '"Zambellas, Rhea"'

2. What is the patient and carer burden of LGI1-autoimmune Limbic Encephalitis and its associated cognitive and behavioural changes? : a mixed methods study using a neuropsychological test battery, semi-structured interviews and digital diaries

Author

Zambellas, Rhea and Clift, Bryan

Subjects
Autoimmune limbic encephalitis
Abstract

Background: Autoimmune Limbic Encephalitis (aLE) is a rare condition, targeting parts of the limbic regions of the brain. Instead of the immune system producing antibodies to destroy foreign invaders such as infections, the antibodies attach to healthy body tissue, in this case, the tissue in the limbic brain. This occurs when the antibodies target the LGI1 (leucine-rich glioma inactivated protein) or the CASPR2 (contactin-associated protein 2). There is still a need to learn how the symptoms and behavioural changes associated with these proteins, affect the patient long-term. This research is two-fold. First it identifies the negative sequelae of LGI1-aLE and determines the extent of the patients' cognitive and emotional impairment, together with an overview from the carers' assessment. Second, it investigates the patient and carer experiences of living with LGI1-aLE. With the current literature predominately focusing on the symptoms, diagnosis and appropriate treatment of the disease, this research has bridged the literary gap to integrate mixed methodology (MM) and add an original synthesis using interpretive phenomenological analysis (IPA) to provide an insight into the patient and carer perspectives on the burden of living with the chronic negative sequelae of LGI1-aLE. Methods: A MM approach incorporating a triangulation method was used for 10 patients and 10 carers. A neuropsychological test battery (NPTB), which assessed the patient's memory, apathy, anhedonia, depression, fatigue and sleep quality, also used carer assessments on neuropsychiatric symptoms, apathy, carer burden, activities of daily living and memory/intelligence changes over ten years. Together with semi-structured interviews and digital diaries, these methods formed the three phases of data collection. Results: Descriptive and inferential statistics demonstrated the severity of symptoms and comparisons at group level. There was very little evidence for group-level deficits across the tests/questionnaires administered. However, there were several patients that scored in the impaired range, especially in episodic memory, fluency and sleep quality. The interviews represented in five themes, revealed shared patterns and unique experiences which contribute markedly to the impact on daily lives. Using Interpretative Phenomenological Analysis (IPA), some narratives showed consistencies with the NPTB findings, whereas others demonstrated contradictions. The direct effect of the acute symptoms illustrated a range of feelings including shock, fear and disappointment. The chronic symptoms demonstrated sadness and frustration with the patients' decline in motivation and confidence, and an increase in irritability and apathy, requiring adjustment from both the patient and carer. The impact on relationships varied in extent and severity, together with the degree of reliance and coping strategies in place. Returning to work in a different capacity and reduced grade evoked feelings of loss, yet a few patients embraced their new roles with pride. A final theme exposed a variety of feelings regarding the uncertainty of making future plans, although possibly attributable to old age and other pre-existing health conditions. Conclusions and implications: The impact of LGI1-aLE leaves many patients with residual, long-term impairment after treatment. The knowledge produced from this thesis has enhanced the knowledgebase beyond traditional measurable datasets and emphasised the need for health professional learning, by exploring the narratives of those impacted by the disease.

Published
2023

4. Apathy Motivation Index--Caregiver Version

Author

Klar, Verena S., primary, Ang, Yuen-Siang, additional, Lockwood, Patricia, additional, Attaallah, Bahaaeddin, additional, Dickson, Shannon, additional, Drew, Daniel, additional, Kienast, Annika, additional, Maio, Maria R., additional, Plant, Olivia, additional, Slavkova, Elitsa, additional, Toniolo, Sofia, additional, Zambellas, Rhea, additional, Irani, Sarosh R., additional, and Husain, Masud, additional

Published
2022
Full Text
View/download PDF

5. Assessment of apathy in neurological patients using the Apathy Motivation Index caregiver version

Author

Klar, Verena S., primary, Ang, Yuen‐Siang, additional, Lockwood, Patricia, additional, Attaallah, Bahaaeddin, additional, Dickson, Shannon, additional, Drew, Daniel, additional, Kienast, Annika, additional, Maio, Maria R., additional, Plant, Olivia, additional, Slavkova, Elitsa, additional, Toniolo, Sofia, additional, Zambellas, Rhea, additional, Irani, Sarosh R., additional, and Husain, Masud, additional

Published
2021
Full Text
View/download PDF

7. Validity of a new brief assessment of apathy: Caregiver version of the apathy motivation index

Author

Klar, Verena S., primary, Ang, Yuen‐Siang, additional, Lockwood, Patricia L., additional, Attaallah, Bahaaeddin, additional, Dickson, Shannon, additional, Drew, Daniel, additional, Kienast, Annika, additional, Maio, Maria R., additional, Plant, Olivia, additional, Slavkova, Elitsa, additional, Toniolo, Sofia, additional, Zambellas, Rhea, additional, Irani, Sarosh, additional, and Husain, Masud, additional

Published
2020
Full Text
View/download PDF

8. Assessment of apathy in neurological patients using the Apathy Motivation Index caregiver version.

Author

Klar, Verena S., Ang, Yuen‐Siang, Lockwood, Patricia, Attaallah, Bahaaeddin, Dickson, Shannon, Drew, Daniel, Kienast, Annika, Maio, Maria R., Plant, Olivia, Slavkova, Elitsa, Toniolo, Sofia, Zambellas, Rhea, Irani, Sarosh R., and Husain, Masud

Subjects
APATHY, NEUROLOGIC examination, COGNITIVE therapy, PARKINSON'S disease, BURDEN of care, ALZHEIMER'S disease
Abstract

Apathy is a common, disabling neuropsychiatric syndrome that occurs across many brain disorders and may be associated with diminished motivation in behavioural, cognitive, emotional and social domains. Assessment is complicated by the variability of symptoms across apathy domains and self‐report from patients, which can be misleading due to their lack of insight. Independent evaluation by clinicians also has limitations though if it has to be performed with limited time. Caregiver reports are a viable alternative, but current assessments for them either do not distinguish between different apathy domains or are interview‐based and take long to administer. In this study, we developed a brief caregiver questionnaire version of the recently developed Apathy Motivation Index (AMI), which is a self‐report tool. We confirmed three apathy factors in this new caregiver measure (AMI‐CG) that were also present in the AMI: Behavioural Activation, Emotional Sensitivity and Social Motivation. Furthermore, we validated the scores against more extensive caregiver interviews using the established Lillle apathy rating scale as well as patient self‐reports of apathy, measures of depression, anhedonia, cognition, activities of daily living and caregiver burden across four different neurological conditions: Parkinson's disease, Alzheimer's disease, subjective cognitive impairment and limbic encephalitis. The AMI‐CG showed good internal reliability, external validity and diagnostic accuracy. It also uncovered cases of social apathy overlooked by traditional instruments. Crucially, patients who under‐rated their apathy compared to informants were more likely to have difficulties performing everyday activities and to be a greater burden to caregivers. The findings provide evidence for a multidimensional conceptualization of apathy and an instrument for efficient detection of apathy based on caregiver reports for use in clinical practice. [ABSTRACT FROM AUTHOR]

Published
2022
Full Text
View/download PDF

9. Oral versus intravenous antibiotics for bone and joint infections: the OVIVA non-inferiority RCT

Author

Scarborough, Matthew, primary, Li, Ho Kwong, additional, Rombach, Ines, additional, Zambellas, Rhea, additional, Walker, A Sarah, additional, McNally, Martin, additional, Atkins, Bridget, additional, Kümin, Michelle, additional, Lipsky, Benjamin A, additional, Hughes, Harriet, additional, Bose, Deepa, additional, Warren, Simon, additional, Mack, Damien, additional, Folb, Jonathan, additional, Moore, Elinor, additional, Jenkins, Neil, additional, Hopkins, Susan, additional, Seaton, R Andrew, additional, Hemsley, Carolyn, additional, Sandoe, Jonathan, additional, Aggarwal, Ila, additional, Ellis, Simon, additional, Sutherland, Rebecca, additional, Geue, Claudia, additional, McMeekin, Nicola, additional, Scarborough, Claire, additional, Paul, John, additional, Cooke, Graham, additional, Bostock, Jennifer, additional, Khatamzas, Elham, additional, Wong, Nick, additional, Brent, Andrew, additional, Lomas, Jose, additional, Matthews, Philippa, additional, Wangrangsimakul, Tri, additional, Gundle, Roger, additional, Rogers, Mark, additional, Taylor, Adrian, additional, Thwaites, Guy E, additional, and Bejon, Philip, additional

Published
2019
Full Text
View/download PDF

10. Oral versus Intravenous Antibiotics for Bone and Joint Infection

Author

Li, Ho-Kwong, primary, Rombach, Ines, additional, Zambellas, Rhea, additional, Walker, A. Sarah, additional, McNally, Martin A., additional, Atkins, Bridget L., additional, Lipsky, Benjamin A., additional, Hughes, Harriet C., additional, Bose, Deepa, additional, Kümin, Michelle, additional, Scarborough, Claire, additional, Matthews, Philippa C., additional, Brent, Andrew J., additional, Lomas, Jose, additional, Gundle, Roger, additional, Rogers, Mark, additional, Taylor, Adrian, additional, Angus, Brian, additional, Byren, Ivor, additional, Berendt, Anthony R., additional, Warren, Simon, additional, Fitzgerald, Fiona E., additional, Mack, Damien J.F., additional, Hopkins, Susan, additional, Folb, Jonathan, additional, Reynolds, Helen E., additional, Moore, Elinor, additional, Marshall, Jocelyn, additional, Jenkins, Neil, additional, Moran, Christopher E., additional, Woodhouse, Andrew F., additional, Stafford, Samantha, additional, Seaton, R. Andrew, additional, Vallance, Claire, additional, Hemsley, Carolyn J., additional, Bisnauthsing, Karen, additional, Sandoe, Jonathan A.T., additional, Aggarwal, Ila, additional, Ellis, Simon C., additional, Bunn, Deborah J., additional, Sutherland, Rebecca K., additional, Barlow, Gavin, additional, Cooper, Cushla, additional, Geue, Claudia, additional, McMeekin, Nicola, additional, Briggs, Andrew H., additional, Sendi, Parham, additional, Khatamzas, Elham, additional, Wangrangsimakul, Tri, additional, Wong, T.H. Nicholas, additional, Barrett, Lucinda K., additional, Alvand, Abtin, additional, Old, C. Fraser, additional, Bostock, Jennifer, additional, Paul, John, additional, Cooke, Graham, additional, Thwaites, Guy E., additional, Bejon, Philip, additional, and Scarborough, Matthew, additional

Published
2019
Full Text
View/download PDF

11. Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial

Author

Li, Ho Kwong, primary, Scarborough, Matthew, additional, Zambellas, Rhea, additional, Cooper, Cushla, additional, Rombach, Ines, additional, Walker, A. Sarah, additional, Lipsky, Benjamin A., additional, Briggs, Andrew, additional, Seaton, Andrew, additional, Atkins, Bridget, additional, Woodhouse, Andrew, additional, Berendt, Anthony, additional, Byren, Ivor, additional, Angus, Brian, additional, Pandit, Hemant, additional, Stubbs, David, additional, McNally, Martin, additional, Thwaites, Guy, additional, and Bejon, Philip, additional

Published
2015
Full Text
View/download PDF

12. Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial.

Author

Ho Kwong Li, Scarborough, Matthew, Zambellas, Rhea, Cooper, Cushla, Rombach, Ines, Walker, A. Sarah, Lipsky, Benjamin A., Briggs, Andrew, Seaton, Andrew, Atkins, Bridget, Woodhouse, Andrew, Berendt, Anthony, Byren, Ivor, Angus, Brian, Pandit, Hemant, Stubbs, David, McNally, Martin, Thwaites, Guy, Bejon, Philip, and Li, Ho Kwong

Subjects
INTRAVENOUS therapy, ANTIBIOTICS, TREATMENT of bone diseases, JOINT disease treatment, RANDOMIZED controlled trials, DIAGNOSIS of bacterial diseases, JOINT disease diagnosis, BACTERIAL diseases, BONE diseases, DRUG administration, EXPERIMENTAL design, JOINT diseases, RESEARCH protocols, ORAL drug administration, TIME, TREATMENT effectiveness, DIAGNOSIS
Abstract

Background: Bone and joint infection in adults arises most commonly as a complication of joint replacement surgery, fracture fixation and diabetic foot infection. The associated morbidity can be devastating to patients and costs the National Health Service an estimated £20,000 to £40,000 per patient. Current standard of care in most UK centres includes a prolonged course (4-6 weeks) of intravenous antibiotics supported, if available, by an outpatient parenteral antibiotic therapy service. Intravenous therapy carries with it substantial risks and inconvenience to patients, and the antibiotic-related costs are approximately ten times that of oral therapy. Despite this, there is no evidence to suggest that oral therapy results in inferior outcomes. We hypothesise that, by selecting oral agents with high bioavailability, good tissue penetration and activity against the known or likely pathogens, key outcomes in patients managed primarily with oral therapy are non-inferior to those in patients treated by intravenous therapy.Methods: The OVIVA trial is a parallel group, randomised (1:1), un-blinded, non-inferiority trial conducted in thirty hospitals across the UK. Eligible participants are adults (>18 years) with a clinical syndrome consistent with a bone, joint or metalware-associated infection who have received ≤7 days of intravenous antibiotic therapy from the date of definitive surgery (or the start of planned curative therapy in patients treated without surgical intervention). Participants are randomised to receive either oral or intravenous antibiotics, selected by a specialist infection physician, for the first 6 weeks of therapy. The primary outcome measure is definite treatment failure within one year of randomisation, as assessed by a blinded endpoint committee, according to pre-defined microbiological, histological and clinical criteria. Enrolling 1,050 subjects will provide 90 % power to demonstrate non-inferiority, defined as less than 7.5 % absolute increase in treatment failure rate in patients randomised to oral therapy as compared to intravenous therapy (one-sided alpha of 0.05).Discussion: If our results demonstrate non-inferiority of orally administered antibiotic therapy, this trial is likely to facilitate a dramatically improved patient experience and alleviate a substantial financial burden on healthcare services.Trial Registration: ISRCTN91566927 - 14/02/2013. [ABSTRACT FROM AUTHOR]

Published
2015
Full Text
View/download PDF

13. Additional file 1: of Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial

Author

Li, Ho, Scarborough, Matthew, Zambellas, Rhea, Cushla Cooper, Rombach, Ines, A. Walker, Lipsky, Benjamin, Briggs, Andrew, Seaton, Andrew, Atkins, Bridget, Woodhouse, Andrew, Berendt, Anthony, Byren, Ivor, Angus, Brian, Pandit, Hemant, Stubbs, David, McNally, Martin, Thwaites, Guy, and Bejon, Philip

Subjects
body regions, nervous system, fungi, 3. Good health
Abstract

OVIVA Patient Information Sheet. Information sheet provided to patients prior to enrolling in the trial. (PDF 127 kb)

14. Additional file 1: of Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial

Author

Li, Ho, Scarborough, Matthew, Zambellas, Rhea, Cushla Cooper, Rombach, Ines, A. Walker, Lipsky, Benjamin, Briggs, Andrew, Seaton, Andrew, Atkins, Bridget, Woodhouse, Andrew, Berendt, Anthony, Byren, Ivor, Angus, Brian, Pandit, Hemant, Stubbs, David, McNally, Martin, Thwaites, Guy, and Bejon, Philip

Subjects
body regions, nervous system, fungi, 3. Good health
Abstract

OVIVA Patient Information Sheet. Information sheet provided to patients prior to enrolling in the trial. (PDF 127 kb)

15. Additional file 2: of Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial

Author

Li, Ho, Scarborough, Matthew, Zambellas, Rhea, Cushla Cooper, Rombach, Ines, A. Walker, Lipsky, Benjamin, Briggs, Andrew, Seaton, Andrew, Atkins, Bridget, Woodhouse, Andrew, Berendt, Anthony, Byren, Ivor, Angus, Brian, Pandit, Hemant, Stubbs, David, McNally, Martin, Thwaites, Guy, and Bejon, Philip

Subjects
body regions, nervous system, fungi, humanities, 3. Good health
Abstract

OVIVA Consent Form. Form used in the OVIVA trial to record informed consent. (PDF 13 kb)

16. Additional file 2: of Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial

Author

Li, Ho, Scarborough, Matthew, Zambellas, Rhea, Cushla Cooper, Rombach, Ines, A. Walker, Lipsky, Benjamin, Briggs, Andrew, Seaton, Andrew, Atkins, Bridget, Woodhouse, Andrew, Berendt, Anthony, Byren, Ivor, Angus, Brian, Pandit, Hemant, Stubbs, David, McNally, Martin, Thwaites, Guy, and Bejon, Philip

Subjects
body regions, nervous system, fungi, humanities, 3. Good health
Abstract

OVIVA Consent Form. Form used in the OVIVA trial to record informed consent. (PDF 13 kb)

Catalog

Books, media, physical & digital resources
See catalog results