A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol.

BACKGROUND: Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist 'Tier 3' Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity. METHODS: This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted. DISCUSSION: This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients. TRIAL REGISTRATION: ISRCTN number 22088800.

Oral care experiences of palliative care patients, their relatives/carers and healthcare professionals.

AIM: To explore the oral care experiences of palliative care patients and of those who support or deliver oral care to these patients: nurses, doctors, dentists, their relatives and carers. DATA SOURCES: An electronic search of the databases included: Embase, MEDLINE, DOSS, AMED and PsycINFO was performed. DATA SELECTION: Six articles were included in the final synthesis. DATA EXTRACTION: Thematic analysis was applied by two researchers. DATA SYNTHESIS: Three themes were identified: 'performing oral care', 'effects on oral health' and 'challenges in palliative care'. CONCLUSIONS: Despite similarities of oral care experiences, this review identified some differences, crucially in terms of the wider impact of oral symptoms, namely social interactions with others and challenges to oral care. This confirms the need to investigate these topics further in relation to different stakeholders, such as nurses; and to have consistent guidance to facilitate the provision of effective oral care to palliative care patients.

Oral Care Experiences of Palliative Care Patients, Their Relatives, and Health Care Professionals: A Qualitative Study.

Oral symptoms in a growing number of palliative care patients are often neglected. Dental professionals are not always involved in palliative care. Oral care is often inadequately delivered to palliative care patients, while oral problems can affect the quality of life. A qualitative study was conducted to explore oral care experiences of palliative care patients, their relatives, and health care professionals (HCPs). Four patients, 4 relatives, and 4 HCPs were interviewed in a hospice. Transcripts were analyzed using thematic analysis and revealed 3 themes. Patients who were capable of performing oral care mainly brushed their teeth and looked after their dentures. Other care tended to be carried out by relatives and HCPs, adapted based on a person's level of consciousness. When describing the effects on oral health, relatives and HCPs tended to focus on xerostomia, whereas patients provided detailed accounts denoting the psychological and social impact of oral symptoms. Perceptions of enablers and barriers to oral care differed between groups. Patients reported lack of access to professional dental care and patients' fatigue were the main barriers to oral care. Nevertheless, there is great scope for further research into good oral care practices identified in this study and possible implementation in other settings.

The influence of cognitive ability and instructional set on causal conditional inference.

We report a large study in which participants are invited to draw inferences from causal conditional sentences with varying degrees of believability. General intelligence was measured, and participants were split into groups of high and low ability. Under strict deductive-reasoning instructions, it was observed that higher ability participants were significantly less influenced by prior belief than were those of lower ability. This effect disappeared, however, when pragmatic reasoning instructions were employed in a separate group. These findings are in accord with dual-process theories of reasoning. We also took detailed measures of beliefs in the conditional sentences used for the reasoning tasks. Statistical modelling showed that it is not belief in the conditional statement per se that is the causal factor, but rather correlates of it. Two different models of belief-based reasoning were found to fit the data according to the kind of instructions and the type of inference under consideration.

Understanding causal conditionals: a study of individual differences.

Previous studies have suggested that a minority of university students, of lower cognitive ability, are inclined to interpret abstract conditional statements, if p then q, as if they were conjunctions: p and q. In the present study we administered the conditional truth table task to a large sample of students (n = 160), but using realistic, everyday causal conditionals. We also measured their general intelligence. While individual differences were found, these were not consistent with some participants adopting a conjunctive interpretation of such statements. Rather, it appears that students of lower cognitive ability are rather likely to assume that a conditional implies its converse, so that it means also if q then p. The results are discussed with reference to the suppositional theory of conditionals and our more general account of hypothetical thinking.

When can we say 'if'?

In this study, we focus on the conditions which permit people to assert a conditional statement of the form 'if p then q' with conversational relevance. In a broadly decision-theoretic approach, also drawing on hypothetical thinking theory [Evans, J. St. B. T. (2007). Hypothetical thinking: Dual processes in reasoning and judgement. Hove, UK: Psychology Press.], we predicted that conditional tips and promises would appear more useful and persuasive and be more likely to encourage an action p when (a) the conditional link from p to q was stronger, (b) the cost of the action p was lower and (c) the benefit of the consequence q was higher. Similarly, we predicted that conditional warnings and threats would be seen as more useful and persuasive and more likely to discourage an action p when (a) the conditional link from p to q was stronger, (b) the benefit of the action p was lower and (c) the cost of the consequence q was higher. All predictions were strongly confirmed, suggesting that such conditionals may best be asserted when they are of high relevance to the goals of the listener.