14422 Orchard Pkwy Ste 200
Westminster CO 80023
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 00201811
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
Appetite for change: a multidisciplinary team approach to behavioral modification for weight management in a community health group setting. - Eating and weight disorders : EWD
Obesity is a growing issue in Australia with limited evidence for brief community based intervention. This preliminary study aimed to investigate the long term effects of a 4-week group based multidisciplinary behavior management program for weight loss in the community health setting.A quasi-experimental study design was employed recruiting patients referred to two Community Health Centers. Participants completed a 4-week Appetite for change program, comprising four 2-h group sessions co-facilitated by a multidisciplinary team. The mindfulness self efficacy scale (MSES), quality of life scale (QoL), and self-reported knowledge and stages of change were measured pre-treatment, immediately post-treatment and, 6 and 12Â months post-treatment. Weight and waist circumference were additionally measured at baseline, 6 and 12Â months post-treatment.Eighty participants (mean age 63Â Â±Â 12.1Â years) comprising 73Â % women consented to participate. Statistically significant improvements (pÂ â‰¤Â 0.01) from pre-treatment were found at both 6 and 12Â months, with a clinically significant mean percentage weight loss of approximately 4Â %, and a mean improvement of 8.5 point on QoL at 12Â months follow-up. Self-reported improvements in stages of change and knowledge were also maintained at 12Â months.Clinically and statistically significant long term improvements in all outcomes were found following a multidisciplinary brief intervention program for overweight/obese adults in the community health setting. The promising results following the Appetite for Change program warrant further controlled investigation.
Gaps in the evidence on improving social care outcomes: findings from a meta-review of systematic reviews. - Health & social care in the community
Adult social care continues to be a central policy concern in the UK. The Adult Social Care Outcomes Framework (ASCOF) is a range of measures nationally available to drive forward improvement on outcomes and quality in local councils. While there is an emphasis on improving transparency, quality and outcomes, drawing on research evidence to achieve these aims is often difficult because the evidence is not easily identifiable, is disparate or of variable quality. We conducted a meta-review to analyse and summarise systematic review-level evidence on the impact of interventions on the four outcomes set out in the ASCOF: quality of life, delaying and reducing the need for services, satisfaction with services and safeguarding of vulnerable adults. This paper focuses on the availability of review-level evidence and the presence of significant gaps in this evidence base. A range of health and social care databases were searched, including MEDLINE, ASSIA and The Cochrane Library in January and February 2012. All systematic reviews evaluating the efficacy of social care interventions for improving ASCOF outcomes for older people, people with long-term conditions, mental health problems or physical and/or learning disabilities were eligible. Two reviewers independently screened systematic reviews for quality and relevance and extracted data; 43 systematic reviews were included, the majority of which examined the impact of interventions on quality of life (nÂ =Â 34) and delaying and reducing the need for support (nÂ =Â 25). Limited systematic review-level evidence was found regarding satisfaction with services and safeguarding. There were also significant gaps in relation to key social care interventions and population groups. Research priorities include addressing these gaps and the collation of data on interventions, outcomes and populations more closely related to social care. Overall, a more relevant, comprehensive and robust evidence base is required to support improvement of outcomes for recipients of adult social care.Â© 2015 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.
Broadening public participation in systematic reviews: a case example involving young people in two configurative reviews. - Research synthesis methods
Arguments supporting the involvement of users in research have even more weight when involving the public in systematic reviews of research. We aimed to explore the potential for public involvement in systematic reviews of observational and qualitative studies.Two consultative workshops were carried out with a group of young people (YP) aged 12-17â€‰years to examine two ongoing reviews about obesity: one about children's views and one on the link between obesity and educational attainment. YP were invited to comment on the credibility of themes, to propose elements of interventions, to suggest links between educational attainment and obesity and to comment on their plausibility.Researchers had more confidence in review findings, after checking that themes identified as important by YP were emphasised appropriately. Researchers were able to use factors linking obesity and attainment identified as important by YP to identify limitations in the scope of extant research.Consultative workshops helped researchers draw on the perspectives of YP when interpreting and reflecting upon two systematic reviews. Involving users in judging synthesis credibility and identifying concepts was easier than involving them in interpreting findings. Involvement activities for reviews should be designed with review stage, purpose and group in mind.Â© 2015 The Authors. Research Synthesis Methods published by John Wiley & Sons, Ltd.
Search wide, dig deep: literature searching for qualitative research. An analysis of the publication formats and information sources used for four systematic reviews in public health. - Research synthesis methods
When literature searching for systematic reviews, it is good practice to search widely across different information sources. Little is known about the contributions of different publication formats (e.g. journal article and book chapter) and sources, especially for studies of people's views.Studies from four reviews spanning three public health areas (active transport, motherhood and obesity) were analysed in terms of publication formats and the information sources they were identified from. They comprised of 229 studies exploring people's perceptions, beliefs and experiences ('views studies') and were largely qualitative.Although most (61%) research studies were published within journals, nearly a third (29%) were published as research reports and 5% were published in books. The remainder consisted of theses, conference papers and raw datasets. Two-thirds of studies (66%) were located in a total of 19 bibliographic databases, and 15 databases provided studies that were not identified elsewhere. PubMed was a good source for all reviews. Supplementary information sources were important for identifying studies in all publication formats.Undertaking sensitive searches across a range of information sources is essential for locating views studies in all publication formats. We discuss some benefits and challenges of utilising different information sources.Copyright Â© 2013 John Wiley & Sons, Ltd.
Public involvement in research: making sense of the diversity. - Journal of health services research & policy
This paper presents a coherent framework for designing and evaluating public involvement in research by drawing on an extensive literature and the authors' experience. The framework consists of three key interrelated dimensions: the drivers for involvement; the processes for involvement and the impact of involvement. The pivotal point in this framework is the opportunity for researchers and others to exchange ideas. This opportunity results from the processes which bring them together and which support their debates and decisions. It is also the point at which research that is in the public interest is open to public influence and the point at which the interaction can also influence anyone directly involved. Judicious choice of methods for bringing people together, and supporting their debate and decisions, depends upon the drivers of those involved; these vary with their characteristics, particularly their degree of enthusiasm and experience, and their motivation.Â© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
'It's on your conscience all the time': a systematic review of qualitative studies examining views on obesity among young people aged 12-18 years in the UK. - BMJ open
To explore the perspectives of young people in the UK on obesity, body size, shape and weight.Systematic review of qualitative studies using thematic synthesis.Sensitive searches of 18 electronic databases from 1997 to February 2010 supplemented by grey literature searches.Studies produced since 1997 using qualitative methods to collect perspectives of people aged 12-18 years in the UK, reporting methods for data collection or analysis. Studies of people with eating disorders and those rated low in reliability and usefulness were excluded.Searches identified 30 studies involving over 1400 young people from a range of contexts. Young people of all sizes placed considerable emphasis on personal responsibility, and on the social, rather than health implications of being overweight. Young people with experience of obesity described severe, unrelenting, size-related abuse and isolation. Regardless of their own size, young people were judgemental of individuals who were overweight, but those with experience of obesity described an environment that contained multiple barriers to weight loss. Only one study asked young people directly what might support them to have a healthy body size. Study findings were configured under three main themes, labelled with quotes from included studies: general perceptions of size and society's responses ('It's on your conscience all the time'); the experiences of young people who were overweight ('If I had the choice I wouldn't be this size') and these larger young people's experiences of trying to loose weight and suggestions for action ('Make sure, even when it's hard, you've got people there').The perspectives of young people in the UK, when synthesised across the spectrum of body sizes, paint a picture of a stigmatising and abusive social world. Research and policy need to engage young people actively so as to address the social implications of obesity.
Understanding the role of the volunteer in specialist palliative care: a systematic review and thematic synthesis of qualitative studies. - BMC palliative care
Volunteers make a major contribution to palliative patient care, and qualitative studies have been undertaken to explore their involvement. With the aim of making connections between existing studies to derive enhanced meanings, we undertook a systematic review of these qualitative studies including synthesising the findings. We sought to uncover how the role of volunteers with direct contact with patients in specialist palliative care is understood by volunteers, patients, their families, and staff.We searched for relevant literature that explored the role of the volunteer including electronic citation databases and reference lists of included studies, and also undertook handsearches of selected journals to find studies which met inclusion criteria. We quality appraised included studies, and synthesised study findings using a novel synthesis method, thematic synthesis.We found 12 relevant studies undertaken in both inpatient and home-care settings, with volunteers, volunteer coordinators, patients and families. Studies explored the role of general volunteers as opposed to those offering any professional skills. Three theme clusters were found: the distinctness of the volunteer role, the characteristics of the role, and the volunteer experience of the role. The first answers the question, is there a separate volunteer role? We found that to some extent the role was distinctive. The volunteer may act as a mediator between the patient and the staff. However, we also found some contradictions. Volunteers may take on temporary surrogate family-type relationship roles. They may also take on some of the characteristics of a paid professional. The second cluster helps to describe the essence of the role. Here, we found that the dominant feature was that the role is social in nature. The third helps to explain aspects of the role from the point of view of volunteers themselves. It highlighted that the role is seen by volunteers as flexible, informal and sometimes peripheral. These characteristics some volunteers find stressful.This paper demonstrates how qualitative research can be sythnesised systematically, extending methodological techniques to help answer difficult research questions. It provides information that may help managers and service planners to support volunteers appropriately.
The selection of search sources influences the findings of a systematic review of people's views: a case study in public health. - BMC medical research methodology
For systematic reviews providing evidence for policy decisions in specific geographical regions, there is a need to minimise regional bias when seeking out relevant research studies. Studies on people's views tend to be dispersed across a range of bibliographic databases and other search sources. It is recognised that a comprehensive literature search can provide unique evidence not found from a focused search; however, the geographical focus of databases as a potential source of bias on the findings of a research review is less clear. This case study describes search source selection for research about people's views and how supplementary searches designed to redress geographical bias influenced the findings of a systematic review. Our research questions are: a) what was the impact of search methods employed to redress potential database selection bias on the overall findings of the review? and b) how did each search source contribute to the identification of all the research studies included in the review?The contribution of 25 search sources in locating 28 studies included within a systematic review on UK children's views of body size, shape and weight was analysed retrospectively. The impact of utilising seven search sources chosen to identify UK-based literature on the review's findings was assessed.Over a sixth (5 out of 28) of the studies were located only through supplementary searches of three sources. These five studies were of a disproportionally high quality compared with the other studies in the review. The retrieval of these studies added direction, detail and strength to the overall findings of the review. All studies in the review were located within 21 search sources. Precision for 21 sources ranged from 0.21% to 1.64%.For reducing geographical bias and increasing the coverage and context-specificity of systematic reviews of people's perspectives and experiences, searching that is sensitive and aimed at reducing geographical bias in database sources is recommended.
Comparing midwife-led and doctor-led maternity care: a systematic review of reviews. - Journal of advanced nursing
A report of a systematic review of reviews which examines the impact of having midwives-led maternity care for low-risk women, rather than physicians.â€‚ A rising birth rate, increasing complexity of births, and economic constraints pose difficulties for maternity services in the UK. Evidence about the most effective, cost-effective, and efficient ways to give maternity services is needed.â€‚ Searches were carried out in August-September 2009 of ten electronic databases, 16 key nursing and research websites, and reference lists of 56 relevant reviews. We also contacted 38 experts for information. No date restrictions were employed.â€‚ A narrative review of systematic reviews or 'meta review' was conducted using transparent and systematic procedures to limit bias at all stages. Systematic reviews that compared midwife-led care during pregnancy and birth with physician-led care were eligible for inclusion.â€‚ Three meta-analytic reviews were included. Midwife-led care for low-risk women was found to be better for a range of maternal outcomes, reduced the number of procedures in labour, and increased satisfaction with care. For some maternal, foetal, and neonatal outcomes reviews found no evidence that care led by midwives is different to that led by physicians. No adverse outcomes associated with midwife-led care were identified.â€‚ For low-risk women, health and other benefits can result from having their maternity care led by midwives rather than physicians. Moreover, there appear to be no negative impacts on mothers and infants receiving midwife-led care.Â© 2012 Blackwell Publishing Ltd.
The views of young children in the UK about obesity, body size, shape and weight: a systematic review. - BMC public health
There are high levels of concern about childhood obesity, with obese children being at higher risk of poorer health both in the short and longer terms. Children's attitudes to, and beliefs about, their bodies have also raised concern. Children themselves have a stake in this debate; their perspectives on this issue can inform the ways in which interventions aim to work.This systematic review of qualitative and quantitative research aimed to explore the views of UK children about the meanings of obesity and body size, shape or weight and their own experiences of these issues.We conducted sensitive searches of electronic databases and specialist websites, and contacted experts. We included studies published from the start of 1997 which reported the perspectives of UK children aged 4-11 about obesity or body size, shape or weight, and which described key aspects of their methods. Included studies were coded and quality-assessed by two reviewers independently.Findings were synthesised in two analyses: i) an interpretive synthesis of findings from open-ended questions; and ii) an aggregative synthesis of findings from closed questions. We juxtaposed the findings from the two syntheses. The effect of excluding the lowest quality studies was explored. We also consulted young people to explore the credibility of a subset of findings.We included 28 studies. Instead of a focus on health, children emphasised the social impact of body size, describing experiences and awareness of abuse and isolation for children with a greater weight. Body size was seen as under the individual's control and children attributed negative characteristics to overweight people. Children actively assessed their own size; many wished their bodies were different and some were anxious about their shape.Reviewers judged that children's engagement and participation in discussion had only rarely been supported in the included studies, and few study findings had depth or breadth.Initiatives need to consider the social aspects of obesity, in particular unhelpful beliefs, attitudes and discriminatory behaviours around body size. Researchers and policy-makers should involve children actively and seek their views on appropriate forms of support around this issue.
Map & Directions
14422 Orchard Pkwy Ste 200 Westminster, CO 80023
13654 Xavier Ln Suite 201B
14300 Orchard Pkwy Floor 3 Pod 1
Westminster, CO 80023