To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Health anxiety and medically unexplained symptoms cost the National
Health Service (NHS) an estimated £3 billion per year in unnecessary
costs with little evidence of patient benefit. Effective treatment is
rarely taken up due to issues such as stigma or previous negative
experiences with mental health services. An approach to overcome this
might be to offer remotely delivered psychological therapy, which can be
just as effective as face-to-face therapy and may be more accessible and
To investigate the clinical outcomes and cost-effectiveness of remotely
delivered cognitive–behavioural therapy (CBT) to people with high health
anxiety repeatedly accessing unscheduled care (trial registration:
A multicentre randomised controlled trial (RCT) will be undertaken in
primary and secondary care providers of unscheduled care across the East
Midlands. One hundred and forty-four eligible participants will be
equally randomised to receive either remote CBT (6–12 sessions) or
treatment as usual (TAU). Two doctoral research studies will investigate
the barriers and facilitators to delivering the intervention and the
factors contributing to the optimisation of therapeutic outcome.
This trial will be the first to test the clinical outcomes and
cost-effectiveness of remotely delivered CBT for the treatment of high
The findings will enable an understanding as to how this intervention
might fit into a wider care pathway to enhance patient experience of
This study assesses the feasibility of collecting genetic samples and self-reported outcome measures after cardiovascular risk assessment, and presenting the genetic test results to participants.
Coronary heart disease (CHD) genetic tests are increasingly available through direct-to-consumer marketing, but their potential clinical impact on cardiovascular risk assessment is unclear.
Observational study in 10 British general practices in Central England. A total of 320 individuals, who had completed conventional cardiovascular risk assessment, were offered CHD genetic test, with follow-up outcome questionnaire at eight months for lifestyle change and State-Trait Anxiety.
A total of 119 (37%) participants returned genetic test specimens, with over a third reporting family history of CHD in a specified relative; 79 (66.4%) were categorized above-average risk on conventional cardiovascular risk assessment, 65 of whom (82.3%) were only average risk on genetic assessment. The dietary fat questionnaire was poorly completed while study participation was not associated with increased anxiety (mean increase in anxiety score=2.1; 95% CI −0.1–4.3; P=0.06).
As a feasibility study, over a third of individuals offered genetic testing in primary care, as part of CVD risk assessment, took up the offer. Although intervention did not appear to increase anxiety, this needs further evaluation. To improve generalizability and effect size, future studies should actively engage individuals from wider socio-economic backgrounds who may not have already contemplated lifestyle change. The current research suggests general practitioners will face the clinical challenge of patients presenting with direct-to-consumer genetic results that are inconsistent with conventional cardiovascular risk assessment.