المؤلفون: Cassey Muir, Sophie G. E. Kedzior, Simon Barrett, Ruth McGovern, Eileen Kaner, Ingrid Wolfe, Julia R. Forman, On behalf of the ORACLE consortium

المصدر: Research Involvement and Engagement, Vol 10, Iss 1, Pp 1-16 (2024)

مصطلحات موضوعية: Family, Adverse childhood experiences, Parents, Mental health, Children, Young people, Medicine, Medicine (General), R5-920

الوصف: Abstract Background Clustering and co-occurring of family adversities, including mental health problems, substance use, domestic violence and abuse, as well as poverty can increase health and behavioural risks for children, which persist throughout the life course. Yet, interventions that acknowledge and account for the complex interactive nature of such risks are limited. This study aimed to develop intervention principles based on reflections from mothers, fathers, and young people who experience multiple and interacting adversities. These principles will show how family members perceive an intervention may bring about positive change and highlight key insights into design and delivery. Methods A series of six co-design workshops with mothers, fathers, and young people who experienced multiple and interacting adversities (n = 41) were iteratively conducted across two regions in England (London and North-East) by four researchers. Workshop content and co-design activities were informed by advisory groups. Data from facilitator notes and activities were analysed thematically, resulting in a set of intervention principles. Results The intervention principles highlighted that: (1) to reduce isolation and loneliness parents and young people wanted to be connected to services, resources, and peer support networks within their local community, particularly by a knowledgeable and friendly community worker; (2) to address feelings of being misunderstood, parents and young people wanted the development of specialised trauma informed training for practitioners and to have the space to build trusting, gradual, and non-stigmatising relationships with practitioners; and (3) to address the needs and strengths of individual family members, mothers, fathers, and young people wanted separate, tailored, and confidential support. Conclusions The current study has important implications for practice in supporting families that experience multiple and interacting adversities. The intervention principles from this study share common characteristics with other intervention models currently on offer in the United Kingdom, including social prescribing, but go beyond these to holistically consider the whole families’ needs, environments, and circumstances. There should be particular focus on the child’s as well as the mothers’ and fathers’ needs, independently of the family unit. Further refinement and piloting of the developing intervention are needed.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2056-7529Test

الوصول الحر: https://doaj.org/article/bd98364e0c3846e1baa5b5eeecc3d758Test

المؤلفون: Natalia K Rojas, Bianca L De Stavola, Tom Norris, Mario Cortina-Borja, Manjula D Nugawela, Dougal Hargreaves, Emma Dalrymple, Kelsey McOwat, Ruth Simmons, Terence Stephenson, Roz Shafran, CLoCk Consortium, Snehal M Pinto Pereira

المصدر: BMC Medical Research Methodology, Vol 24, Iss 1, Pp 1-15 (2024)

مصطلحات موضوعية: Long covid, Survey weights, Children and young people, Representativeness, Matched cohort study, Selection bias, Medicine (General), R5-920

الوصف: Abstract Background Findings from studies assessing Long Covid in children and young people (CYP) need to be assessed in light of their methodological limitations. For example, if non-response and/or attrition over time systematically differ by sub-groups of CYP, findings could be biased and any generalisation limited. The present study aimed to (i) construct survey weights for the Children and young people with Long Covid (CLoCk) study, and (ii) apply them to published CLoCk findings showing the prevalence of shortness of breath and tiredness increased over time from baseline to 12-months post-baseline in both SARS-CoV-2 Positive and Negative CYP. Methods Logistic regression models were fitted to compute the probability of (i) Responding given envisioned to take part, (ii) Responding timely given responded, and (iii) (Re)infection given timely response. Response, timely response and (re)infection weights were generated as the reciprocal of the corresponding probability, with an overall ‘envisioned population’ survey weight derived as the product of these weights. Survey weights were trimmed, and an interactive tool developed to re-calibrate target population survey weights to the general population using data from the 2021 UK Census. Results Flexible survey weights for the CLoCk study were successfully developed. In the illustrative example, re-weighted results (when accounting for selection in response, attrition, and (re)infection) were consistent with published findings. Conclusions Flexible survey weights to address potential bias and selection issues were created for and used in the CLoCk study. Previously reported prospective findings from CLoCk are generalisable to the wider population of CYP in England. This study highlights the importance of considering selection into a sample and attrition over time when considering generalisability of findings.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2288Test

الوصول الحر: https://doaj.org/article/c3a48ff1645c4623ae7b8257d764862bTest

المؤلفون: Nikki Totton, Ed Waddingham, Ruth Owen, Steven Julious, Dyfrig Hughes, Jonathan Cook

المصدر: Trials, Vol 25, Iss 1, Pp 1-12 (2024)

مصطلحات موضوعية: Adverse events, Harms, RCT reporting, Benefit-risk, Medicine (General), R5-920

الوصف: Abstract Adverse events suffer from poor reporting within randomised controlled trials, despite them being crucial to the evaluation of a treatment. A recent update to the CONSORT harms checklist aims to improve reporting by providing structure and consistency to the information presented. We propose an extension wherein harms would be reported in conjunction with effectiveness outcome(s) rather than in silo to provide a more complete picture of the evidence acquired within a trial. Benefit-risk methods are designed to simultaneously consider both benefits and risks, and therefore, we believe these methods could be implemented to improve the prominence of adverse events when reporting trials. The aim of this article is to use case studies to demonstrate the practical utility of benefit-risk methods to present adverse events results alongside effectiveness results. Two randomised controlled trials have been selected as case studies, the Option-DM trial and the SANAD II trial. Using a previous review, a shortlist of 17 benefit-risk methods which could potentially be used for reporting RCTs was created. From this shortlist, three benefit-risk methods are applied across the two case studies. We selected these methods for their usefulness to achieve the aim of this paper and which are commonly used in the literature. The methods selected were the Benefit-Risk Action Team (BRAT) Framework, net clinical benefit (NCB), and the Outcome Measures in Rheumatology (OMERACT) 3 × 3 table. Results using the benefit-risk method added further context and detail to the clinical summaries made from the trials. In the case of the SANAD II trial, the clinicians concluded that despite the primary outcome being improved by the treatment, the increase in adverse events negated the improvement and the treatment was therefore not recommended. The benefit-risk methods applied to this case study outlined the data that this decision was based on in a clear and transparent way. Using benefit-risk methods to report the results of trials can increase the prominence of adverse event results by presenting them alongside the primary efficacy/effectiveness outcomes. This ensures that all the factors which would be used to determine whether a treatment would be recommended are transparent to the reader.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1745-6215Test

الوصول الحر: https://doaj.org/article/fd85d3ba3c174a30841bdefa0054237fTest

المؤلفون: Yinfei Duan, Jing Wang, Holly J. Lanham, Whitney Berta, Stephanie A. Chamberlain, Matthias Hoben, Katharina Choroschun, Alba Iaconi, Yuting Song, Janelle Santos Perez, Shovana Shrestha, Anna Beeber, Ruth A. Anderson, Leslie Hayduk, Greta G. Cummings, Peter G. Norton, Carole A. Estabrooks

المصدر: Implementation Science Communications, Vol 5, Iss 1, Pp 1-18 (2024)

مصطلحات موضوعية: Care aides, Best practice use, Coincidence analysis, Configurational comparative methods, Context, Evidence-based practice, Medicine (General), R5-920

الوصف: Abstract Background Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides. Methods In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides’ best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations. Results Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints. Conclusions Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2662-2211Test

الوصول الحر: https://doaj.org/article/07a123a5d9394a6a8fc21eb1bba2f0adTest

المؤلفون: Jessica A. Matthews, DBH, NBC-HWC, DipACLM, FACLM, Simon Matthews, MHlthSc, NBC-HWC, PCC, DipIBLM, FASLM, Mark D. Faries, PhD, Ruth Q. Wolever, PhD, NBC-HWC

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 8, Iss 3, Pp 263-275 (2024)

مصطلحات موضوعية: Medicine (General), R5-920

الوصف: Behavior change is the foundation for effective lifestyle prescriptions, yet such change is individualized, nonlinear and typically requires ongoing support. Health and wellness coaching (HWC) is a behavior change intervention with rapidly accruing evidence of positive impact on health behaviors such as exercise, nutrition and stress management. Furthermore, HWC enhances prevention and mitigates exacerbation of chronic lifestyle diseases, at least in the short-term (up to 6 months post intervention). Although the impact on long-term stability of behavior change remains unclear, it is evident that effective partnering with patients using key communication strategies, autonomy promotion, and flexible permissiveness can empower patients to develop healthy lifestyles. This partnership can be cultivated by clinicians as well as clinical team members including nationally board-certified coaches. Although much research is needed regarding the ongoing maintenance of lifestyle changes beyond 6 months, this article seeks to equip clinicians with current evidence, theoretical insights and practical strategies from a “coach approach” to foster more intrinsic forms of motivation which, in turn, empowers patients to adopt and maintain health-promoting behaviors.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2542454824000225Test; https://doaj.org/toc/2542-4548Test

الوصول الحر: https://doaj.org/article/940fd855c5b8456d823a7612153af135Test

المؤلفون: Carolina Fernandes, Denise Campbell-Scherer, Aisha Lofters, Eva Grunfeld, Kris Aubrey-Bassler, Heidi Cheung, Katherine Latko, Wendy Tink, Richard Lewanczuk, Melissa Shea-Budgell, Ruth Heisey, Tracy Wong, Huiming Yang, Sakina Walji, Margo Wilson, Elizabeth Holmes, Kelly Lang-Robertson, Christina DeLonghi, Donna Patricia Manca

المصدر: BMC Primary Care, Vol 25, Iss 1, Pp 1-40 (2024)

مصطلحات موضوعية: Clinical practice guidelines, Prevention, Primary care, Screening, Chronic disease, Medicine (General), R5-920

الوصف: Abstract Background Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations. We describe the process used to harmonize high-quality cancer and chronic disease prevention and screening (CCDPS) CPGs to update the BETTER program. Methods A review of CPG databases, repositories, and grey literature was conducted to identify international and Canadian (national and provincial) CPGs for CCDPS in adults 40–69 years of age across 19 topic areas: cancers, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, hepatitis C, obesity, osteoporosis, depression, and associated risk factors (i.e., diet, physical activity, alcohol, cannabis, drug, tobacco, and vaping/e-cigarette use). CPGs published in English between 2016 and 2021, applicable to adults, and containing CCDPS recommendations were included. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and a three-step process involving patients, health policy, content experts, primary care providers, and researchers was used to identify and synthesize recommendations. Results We identified 51 international and Canadian CPGs and 22 guidelines developed by provincial organizations that provided relevant CCDPS recommendations. Clinical recommendations were extracted and reviewed for inclusion using the following criteria: 1) pertinence to primary prevention and screening, 2) relevance to adults ages 40–69, and 3) applicability to diverse primary care settings. Recommendations were synthesized and integrated into the BETTER toolkit alongside resources to support shared decision-making and care paths for the BETTER program. Conclusions Comprehensive care requires the ability to address a person’s overall health. An approach to identify high-quality clinical guidance to comprehensively address CCDPS is described. The process used to synthesize and harmonize implementable clinical recommendations may be useful to others wanting to integrate evidence across broad content areas to provide comprehensive care. The BETTER toolkit provides resources that clearly and succinctly present a breadth of clinical evidence that providers can use to assist with implementing CCDPS guidance in primary care.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2731-4553Test

الوصول الحر: https://doaj.org/article/03cd1b512f1640d78af820ee1cc8e57bTest

المؤلفون: Amy Grant, Rachel Giacomantonio, Kelly Lackie, Adrian MacKenzie, Elizabeth Jeffers, Julia Kontak, Emily Gard Marshall, Susan Philpott, Debbie Sheppard-LeMoine, Elizabeth Lappin, Alice Bruce, Amy Mireault, Deanna Beck, Lindsay Cormier, Ruth Martin-Misener

المصدر: BMC Primary Care, Vol 25, Iss 1, Pp 1-14 (2024)

مصطلحات موضوعية: Collaborative family practice, Interprofessional teams, Primary care, Consolidated Framework for Implementation Research, Implementation, Workforce, Medicine (General), R5-920

الوصف: Abstract Background Interprofessional primary care teams (IPCTs) work together to enhance care. Despite evidence on the benefits of IPCTs, implementation remains challenging. This research aims to 1) identify and prioritize barriers and enablers, and 2) co-develop team-level strategies to support IPCT implementation in Nova Scotia, Canada. Methods Healthcare providers and staff of IPCTs were invited to complete an online survey to identify barriers and enablers, and the degree to which each item impacted the functioning of their team. Top ranked items were identified using the sum of frequency x impact for each response. A virtual knowledge sharing event was held to identify strategies to address local barriers and enablers that impact team functioning. Results IPCT members (n = 117), with a mix of clinic roles and experience, completed the survey. The top three enablers identified were access to technological tools to support their role, standardized processes for using the technological tools, and having a team manager to coordinate collaboration. The top three barriers were limited opportunity for daily team communication, lack of conflict resolution strategies, and lack of capacity building opportunities. IPCT members, administrators, and patients attended the knowledge sharing event (n = 33). Five strategies were identified including: 1) balancing patient needs and provider scope of practice, 2) holding regular and accessible meetings, 3) supporting team development opportunities, 4) supporting professional development, and 5) supporting involvement in non-clinical activities. Interpretation This research contextualized evidence to further understand local perspectives and experiences of barriers and enablers to the implementation of IPCTs. The knowledge exchange event identified actionable strategies that IPCTs and healthcare administrators can tailor to support teams and care for patients.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2731-4553Test

الوصول الحر: https://doaj.org/article/901e376d8ab541fcb0898bc1d25c5396Test

المؤلفون: Alasdair D. Henderson, Ben FC. Butler-Cole, John Tazare, Laurie A. Tomlinson, Michael Marks, Mark Jit, Andrew Briggs, Liang-Yu Lin, Oliver Carlile, Chris Bates, John Parry, Sebastian CJ. Bacon, Iain Dillingham, William A. Dennison, Ruth E. Costello, Yinghui Wei, Alex J. Walker, William Hulme, Ben Goldacre, Amir Mehrkar, Brian MacKenna, Emily Herrett, Rosalind M. Eggo, Alex Walker, Amelia Green, Andrea Schaffer, Andrew Brown, Ben Butler-Cole, Caroline Morton, Caroline Walters, Catherine Stables, Christine Cunningham, Christopher Wood, Colm Andrews, David Evans, George Hickman, Helen Curtis, Henry Drysdale, Jessica Morley, Jon Massey, Linda Nab, Lisa Hopcroft, Louis Fisher, Lucy Bridges, Milan Wiedemann, Nicholas DeVito, Orla Macdonald, Peter Inglesby, Rebecca Smith, Richard Croker, Robin Park, Rose Higgins, Sebastian Bacon, Simon Davy, Steven Maude, Thomas O'Dwyer, Tom Ward, Victoria Speed, Liam Hart, Pete Stokes, Krishnan Bhaskaran, Ruth Costello, Thomas Cowling, Ian Douglas, Rosalind Eggo, Stephen Evans, Harriet Forbes, Richard Grieve, Daniel Grint, Sinead Langan, Viyaasan Mahalingasivam, Kathryn Mansfield, Rohini Mathur, Helen McDonald, Edward Parker, Christopher Rentsch, Anna Schultze, Liam Smeeth, Laurie Tomlinson, Jemma Walker, Elizabeth Williamson, Kevin Wing, Angel Wong, Bang Zheng, Christopher Bates, Jonathan Cockburn, Frank Hester, Sam Harper, Shaun O'Hanlon, Alex Eavis, Richard Jarvis, Dima Avramov, Paul Griffiths, Aaron Fowles, Nasreen Parkes, Rafael Perera, David Harrison, Kamlesh Khunti, Jonathan Sterne, Jennifer Quint

المصدر: EClinicalMedicine, Vol 72, Iss , Pp 102638- (2024)

مصطلحات موضوعية: Long COVID, Vaccination, Descriptive cohort, Medicine (General), R5-920

الوصف: Summary: Background: Long COVID is the patient-coined term for the persistent symptoms of COVID-19 illness for weeks, months or years following the acute infection. There is a large burden of long COVID globally from self-reported data, but the epidemiology, causes and treatments remain poorly understood. Primary care is used to help identify and treat patients with long COVID and therefore Electronic Health Records (EHRs) of past COVID-19 patients could be used to help fill these knowledge gaps. We aimed to describe the incidence and differences in demographic and clinical characteristics in recorded long COVID in primary care records in England. Methods: With the approval of NHS England we used routine clinical data from over 19 million adults in England linked to SARS-COV-2 test result, hospitalisation and vaccination data to describe trends in the recording of 16 clinical codes related to long COVID between November 2020 and January 2023. Using OpenSAFELY, we calculated rates per 100,000 person-years and plotted how these changed over time. We compared crude and adjusted (for age, sex, 9 NHS regions of England, and the dominant variant circulating) rates of recorded long COVID in patient records between different key demographic and vaccination characteristics using negative binomial models. Findings: We identified a total of 55,465 people recorded to have long COVID over the study period, which included 20,025 diagnoses codes and 35,440 codes for further assessment. The incidence of new long COVID records increased steadily over 2021, and declined over 2022. The overall rate per 100,000 person-years was 177.5 cases in women (95% CI: 175.5–179) and 100.5 in men (99.5–102). The majority of those with a long COVID record did not have a recorded positive SARS-COV-2 test 12 or more weeks before the long COVID record. Interpretation: In this descriptive study, EHR recorded long COVID was very low between 2020 and 2023, and incident records of long COVID declined over 2022. Using EHR diagnostic or referral codes unfortunately has major limitations in identifying and ascertaining true cases and timing of long COVID. Funding: This research was supported by the National Institute for Health and Care Research (NIHR) (OpenPROMPT: COV-LT2-0073).

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2589537024002177Test; https://doaj.org/toc/2589-5370Test

الوصول الحر: https://doaj.org/article/44f9e56ee26a435d9956ffa4a1354eaaTest

المؤلفون: Ruth A. Mathew Kalathil, MD, Akshay Machanahalli Balakrishna, MD, Ahmed El-Shaer, MD, Andrew M. Goldsweig, MD, MS, Khagendra Dahal, MD, Saraschandra Vallabhajosyula, MD, MSc, Ahmed Aboeata, MD

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 8, Iss 3, Pp 276-278 (2024)

مصطلحات موضوعية: Medicine (General), R5-920

الوصف: Coronary artery disease is the most common cause of heart failure, which is the leading cause of cardiovascular-related death worldwide. There are insufficient data to make strong recommendations for percutaneous coronary intervention (PCI) in patients with severe ischemic left ventricular systolic dysfunction (LVSD). In that context, we performed a meta-analysis to compare the outcomes of PCI with those of optimal medical therapy alone in patients with severe ischemic LVSD. A systematic search was conducted in PubMed, EMBASE, and ClinicalTrials.gov from inception to December 2023. Our outcome of interest was all-cause mortality in patients undergoing PCI vs medical therapy. We used random effects models to aggregate data and to calculate pooled incidence and relative risk with 95% CIs. Four studies including 2 randomized controlled trials with 2080 patients (PCI, 1082; optimal medical therapy, 998) were included. All-cause mortality did not differ significantly between the groups: 168 patients (15.5%) in the PCI group vs 200 patients (20.0%) in the optimal medical therapy group (relative risk, 0.88; 95% CI, 0.75-1.09; P=.25). In conclusion, the available evidence indicates that PCI does not improve all-cause mortality in patients with severe LVSD without lifestyle-limiting anginal symptoms. Further data are needed to identify subgroups of patients better served by each modality.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2542454824000250Test; https://doaj.org/toc/2542-4548Test

الوصول الحر: https://doaj.org/article/2bd3be6dfffd4b61a100d2376b2041b4Test

المؤلفون: Dr. Ruth Hecker, Prof. Dr. Reinhold Roski, Peter Stegmaier

المصدر: Monitor Versorgungsforschung, Vol 2024, Pp 6-10 (2024)

مصطلحات موضوعية: patientensicherheit, patient safety, who, sektorübergreifend, multinational, gesundheitssystem, honorarsystem, einzelleistung, patienteneinbindung, patientenbefähigung, Public aspects of medicine, RA1-1270, Medicine (General), R5-920

الوصف: „Patientensicherheit ist nur bei uns in Deutschland reduziert worden auf einige wenige, wenn auch wichtige Detailthemen.“ Im Titelinterview mit „Monitor Versorgungsforschung“ spricht sich Dr. Ruth Hecker, Vorsitzende des Aktionsbündnisses Patientensicherheit e.V. (APS) dafür aus, den Begriff neu aufzuladen und eher im Sinne des angelsächsischen „Patient Safety“ zu begreifen. Dazu führt sie den WHO-Aktionsplan „Patientensicherheit – 2021 bis 2030“ an, in dem Patientensicherheit als System zur „Entwicklung und Aufrechterhaltung sektorübergreifender und multinationaler Synergien, Partnerschaften und Solidarität zur Verbesserung der Patientensicherheit und der Qualität der Versorgung“ verstanden wird.

وصف الملف: electronic resource

العلاقة: https://www.monitor-versorgungsforschung.de/abstract/kein-resilientes-sondern-ein-vulnerables-gesundheitssystemTest/; https://doaj.org/toc/1866-0533Test; https://doaj.org/toc/2509-8381Test

الوصول الحر: https://doaj.org/article/7eb4bcfab0d14a1db7a0b2d184c6e60cTest