Exploring the requirements for a decision aid on familial breast cancer in the UK context: a qualitative study with patients referred to a cancer genetics service

Evaluation of the Efficacy of Artificial Neural Network-Based Music Therapy for Depression

In order to evaluate the therapeutic effect of music therapy on patients with depression, this paper proposes a CNN-based noise detection method with the combination of HHT and FastICA for noise removal, with good data support from the DBN model. DBN-based feature extraction and classification are completed. As the training process of DBN itself requires a large number of training samples, there are also disadvantages such as slow convergence speed and easy to fall into local minima, which lead to a large amount of effort and time, and the learning efficiency is relatively low. A DBN optimization algorithm based on artificial neural network was proposed to evaluate the efficacy of music therapy. First of all, through the comparison of music therapy experimental group and control group, to verify that music therapy is effective for the treatment of depressed patients. Secondly, we propose to optimize the selection of features based on the frequency band energy ratio and the sliding average sample entropy, respectively, and then to classify the EEG of depressed patients under different music perceptions by training the DBN model and continuously adjusting the parameters, combined with the surtax classifier, and the classification accuracy is high. In particular, it can detect the different effects of different music styles, which is of great significance for the selection of appropriate music for the treatment of depressed patients.

Qualitative, multimethod study of behavioural and attitudinal responses to cochlear implantation from the patient and healthcare professional perspective in Australia and the UK: study protocol

INTRODUCTION

The growing prevalence of adults with 'severe or greater' hearing loss globally is of great concern, with hearing loss leading to diminished communication, and impacting on an individual's quality of life (QoL). Cochlear implants (CI) are a recommended device for people with severe or greater, sensorineural hearing loss, who obtain limited benefits from conventional hearing aids (HA), and through improved speech perception, CIs can improve the QoL of recipients. Despite this, utilisation of CIs is low.

METHODS AND ANALYSIS

This qualitative, multiphase and multimethod dual-site study (Australia and the UK) explores patients' and healthcare professionals' behaviours and attitudes to cochlear implantation. Participants include general practitioners, audiologists and older adults with severe or greater hearing loss, who are HA users, CI users and CI candidates. Using purposive time frame sampling, participants will be recruited to take part in focus groups or individual interviews, and will each complete a demographic questionnaire and a qualitative proforma. The study aims to conduct 147 data capture events across a sample of 49 participants, or until data saturation occurs. Schema and thematic analysis with extensive group work will be used to analyse data alongside reporting of demographic and participant characteristics.

ETHICS AND DISSEMINATION

Ethics approval for this study was granted by Macquarie University (HREC: 5201700539), and the study will abide by Australian National Health and Medical Research Council ethical guidelines. Study findings will be published through peer-reviewed journal articles, and disseminated through public and academic conference presentations, participant information sheets and a funders' final report.

Patient-centered decision making in amyotrophic lateral sclerosis: where are we?

Developments in amyotrophic lateral sclerosis research and care delivery have created new arenas, and new dilemmas, for patients’ decision making. This review explores three aspects of amyotrophic lateral sclerosis patient-centered care and decision making: patient-centered service delivery through the expanding multidisciplinary team; decision making for genetic testing and the implications of undergoing testing; and development of user-designed decision support tools to help patients and families make decisions as their choices become more complex. Until a cure is found, well-timed and effective decision making will rely on patient and family preferences to guide them through an increasingly complicated disease landscape.

Barriers and facilitators to change in the organisation and delivery of endoscopy services in England and Wales: a focus group study

OBJECTIVE

Explore professional views of changes to gastroenterology service organisation and delivery and barriers and facilitators impacting on change. The work was undertaken as part of an evaluation in endoscopy service provision catalysed by the Modernising Endoscopy Services Programme of the Modernisation Agency.

DESIGN

Focus groups followed by analysis and group-working activities identifying key themes.

SETTING

English and Welsh secondary care gastroenterology units.

PARTICIPANTS

20 professionals working in gastroenterology in England and Wales. Medical, surgical and nursing specialists including endoscopy nurses. Opportunistic sampling to include senior people in leadership and management roles who were directly involved in service modernisation, excluding those involved in the Modernisation Endoscopy Services Programme.

RESULTS

Four 1.5 h focus groups took place in 2007. Summative and thematic analyses captured essential aspects of text and achieved consensus on key themes. 4 themes were revealed: 'loss of personal autonomy and erosion of professionalism', 'lack of senior management understanding', 'barriers and facilitators to change' and 'differences between English and Welsh units'. Themes indicated that low staff morale, lack of funding and senior management support were barriers to effective change. Limitations to the study include the disproportionately low number of focus group attendees from English units and the time delay in reporting these findings.

CONCLUSIONS

Despite ambitions to implement change, ineffective management support continued to hamper modernisation of service organisation and delivery. While the National Health Service Modernisation Agency Modernising Endoscopy Services Programme acted as a catalyst for change, affecting the way staff work, communicate and think, it was not effective in heralding change itself. However, gastroenterologists were keen to consider the potential for change and future service modernisation. The methodological framework of innovative qualitative enquiry offers comprehensive and rigorous enhancement of quantitative studies, including randomised trials, when a mixed methods approach is needed.

Evaluating innovations in the delivery and organization of endoscopy services in England and Wales

This article presents four focus groups conducted with health professionals, part of a mixed-method evaluation of modernization of endoscopy services in England catalyzed by the UK National Health Service Modernisation Agency. Transcripts were analyzed adapting van Manen's "sententious" or "wholistic" approach to thematic analysis. Seven analysts worked to distil lengthy transcripts into summative paragraphs to capture the essentiality of text. Five major themes emerged: lack of senior management understanding and appropriate management systems, inadequate resources, loss of personal autonomy and erosion of professionalism, barriers and facilitators to change, and differences between English and Welsh units-the Welsh perspective. Achieving long-lasting, positive effects of modernization within complex systems demands senior management to actively support innovations, consider staff morale, and provide appropriate levels of funding. However, although professional morale was low, ambition to improve services was strong. The methodological framework offered a comprehensive and applicable approach to data analysis, and our analysis approach was inclusive and collaborative, with far-reaching possibilities for experimental studies and large-scale, mixed-method studies, including trials.

Do audio-guided decision aids improve outcomes? A randomized controlled trial of an audio-guided decision aid compared with a booklet decision aid for Australian women considering labour analgesia

OBJECTIVE

To assess the effectiveness of an audio-guided component: an audio-guided decision aid vs. a stand-alone booklet decision aid.

BACKGROUND

Despite extensive evaluation of decision aids in clinical settings the presentation style has not been properly assessed, and audio-guided decision aids are widely used although not supported by evidence-based research.

DESIGN

Randomized controlled trial.

SETTING AND PARTICIPANTS

Two obstetric hospitals in Sydney, Australia. A total of 395 pregnant women having their first baby and approximately > or =36 weeks of gestation, planning a vaginal birth of a single infant and with self-assessed English sufficiency to read and listen to English-presented material.

INTERVENTION

A decision aid for labour and childbirth analgesia that was presented in two ways: an audio-guided decision aid compared with a booklet only style decision aid.

MAIN OUTCOME MEASURES

Decisional conflict, knowledge and anxiety.

RESULTS

Although both groups improved their knowledge scores and decreased their decisional conflict there were no significant differences between groups: mean knowledge score - audio-guided group, 65.9 vs. booklet group, 64.3; mean difference, 1.7; 95% CI (-7.5, 4.2); mean decisional conflict score - audio-guided group, 23.6 vs. booklet group, 24.3; mean difference, 0.7; 95% CI (-1.4, 2.9). Acceptability and compliance were high.

DISCUSSION AND CONCLUSIONS

This evaluation highlights the lack of additional benefit in using audio-guided formats for presenting health information to consumers who are from a general English-speaking population. These results considered together with the increase in costs and work involved in producing audio components suggests that written and pictorial methods may be sufficient for decision aids aimed at a general audience.