GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research

Understanding behaviour change maintenance after attending a self-management education and support programme for type 2 diabetes: A longitudinal qualitative study

AIMS

This study aimed to explore behaviour change maintenance experiences of adults with type 2 diabetes over 15 months following attendance at a diabetes self-management education and support (DSMES) programme and their needs for post-programme support.

METHODS

A longitudinal qualitative study using four interviews and experience sampling (written notes and photographs) was conducted. Data were analysed through a deductive analysis based on an existing framework combined with an inductive thematic analysis approach.

RESULTS

Twenty-one adults (67% women, aged 39-74) participated; seventeen completed all interviews. Analysis resulted in the refined Supporting Understanding and Strategies for Type 2 Diabetes Maintenance Self-Management (SUSTAIN) framework and three themes capturing key trends and changes over time: (1) integrating the changes amidst the constant ebb and flow of life; (2) consolidating the changes: moving towards independent maintenance; and (3) building bridges to self-maintenance: the role of support post-programme.

CONCLUSIONS

People may experience difficulties in maintaining behavioural changes post-DSMES programmes. Programmes should address the role of emotions, psychological and physical resources and environmental and social influences in behaviour change maintenance and promote the development of skills for longer-term management, including self-regulation, behavioural autonomy, intrinsic motivation and habit formation. As some people may also benefit from longer-term, ongoing support, digitally delivered with occasional sessions involving peers and educators beyond 12 months should be considered. Suggestions for ongoing support include progress monitoring, expert guidance, educational updates, troubleshooting opportunities and encouragement and motivational support.

Involving people with lived experience when setting cerebral palsy research priorities: A scoping review

AIM

To describe research priority-setting activities for cerebral palsy (CP) that have been conducted worldwide involving people with lived experience, focusing on participant characteristics, methods employed, identified research priorities, and collaboration as research partners.

METHOD

The JBI scoping review approach was followed. Six electronic databases and grey literature were searched for all publications up to February 2024. We extracted study and participant characteristics, methods, and research priorities. Priorities were then categorized into prevention and cure, quality of life and community engagement, and service provision and intervention.

RESULTS

Five studies from North America and Australia met the inclusion criteria. Participants with lived experience were most often parents/caregivers (n = 135, proportion 12-80%), with 54 (proportion 12-25%) people with CP participating in the priority-setting exercises. The studies' methods were varied, with surveys and workshops being the most common. The most reported category of research priorities was optimal intervention. People with lived experience collaborated as research partners (e.g. in aspects of study development/analysis/reporting) in four studies.

INTERPRETATION

This review, the first to examine CP research priority-setting efforts on a global scale, identified five activities conducted to date. The small overall number of participants with lived experience of CP, originating only from North America and Australia, highlights the need for increased representation to better reflect the diverse CP community worldwide. Future projects need to address these gaps, using rigorous methodologies, and continued collaboration with research partners to ensure their perspectives shape and enhance the research agenda.

Adapting Experience-Based Co-Design to Disability Research: Co-Producing the CycLink Co-Design Study

INTRODUCTION

Participatory methods like experience-based co-design (EBCD) can be used to develop complex interventions, but may need adaptations when co-designers include young people with disability, parents and community partners. We aimed to adapt EBCD through co-production by involving people with lived experience of disability as co-researchers. This paper reports the co-produced protocol and reflects on co-researchers' contributions.

METHODS

Guided by a six-stage co-production process, we formed a team of co-researchers, academic researchers, co-design convenors and evaluators. A five-person steering group, comprising three co-researchers and two academic researchers, led decision-making and project oversight. We communicated via videoconferencing, phone and email. Briefing documents, meeting minutes and diaries supported our reflections and reporting.

RESULTS

We adapted EBCD to include people with disability through creative online methods and co-produced a two-part 'CycLink Co-design Study' protocol. Part 1 proposed using EBCD to design principles for a community cycling intervention (CycLink). Part 2 planned a mixed-methods evaluation of our adapted EBCD. Co-researchers influenced participant choice and accessibility by developing phased involvement options, inclusive consent processes and adapted research materials. Interpretative support during qualitative analysis improved the relevance and reflexive rigour of findings. However, resource constraints limited co-researcher involvement in conducting EBCD activities.

CONCLUSION

Co-production enabled us to adapt EBCD for people with diverse support needs and invite under-represented populations (e.g., young people with childhood-onset disability) to co-design. Cumulative adjustments resulted from our disability expertise, guidelines and approaches facilitating co-designers' opportunities to engage. Future studies should consider early and ongoing co-researcher involvement within both processes.

PATIENT OR PUBLIC CONTRIBUTION

Two adults with disability and a parent of a young child with disability joined our team as co-researchers. Co-researchers valued flexible involvement, which ranged from consultative to collaborative. Co-researchers' experiential expertise influenced the relevance of project materials and qualitative findings. We reported on co-researcher involvement through the Guidance for Reporting Involvement of Patients and the Public Version 2 Short Form (GRIPP2-SF) [1] (Supplemental File S1-Section A, Table S1).

Listening to Women's Voices: A Patient and Public Involvement Exercise Exploring Vulval Reconstructive Surgery for UK Women With Female Genital Mutilation (FGM)

INTRODUCTION

This article presents patient and public involvement and engagement (PPIE) work undertaken to explore FGM survivors' and stakeholders' views on reconstructive surgery, potential service models, care pathways, barriers to access and other support needs. The aim was to set research priorities, identify key themes and help inform subsequent research in the field.

METHODS

A national research collective was established comprising over 20 stakeholders, including FGM survivors/women with lived experience, healthcare professionals, academics and advocacy groups. The group undertook two discussion workshops with FGM survivors (n = 11 participants), two national stakeholder events (n = 142 attendees) and significant advocacy and partnership-building activities.

RESULTS

Key insights were that FGM survivors would value reconstructive surgery to address body image concerns, genital pain and sexual difficulties. Potential barriers to surgery included stigma, safeguarding concerns, lack of awareness and fear. Significant gaps were identified around women's knowledge of clitoral anatomy, FGM types and specialist services. Survivors and stakeholders emphasised the need to complement surgical reconstruction with a comprehensive care pathway including trauma counselling and psychosexual therapy.

CONCLUSION

This study highlights the importance of a survivor-led approach to FGM service development, as often the voices of FGM survivors are not included. The exercise demonstrated that, with the right approach, it is possible to engage 'minoritised communities/individuals from the global majority' and communities dispayed considerable willingness to participate in this sensitive research field. It also emphasises an urgent need for accessible, high-quality FGM care informed by the voices of those affected, to improve outcomes and support for FGM survivors in the United Kingdom.

PATIENT OR PUBLIC CONTRIBUTION

Women with lived experience of FGM and women from FGM-affected communities, as well as other national stakeholders (including Non Government Organisation's and charities working with FGM survivors, academics, artists and campaigners were involved in the design and conduct of this study, analysis and interpretation of the data and preparation of the manuscript.

PErioperative respiratory care aNd outcomes for patients underGoing hIgh risk abdomiNal surgery (PENGUIN): a randomised international internal pilot trial

Background

Infections are a common complication of abdominal surgery in low- and middle-income countries (LMICs). The role of a high fraction of inspired oxygen (FiO2) and chlorhexidine mouthwash in preventing post-operative infections is unconfirmed.

Methods

Internal pilot phase of an international outcome assessor-blinded, 2x2 factorial randomised trial of patients aged ≥10-years undergoing midline laparotomy in LMIC hospitals. The main trial objectives are to compare the clinical effectiveness of preoperative 0.2% chlorhexidine mouthwash in preventing pneumonia versus no mouthwash, and 80-100% perioperative FiO2 to prevent surgical site infection (SSI) versus 21-35% FiO2. This 12-month internal pilot assessed feasibility of hospital site opening, patient recruitment, intervention adherence, patient follow-up and safety. Patients were randomised in a 1:1:1:1 ratio to the four intervention group combinations and followed up for 30 days.

Results

We recruited 927 patients from seven hospitals in India and South Africa over 12 months from November 2020. There were 907 adults (97.8%) and 20 children aged ten or over (2.2%): 89/927 (9.6%) patients died. Site opening reached 70% of our target (7/10) hospitals, and patient recruitment 107% (927/870). 917/927 (99%) patients in the mouthwash arm, and 840/927 (91%) patients in the oxygen arm received the allocated intervention. Lower adherence to the oxygen intervention related mainly to clinically necessary FiO2 increases in the 21-35% FiO2 arm. 30-day follow-up was completed appropriately for 924/927 (99%) patients. and was performed by a masked assessor for all patients. There were no reported safety events.

Conclusion

This pilot showed the feasibility and safety of a major phase III trial in post-operative infection prevention in LMICs.

Trial registration

ClinicalTrials.gov NCT04256798.

The Experiences of Adults Experiencing Homelessness When Accessing and Using Psychosocial Interventions: A Systematic Review and Qualitative Evidence Synthesis

Background

Adults experiencing homelessness in high-income countries are more likely to have mental ill-health and engage in problematic substance use. They are also more likely to experience challenges when accessing services. Psychosocial interventions are increasingly used with this group. Most of the evidence around these interventions is not specific to their use with adults experiencing homelessness.

Objectives

To summarise the best available evidence of the views and experiences of adults experiencing homelessness in high-income countries about psychosocial interventions.

Search Methods

This review is based on evidence identified in an Evidence and Gap Map (EGM) on interventions for people experiencing homelessness. The EGM searches were conducted in September 2021. Additionally, we undertook a call for evidence and hand searches of key journals.

Selection Criteria

We included qualitative data from studies of psychosocial interventions. Participants were adults aged 18+ experiencing homelessness in high-income countries. Only studies that reported the views, opinions, perceptions, and experiences of participants were included.

Data Collection and Analysis

Of the 468 studies originally screened, 17 were eligible for full-text review, which was undertaken independently by two reviewers. Ten were excluded at this stage, and seven were identified as meeting the inclusion criteria. Analysis was undertaken using thematic synthesis in three stages: (1) findings data were extracted from studies. Two reviewers independently extracted findings from included studies. These were compared and agreed on which findings to include for analysis; (2) two reviewers gave each line of extracted data a descriptive code (a short descriptive summary). These were compared and a set of codes for inclusion in the next stage of analysis was agreed; (3) the reviewers iteratively examined the descriptive themes, inferring from these themes the experiences of participants and their perceptions of how the intervention worked for them. These analytical themes were discussed with a panel of people with experience of homelessness.

Main Results

Seven studies were included in this review, covering several intervention types. A total of 84 adults experiencing homelessness were included in these studies. Three studies were conducted in Canada, three in the United States, and one in Scotland. All were published after 2009. The studies used various qualitative methods of data collection and analysis. None of the included studies were assessed as high quality. The most significant area of concern across the included studies concerned relationships between researchers and research participants, where five included studies were assessed as low quality. Areas of higher quality were clarity of research questions and methods. Overall, 368 lines of findings were extracted and coded under 118 descriptive codes. Of these, 55 related to direct quotes of participants' views and experiences. The remainder were the study authors' interpretations of the research participants' experiences. The 118 descriptive codes were grouped into 14 descriptive themes. The themes are descriptions of patterns in the data (the findings extracted from the included studies). These 14 descriptive themes (and the 118 descriptive codes underpinning them) summarise data from the primary studies. The final analysis stage was interpretation of the descriptive themes and development of analytical themes to answer the review questions. The reviewers were able to answer two of the four review questions: the experiences of participants when using psychosocial interventions, and whether they felt the interventions worked for them. The question concerning underlying theories of how the interventions are intended to work was addressed through a separate analysis. The question of differences between interventions could not be answered because of the small number of included studies. The final analysis stage identified three analytical themes. These are: (1) the individual plays a pivotal role in their recovery and change journey; (2) accessibility is a key component of intervention success; and (3) relationships are an important intervention ingredient.

Author's Conclusions

The reviewers draw two broad conclusions from this analysis: (1) it is important to place adults experiencing homelessness at the centre of the design of psychosocial interventions; and (2) it is important to treat adults experiencing homelessness as individuals.

Stakeholder Involvement in the Development of a New Proactive Clinical Review of Patients Prescribed Opioid Medicines Long-Term for Persistent Pain in Primary Care

BACKGROUND

Stakeholder involvement is a core element of the Medical Research Council (MRC) framework for developing and evaluating complex interventions, but approaches to involve stakeholders are not well-reported. We outline how stakeholders contributed to co-designing a Proactive clinical Review of patients taking Opioid Medicines long-term for persistent Pain led by Pharmacists working in primary care Teams (the PROMPPT intervention-a review and pharmacist training package).

METHODS

We brought key stakeholders together to co-design the PROMPPT intervention using a person-based approach, alongside evidence from best practice guidance. We established a community of practice comprising three complementary groups: a patient advisory group, a pharmacist advisory group and a mixed stakeholder group. Patient stakeholders were identified from an existing patient involvement group. Professional stakeholders were identified using networks and social media. The three groups met in iterative workshops with predefined aims. We offered reimbursement for the stakeholders' time.

OUTCOMES

The patient advisory group (n = 10), pharmacist advisory group (n = 6) and mixed stakeholder group (n = 16) each met for 2 or 3 workshops between April 2019 and February 2020. Stakeholders had expertise, often cross-cutting, in lived experience, persistent pain, opioids, delivering primary healthcare and/or promoting behaviour change. Patient stakeholders provided their perspectives of consulting about their pain and opioids. Pharmacist stakeholders provided their perspectives on how pain reviews were happening in practice and on considerations for training (e.g., vignettes and experiential learning were considered important). The mixed stakeholder group provided a breadth of views highlighting current practice, including the value of engaging the wider GP practice team, issues around clinical responsibility for prescribing and the fact that international clinical guidance was not always relevant to UK primary care.

CONCLUSIONS

By understanding the context of the PROMPPT intervention, stakeholders worked to develop a new pharmacist-led primary care review ahead of feasibility testing. We make recommendations for future developers of complex interventions.

PATIENT AND PUBLIC CONTRIBUTION

Patient stakeholders, including a lay co-applicant (C.S.) supported by a PPI support worker (A.H.), helped develop and refine the intervention. C.S. and A.H. read and contributed to the initial manuscript and approved the final manuscript.

The meaning of apathy in Huntington's disease: A qualitative study of caregiver perspectives

Although one of the most prevalent and impactful features of Huntington's disease (HD), little is known about the impact of apathy on HD caregivers, although there is evidence it affects perceptions of distress and burden. Given the importance of the caregivers, we aimed to explore the lived experience of people supporting someone with HD and associated apathy. Semi-structured interviews were conducted with 11 caregivers and analysed using reflective thematic analysis, informed by a phenomenological framework. Five overarching themes were produced: (1) What even is apathy? (2) It makes my life harder: the practical impact of apathy, (3) They haven't forgotten me, but they have forgotten that they ever loved me, (4) I'm grieving for someone who hasn't died yet, and (5) I need a safe space to say what I really feel without fear of judgement. Inter-woven between these themes were complex narratives about the unspoken nature of HD, the invisibility of caregivers who felt trapped and unheard, and the one-sided nature of loving someone with the disease. Findings are discussed in relation to theoretical frameworks of anticipatory grief and ambiguous loss, and situated within the wider literature on caregiving for people with a neurodegenerative condition.

Protocol for the Process Evaluation of the SENSE-Cog Sensory Support Intervention Field Trial to Improve Quality of Life for Older People Receiving Home Care in Australia

BACKGROUND

A field trial of a home-delivered hearing and vision support intervention will assess its impact on the quality of life and well-being of home care recipients with hearing and/or vision impairment and their care partners.

AIMS

This paper outlines the protocol for a process evaluation of the field trial. The process evaluation aims to identify discrepancies between expected and actual outcomes, understand contextual influences, assess implementation fidelity and evaluate the feasibility, appropriateness and acceptability of the intervention.

METHODS

Data will be collected from 87 home care recipients with hearing/vision impairment, their care partner and the sensory therapist who will deliver the intervention at multiple points during the 3-month intervention. Likert-scale ratings for feasibility, appropriateness and acceptability will be gathered. Proxy measures of fidelity, such as intervention session completion rates, will be obtained to ascertain whether the intervention was delivered as designed. Post-intervention, 20% of participants will complete semi-structured interviews to explore contextual and causal factors. Data analysis will include descriptive statistics, regression analysis and thematic qualitative analysis.

DISCUSSION

The process evaluation will elicit the perspectives of home care recipients and their care partners regarding the intervention experience.

PATIENT OR PUBLIC CONTRIBUTION

Older adults with lived experience with dementia and hearing and/or vision will contribute to the proposed research by shaping the interview topic guide to ensure its appropriateness and relevance for the target population. Their insights will result in a more rigorous study and improve the likelihood of the final intervention meeting real-world needs.

Cocreating a programme to prevent injuries and improve performance in Australian Police Force recruits: consumer, industry partner and researcher involvement protocol

We are conducting a research program to cocreate, implement and evaluate an injury prevention intervention for the Western Australia (WA) Police Force Recruit Training Academy. This programme of research has three primary phases: (1) cocreate an injury prevention intervention for the WA Police Force with WA Force recruits, WA Police Force staff, health professionals and injury prevention experts, (2) implement the injury prevention intervention into WA Police Force Recruit training and (3) evaluate the reach, effectiveness, adoption, implementation and maintenance of the injury prevention intervention. Our research programme includes the involvement of consumers, industry partners and researchers. To ensure collaboration and to measure our consumer, industry partner and researcher involvement, we have developed a protocol, including qualitative and quantitative evaluation, to address potential barriers to involvement. Thus, this protocol details our consumer, industry partner and researcher involvement plan across all three phases of this 5-year project and how we will evaluate their experience and influence. Our primary objective is to ensure meaningful consumer, industry partner and researcher involvement at all stages of the research process and evaluate how the research programme was influenced by consumer, industry partner and researcher involvement.

The mental-health patient-activation measure: assessing validity, reliability, and responsiveness in outpatient settings

INTRODUCTION

The patient activation measure-mental health (PAM-MH) scale, adapted from the Patient Activation Measure-13 Items (PAM-13) developed in the United States, was designed to assess patient engagement and activation in mental health care. Despite initial validation of the PAM-MH in its original context, its applicability in other settings and its comparison to the gold standard PAM-13 remain unexplored. Furthermore, research addressing the face and construct validity of the PAM-MH is limited. This multi-phase study evaluated the face validity, construct validity, reliability and responsiveness of the PAM-MH in a Norwegian outpatient setting.

METHODS

A participatory approach was adopted to actively involve user representatives in validating the scale. The validation process consisted of four interconnected studies. In the first sub-study, user representatives were invited to contribute to establish face validity by providing quantitative feedback on the perceived value and burden of completing the PAM-MH. The second sub-study examined the construct validity. It was hypothesised that the PAM-MH measures the construct of patient activation and would therefore correlate with the PAM-13. This hypothesis was tested using Pearson's r in a sample of 55 outpatients. The third sub-study evaluated test-retest reliability (via ICC) and internal consistency (using Cronbach's α), in a sample of 27 outpatients who completed the PAM-MH on two separate occasions. The final sub-study explored the responsiveness of the scale to change, guided by predefined hypotheses, in a sample of 11 outpatients.

RESULTS

Adequate acceptability was established from users' views of the value and burden of the scale (overall mean "value" score was 59.7% and mean "burden" was 39.6%). All hypotheses, established a priori for construct validity, reliability, and responsiveness-to-change, were confirmed.

CONCLUSION

This multi-phase study employed a participatory approach to validate the PAM-MH in a Norwegian outpatient context. Preliminary results demonstrated satisfactory face validity and construct validity, along with good reliability and responsiveness-to-change. The findings suggest that the PAM-MH is both valid and reliable, making it a suitable questionnaire to measure patient activation in a Norwegian outpatient setting.

Developing consensus for upper limb rehabilitation, physical preparation and return to climbing in adults: protocol for an international e-Delphi study

Climbing has grown into a grassroots participation sport and Olympic discipline. The high loads expressed through the upper limb may increase the risk of injury in this population. This may also affect rehabilitation and return to sport (RTS) considerations after injury. Treatment, management, rehabilitation and RTS parameters after injury are poorly documented. The aim of this study is to reach international expert consensus on the postinjury and surgical rehabilitation, physical preparation and RTS strategies in a range of climbers. This will provide a framework for the safe RTS of climbers. The study will be reported in accordance with guidance on conducting and reporting Delphi Studies guidelines. Panel members will be recruited with expertise in either the delivery of healthcare and/or physical preparation of climbers. The electronic Delphi is anticipated to consist of three irritative rounds. Round 1 will consist of open and closed questions to generate a broad range of statements on the rehabilitation, RTS and outcome measures used after climbing injury. In round 2, all participants will be provided with a summary of the current literature of the rehabilitation and RTS strategies for upper limb sports injuries. Rounds 2 and 3 will consist of a summary of the results from the previous round including any dissonance. Participants will be asked to anonymously rate responses on a 5-point Likert scale. The study steering group and patient public involvement representatives will be involved from conceptualisation until final dissemination.

Research collaboration with care home residents: a systematic review of public involvement approaches

BACKGROUND

Public involvement is crucial to ensure research is relevant and addresses the needs of its target population. However, care home residents, a potentially vulnerable group, are often excluded from research that could directly benefit them. This systematic review examined the existing literature on public involvement approaches in research involving older adults residing in long-term care homes.

METHODS

A systematic search of CINAHL, MEDLINE and PsychINFO was conducted, using search terms related to public involvement and long-term care. The search was limited to English language papers published from 2014, building on a 2016 review conducted by Backhouse et al. Articles were screened by title and abstract, and full texts of potentially eligible papers were reviewed for inclusion. Data from included studies was extracted and synthesised using a narrative approach.

RESULTS

This review identified 15,809 citations, abstract-screened 4000, and ultimately included six articles after applying eligibility criteria and a rigorous screening process. Reported public involvement in this setting was limited, with even fewer studies demonstrating genuine collaboration and the full involvement of residents throughout the research process. There was a lack of representation of residents with advanced cognitive decline or dementia. Terminology used to describe public involvement varied considerably across studies, highlighting a lack of clarity in defining and reporting activities.

CONCLUSIONS

This review highlights the need for greater emphasis on public involvement in care home research, particularly for residents with cognitive impairments. Future research should prioritise transparent reporting of public involvement processes, involving residents as active partners from the outset, and ensuring research findings are effectively communicated for all stakeholders, including residents. Barriers and facilitators to public involvement activities in care homes are summarised.

Advanced Nursing Roles for People With Cognitive Impairment and Their Relatives in Acute Care Hospitals: A Systematic Review

AIM

To systematically review advanced nursing roles in caring for people with cognitive impairment and their relatives in acute care hospitals, focusing on describing roles and intervention components.

DESIGN

Systematic review.

METHODS

We included qualitative and quantitative studies on nurses in advanced roles caring for people with diagnosed or suspected cognitive impairment and their relatives, assessing outcomes at patient, staff and organisational levels. Nurses' advanced role profiles ranged from nurse-led interventions up to Advanced Practice Nurses. We employed the Mixed Methods Appraisal Tool for critical appraisal and conducted a synthesis without meta-analysis using a content analysis approach.

DATA SOURCES

MEDLINE, CINAHL, Cochrane Library, ALOIS, Web of Science and LIVIVO up to May 2024, along with forward and backward citation tracking.

RESULTS

We included 48 studies that described 39 distinct interventions. The majority of these studies employed a quasi-experimental design. Most interventions involved Advanced Practice Nurses (n = 23) and focused on people at risk of or experiencing delirium (n = 22). Nurses in advanced roles predominantly engaged in tasks related to direct clinical practice, as well as coaching and guidance for patients, relatives and colleagues. Their responsibilities also included leadership, collaboration and consultation on a regular basis. Activities related to research and ethical decision-making were infrequently reported.

CONCLUSION

Many areas of responsibility of nurses in advanced roles align with the needs of hospitalised people with cognitive impairment. Nurses in advanced roles increasingly take on diverse activities across all competence domains of Advanced Practice Nursing, with a focus on coaching and guidance, as well as clinical practice, while leadership, collaboration, research and ethical decision-making become more prominent as their formal training advances.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Our comprehensive description of advanced nursing roles in the care of people with cognitive impairment provides a foundation for developing and refining such roles in hospitals.

REPORTING METHOD

We followed the PRISMA guideline and SWiM guideline for reporting.

PATIENT OR PUBLIC CONTRIBUTION

This study did not include patient or public involvement in its design, conduct or reporting.

TRIAL REGISTRATION

Prospero number: CRD42021265157.

[Rethinking scientific integrity in plastic surgery: Reflections on editorial and institutional responsibilities]

Plastic surgery, by nature an innovative discipline, has historically relied on clinical case reports to advance its techniques. Often unique, these cases are a valuable vehicle for disseminating breakthroughs - especially in a field marked by highly individualized practices and artisanal surgical approaches, where randomized trials are often impractical. However, this reliance on case reports raises significant ethical concerns. In multidisciplinary settings, attribution of contributions often remains ambiguous. Misconduct, such as unauthorized publications or omission of institutional recognition, threatens the integrity of scientific output. As artificial intelligence reshapes biomedical research - automating literature reviews and meta-analyses - original case reports, by their singularity, escape these predictive models. Their heuristic value fully justifies their inclusion within the spectrum of scientific evidence. For this reason, their publication must be tightly regulated. Redefining publication standards in our field is essential. This includes the systematic application of international guidelines (CARE, SCARE, STROBE, GRIPP2), mandatory institutional approval before submission, formal training in research ethics for junior staff, and full transparency regarding patient consent and authorship attribution. When rigorous, novel, and well-contextualized, the clinical case remains a cornerstone of surgical progress. By safeguarding it from opportunistic misuse, we preserve its scientific and educational value.

Exploring what works in mental health education for health profession students: a realist review

INTRODUCTION

Mental health education is essential for preparing healthcare professionals to address the growing needs of patients with mental health challenges. The aim of this study was to understand the current landscape of teaching and learning approaches to mental health education for undergraduate health profession students.

METHODOLOGY

A realist review was chosen to explore what works for whom, how, and why in teaching and learning for mental health education for undergraduate health profession students. The search strategy was developed iteratively, with support from a research librarian, and additional searches supplemented the initial search. Following screening in duplicate, the selected studies were appraised for relevance, richness and rigour. Intervention (I), Context (C), Actor (A), Mechanism (M) and Outcome (O) configurations were extracted from the data and analysed for patterns and conceptual areas. Stakeholder and Patient and Public Involvement panels supported the refinement of both the Initial Programme Theory (IPT) and Programme Theories (PT).

RESULTS

78 articles were included. The results identified three critical program theories: (1) direct contact with individuals with lived experience (2), longitudinal and integrative learning approach, and (3) diversity of experiential and community-engaged learning. Integrating these theories into health education curricula may lead to professionals better prepared to address mental health challenges.

CONCLUSION

Our realist review identified three critical programme theories for teaching and learning strategies that foster this literacy, including direct engagement with individuals who have lived experiences, a longitudinal and integrative approach to education, and a diverse array of experiential and community-engaged learning opportunities.

Weight-neutral interventions for people with obesity and the perspective of patients, carers and healthcare professionals: a mixed methods review

OBJECTIVES

This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To assess the effects of weight-neutral interventions for managing obesity in children and adults (quantitative data). To explore the views, perspectives and experiences of children and adults receiving the intervention, their close family members or, if appropriate, carers, and healthcare personnel who recommend or deliver weight-neutral interventions to determine their feasibility and acceptability and any factors that create barriers and facilitators to optimal implementation (qualitative data). To determine whether the programme theories, components and delivery of interventions take account of the views, perspectives and experiences of intervention recipients and whether patient-centred interventions have greater effects.

Patient perspectives on surgical handover quality: a mixed-methods survey

BACKGROUND

In-hospital handover of patient care is an essential but high-risk professional activity that often lacks transparency for patients. The purpose of this survey was to gain insight into surgical patients' perceptions of handover communications between doctors, incorporating patient and public involvement to enhance accessibility and understanding.

METHODS

A cross-sectional, mixed-methods survey was developed with patient and public involvement and distributed to general surgery patients in two University Teaching Hospitals between 24 October 2023 and 21 July 2024. Comparative analyses of quantitative data were performed using McNemar's test for paired nominal data and Wilcoxon rank-sum test for continuous data. Free-text responses underwent thematic analysis to validate and expand on quantitative findings. Patient and public involvement partners contributed to study design, methodology, and the final manuscript.

RESULTS

In total, 208 responses were received (52.3%). Significantly more patients reported having prior knowledge of nursing handovers (73.1%) compared to doctors' handovers (63.9%; x2 = 14.53, p = 0.0002). Patient perceptions of the handover process were generally positive; although satisfaction declined significantly with weekend handovers (p < 0.05). Thematic analysis identified four themes: (1) the impact of poor inter-professional communication, (2) the importance of teamwork, (3) external factors influencing handover effectiveness, and (4) patient nonchalance about their care. The use of patient and public involvement in this study improved survey accessibility and understanding of the concept and importance of handover.

CONCLUSIONS

This study shows limited prior awareness of handover between doctors among surgical patients, especially the potential hazards that can arise if performed poorly. Patient and public involvement improved accessibility and understanding of the topic; however, challenges such as adequate training for meaningful engagement remain.

When pain overwhelms the self: A phenomenological study of a new mode of suffering, based on adults' recollections of their worst pain episodes

Suffering is a foundational yet understudied construct within the field of pain. There is general agreement that pain-related suffering involves disruption to one's sense of self. The selfhood literature characterizes two inter-related modes of self-experience. One mode entails in-the-moment experiences that shape one's stream of consciousness; another involves self-reflective thoughts about the past or expected future, related to self-narratives and identity. The field's current conceptualization of pain-related suffering is exclusively anchored to the latter, self-reflective mode of experience. Our past work argues that this framing fails to account for pain's immediate, disruptive impact and denies the potential for suffering among individuals without self-reflective capacities (e.g. infants). The purpose of this theoretically-informed, phenomenological study was to explore a new potential way by which people living with pain can suffer. We conducted in-depth, qualitative interviews with 12 adults across Canada living with various pain conditions. Interviews focused on understanding the moment-to-moment experiences of their worst episodes of pain. Results revealed important accounts of pain that overwhelmed thoughts and self-reflective capacities and disrupted foundational aspects of self-experience, including senses of agency, bodily ownership and time. Participants reported that these experiences were incapacitating, dehumanizing and dissociating. The findings are remarkably similar to first-hand accounts of torture and support a new mode of pain-related suffering that does not require self-reflection and is characterized by an immediate, disruptive impact on one's sense of self. Findings will inform the development of the first theoretically-informed and evidence-based definition of pain-related suffering and help advance pain theory and practice. PERSPECTIVE: This qualitative phenomenological study characterizes how pain can radically transform one's in-the-moment sense of self. Results reveal a new mode of pain-related suffering that does not require self-reflection. This supports the expansion of traditional understandings of suffering, exclusively anchored to self-reflection, to now include two inter-related modes of pain-related suffering.

A stakeholder-involved adaptation of pathways and resources for engagement and participation (PREP) material with young adults with complex disability in Australia: an implementation feasibility study

PURPOSE

Pathways and Resources for Engagement and Participation (PREP) is an intervention to optimise individuals' participation by building problem-solving capacity and addressing environmental barriers. We investigated the feasibility of implementing PREP with young adults (18-30 years) with complex disability in Australia.

MATERIALS AND METHODS

Explanatory sequential mixed methods study in three stages. (i) PREP materials were collaboratively adapted by the research team and consumer research partners. (ii) Steps 1 and 2 of PREP (YA Supplement) were completed with three young adults with disability, and preliminary feasibility explored using qualitative methods. (iii) The feasibility of implementing adapted materials was examined using quantitative and qualitative methods involving four young adults with disability, six support people and two service providers.

RESULTS

Stage 1: PREP Young Adults Supplement (PREP (YA Supplement)) for use alongside PREP was developed. Stages 2 and 3: findings indicated PREP (YA Supplement) was acceptable, appropriate and feasible. Three themes were identified: setting and achieving goals were associated with challenges and benefits; finding the right time to implement the program was necessary; and PREP (YA Supplement) drives a shift to a participation-focused approach.

CONCLUSION

PREP delivered alongside PREP (YA Supplement) appears feasible with Australian young adults with complex disability.

Patient- and public-driven health research: a model of co-leadership and partnership in research priority setting using a modified James Lind Alliance approach

OBJECTIVES

To describe the Strategy for Patient-Oriented Research Evidence Alliance's methodological approach to systematically identify 23 high priority health research topics (three in 2021 and 20 in 2023) from patient partners (including caregivers) and members of the public across Canada and beyond.

STUDY DESIGN AND SETTING

In 2021 and 2023, we collaborated with patient and public partners to co-design and co-conduct two priority setting initiatives. These initiatives involved a diverse group of patients, the public, clinicians, researchers, and health system decision-makers to systematically and collectively prioritize research topics based on their perceived importance and anticipated impact. We used a modified James Lind Alliance approach, where all participants were engaged as equal partners. The prioritization process consisted of the following steps: 1) identification and collection of research priorities from patients and the public; 2) summarizing the research priorities gathered; 3) conducting semistructured interviews (1-on-1 or focus groups depending on the number of submissions for each unique topic), conducting literature searches on each topic to identify relevant knowledge synthesis and appraising the quality of relevant evidence using the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews) checklist, and preparing lay summaries (1-2 pages) for each unique topic using a predefined template cocreated with patient partners; 4) conducting a priority setting exercise with a multidisciplinary panel consisting of an interim priority setting rating questionnaire to score each topic based on nine questions, followed by a virtual workshop to reach consensus on the final rating and ranking of topics; and 5) facilitating research by funding selected topics and providing capacity-building support to research teams. We conducted a formal process evaluation of engagement, transparency, information management, and considerations of values and context in 2023.

RESULTS

A total of 98 topics were received across two research priority setting initiatives. Approximately, half the submissions were made by individuals who identified as patients (2021: 45% [n = 5] and 2023: 52% [n = 45]), whereas the rest identified as caregivers or members of the public. Topics were spread across 26 health themes, with arthritis and osteoporosis (27% [n = 3]) being the most common theme in 2021 and quality of care (26% [n = 23]) in 2023. Twenty-three priorities from 98 topics submitted by patients and public were selected. A formal process evaluation in 2023 revealed 85% of the respondents who participated in the priority setting panel "strongly agreed" that their experience was valuable and they would participate again in a future initiative. The 23 prioritized projects are currently being co-led with the patient and public partner topic submitters and nominated research teams.

CONCLUSION

Priority setting exercises successfully engaged a diverse group of interested parties, resulting in the identification of relevant and impactful research topics. The positive feedback from participants suggests that these exercises were well-received and that similar methodologies should be applied and refined in future efforts.

PLAIN LANGUAGE SUMMARY

The Strategy for Patient-Oriented Research Evidence Alliance used a patient- and public-driven approach to set research priorities across different topics. They conducted two priority setting initiatives in 2021 and 2023, involving patients, the public, researchers, clinicians, and health system managers. This approach aimed to prioritize research topics based on their perceived importance and anticipated impact. A total of 98 topics were received across two research priority setting initiatives, with nearly half the submissions from patients and the other half from caregivers or members of the public. The topics covered 26 health themes, with arthritis and osteoporosis (2021) and quality of care (2023) being the most common themes. From these topics, the 23 highest priority topics were selected by a multidisciplinary priority setting panel. A formal process evaluation in 2023 revealed that 85% of the respondents who participated in the priority setting panel "strongly agreed" that their experience was valuable, and they would participate again in a future initiative. In conclusion, the priority setting exercises successfully engaged a diverse group of individuals and identified important research topics. The positive feedback suggests that this approach was well received and should be applied in future efforts.

[A qualitative interview study to streamline integration of patient participation in research]

Integration of the patient perspective in research projects is essential to strengthen the relevance and quality of research results. In order to rectify the lack of structured procedures for patient integration in German research projects, this study summarises the currently available knowledge in a simplified practice-oriented checklist for researchers.Through 13 semi-structured qualitative interviews conducted with members of a research group in December 2022, this study explored patient participation possibilities and barriers. The inductive-deductive coding and analysis in the software MAXQDA led to a standardized checklist development for seamless patient integration across similar contexts and research fields.Of 13 experts, nine researchers (69%) incorporated patient insights into their work, covering topics, concepts, focus prioritization, and study materials. Four researchers (31%) faced barriers due to the absence of guidelines. More than 90% recognized potential for patient integration in topic prioritization, concept formation, evaluation, result review, and interpretation. Researchers highlighted barriers such as patient's limited scientific basis, restricted access, and knowledge gaps in patient interaction. Among the respondents, 56% pointed to training needs and 44% to structural barriers such as workload, unclear funding, guidelines and stakeholder involvement. The resulting checklist includes six sub-categories, each with an average of four sub-items, which operationalise the integration process.Current research lacks effective patient inclusion processes due to inadequate access, tools, and knowledge. While immediate training can address some challenges, longer-term changes in policy and funding are necessary. With the new checklist, researchers receive a support tool to integrate the patient perspective in their projects in a systematic manner.

Stronger together; evaluating consumers and researchers working in partnership

BACKGROUND

Consumer engagement in medical research should be early, ongoing, and meaningful, to improve patient-centred research design and outcomes. Evaluating the impact of consumer input builds the evidence base needed to sustain and improve ongoing involvement efforts. Multiple evaluation tools are available. Here we explore the landscape of evaluation tools and apply the Australian Clinical Trials Alliance (ACTA) tool to evaluate the impact and process of consumer involvement in a recently completed project.

METHODS

The ACTA evaluation tool was administered to all consumers and research team members in the "RECAP" study. The RECAP study is co-designed as a single-arm trial that implemented registry-generated personalised care plans for patients with newly diagnosed rectal cancer. The ACTA evaluation tool responses underwent thematic analysis, and the research and consumer group assessed the utility of the tool.

RESULTS

The ACTA evaluation tool was completed by the entire team, including six consumers and four researchers. Thematic analysis highlighted inclusivity, workload, communication and remuneration as key considerations in the process of consumer involvement. Consumer impact was measured in terms of seven domains of critical research outcomes. Consumer involvement in the RECAP project was identified to be meaningful, respectful, inclusive, and impactful. The evaluation tool was considered appropriate by all respondents, who identified the ease of use, low burden and ability to address both the consumer impact and experience as positive factors. Identified areas for development included the repetitiveness and lack of specify of some questions, and the uncertainty about the desired length of response.

CONCLUSION

The ACTA evaluation tool was successfully administered to a team of consumers and researchers engaged in a recently completed trial with positive assessment of tool utility.

An updated systematic review and consensus definitions for standardised endpoints in perioperative medicine: patient comfort and pain relief

BACKGROUND

Improving comfort during and after surgery is a key concern for anaesthetists and other clinicians. With the inclusion of patient and public involvement, we undertook a Delphi consensus process to update previously recommended endpoints to be used in clinical trials evaluating treatments aiming to improve patient comfort after surgery.

METHODS

We undertook a systematic review to identify domains and outcome measures of patient comfort used in perioperative studies. Focus groups, workshops, and a multi-round Delphi consensus process that included clinician-researchers and a patient experience and consumer group updated a recommended list of standardised endpoints focused on patient comfort. Consensus was defined as a median item score of 7 or greater and at least 70% of responses achieving a score of 7 or greater on a 9-point Likert scale. Additional ratings were done to determine validity, reliability, feasibility, and patient-centredness. Qualitative analyses were undertaken to identify themes.

RESULTS

Response rates for each of the Delphi rounds were 100%. A final list of eight defined endpoints was identified: supplementary analgesic use, subjective analgesic effectiveness, pain intensity (at rest, during movement, and at 12, 24, and 72 h), postoperative nausea and vomiting (PONV, at 0-6 h, at 6-24 h, and overall), postdischarge nausea and vomiting (PDNV), severe PONV, quality of recovery (QoR-15), and time to mobilisation. All endpoints were assessed as valid, reliable, and feasible measures of patient comfort and were considered patient-centred. Patient and public involvement highlighted the importance of clear communication and shared decision-making to enhance comfort through the surgical journey.

CONCLUSIONS

We recommend that at least some of these standardised endpoints be included as outcome measures in clinical trials assessing patient comfort and pain after surgery.

SYSTEMATIC REVIEW PROTOCOL

Open Science Framework (10.17605/OSF.IO/DJQFE).

Optimizing Face Validity and Clinical Relevance of a Mathematical Population Cancer Epidemiology Model Using a Novel Advisory Group Approach

BackgroundCancer simulation models can answer research and policy questions when prospective evidence is incomplete or not feasible. However, such models require incorporating unmeasureable inputs for which there is often not strong evidence, and model utility is limited if assumptions lack face validity or if the model is not clinically relevant. We systematically incorporated formal advisory input to mitigate these challenges as we developed a microsimulation model of papillary thyroid cancer (PApillary Thyroid CArcinoma Microsimulation model [PATCAM]).MethodsWe used a participatory action research approach incorporating focus group techniques and using principles of bidirectional learning.ResultsWe assembled a formal standing advisory group with representation by perspective (medical, patient, and payor), geography, and local practice culture to understand current and historical clinical beliefs and practices about thyroid cancer diagnosis and treatment. The group provided input on critical modeling assumptions and decisions: 1) the role of nodule size in biopsy decisions, 2) trends in provider biopsy behavior, 3) specialty propensity to biopsy, 4) population prevalence of thyroid cancer over time, 5) proportion of malignant tumors showing regression, and 6) cancer epidemiology and diagnostic practices by sex and age. Advisory group questions and concerns about model development will inform future research questions and strategies to communicate and disseminate model results.ConclusionsWe successfully used our advisory group to provide critical inputs on unmeasurable assumptions, increasing the face validity of our model. The use of a standing advisory group improved model transparency and contributed to future research plans and dissemination of model results so they can have maximum impact when guiding clinical decisions and policy.HighlightsUnfamiliarity with simulation modeling poses a threat to its acceptability and adoption. The effectiveness of these models is contingent on end-users' willingness to accept and adopt model results. The effectiveness of the models is further limited if they lack face validity to potential users or do not have clinical relevance.Several approaches to overcoming validity challenges have been advanced, such as collaborative modeling, which involves developing multiple models independently using common data sources. However, when only a single model exists, another approach is needed. We used an Advisory Group and "participatory modeling," which has been used in other settings but has not been previously reported in cancer modeling. We describe the methods used for and results of incorporating a formal advisory group into the development of a cancer microsimulation model.The use of a formal, standing advisory group (as opposed to one-off focus groups or interviews) strengthened our model by rigorously vetting modeling assumptions and model inputs with subject matter experts. The formal, ongoing structure promoted transparency. The group education in cancer modeling improved participant ability to provide useful input and may help with dissemination. The advisory group also provided critical feedback about how to effectively communicate model results and informed planned future research questions.

Co-design of medication management guidance tools for people living with dementia and carers at discharge

INTRODUCTION

People with dementia and carers face challenges in understanding and managing medications at discharge. This study aimed to develop user-centered, co-designed medication management guidance tools to enhance medication management literacy post-hospitalization for these populations.

METHODS

A four-phase, multi-methods study integrating experience-based co-design: (1) literature review, qualitative study, and survey; (2) expert advisory panels involving people with dementia; (3) focus groups with people with dementia, carers, and healthcare professionals; and (4) quantitative readability and suitability analysis.

RESULTS

Two tools were developed: a simplified medication management guide for people with dementia and a carer-focused guide. Topics included shared decision-making, informed consent, and medications that can affect cognition. Participants valued the use of simple and active language, goal-of-care discussions, and the right to second opinion. Tools were acceptable for use from admission and during hospitalization.

DISCUSSION

This study addresses gaps in medication related health literacy tools for dementia care, offering a framework for developing similar resources.

HIGHLIGHTS

Medication management guidance tools have not included people living with dementia or their carers in their development. This study is the first to describe the co-design of medication management guidance tools for people with dementia. Two tools were generated, one for people with dementia and one for carers to extend their agency. This co-design study can serve as a framework to inform the development of future tools for people with dementia and carers.

Policy and practice recommendations for services for disabled children during emergencies: Learning from COVID-19

AIM

To seek consensus on recommendations for the delivery of services to disabled children in England during future emergencies.

METHOD

Candidate recommendations were drafted based on our related mapping review and qualitative research related to experiences during the COVID-19 pandemic. Iterative workshops with professionals and parent carers helped to refine the recommendations. A Delphi survey, rating the importance of each recommendation, was conducted with (1) parent carers of disabled children, (2) disabled young people aged 8 to 19 years, and (3) health, education, and social care professionals. A consensus meeting was convened online to discuss the findings and ratify the recommendations.

RESULTS

Twenty-eight recommendations were included in the Delphi survey. There were 141 participants in round 1 and 91 in round 2. Seven recommendations reached the agreed consensus criteria for being critical across all stakeholder groups, while 21 recommendations did not reach consensus across all groups. Fourteen participants ratified 23 recommendations, which when aggregated and refined further produced our final 19 recommendations.

INTERPRETATION

Reductions in services for disabled children and their families during the COVID-19 pandemic had serious and lasting consequences. This study enabled parent carers, disabled young people, and health, education, and social care professionals to agree recommendations on services for disabled children during future emergencies.

Beyond bereavement: Women's healthcare experiences and cardiovascular disease risk in the years after stillbirth and recurrent early pregnancy loss

PROBLEM

Cardiovascular disease (CVD) is the leading cause of death among women.

BACKGROUND

Adverse pregnancy outcomes, such as stillbirth and recurrent pregnancy loss, are sex-specific risk factors for CVD. Little research investigates CVD preventive healthcare following bereavement.

AIM

To describe women's preferences and experiences regarding CVD preventive healthcare after bereavement and identify their questions to inform future research and intervention design.

METHODS

A participatory, qualitative approach was adopted, involving a Lived Experience Expert Group to plan, conduct and interpret focus groups with women who experienced stillbirth or recurrent pregnancy loss. Focus groups involved facilitated group discussion, and a nominal group technique activity to prioritise questions about CVD risk. Focus group transcripts were analysed thematically.

FINDINGS

Sixteen women participated, all previously unaware of the association between their bereavement and increased CVD risk. Two major themes emerged: women have unmet needs for supportive care after bereavement, and a cautious desire for information about CVD risk. The 'top ten' questions focussed on improving bereavement care, preventing CVD, and concerns beyond CVD.

DISCUSSION

Although women valued information about CVD risk, they were concerned about adding to the burden of bereaved women, especially in the context of inadequate bereavement care.

CONCLUSION

Gaps in bereavement care have an enduring impact on women after early pregnancy loss and stillbirth. Beyond improving women's experiences and mental health outcomes, improving bereavement care may also support uptake of long-term CVD preventive healthcare.

The Use of 360-Degree Video to Reduce Anxiety and Increase Confidence in Mental Health Nursing Students: A Mixed Methods Preliminary Study

Background: Stress affects 45% of NHS staff. More research is needed to explore how to develop resilient mental health nurses who face multiple workplace stressors, including interacting with distressed clients. Higher Education Institutions are uniquely placed to introduce coping skills that help reduce anxiety and increase confidence for pre-registration nurses entering placements for the first time. Methods: A convenience sample of first year mental health student nurses (whole cohort), recruited before their first clinical placement, were invited to participate. Following a mixed methods design, we developed a 360-degree virtual reality (VR) video, depicting a distressed service user across three scenes, filmed in a real-life decommissioned in-patient ward. Participants followed the service user through the scenes, as though in real life. We used the video alongside a cognitive reappraisal/solution-focused/VERA worksheet and supportive clinical supervision technique to explore students' experiences of VR as an educative tool and to help build emotional coping skills. Results: N = 21 mental health student nurses were recruited to the study. Behavioural responses to the distressed patient scenario were varied. Students that had prior experience in health work were more likely to feel detached from the distress of the service user. Although for some students VR provided a meaningful learning experience in developing emotional awareness, other students felt more like a 'fly on the wall' than an active participant. Empathetic and compassionate responses were strongest in those who perceived a strong immersive effect. Overall, the supportive supervision appeared to decrease the anxiety of the small sample involved, but confidence was not affected. Conclusion: The use of 360-degree VR technology as an educative, classroom-based tool to moderate anxiety and build confidence in pre-placement mental health nursing students was partially supported by this study. The effectiveness of such technology appeared to be dependent on the degree to which 'immersion' and a sense of presence were experienced by students. Our cognitive reappraisal intervention proved useful in reducing anxiety caused by 'the patient in distress scenario' but only for students who achieved a deep immersive effect. Students with prior exposure to distressing events (in their personal lives and in clinical settings) might have developed other coping mechanisms (e.g., detachment). These findings support the idea that 'presence' is a subjective VR experience and can vary among users.

'Accumulating harm and waiting for crisis': Parents' perspectives of accessing Child and Adolescent Mental Health Services for their autistic child experiencing mental health difficulties

Autistic children and young people are at increased risk of mental health difficulties, but often face barriers when seeking help from Child and Adolescent Mental Health Services. This study aimed to (1) explore the experiences of parents/carers seeking help from Child and Adolescent Mental Health Services for their autistic child's mental health difficulties, and (2) gain parents' perceptions of the accessibility of Child and Adolescent Mental Health Services for their child. A mixed-methods survey design was used. In total, 300 parents/carers took part from across the United Kingdom. Quantitative data were analysed using descriptive statistics, and qualitative data using qualitative content analysis. Findings demonstrated ongoing struggles that parents/carers faced when seeking help from Child and Adolescent Mental Health Services. Those who were referred reported a lack of reasonable adjustments and offers of ineffective or inappropriate therapies. Ultimately, parents felt their child's mental health difficulties either did not improve or declined to the point of crisis. However, there was a recognition that some professionals were kind and compassionate. There is a need for a more neuro-inclusive and personalised approach in Child and Adolescent Mental Health Services. Further research, funding and training are urgently needed to ensure support is accessible, timely and effective for autistic young people.Lay abstractAutistic children and young people are more likely to experience mental health difficulties than neurotypical peers, but also face more barriers when seeking help from Child and Adolescent Mental Health Services. Findings highlight the need for a more neuroaffirmative approach from the professionals themselves, in the adjustments offered, and in the therapies provided. Barriers to Child and Adolescent Mental Health Services for autistic children and young people include diagnostic overshadowing (i.e. assuming mental health difficulties are part of autism), high thresholds for assessment and a lack of professional knowledge about autism and care pathways. Healthcare policies should ensure that all Child and Adolescent Mental Health Services professionals receive neuroaffirmative training and that resources/funding are provided for appropriate adjustments and early support. There is also a need for further research and funding to develop and evaluate effective neuroaffirmative therapeutic interventions.

Lessons learned from the participatory development of a framework to actively involve people living with dementia, individuals from their social networks, and healthcare professionals in systematic reviews: the DECIDE-SR study

BACKGROUND

To date, there is no framework for actively involving people living with dementia, individuals from their social networks and healthcare professionals in systematic reviews (SRs). Additionally, no SRs have been planned or partially carried out with the active involvement of these individuals. For these reasons, a framework and a review protocol for a planned SR were developed as part of the federal-funded DECIDE-SR project, in which the abovementioned groups were actively involved as coresearchers. The purpose of this paper is to provide an overview of the project and to illustrate the lessons learned from conducting active research involving this case example.

METHODS

A framework for actively involving coresearchers in SRs was developed via the synthesis of theoretical and empirical findings from a previous research project. The coresearchers participated in meetings and one workshop, which were planned on the basis of the INVOLVE criteria and the ACTIVE framework model, to test and reflect on the previously developed framework. Additionally, an SR protocol was jointly planned during these meetings, and individual SR steps were conducted (e.g., development of the research question). The lessons learned were drawn from the workshop with the coresearchers, who were clustered using the Engaging with Purpose Patient Engagement Framework (EwPPEF).

RESULTS

Eight coresearchers were actively involved in 15 meetings and one workshop to test and reflect on the framework. The framework allows coresearchers to individually choose their own level of involvement (where the levels are nonhierarchical), and the individual support needs at each step of an SR are considered. Additionally, an SR protocol was developed together with the research question "What is the effect of hospital treatment provided in one's own living place on people living with dementia?". The lessons learned provide information on all aspects of the EwPPEF (e.g., cobuilding, impact, and inclusiveness) and include implications for conducting SRs that actively involve the public.

CONCLUSIONS

The framework and the SR protocol can now be used for further tests and to gain initial experience in conducting SRs that actively involve the public. Furthermore, the lessons learned can provide other project groups with important insights into actively planning and conducting SRs.

Co-Designing Priority Components of an mHealth Intervention to Enhance Follow-Up Care in Young Adult Survivors of Childhood Cancer and Health Care Providers: Qualitative Descriptive Study

BACKGROUND

Survivors of childhood cancer are at risk of medical, psychological, and social late effects. To screen for their risks, receipt of consistent, cancer-specific follow-up care is crucial. However, <50% of survivors attend their aftercare, and only 35% of them recognize that they could have a serious health problem. The use of mobile health (mHealth) is a promising form of intervention to educate, connect, and empower survivors of childhood cancer on the importance of follow-up care.

OBJECTIVE

This study aimed to use co-design to identify the priority components to include in an mHealth intervention with young adult (aged between 18 and 39 years) survivors of childhood cancer and health care providers.

METHODS

This study was conducted between January and November 2022 in Canada and used patient-oriented research methods. Participants were recruited through local or provincial long-term follow-up clinics, using convenience sampling from patient partners who assisted in recruiting survivors across geographical areas in western, central, and eastern Canada, and social media outreach (X, formally known as Twitter; Facebook; and Instagram). Qualitative descriptive data (focus group interviews) from survivors of childhood cancer and health care providers (individual interviews) were gathered. We analyzed the collected data using reflexive thematic analysis and verified it through member checking techniques through an online community engagement event.

RESULTS

We conducted with patient partners 5 online (Zoom) focus groups with 22 survivors of childhood cancer (mean age 29.19, SD 4.78 y). We conducted individual telephone interviews with 7 health care providers. Participants identified five priority areas to be included in an mHealth intervention: (1) connections, (2) education and information, (3) engagement, (4) personalization, and (5) resources. Results were shared with and validated by survivors of childhood cancer, their families, health care providers, and academic researchers as part of a community engagement event. Small and large group discussions were facilitated to allow participants to review and discuss the accuracy of the themes derived regarding the core components to be included in mHealth. A graphic recording artist visually captured key ideas from the event. A subset of the participants also completed a web-based satisfaction survey, and responses indicated that the community engagement event was generally well received.

CONCLUSIONS

Results from this study have provided the necessary foundation to progress in intervention development. The next step of this multiphased project is to build an innovative and accessible mHealth intervention prototype that is based on the identified core components and is grounded in an established conceptual framework for co-design of mHealth.

Co-designing and pilot-testing an infographic to support the consent process in an adaptive platform trial for adults in ICU with community-acquired pneumonia or COVID-19: a mixed methods study within a trial (SWAT)

BACKGROUND

Informed consent documents educate patients and families about research participation and alternatives. However, given their length and complexity, consent documents can be challenging to understand, particularly in high-stress environments such as the Intensive Care Unit (ICU) and for complex study designs such as platform trials.

METHODS

This is an exploratory sequential mixed methods study-within-a-trial (SWAT) of REMAP-CAP (Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia). Phase 1: We conducted focus groups with individuals with lived experience, including ICU survivors, substitute decision makers (SDMs) and research coordinators (RCs) to refine an infographic to augment a priori REMAP-CAP consent encounters. We analyzed data using inductive content analysis. Phase 2: We piloted the infographic with patients/SDMs approached a priori to participate in REMAP-CAP, who could communicate in English, at five sites in Ontario, Canada. We assessed implementation according to 1) eligible consent encounters (number of patients/SDMs eligible for SWAT / approached for REMAP-CAP), 2) receipt of infographic (number of patients/SDMs who received the infographic / eligible consent encounters), 3) consent to participation in this SWAT by patients/SDMs (number of patients/SDMs who consented / those approached), and 4) feedback questionnaire completion (number of patients/SDMs who completed the questionnaire / those who received it).

RESULTS

Phase 1: We conducted two, two-hour focus groups with 5 participants (10 participants total). Participants identified important infographic design considerations (visual presentation, language) and content (study details, participation in research). Integration: Results from Phase 1 were used to develop a final consent infographic. Phase 2: Sixty-three patients were eligible for REMAP-CAP during the study period; 21 were eligible (33%) for the SWAT. Of these, 18 patients/SDMs (86%) received the infographic, 17 consented to the SWAT (94%) and 15 (88%) completed questionnaires. RCs completed case report forms for each consent encounter (n = 18, 100%).

CONCLUSIONS

We engaged individuals with lived experience to co-design a consent infographic. We achieved three of four pre-specified feasibility objectives during pilot testing of the infographic for a priori REMAP-CAP consent encounters. Although there were fewer eligible consent encounters than anticipated, we identified acceptable rates of infographic delivery, consent to SWAT participation and questionnaire completion.

TRIAL REGISTRATION

The Northern Ireland Hub for Trials Methodology Research SWAT Repository (SWAT #176).

Co-designed point-of-care ultrasound program development and implementation at a Veterans Affairs emergency department

Integrating point-of-care ultrasound (POCUS) into patient care requires a multifaceted culture change using a multi-pronged approach. A standardized implementation method is lacking for POCUS program sustainability. We developed a standardized training curriculum and clinical POCUS documentation, archival, and image review process at a single Veterans Affairs Emergency Department (ED). We hypothesized that co-designed development and implementation of the multifaceted POCUS intervention would maximize ED provider uptake and sustainability. Using Participatory Action Research (PAR) and adapted Experience-Based Co-design (EBCD) methods, stakeholders collaboratively co-designed our POCUS intervention to optimize implementation. Using the PRODUCES framework, 12 stakeholder participants (co-creators including study researchers, ultrasound faculty, ED leadership, and ED providers (POCUS end-users)) met in four monthly co-design meetings from July to October 2021 to brainstorm, discuss, refine, and finalize the POCUS intervention and implementation plan. Throughout the co-design process, stakeholders reviewed findings from prior meetings, reflected on successes and failures, and held open discussions on refining and finalizing the proposed POCUS educational and clinical program. By involving stakeholders as co-creators throughout the co-design process, we maximized end-user POCUS enthusiasm, program uptake, and sustained use. This simple, streamlined, and generalizable user-centered co-design method serves as a framework for future POCUS implementation and dissemination plans.

Comparative efficacy and acceptability of interventions for universal, selective and indicated prevention of eating disorders: study protocol for a systematic review and network meta-analysis

BACKGROUND

Eating disorders (EDs) are severe psychiatric conditions, with prevalence rates ranging from 5.5 to 17.9% in women and 0.6 to 2.4% in men. EDs carry a high risk of chronicity and mortality, highlighting the need for effective prevention strategies. Primary prevention can target the entire population (universal), high-risk groups (selective), or individuals with early signs (indicated). Despite substantial research, prior reviews often show limitations, such as single-author data extraction, lack of quality assessment, reliance on endpoint data, exclusion of obesity prevention programs, or outdated findings. No review has yet evaluated the comparative effectiveness of multiple interventions across risk groups. This article outlines a systematic review and network meta-analysis (NMA) protocol to assess the comparative effectiveness of various ED preventive interventions across different prevention types and populations.

METHODS

Eligible studies will include (cluster) randomized controlled trials (RCTs) involving children, adolescents, and adults across a range of settings. Databases to be searched include MEDLINE, Embase, PsycINFO, and CENTRAL. All prevention types (universal, selective, indicated) will be included. Interventions will encompass psychological, educational, physical, and nutritional approaches aimed at preventing EDs, disordered eating, or negative body image and/or reducing risk factors. Coprimary outcomes will be ED diagnostic symptoms, overall ED pathology, ED onset, and intervention all-cause discontinuation (acceptability). A frequentist NMA framework will be used for data synthesis, with sensitivity and subgroup analyses to identify effect modifiers.

DISCUSSION

This first NMA on ED prevention aims to provide valuable insights for clinicians, researchers, policymakers and the public by identifying the most effective interventions and highlighting research gaps. The findings will inform intervention selection for specific populations and guide future prevention strategies to reduce the burden of EDs on affected individuals, their communities, and wider society.

CLINICAL TRIAL REGISTRATION NUMBER

CRD42024498102.

Expanding the pragmatic lens in implementation science: why stakeholder perspectives matter

BACKGROUND

Pragmatism is important in implementation science to ensure that implementation methods reflect the practical concerns of the stakeholders and services involved in change. To evaluate the usability of these methods, pragmatic measures have been developed using psychometrics. However, existing approaches have predominantly inherited a definition of pragmatism from the evidence-based healthcare movement. These metrics may not reflect concerns with pragmatism that public stakeholders (defined as those with expertise by experience of healthcare systems) may have with implementation science.

AIMS

Consequently, our aim was to carry out participatory research to explore stakeholder views of pragmatic measures in implementation science theory.

METHODS

We convened a working group of eight stakeholders. To facilitate discussion, we created educational materials, including a video and flyer. The working group conducted three meetings, engaging in abductive analysis to investigate the presented issues.

RESULTS

Stakeholders expressed concerns about the restricted definition of pragmatism, the potential for biases in measurement, and the necessity for a holistic, pluralistic approach that incorporates diverse perspectives when developing and evaluating implementation theory and metrics. These findings underscore the risk of distorting the development of implementation science methods without the input and scrutiny of stakeholders. Neglecting the wider application of pragmatic philosophy in implementation science could limit stakeholder involvement in the design of implementation methods and service transformation.

CONCLUSIONS

This study, guided by experts with lived experience in healthcare services, opens doors for considering pragmatic philosophy in the evolution of pragmatic implementation measures and metrics, offering numerous promising directions for further exploration.

Informing research design through patient and public involvement; patients and carers with lived experience post-hospital discharge and potential roles for general practice pharmacists

BACKGROUND

Medication safety across care transitions remains a significant burden on healthcare systems. Patient and Public Involvement (PPI) is useful at the very early stages of intervention development to inform research priorities. The aim of this PPI was to scope patients' and carers' lived experiences of medicines management post-hospital discharge to inform the design of a research proposal.

METHODS

A research planning PPI workshop and additional one-to-one discussions were undertaken with patients and informal carers who had experienced a recent discharge from hospital and were prescribed regular repeat medications.

RESULTS

The 12 public contributors identified that the priority for patients was not limited to medication management alone but rather a broader care package. Multiple themes as priorities for research emerged: (1) broader holistic and social aspects of care involving various healthcare professionals, (2) practical aspects such as timeliness of follow-up and co-ordination of medication management, and (3) communication with the patient/carer and information transfer between settings.

CONCLUSION

Valuable insights from this PPI helped inform future research design priorities and identify the need for a more holistic approach to care. Future work with multi-stakeholder engagement involving different professionals across sectors is needed to explore safer integrated transitions of care, as well as the use of ongoing PPI and co-design, considering populations that are most vulnerable.

Managing obesity in children: a clinical practice guideline

BACKGROUND

Obesity is a complex, chronic, stigmatized disease whereby abnormal or excess body fat may impair health or increase the risk of medical complications, and can reduce quality of life and shorten lifespan in children and families. We developed this guideline to provide evidence-based recommendations on options for managing pediatric obesity that support shared decision-making among children living with obesity, their families, and their health care providers.

METHODS

We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We used the Guidelines International Network principles to manage competing interests. Caregivers, health care providers, and people living with obesity participated throughout the guideline development process, which optimized relevance. We surveyed end users (caregivers, health care providers) to prioritize health outcomes, completed 3 scoping reviews (2 on minimal important difference estimates; 1 on clinical assessment), performed 1 systematic review to characterize families' values and preferences, and conducted 3 systematic reviews and meta-analyses to examine the benefits and harms of behavioural and psychological, pharmacologic, and surgical interventions for managing obesity in children. Guideline panellists developed recommendations focused on an individualized approach to care by using the GRADE evidence-to-decision framework, incorporating values and preferences of children living with obesity and their caregivers.

RECOMMENDATIONS

Our guideline includes 10 recommendations and 9 good practice statements for managing obesity in children. Managing pediatric obesity should be guided by a comprehensive child and family assessment based on our good practice statements. Behavioural and psychological interventions, particularly multicomponent interventions (strong recommendation, very low to moderate certainty), should form the foundation of care, with tailored therapy and support using shared decision-making based on the potential benefits, harms, certainty of evidence, and values and preferences of children and families. Pharmacologic and surgical interventions should be considered (conditional recommendation, low to moderate certainty) as therapeutic options based on availability, feasibility, and acceptability, and guided by shared decision-making between health care providers and families.

INTERPRETATION

This guideline will support children, families, and health care providers to have informed discussions about the balance of benefits and harms for available obesity management interventions to support value- and preference-sensitive decision-making.

Evolution of reported patient and public involvement over time in randomised controlled trials in major medical journals and in their protocols: meta-epidemiological evaluation

OBJECTIVE

To investigate the reporting and evolution of patient and public involvement (PPI) in randomised controlled trials published over time in major medical journals and in their trial protocols.

DESIGN

Meta-epidemiological evaluation.

DATA SOURCE

PubMed was searched for articles reporting randomised controlled trials published since 2015 in four major medical journals and their corresponding peer reviewed protocols.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The first 10 randomised controlled trials published each year in each journal were included.

DATA EXTRACTION

Data extraction focused on involved stakeholders, description and extent of PPI activities/processes, and recognition of PPI contributions. Published articles and protocols were assessed for consistency of the reported PPI in both.

RESULTS

Of the 360 published articles reporting randomised controlled trials and 299 respective protocols, PPI was only reported in 64 (18%) articles and 56 (19%) protocols. When PPI was reported, patients and their representatives were mainly involved, with the most common PPI activity being participation in trial committees (44/64 PPI reporting articles; 39/56 protocols). PPI primarily occurred during the trial development phase, including feedback on study design, review of study materials, and assessment of feasibility. Protocols occasionally had more detailed information than the published articles, but in most cases the PPI contributions were often vague without detailed information on specific outcomes and the effect on decision making within the randomised controlled trial. Recognition of PPI contributions was more frequent in published articles (n=37; 58%) than in protocols (n=18; 32%), mainly in the acknowledgment section.

CONCLUSION

This study found limited PPI reported in randomised controlled trials published in major medical journals and in their respective protocols, underscoring the need for consistent, detailed, and transparent PPI reporting practices in clinical research.

STUDY REGISTRATION

https://doi.org/10.17605/OSF.IO/4EQG2.

Effectiveness of mucoactives (carbocisteine and hypertonic saline) in addition to usual airway clearance management with usual airway clearance management alone in acute respiratory failure (MARCH): study protocol for a multi-centre 2x2 factorial, randomised, controlled, open-label, Phase 3, pragmatic, clinical and cost-effectiveness trial with internal pilot

Background

Usual airway clearance management in critically ill patients with acute respiratory failure includes suctioning, humidification, use of isotonic saline, and respiratory physiotherapy techniques. Escalation to use of mucoactives occurs when secretions are difficult to clear. Use of mucoactives in clinical practice for this patient population is extensive, yet empirical and variable. Carbocisteine and hypertonic saline are the most used agents, but evidence for their effectiveness is absent or minimal. The lack of existing large-scale randomised trials comparing mucoactives to usual airway clearance management alone in critically ill patients with acute respiratory failure highlights the urgency and necessity of this study.

Aim

To determine whether the use of mucoactives in critically ill patients with acute respiratory failure improves clinical outcomes and is cost effective, compared to usual airway clearance management alone.

Methods

A UK multi-centre, 2x2 factorial, randomised, controlled, open-label, Phase 3, pragmatic, clinical and cost effectiveness trial with internal pilot. The target sample is 1956 critically ill adults. Participants will be equally allocated across four trial arms. All participants will receive usual airway clearance management. In three intervention groups, participants will receive either carbocisteine, hypertonic saline, or a combination of carbocisteine and hypertonic saline. In the fourth comparator group, participants will receive usual airway clearance management alone. The primary outcome is the duration of mechanical ventilation with secondary clinical, safety, and health resource utilisation outcomes. The trial will be reported in accordance with CONSORT guidelines. Ethical approval was granted by Leeds East (Yorkshire & The Humber) Research Ethics Committee (reference 21/YH/0234) on 28 th October 2021. All participants will provide written, informed consent via either Personal or Professional Legal Representatives, and subsequently directly once capacity is regained.

Trial registration

Main trial: ISRCTN17683568, https://www.isrctn.com/ISRCTN17683568, 25 th November 2021Study Within A Trial: ISRCTN16675252, https://www.isrctn.com/ISRCTN16675252, 3 rd November 2021EudraCT Number, 2021-003763-94.

Interventions for Reducing Mental Health-Related Stigma in Emergency Medicine: An Integrative Review

INTRODUCTION

The prevalence and impact of mental health disorders are increasing worldwide. A growing number of people with mental health problems require ambulance and emergency department care, many of whom face stigmatization from health care professionals in these environments. Interpersonal stigma comprises insufficient knowledge (ignorance or misinformation), negative attitudes (negative emotional reactions, such as prejudice), and negative behaviors (such as avoidance or rejection).

METHODS

An integrative review was conducted to assess the current landscape of interventions aimed at reducing stigmatization among health care professionals in ambulance and emergency department settings.

RESULTS

Of the 18 publications included, 1 targeted stigma reduction. Although 2 additional studies examined interventions not specifically aimed at reducing stigma, these studies have examined the impact of interventions on stigma. The other included studies reported measures of attitudes. One study involved patients evaluating the intervention, whereas the rest relied on assessments by health care professionals. Four studies mentioned patient involvement in the development of interventions. The predominant approach in these studies involved educational and training interventions associated with improvements in knowledge levels and attitudes. However, the direct impact of these changes on reducing stigmatizing behavior remains unclear. It is concerning that national practice guidelines in ambulance and emergency care hardly address mental health-related stigma despite longstanding awareness of this issue.

DISCUSSION

The findings underscore the urgent need for concerted efforts in practice, research, and policy within ambulance and emergency department settings to address and combat stigmatizing behaviors toward patients with mental health challenges by enhancing knowledge and reshaping attitudes.

Remote multicomponent rehabilitation compared to standard care for survivors of critical illness after hospital discharge (iRehab): a protocol for a randomised controlled assessor-blind clinical and cost-effectiveness trial

Background

The consequences of critical illness can be substantial and multifactorial, encompassing physical deconditioning, mental health impairments, fatigue, and declines in health-related quality of life. We hypothesise that for people discharged after intensive care unit (ICU) for a critical illness, a six-week remote multicomponent rehabilitation intervention improves health-related quality of life, physical function, fatigue, mood, and other health-related outcomes after eight weeks, compared to standard care.

Methods

This is a pragmatic, randomised controlled, open-label, assessor blind, multicentre, clinical and cost effectiveness trial with internal pilot and embedded process evaluation. Recruitment will take place in NHS hospitals across the UK. Adults (n=428: control n= 197; intervention: n=231) within 12 weeks of discharge from hospital following an ICU admission for critical illness, requiring mechanical ventilation ≥48hours will be recruited.The intervention is a six week multicomponent, structured, rehabilitation programme, delivered remotely by a trained intervention team. The intervention includes four components: weekly symptom management; targeted exercise; psychological support, and peer support and information. The control group will receive standard NHS care.The primary outcome is Health-related quality of life (HRQoL) at eight weeks post-randomisation measured using the EQ-5D-5L. Secondary outcomes are: HRQoL (six months), physical function, fatigue, anxiety and depression, healthcare resource use at eight weeks and six months and intervention acceptability.

Conclusions

This trial will test a centrally delivered mulitcomponent rehabilitation intervention for survivors of critical illness, irrespective of geographic location or critical illness diagnosis.

Trial registration

The trial is registered (04.07.2022) with the International Standard Randomised Controlled Trial Number (ISRCTN) Register ISRCTN11266403 https://doi.org/10.1186/ISRCTN11266403.

Study protocol for assessing the effectiveness, implementation fidelity and uptake of attachment & child health (ATTACH™) Online: helping children vulnerable to early adversity

BACKGROUND

Exposure to early childhood adversities, such as family violence, parental depression, or low-income, undermine parent-child relationship quality and attachment leading to developmental and mental health problems in children. Addressing impacts of early childhood adversity can promote children's development, giving them the best start in life. Parental reflective function (RF), or parents' ability to understand their own and children's mental states, can strengthen parent-child relationships and attachment and buffer the negative effects of early adversity. We developed and tested ATTACH™ (Attachment and Child Health), an effective RF intervention program for parents and their preschool-aged children at-risk from early adversity. Pilot studies revealed significantly positive impacts of ATTACH™ from in-person (n = 91 observations of 64 dyads) and online (n = 10 dyads) implementation. The two objectives of this study are to evaluate: (1) effectiveness, and (2) implementation fidelity and uptake of ATTACH™ Online in community agencies serving at-risk families in Alberta, Canada. Our primary hypothesis is ATTACH™ Online improves children's development. Secondary hypotheses examine whether ATTACH™ Online improves children's mental health, parent-child relationships, and parental RF.

METHODS

We will conduct an effectiveness-implementation hybrid (EIH) type 2 study. Effectiveness will be examined with a quasi-experimental design while implementation will be examined via descriptive quantitative and qualitative methods informed by Normalization Process Theory (NPT). Effectiveness outcomes examine children's development and mental health, parent-child relationships, and RF, measured before, after, and 3 months post-intervention. Implementation outcomes include fidelity and uptake of ATTACH™ Online, assessed via tailored tools and qualitative interviews using NPT, with parents, health care professionals, and administrators from agencies. Power analysis revealed recruitment of 100 families with newborn to 36-month-old children are sufficient to test the primary hypothesis on 80 complete data sets. Data saturation will be employed to determine final sample size for the qualitative component, with an anticipated maximum of 20 interviews per group (parents, heath care professionals, administrators).

DISCUSSION

This study will: (1) determine effectiveness of ATTACH™ Online and (2) understand mechanisms that promote implementation fidelity and uptake of ATTACH™ Online. Findings will be useful for planning spread and scale of an effective online program poised to reduce health and social inequities affecting vulnerable families.

TRIAL REGISTRATION

Name of registry: https://clinicaltrials.gov/ .

REGISTRATION NUMBER

NCT05994027. Date of registration: July 22, 2023.

PROTOCOL VERSION

Version 1.

Developing an Internet-Based Cognitive Behavioral Therapy Intervention for Adolescents With Anxiety Disorders: Design, Usability, and Initial Evaluation of the CoolMinds Intervention

BACKGROUND

Digital mental health interventions may help increase access to psychological treatment for adolescents with anxiety disorders. However, many clinical evaluations of digital treatments report low adherence and engagement and high dropout rates, which remain challenges when the interventions are implemented in routine care. Involving intended end users in the development process through user-centered design methods may help maximize user engagement and establish the validity of interventions for implementation.

OBJECTIVE

This study aimed to describe the methods used to develop a new internet-based cognitive behavioral therapy intervention, CoolMinds, within a user-centered design framework.

METHODS

The development of intervention content progressed in three iterative design phases: (1) identifying needs and design specifications, (2) designing and testing prototypes, and (3) running feasibility tests with end users. In phase 1, a total of 24 adolescents participated in a user involvement workshop exploring their preferences on graphic identity and communication styles as well as their help-seeking behavior. In phase 2, a total of 4 adolescents attended individual usability tests in which they were presented with a prototype of a psychoeducational session and asked to think aloud about their actions on the platform. In phase 3, a total of 7 families from the feasibility trial participated in a semistructured interview about their satisfaction with and initial impressions of the platform and intervention content while in treatment. Activities in all 3 phases were audio recorded, transcribed, and coded using thematic analysis and qualitative description design. The intervention was continuously revised after each phase based on the feedback.

RESULTS

In phase 1, adolescent feedback guided the look and feel of the intervention content (ie, color scheme, animation style, and communication style). Participants generally liked content that was relatable and age appropriate and felt motivating. Animations that resembled "humans" received more votes as adolescents could better "identify" themselves with them. Communication should preferably be "supportive" and feel "like a friend" talking to them. Statements including praise-such as "You're well on your way. How are you today?"-received the most votes (12 votes), whereas directive statements such as "Tell us how your day has been?" and "How is practicing your steps going?" received the least votes (2 and 0 votes, respectively). In phase 2, adolescents perceived the platform as intuitive and easy to navigate and the session content as easy to understand but lengthy. In phase 3, families were generally satisfied with the intervention content, emphasizing the helpfulness of graphic material to understand therapeutic content. Their feedback helped identify areas for further improvement, such as editing down the material and including more in-session breaks.

CONCLUSIONS

Using user involvement practices in the development of interventions helps ensure continued alignment of the intervention with end-user needs and may help establish the validity of the intervention for implementation in routine care practice.

Preclinical systematic review of CCR5 antagonists as cerebroprotective and stroke recovery enhancing agents

C-C chemokine receptor type 5 (CCR5) antagonists may improve both acute stroke outcome and long-term recovery. Despite their evaluation in ongoing clinical trials, gaps remain in the evidence supporting their use. With a panel of patients with lived experiences of stroke, we performed a systematic review of animal models of stroke that administered a CCR5 antagonist and assessed infarct size or behavioural outcomes. MEDLINE, Web of Science, and Embase were searched. Article screening and data extraction were completed in duplicate. We pooled outcomes using random effects meta-analyses. We assessed risk of bias using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool and alignment with the Stroke Treatment Academic Industry Roundtable (STAIR) and Stroke Recovery and Rehabilitation Roundtable (SRRR) recommendations. Five studies representing 10 experiments were included. CCR5 antagonists reduced infarct volume (standard mean difference -1.02; 95% confidence interval -1.58 to -0.46) when compared to stroke-only controls. Varied timing of CCR5 administration (pre- or post-stroke induction) produced similar benefit. CCR5 antagonists significantly improved 11 of 16 behavioural outcomes reported. High risk of bias was present in all studies and critical knowledge gaps in the preclinical evidence were identified using STAIR/SRRR. CCR5 antagonists demonstrate promise; however, rigorously designed preclinical studies that better align with STAIR/SRRR recommendations and downstream clinical trials are warranted. Prospective Register of Systematic Reviews (PROSPERO CRD42023393438).

Patient and Public Involvement in Malnutrition Disorders Health Research: A Methodological Systematic Review Protocol

Background/Objectives: Older adults are particularly susceptible to undernutrition and conditions that can aggravate it, such as frailty and conditions associated with swallowing difficulties or dysphagia. To address these challenges, it is important to consider the perspectives of older adults and their caregivers, especially those with conditions such as frailty or cognitive impairment, as they can provide valuable insights on supporting nutrition in these vulnerable populations. This participatory approach requires structures formed by scientific research committees working together with other stakeholders, involving various actors at all stages of the research process. The aim of this study is to analyze the methodology for involving patients aged 65 and older with malnutrition or at risk of malnutrition as co-investigators in research. Methods: This protocol has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) checklist. A literature search will be carried out in the following electronic databases: PubMed/MEDLINE, EMBASE and CINAHL. Through the COVIDENCE program, the research team will independently review the different screening phases of the identified studies for possible inclusion or exclusion. Expected Results: This systematic review will provide up-to-date evidence on the use of non-scientific actors at different stages of research. The main limitation stems from the use of non-scientific agents in a topic as specific as adults with or at risk of undernutrition, which may make it difficult to extrapolate the results to other settings. The registration number in PROSPERO is CRD42024444374.

Development and evaluation of a stroke research Public Patient Involvement Panel

Background

Public and patient involvement (PPI) is important in stroke research to ensure that research conducted reflects the priorities and needs of people after stroke. Several factors have been found to affect PPI, including location of the research and time requirements for participation. The incidence of stroke is rising, and can result in symptoms including fatigue, depression, and physical/cognitive impairments.

Aims

1) Describe the development of a PPI panelpanel and a healthcare professional panelpanel for stroke rehabilitation research and 2) to explore the perspectives of the members of the PPI groups on being involved in the research process.

Methods

A stakeholder panel consisting of up to 20 people with stroke, members of the public and healthcare professionals will be formed. A pragmatic purposive sampling technique using snowball sampling will be used to recruit members. The PPI panel will meet four times and will be supported by the guidelines developed from the INVOLVE framework. The PPI panel will be involved as co-researchers in the conceptualisation of future stroke rehabilitation research, the delivery of such studies, the analysis and dissemination of findings. Following the development of the panel, we will conduct a semi-structured focus groups to collect qualitative data, examining the perspectives of members. Data will be transcribed and analysed using Braun and Clarke's Reflexive Thematic Analysis. This will result in a set of themes and subthemes describing participants' opinions and experience of being on a PPI panel in stroke rehabilitation research.

Conclusions

PPI is an essential part of research in stroke. Stakeholders can provide key insights into the research processes. The results of this qualitative study will provide insight into the barriers and enablers of their participation in PPI in stroke rehabilitation research.