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Bray EP, Georgiou RF, Hives L, Iqbal N, Benedetto V, Spencer J, Harris C, Clegg A, Williams N, Rutter P, Watkins C. Non-pharmacological interventions for the reduction and maintenance of blood pressure in people with prehypertension: a systematic review protocol. BMJ Open 2024; 14:e078189. [PMID: 38253457 PMCID: PMC10806604 DOI: 10.1136/bmjopen-2023-078189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Prehypertension is defined as blood pressure that is above the normal range but not high enough to be classed as hypertension. Prehypertension is a warning of development of hypertension as well as a risk for cardiovascular disease, heart attack and stroke. In the UK, non-pharmacological interventions are recommended for prehypertension management but no reviews have focused on the effectiveness of these types of interventions solely in people with prehypertension. Therefore, the proposed systematic review will assess the clinical effectiveness and cost-effectiveness of non-pharmacological interventions in reducing or maintaining blood pressure in prehypertensive people. METHODS AND ANALYSIS This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases/trial registries that will be searched to identify relevant randomised controlled trials (RCTs) and economic evaluations include Medline, EMBASE, CINAHL, PsycINFO, CENTRAL, the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Cochrane Library, Scopus and the International HTA Database. Search terms have been identified by the team including an information specialist. Three reviewers will be involved in the study selection process. Risk of bias will be evaluated using the Cochrane risk-of-bias tool for RCTs and the Consensus Health Economic Criteria list for economic evaluations. Findings from the included studies will be tabulated and synthesised narratively. Heterogeneity will be assessed through visual inspection of forest plots and the calculation of the χ2 and I2 statistics and causes of heterogeneity will be assessed where sufficient data are available. If possible, we plan to investigate differential effects on specific subgroups and from different types of interventions using meta-regression. Where relevant, the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) will be used to assess the certainty of the evidence found. ETHICS AND DISSEMINATION Ethical approval is not needed. Results will be published in a peer-reviewed journal, disseminated via the wider study website and shared with the study sites and participants. REGISTRATION DETAILS The review is registered with PROSPERO (CRD420232433047).
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Affiliation(s)
- Emma P Bray
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | | | - Lucy Hives
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Nafisa Iqbal
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire, Preston, UK
| | - Joseph Spencer
- Research Facilitation and Delivery Unit, University of Central Lancashire, Preston, UK
| | - Cath Harris
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire, Preston, UK
| | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire, Preston, UK
| | - Nefyn Williams
- Primary Care, Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Paul Rutter
- Pharmacy Practice, School of Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Caroline Watkins
- Stroke Research Team, University of Central Lancashire, Preston, UK
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Hives L, Georgiou RF, Spencer J, Benedetto V, Clegg A, Rutter P, Watkins C, Williams N, Bray EP. Risk reduction intervention for raised blood pressure (REVERSE): protocol for a mixed-methods feasibility study. BMJ Open 2023; 13:e072225. [PMID: 37258072 DOI: 10.1136/bmjopen-2023-072225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Around 40% of adults have pre-hypertension (blood pressure between 120-139/80-89), meaning they are at increased risk of developing hypertension and other cardiovascular disease-related conditions. There are limited studies on the management of pre-hypertension; however, guidance recommends that it should be focused on lifestyle modification rather than on medication. Self-monitoring of blood pressure could allow people to monitor and manage their risk status and may allow individuals to modify lifestyle factors. The purpose of this study is to determine the feasibility and acceptability, to both healthcare professionals and people with pre-hypertension, of blood pressure self-monitoring. METHODS AND ANALYSIS A prospective, non-randomised feasibility study, with a mixed-methods approach will be employed. Eligible participants (n=114) will be recruited from general practices, pharmacies and community providers across Lancashire and South Cumbria. Participants will self-monitor their blood pressure at home for 6 months and will complete questionnaires at three timepoints (baseline, 6 and 12 months). Healthcare professionals and participants involved in the study will be invited to take part in follow-up interviews and a focus group. The primary outcomes include the willingness to engage with the concept of pre-hypertension, the acceptability of self-monitoring, and the study processes. Secondary outcomes will inform the design of a potential future trial. A cost-analysis and cost-benefit analysis will be conducted. ETHICS AND DISSEMINATION Ethics approval has been obtained from London-Fulham NHS Research Ethics Committee, the University of Central Lancashire Health Ethics Review Panel and the HRA. The results of the study will be disseminated via peer-reviewed publications, feedback to service users and healthcare professionals, and to professional bodies in primary care and pharmacy. TRIAL REGISTRATION NUMBER ISRCTN13649483.
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Affiliation(s)
- Lucy Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Rachel F Georgiou
- Stroke Research Team, School of Nursing, University of Central Lancashire, Preston, UK
| | - Joseph Spencer
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Andrew Clegg
- Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Paul Rutter
- Faculty of Science and Health, School of Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Caroline Watkins
- Stroke Research Team, School of Nursing, Facility of Health and Care, University of Central Lancashire, Preston, UK
| | - Nefyn Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Emma P Bray
- Stroke Research Team, School of Nursing, Facility of Health and Care, University of Central Lancashire, Preston, UK
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Olive P, Hives L, Ashton A, O’Brien MC, Taylor A, Mercer G, Horsfield C, Carey R, Jassat R, Spencer J, Wilson N. Psychological and psychosocial aspects of major trauma care: A survey of current practice across UK and Ireland. Trauma 2023. [DOI: 10.1177/14604086221145529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction Psychological and psychosocial impacts of major trauma, defined as any injury that has the potential to be life-threatening and/or life changing, are common, far-reaching and often enduring. There is evidence that these aspects of major trauma care are often underserved. The aim of this research was to gain insight into the current provision and operationalisation of psychological and psychosocial aspects of major trauma care across the UK and Ireland. Methods A cross-sectional online survey, open to health professionals working in major trauma network hospitals was undertaken. The survey had 69 questions across six sections: Participant Demographics, Psychological First Aid, Psychosocial Assessment and Care, Assessing and Responding to Distress, Clinical Psychology Services, and Major Trauma Keyworker (Coordinator) Role. Results There were 102 respondents from across the regions and from a range of professional groups. Survey findings indicate a lack of formalised systems to assess, respond and evaluate psychological and psychosocial aspects of major trauma care, most notably for patients with lower-level distress and psychosocial support needs, and for trauma populations that don't reach threshold for serious injury or complex health need. The findings highlight the role of major trauma keyworkers (coordinators) in psychosocial aspects of care and that although major trauma clinical psychology services are increasingly embedded, many lack the capacity to meet demand. Conclusion Neglecting psychological and psychosocial aspects of major trauma care may extend peritraumatic distress, result in preventable Years Lived with Disability and widen post-trauma health inequalities. A stepped psychological and psychosocial care pathway for major trauma patients and their families from the point of injury and continuing as they move through services towards recovery is needed. Research to fulfil knowledge gaps to develop and implement such a model for major trauma populations should be prioritised along with the development of corresponding service specifications for providers.
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Affiliation(s)
- P Olive
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - L Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - A Ashton
- Psychology Service, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - MC O’Brien
- Neuropsychology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - A Taylor
- Trauma Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - G Mercer
- Acute Rehabilitation Trauma Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - C Horsfield
- West Yorkshire Critical Care & Major Trauma Operational Delivery Networks and South Yorkshire & Bassetlaw Critical Care ODN, Leeds, UK
| | - R Carey
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - R Jassat
- School of Medicine, University of Central Lancashire, Preston, UK
| | - J Spencer
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - N Wilson
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
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Boaden E, Burnell J, Hives L, Dey P, Clegg A, Lyons MW, Lightbody CE, Hurley MA, Roddam H, McInnes E, Alexandrov AW, Watkins CL. Screening for Aspiration Risk Associated With Dysphagia in Acute Stroke. Stroke 2022. [PMID: 35994682 DOI: 10.1161/strokeaha.122.037998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Elizabeth Boaden
- Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom
| | - Jane Burnell
- Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom
| | - Lucy Hives
- Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom
| | - Paola Dey
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom (P.D.)
| | - Andrew Clegg
- Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom
| | - Mary W Lyons
- Liverpool School of Tropical Medicine, United Kingdom (M.W.L.)
| | - C Elizabeth Lightbody
- Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom.,Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom (C.E.L.)
| | - Margaret A Hurley
- Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom
| | - Hazel Roddam
- Faculty of Allied Health and Well-being (H.R.), University of Central Lancashire, Preston, United Kingdom
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University, Sydney, Australia (E.M.)
| | - Anne W Alexandrov
- Department of Acute and Tertiary Care, University of Tennessee Health Science Center (UTHSC), Memphis (A.W.A.)
| | - Caroline L Watkins
- Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom
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Olive P, Hives L, Wilson N, Ashton A, O’Brien MC, Mercer G, Jassat R, Harris C. Psychological and psychosocial aspects of major trauma care in the United Kingdom: A scoping review of primary research. Trauma 2022. [DOI: 10.1177/14604086221104934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction More people are surviving major trauma, often with life changing injuries. Alongside physical injury, many survivors of major trauma experience psychological and psychosocial impacts. Presently, there is little guidance at the UK national level for psychological and psychosocial aspects of major trauma care. Set in the context of the regional model of major trauma care implemented in the UK in 2012, the purpose of this review was to identify and bring together primary research about psychological and psychosocial aspects of major trauma care in the UK to produce an overview of the field to date, identify knowledge gaps and set research priorities. Methods A scoping review was undertaken. Seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Embase, PsycINFO, SocINDEX with Full Text and PROSPERO) were searched alongside a targeted grey literature search. Data from included studies were extracted using a predefined extraction form and underwent bibliometric analysis. Included studies were then grouped by type of research, summarised, and synthesised to produce a descriptive summary and overview of the field. Results The searches identified 5,975 articles. Following screening, 43 primary research studies were included in the scoping review. The scoping review, along with previous research, illustrates that psychological and psychosocial impacts are to be expected following major trauma. However, it also found that these aspects of care are commonly underserved and that there are inherent inequities across major trauma care pathways in the UK. Conclusion Though the scoping review identified a growing body of research investigating psychological and psychosocial aspects of major trauma care pathways in the UK, significant gaps in the evidence base remain. Research is needed to establish clinically effective psychological and psychosocial assessment tools, corresponding interventions, and patient-centred outcome measures so that survivors of major trauma (and family members or carers) receive the most appropriate care and intervention.
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Affiliation(s)
- Philippa Olive
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Lucy Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Neil Wilson
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Amy Ashton
- Clinical Health Psychology Service, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Marie Claire O’Brien
- Neuropsychology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Gemma Mercer
- Acute Rehabilitation Trauma Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Raeesa Jassat
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Catherine Harris
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, UK
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Boaden E, Burnell J, Hives L, Dey P, Clegg A, Lyons MW, Lightbody CE, Hurley MA, Roddam H, McInnes E, Alexandrov A, Watkins CL. Screening for aspiration risk associated with dysphagia in acute stroke. Cochrane Database Syst Rev 2021; 10:CD012679. [PMID: 34661279 PMCID: PMC8521523 DOI: 10.1002/14651858.cd012679.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stroke can affect people's ability to swallow, resulting in passage of some food and drink into the airway. This can cause choking, chest infection, malnutrition and dehydration, reduced rehabilitation, increased risk of anxiety and depression, longer hospital stay, increased likelihood of discharge to a care home, and increased risk of death. Early identification and management of disordered swallowing reduces risk of these difficulties. OBJECTIVES Primary objective • To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke Secondary objectives • To assess the influence of the following sources of heterogeneity on the diagnostic accuracy of bedside screening tools for dysphagia - Patient demographics (e.g. age, gender) - Time post stroke that the study was conducted (from admission to 48 hours) to ensure only hyperacute and acute stroke swallow screening tools are identified - Definition of dysphagia used by the study - Level of training of nursing staff (both grade and training in the screening tool) - Low-quality studies identified from the methodological quality checklist - Type and threshold of index test - Type of reference test SEARCH METHODS: In June 2017 and December 2019, we searched CENTRAL, MEDLINE, Embase, CINAHL, and the Health Technology Assessment (HTA) database via the Centre for Reviews and Dissemination; the reference lists of included studies; and grey literature sources. We contacted experts in the field to identify any ongoing studies and those potentially missed by the search strategy. SELECTION CRITERIA We included studies that were single-gate or two-gate studies comparing a bedside screening tool administered by nurses or other healthcare professionals (HCPs) with expert or instrumental assessment for detection of aspiration associated with dysphagia in adults with acute stroke admitted to hospital. DATA COLLECTION AND ANALYSIS Two review authors independently screened each study using the eligibility criteria and then extracted data, including the sensitivity and specificity of each index test against the reference test. A third review author was available at each stage to settle disagreements. The methodological quality of each study was assessed using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) tool. We identified insufficient studies for each index test, so we performed no meta-analysis. Diagnostic accuracy data were presented as sensitivities and specificities for the index tests. MAIN RESULTS Overall, we included 25 studies in the review, four of which we included as narratives (with no accuracy statistics reported). The included studies involved 3953 participants and 37 screening tests. Of these, 24 screening tests used water only, six used water and other consistencies, and seven used other methods. For index tests using water only, sensitivity and specificity ranged from 46% to 100% and from 43% to 100%, respectively; for those using water and other consistencies, sensitivity and specificity ranged from 75% to 100% and from 69% to 90%, respectively; and for those using other methods, sensitivity and specificity ranged from 29% to 100% and from 39% to 86%, respectively. Twenty screening tests used expert assessment or the Mann Assessment of Swallowing Ability (MASA) as the reference, six used fibreoptic endoscopic evaluation of swallowing (FEES), and 11 used videofluoroscopy (VF). Fifteen screening tools had an outcome of aspiration risk, 20 screening tools had an outcome of dysphagia, and two narrative papers did not report the outcome. Twenty-one screening tests were carried out by nurses, and 16 were carried out by other HCPs (not including speech and language therapists (SLTs)). We assessed a total of six studies as low risk across all four QUADAS-2 risk of bias domains, and we rated 15 studies as low concern across all three applicability domains. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing combined water swallow and instrumental tool was the Bedside Aspiration test (n = 50), the best performing water plus other consistencies tool was the Gugging Swallowing Screen (GUSS; n = 30), and the best water only swallow screening tool was the Toronto Bedside Swallowing Screening Test (TOR-BSST; n = 24). All tools demonstrated combined highest sensitivity and specificity and low risk of bias for all domains. However, clinicians should be cautious in their interpretation of these findings, as these tests are based on single studies with small sample sizes, which limits the estimates of reliability of screening tests. AUTHORS' CONCLUSIONS We were unable to identify a single swallow screening tool with high and precisely estimated sensitivity and specificity based on at least one trial with low risk of bias. However, we were able to offer recommendations for further high-quality studies that are needed to improve the accuracy and clinical utility of bedside screening tools.
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Affiliation(s)
- Elizabeth Boaden
- Faculty of Health and Care , University of Central Lancashire , Preston, UK
| | - Jane Burnell
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Lucy Hives
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Paola Dey
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | - Andrew Clegg
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Mary W Lyons
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Margaret A Hurley
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Hazel Roddam
- Faculty of Allied Health and Well-being, University of Central Lancashire, Preston, UK
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Anne Alexandrov
- University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee, USA
| | - Caroline L Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
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Olive P, Hives L, Wilson N, Nowland R, Clegg A. Harms to health and well-being experienced by adult victims of interpersonal violence: a scoping review protocol. JBI Evid Synth 2021; 19:1632-1644. [PMID: 33394618 DOI: 10.11124/jbies-20-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this scoping review is to identify the extent of research exploring the harms to health and well-being experienced by adult victims of different types of interpersonal violence. INTRODUCTION Interpersonal violence is defined as violence between individuals. It can take many forms and may be physical, sexual, psychological, coercive, or deprivational in nature. Harms to health and well-being from being subjected to interpersonal violence are common and often endure long-term. Interpersonal violence may cause physical injury, often has mental health impacts, and is associated with greater risk for long-term medical conditions. Although a substantial body of research of the harms of different types of interpersonal violence exists, to date this has not been collated and mapped; this scoping review will address this gap. INCLUSION CRITERIA Peer-reviewed primary and secondary research studies that address the negative effects of interpersonal violence on the health and well-being of adult victims will be included. Studies of group violence, military veterans, and violence as acts of war will be excluded. METHODS Six electronic databases (MEDLINE, CINAHL Complete, Embase, PsycINFO, SocINDEX, and Cochrane Library) and web sources of specialist gray literature will be searched. The search will be restricted to publications from 2000 onward. Only studies published in English will be included. Screening and data extraction will be assessed by independent researcher verification processes. Relevant studies and their characteristics will be summarized using a pre-designed data extraction form. Further data synthesis will be undertaken to produce a coherent and comprehensive map of research in the field, identify gaps, and inform priorities for future directions of research and innovation.
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Affiliation(s)
- Philippa Olive
- School of Nursing, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Lucy Hives
- Research Support Team, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Neil Wilson
- Research Support Team, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Rebecca Nowland
- School of Nursing, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Andrew Clegg
- Evidence Synthesis, Health Implementation Science Team, School of Sport & Health Sciences, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Boaden E, Nightingale J, Hives L, Bradbury C, Benfield J, Patel T, Georgiou R. Current videofluoroscopy practice in the United Kingdom: A survey of imaging professionals. Radiography (Lond) 2020; 27:499-504. [PMID: 33234485 DOI: 10.1016/j.radi.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Videofluoroscopy (VFSS) is a frequently used radiological investigation for dysphagia and is conducted within a radiology setting by speech and language therapists (SLTs) working alongside imaging personnel (radiologists and/or radiographers). Previous surveys of SLT practice have reported variability in VFSS protocols and procedures. The aim of this study was to explore current clinical practice for VFSS from the perspective of imaging personnel engaged in VFSS within the United Kingdom. METHODS A comprehensive online survey enabled exploration of current practices of imaging professionals. Target participants were diagnostic imaging personnel (radiographers and radiologists) with experience of working in VFSS clinics. Descriptive statistics describe and summarise the data alongside inferential statistics where appropriate. RESULTS 54 survey participants represented 40 unique acute healthcare organisations in the UK, in addition to two respondents from the Republic of Ireland. The survey demonstrated high variance in clinical practice across all stages of the VFSS procedure. Clinicians were not always compliant with current UK guidelines and the roles and responsibilities of different professionals working within the clinics were often not clearly defined. CONCLUSION Further research is required to develop new international, interprofessional VFSS guidelines to standardise service delivery for VFSS, improving diagnostic accuracy, efficiency and patient experience. IMPLICATIONS FOR PRACTICE In the absence of VFSS guidelines for imaging personnel, practitioners should familiarise themselves with the UK Royal College of Speech and Language Therapists VFSS Position paper; IR (ME)R guidelines and DRLs for the client groups with which they work to guide clinics and improve practice. Clinicians should revisit protocols and clinical governance regarding safe practice in order to improve the quality of care within the VFSS clinic.
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Affiliation(s)
- E Boaden
- University of Central Lancashire, Preston, Lancashire, UK
| | - J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, Sheffield, UK.
| | - L Hives
- University of Central Lancashire, Preston, Lancashire, UK
| | - C Bradbury
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire, UK
| | - J Benfield
- Division of Medical Sciences, School of Medicine, University of Nottingham, UK; Derbyshire Community Health Services NHS Foundation Trust, UK
| | - T Patel
- University of Central Lancashire, Preston, Lancashire, UK
| | - R Georgiou
- University of Central Lancashire, Preston, Lancashire, UK
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Boaden E, Nightingale J, Bradbury C, Hives L, Georgiou R. Clinical practice guidelines for videofluoroscopic swallowing studies: A systematic review. Radiography (Lond) 2020; 26:154-162. [DOI: 10.1016/j.radi.2019.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022]
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Hives L, Bradley A, Richards J, Sutton C, Selfe J, Basu B, Maguire K, Sumner G, Gaber T, Mukherjee A, Perrin RN. Can physical assessment techniques aid diagnosis in people with chronic fatigue syndrome/myalgic encephalomyelitis? A diagnostic accuracy study. BMJ Open 2017; 7:e017521. [PMID: 29133321 PMCID: PMC5695376 DOI: 10.1136/bmjopen-2017-017521] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess five physical signs to see whether they can assist in the screening of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and potentially lead to quicker treatment. METHODS This was a diagnostic accuracy study with inter-rater agreement assessment. Participants recruited from two National Health Service hospitals, local CFS/ME support groups and the community were examined by three practitioners on the same day in a randomised order. Two allied health professionals (AHPs) performed independent examinations of physical signs including: postural/mechanical disturbances of the thoracic spine, breast varicosities, tender Perrin's point, tender coeliac plexus and dampened cranial flow. A physician conducted a standard clinical neurological and rheumatological assessment while looking for patterns of illness behaviour. Each examination lasted approximately 20 min. RESULTS Ninety-four participants were assessed, 52 patients with CFS/ME and 42 non-CFS/ME controls, aged 18-60. Cohen's kappa revealed that agreement between the AHPs was substantial for presence of the tender coeliac plexus (κ=0.65, p<0.001) and moderate for postural/mechanical disturbance of the thoracic spine (κ=0.57, p<0.001) and Perrin's point (κ=0.56, p<0.001). A McNemar's test found no statistically significant bias in the diagnosis by the experienced AHP relative to actual diagnosis (p=1.0) and a marginally non-significant bias by the newly trained AHP (p=0.052). There was, however, a significant bias in the diagnosis made by the physician relative to actual diagnosis (p<0.001), indicating poor diagnostic utility of the clinical neurological and rheumatological assessment. CONCLUSIONS Using the physical signs appears to improve the accuracy of identifying people with CFS/ME and shows agreement with current diagnostic techniques. However, the present study concludes that only two of these may be needed. Examining for physical signs is both quick and simple for the AHP and may be used as an efficient screening tool for CFS/ME. This is a small single-centre study, and therefore, further validation in other centres and larger populations is needed.
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Affiliation(s)
- Lucy Hives
- School of Dentistry, University of Central Lancashire, Preston, UK
| | - Alice Bradley
- Department of Neurophysiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Jim Richards
- Allied Health Research Unit, University of Central, Lancashire, UK
| | - Chris Sutton
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Bhaskar Basu
- University Hospital of South Manchester NHS Foundation Trust/ Central, Manchester University Hospitals NHS Foundation Trust, Rehabilitation Medicine, Manchester, UK
| | - Kerry Maguire
- Department of Osteopathy, The Good Health Centre, County Clare, Ireland
| | | | - Tarek Gaber
- Taylor Rehabilitation Unit leigh, Leigh Infirmary, Leigh, Greater Manchester, UK
| | - Annice Mukherjee
- Department of Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Raymond N Perrin
- Allied Health Research Unit, University of Central, Lancashire, UK
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