1
|
Rogers M, Sutton A, Campbell F, Whear R, Bethel A, Coon JT. Streamlining search methods to update evidence and gap maps: A case study using intergenerational interventions. Campbell Syst Rev 2024; 20:e1380. [PMID: 38188228 PMCID: PMC10771710 DOI: 10.1002/cl2.1380] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
Background Evidence and Gap Maps (EGMs) should be regularly updated. Running update searches to find new studies for EGMs can be a time-consuming process. Search Summary Tables (SSTs) can help streamline searches by identifying which resources were most lucrative for identifying relevant articles, and which were redundant. The aim of this study was to use an SST to streamline search methods for an EGM of studies about intergenerational activities. Methods To produce the EGM, 15 databases were searched. 8638 records were screened and 500 studies were included in the final EGM. Using an SST, we determined which databases and search methods were the most efficient in terms of sensitivity and specificity for finding the included studies. We also investigated whether any database performed particularly well for returning particular study types. For the best performing databases we analysed the search terms used to streamline the strategies. Results No single database returned all of the studies included in the EGM. Out of 500 studies PsycINFO returned 40% (n = 202), CINAHL 39% (n = 194), Ageline 25% (n = 174), MEDLINE 23% (n = 117), ERIC 20% (n = 100) and Embase 19% (n = 98). HMIC database and Conference Proceedings Citation Index-Science via Web of Science returned no studies that were included in the EGM. ProQuest Dissertations & Theses (PQDT) returned the highest number of unique studies (n = 42), followed by ERIC (n = 33) and Ageline (n = 29). Ageline returned the most randomised controlled trials (42%) followed by CINAHL (34%), MEDLINE (29%) and CENTRAL (29%). CINAHL, Ageline, MEDLINE and PsycINFO performed the best for locating systematic reviews. (62%, 46% and 42% respectively). CINAHL, PsycINFO and Ageline performed best for qualitative studies (41%, 40% and 34%). The Journal of Intergenerational Relationships returned more included studies than any other journal (16%). No combinations of search terms were found to be better in terms of balancing specificity and sensitivity than the original search strategies. However, strategies could be reduced considerably in terms of length without losing key, unique studies. Conclusion Using SSTs we have developed a method for streamlining update searches for an EGM about intergenerational activities. For future updates we recommend that MEDLINE, PsycINFO, ERIC, Ageline, CINAHL and PQDT are searched. These searches should be supplemented by hand-searching the Journal of Intergenerational Relationships and carrying out backwards citation chasing on new systematic reviews. Using SSTs to analyse database efficiency could be a useful method to help streamline search updates for other EGMs.
Collapse
Affiliation(s)
- Morwenna Rogers
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Anthea Sutton
- SCHARR, University of Sheffield, Regent CourtSheffieldUK
| | - Fiona Campbell
- Population Health Sciences InstituteNewcastle UniversityNewcastleUK
| | - Rebecca Whear
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Alison Bethel
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Jo Thompson Coon
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| |
Collapse
|
2
|
Eke H, Ball S, Allinson A, Anderson R, Hunt H, Hutton E, Lindsay C, Logan S, Madden N, Melluish J, Richardson D, Rogers J, Thompson Coon J, Whear R, Wright A, Morris C. Interventions to improve continence for children and young people with neurodisability: a national survey of practitioner and family perspectives and experiences. BMJ Paediatr Open 2024; 8:e002238. [PMID: 38242630 PMCID: PMC10806478 DOI: 10.1136/bmjpo-2023-002238] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/23/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Describe families' experiences of interventions to improve continence in children and young people with neurodisability, and health professionals' and school and social care staff's perspectives regarding factors affecting intervention use. DESIGN Four online surveys were developed and advertised to parent carers, young people with neurodisability, health professionals and school and social care staff, via societies, charities, professional contacts, schools, local authorities, and national parent carer and family forums, who shared invitations with their networks. Survey questions explored: difficulties helping children and young people use interventions; acceptability of interventions and waiting times; ease of use and availability of interventions, and facilitators and barriers to improving continence. RESULTS 1028 parent carers, 26 young people, 352 health professionals and 202 school and social care staff registered to participate. Completed surveys were received from 579 (56.3%) parent carers, 20 (77%) young people, 193 (54.8%) health professionals, and 119 (58.9%) school and social care staff. Common parent carer-reported difficulties in using interventions to help their children and young people to learn to use the toilet included their child's lack of understanding about what was required (reported by 337 of 556 (60.6%) parent carers who completed question) and their child's lack of willingness (343 of 556, 61.7%). Almost all (142 of 156, 91%) health professionals reported lack of funding and resources as barriers to provision of continence services. Many young people (14 of 19, 74%) were unhappy using toilet facilities while out and about. CONCLUSIONS Perceptions that children lack understanding and willingness, and inadequate facilities impact the implementation of toileting interventions for children and young people with neurodisability. Greater understanding is needed for children to learn developmentally appropriate toileting skills. Further research is recommended around availability and acceptability of interventions to ensure quality of life is unaffected.
Collapse
Affiliation(s)
- Helen Eke
- Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Susan Ball
- Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Annette Allinson
- Peninsula Childhood Disability Research Unit, University of Exeter, Exeter, UK
| | - Rob Anderson
- Medical School, University of Exeter, Exeter, UK
| | - Harriet Hunt
- Medical School, University of Exeter, Exeter, UK
| | - Eve Hutton
- Canterbury Christ Church University, Canterbury, UK
| | | | - Stuart Logan
- Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Nicholas Madden
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julia Melluish
- Peninsula Childhood Disability Research Unit, University of Exeter, Exeter, UK
| | | | | | - Jo Thompson Coon
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Rebecca Whear
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Anne Wright
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Christopher Morris
- Medical School, University of Exeter, Exeter, UK
- Peninsula Childhood Disability Research Unit, University of Exeter, Exeter, UK
| |
Collapse
|
3
|
Whear R, Campbell F, Rogers M, Sutton A, Robinson‐Carter E, Sharpe R, Cohen S, Fergy R, Garside R, Kneale D, Melendez‐Torres GJ, Thompson‐Coon J. What is the effect of intergenerational activities on the wellbeing and mental health of older people?: A systematic review. Campbell Syst Rev 2023; 19:e1355. [PMID: 37795424 PMCID: PMC10546258 DOI: 10.1002/cl2.1355] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Opportunities for social connection between generations have diminished over the last few decades around the world as a result of changes in the way that we live and work. The COVID-19 pandemic has exacerbated loneliness for many with young and old being kept apart for safety. The Public Health England prevention concordat for better mental health (Office for Health Improvement and Disparities) aims to bring a prevention-focused approach to improving public mental health. The concordat promotes evidence-based planning and commissioning to increase the impact on reducing health inequalities using sustainable and cost-effective interventions that impact on the wider determinants of mental health and wellbeing for children and young people and older people. Intergenerational activities could provide an opportunity to support both populations. In 2023, we produced an evidence and gap map to illustrate the amount and variety of research on intergenerational interventions and the gaps in research that still exist in this area. The review conducted here is based on the evidence in that map. Objectives This systematic review examines the impact of intergenerational interventions on the wellbeing and mental health of older people and identifies areas for future research as well as key messages for service commissioners. Search Methods We searched an evidence and gap map published in 2022 (comprehensive searches conducted July 2021 and updated June 2023) to identify randomised controlled trials of intergenerational interventions that report mental health and wellbeing outcomes for older people. Selection Criteria Randomised controlled trials of intergenerational interventions that involved unrelated younger and older people with at least one skipped generation between them and reported mental health or wellbeing outcomes for older people were included in this review. Data Collection and Analysis We used standard methodological procedures expected by The Campbell Collaboration. We conducted data extraction and Cochrane risk of bias assessments in EPPI reviewer. Where data allowed meta-analyses were conducted in STATA. Main Results This review includes 14 trials from six different countries. The trials had some important methodological weaknesses. Interventions were mainly delivered in-person and often in groups. They included visiting programmes, school volunteering programmes, music-based interventions and task-oriented interventions such as activities set in a multigenerational park, reminiscing activities, aggression management programmes, learning a language, making local environmental changes and in-school project work. Intergenerational interventions showed a small positive trend towards improving self-esteem (effect size [ES]: 0.33, 95% confidence interval [CI]: -0.35, 1.01) and depression (ES: 0.19, 95% CI: -0.23, 0.60) for older people participating. However, due to the small study sizes and low number of studies available, we cannot be confident about any effects. The results for other mental health and wellbeing outcomes are reported but due to little overlap in similar assessments across the studies, we could not combine them to assess the strength of evidence. There were no data about social isolation, spiritual health or sense of community. There are no long-term studies and no data on equity. We still know very little about what works and how or why. Whilst some interventions do use theories and logic to inform their development others do not. More exploration of this is needed. Authors’ Conclusions Commissioners and intervention developers should ensure interventions provide sufficient theoretical evidence for the logic behind the proposed intervention and should improve their consideration of equity within the interventions Research on intergenerational interventions need more consistent and agreed measures for reporting outcomes including community outcomes (core outcome sets). More understanding is needed on how best to measure 'community' outcomes. Research on intergenerational interventions should measure outcomes for BOTH the older and younger population engaged in the intervention-these may or may not be the same outcomes reflected in both populations. Further research is needed on the long-term impact of interventions on outcomes (whether participants need to keep being involved in an 'intervention' to continue to benefit) and sustainability of interventions beyond the initial funding of the research project. Supporting this our stakeholders highlighted that interventions that are initiated for research and then end (usually within a year) are not helpful.
Collapse
Affiliation(s)
- Rebecca Whear
- NIHR ARC South West Peninsula (PenARC) University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Fiona Campbell
- School of Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Morwenna Rogers
- NIHR ARC South West Peninsula (PenARC) University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Anthea Sutton
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | - Richard Sharpe
- Public HealthCornwall Council & University of Exeter Medical SchoolSt. AustellUK
| | - Stuart Cohen
- NHS Kernow Clinical Commissioning GroupSt. AustellUK
| | | | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical SchoolUniversity of ExeterTruroUK
| | - Dylan Kneale
- EPPI‐Centre, Social Science Research UnitUniversity College LondonLondonUK
| | | | - Joanna Thompson‐Coon
- NIHR ARC South West Peninsula (PenARC) University of Exeter Medical SchoolUniversity of ExeterExeterUK
| |
Collapse
|
4
|
Campbell F, Whear R, Rogers M, Sutton A, Barlow J, Booth A, Tattersall A, Wolstenholme L, Thompson‐Coon J. PROTOCOL: What is the effect of intergenerational activities on the wellbeing and mental health of children and young people? Campbell Syst Rev 2023; 19:e1347. [PMID: 37475878 PMCID: PMC10354504 DOI: 10.1002/cl2.1347] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: this systematic review will examine the impact of intergenerational interventions on the wellbeing and mental health in children and young people and will identify areas for future research as well as key messages for service commissioners.
Collapse
Affiliation(s)
- Fiona Campbell
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUnited KingdomUK
| | - Rebecca Whear
- NIHR CLAHRC South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolExeterUK
| | - Morwenna Rogers
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical School, University of ExeterExeterUK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUnited KingdomUK
| | - Jane Barlow
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Andrew Booth
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUnited KingdomUK
| | - Andrew Tattersall
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUnited KingdomUK
| | | | | |
Collapse
|
5
|
Abbott R, Thompson Coon J, Bethel A, Rogers M, Whear R, Orr N, Garside R, Goodwin V, Mahmoud A, Lourida I, Cheeseman D. PROTOCOL: Health and social care interventions in the 80 years old and over population: An evidence and gap map. Campbell Syst Rev 2023; 19:e1326. [PMID: 37180568 PMCID: PMC10168690 DOI: 10.1002/cl2.1326] [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] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: identify available systematic reviews and randomised controlled trials on interventions targeting health or social needs of the people aged over 80; identify qualitative studies relating to the experiences of people aged over 80 of interventions that target their health or social needs; identify areas where systematic reviews are needed; identify gaps in evidence where further primary research is needed; assess equity considerations (using the PROGRESS plus criteria) in available systematic reviews, randomised trials and qualitative studies of identified interventions; assess gaps and evidence related to health equity.
Collapse
Affiliation(s)
- Rebecca Abbott
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Jo Thompson Coon
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Alison Bethel
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Morwenna Rogers
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Rebecca Whear
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Noreen Orr
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Ruth Garside
- Knowledge Spa, Royal Cornwall HospitalUniversity of Exeter Medical SchoolTruroUK
| | - Victoria Goodwin
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Aseel Mahmoud
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Ilianna Lourida
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Debbie Cheeseman
- Royal Devon and Exeter NHS TrustRoyal Devon & Exeter HospitalExeterUK
| |
Collapse
|
6
|
Whear R, Campbell F, Rogers M, Sutton A, Robinson‐Carter E, Sharpe R, Cohen S, Fergy R, Garside R, Kneale D, Melendez‐Torres GJ, Thompson‐Coon J. PROTOCOL: What is the effect of intergenerational activities on the wellbeing and mental health of older people? Campbell Syst Rev 2023; 19:e1325. [PMID: 37131457 PMCID: PMC10084745 DOI: 10.1002/cl2.1325] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: This systematic review will examine the impact of intergenerational interventions on the mental health and wellbeing of older people and will identify areas for future research as well as key messages for service commissioners.
Collapse
Affiliation(s)
- Rebecca Whear
- NIHR CLAHRC South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolExeterUK
| | - Fiona Campbell
- School of Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Morwenna Rogers
- NIHR ARC South West Peninsula (PenARC) University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Anthea Sutton
- School of Health and Related ResearchThe University of SheffieldSheffieldUK
| | | | - Richard Sharpe
- Public Health, Cornwall Council & University of Exeter Medical SchoolSt. AustellUK
| | - Stuart Cohen
- NHS Kernow Clinical Commissioning GroupSt. AustellUK
| | | | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical SchoolUniversity of ExeterTruroUK
| | - Dylan Kneale
- Social Science Research Unit, EPPI‐Centre, UCL Institute of EducationUniversity College LondonLondonUK
| | | | - Joanna Thompson‐Coon
- NIHR CLAHRC South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolExeterUK
- NIHR ARC South West Peninsula (PenARC) University of Exeter Medical SchoolUniversity of ExeterExeterUK
| |
Collapse
|
7
|
Orr N, Abbott R, Bethel A, Paviour S, Whear R, Garside R, Coon JT. What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence. BMC Geriatr 2023; 23:170. [PMID: 36964508 PMCID: PMC10038779 DOI: 10.1186/s12877-023-03834-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/16/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND There is some evidence to suggest that animal-assisted interventions can have beneficial impact for residents in long-term care, but the focus of the evidence has largely been on behavioural and psychosocial measured outcomes. Animals, either as companion animals or in the form of pet/animal-assisted therapy, may provide benefits in the form of social contact, as well as opportunities for sensory experiences and meaningful engagement not picked up by outcome tools. This review aimed to create a state-of-knowledge synthesis, bringing together qualitative and quantitative findings, on the impact of animal-human interaction on care home residents and care home staff. METHODS Fourteen databases were searched from inception to July 2020. Forward and backward citation chasing of included articles was conducted. Screening was undertaken independently by a team of reviewers. Thematic synthesis and meta-analysis were used to synthesise the qualitative and quantitative data. RESULTS Thirty-four studies, published in 40 articles (20 qualitative and 20 quantitative) were included. Five themes relating to resident wellbeing were identified in the qualitative evidence synthesis. These were animals as 'living beings', reminiscence and storytelling, caring (as 'doing' and 'feeling'), respite (from loneliness, institutionalisation, and illness), and sensory engagement. A sixth theme related to staff perceptions and wellbeing, and a seventh to animal health and wellbeing. Maintaining identity was identified as an overarching theme. The majority of randomised trials had small sample sizes and were rated as low quality, mostly showing no evidence of beneficial effect. There was, however, limited evidence of a positive effect of pet/animal interaction on outcomes of loneliness, anxiety and depression, supporting the themes of respite and sensory engagement. CONCLUSIONS The presence of animals can significantly impact the health and wellbeing of some care home residents. Residents had meaningful relationships with animals and derived pleasure and comfort from them. Interacting with animals offered residents a way to maintain a sense of self in the care homes, and with support, residents with dementia could also express their identities. Facilitating residents to interact with animals as part of person-centred care may also help residents to feel 'at home' in the care home. TRIAL REGISTRATION PROSPERO registration no: CRD42017058201.
Collapse
Affiliation(s)
- Noreen Orr
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK.
| | - Rebecca Abbott
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK
| | - Alison Bethel
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK
| | - Sarah Paviour
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical School, Royal Cornwall Hospital, Knowledge Spa, Truro, Cornwall, TR1 3HD, UK
| | - Joanna Thompson Coon
- NIHR ARC South West Peninsula (PenARC), College of Medicine & Health, Evidence Synthesis Team, University of Exeter, South Cloisters, St. Luke's Campus, Exeter, EX1 2LU, Devon, UK
| |
Collapse
|
8
|
Campbell F, Whear R, Rogers M, Sutton A, Robinson‐Carter E, Barlow J, Sharpe R, Cohen S, Wolstenholme L, Thompson‐Coon J. Non-familial intergenerational interventions and their impact on social and mental wellbeing of both younger and older people-A mapping review and evidence and gap map. Campbell Syst Rev 2023; 19:e1306. [PMID: 36913218 PMCID: PMC9934919 DOI: 10.1002/cl2.1306] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Opportunities for social connection between generations in the UK have diminished over the last few decades because of changes in the way that we live and work. The decline in communal spaces such as libraries, youth clubs and community centres mean that there are fewer opportunities to meet and mix socially with other generations outside our own families. Increased working hours, improved technology, changes in family patterns, relationship breakdowns within families and migration are also believed to be contributory factors to generation segregation. There are many potential economic, social and political impacts of generations living separate and parallel lives, for example, higher health and social care costs, an undermining of trust between generations reduced social capital, a reliance on the media to form understanding of others' viewpoints and higher levels of anxiety and loneliness. Intergenerational programmes and activities can take many forms and are delivered in many settings. Evidence suggests that intergenerational activity can have a positive impact on participants, for example, in reducing loneliness and exclusion for both older people and children and young people, improving mental health, increasing mutual understanding and addressing important issues such as ageism, housing and care. There are currently no other EGMs that exist that address this type of intervention; however, it would complement existing EGMs addressing child welfare. OBJECTIVES To identify, appraise and bring together the evidence on the use of intergenerational practice, to answer the following specific research questions: What is the volume, nature and diversity of research on, and evaluation of, intergenerational practice and learning?What approaches have been used to deliver intergenerational activities and programmes that may be relevant to providing such services during and in the subsequent recovery from the COVID-19 pandemic?What promising intergenerational activities and programmes have been developed and are being used but have not yet been subject to formal evaluation? SEARCH METHODS We searched MEDLINE (via OvidSp), EMBASE (via OvidSp), PsycINFO (via OvidSp), CINAHL (via EBSCOHost), Social Policy and Practice (via OvidSp), Health Management Information Consortium (via OvidSp), Ageline (via EBSCOhost), ASSIA (via ProQuest), Social Science Citations Index (via Web of Science), ERIC (via EBSCOhost), Community Care Inform Children, Research in Practice for Children, ChildData (via Social Policy and Practice), the Campbell Library, the Cochrane Database of Systematic Reviews and the CENTRAL database between 22 and 30 July 2021. We searched for additional grey literature via the Conference Proceedings Citation Index (via Web of Science) and ProQuest Dissertation & Theses Global and via relevant organisation websites, for example, Age UK, Age International, the Centre for Ageing Better, Barnado's, Children's Commission, UNICEF, Generations Working Together, the Intergenerational Foundation, Linking Generations and The Beth Johnson Foundation) and the Ottawa initiative called Older Adults and Students for Intergenerational support. SELECTION CRITERIA Any intervention that brings older and younger people together with the purpose of interacting to achieve positive health and/or social and/or educational outcomes from any study design including systematic reviews, randomised controlled studies, observational studies, surveys and qualitative studies are included. The titles and abstracts, and later full texts, of records identified by the search methods were screened against inclusion criteria by two independent reviewers. DATA COLLECTION AND ANALYSIS Data extraction was undertaken by one reviewer and checked by a second with any inconsistencies identified and resolved through discussion. The data extraction tool was developed on EPPI reviewer and was modified and tested through stakeholder and advisor consultation, and piloting of the process. The tool was informed by the research question and the structure of the map. We did not undertake quality appraisal of the included studies. MAIN RESULTS Our searches identified 12,056 references, after screening 500 research articles were included in the evidence gap map conducted across 27 countries. We identified 26 systematic reviews, 236 quantitative comparative studies (of which 38 were randomised controlled trials), 227 were qualitative studies (or had a qualitative element), 105 were observational studies (or had elements of observational methods) and 82 used a mixed methods approach. The outcomes reported in the research cover mental health (n = 73), physical health (n = 62), attainment and knowledge (n = 165), agency (n = 174), mental wellbeing (n = 224), loneliness and social isolation (n = 54), attitudes towards the other generation (n = 283), intergenerational interactions (n = 196), peer interactions (n = 30) and health promotion (n = 23) and including mutual outcomes such as the impact on community (n = 37) and perceptions on the sense of community (n = 43). Gaps in the evidence that were identified include: research that reports on mutual, societal and community outcomes of intergenerational interventions; more research on interventions classified as levels 1-4 and level 7 on the Intergenerational Engagement Scale, mental health, loneliness, social isolation, peer interactions, physical health and health promotion outcomes in children and young people; health promotion in older people; outcomes centred on care giver wellbeing, mental health and attitudes; economic outcomes; process outcomes and adverse or unexpected outcomes. AUTHORS’ CONCLUSIONS Whilst a substantional amount of research on intergenerational interventions has been identified in this EGM, as well as the gaps identified above, there is a need to explore promising interventions not yet formally evaluated. Research on this topic is gradually increasing, and systematic reviews will be important to determine how and why interventions are or are not beneficial. However, the primary research needs to build more cohesively so that the findings can be comparable and avoid research waste. The EGM presented here will nevertheless be a useful resource for decision-makers allowing them to explore the evidence with regard to the different interventions that may be relevant to their population needs and the settings or resources available to them.
Collapse
Affiliation(s)
- Fiona Campbell
- Evidence Synthesis Group Population Health Sciences Institute Newcastle UniversityNewcastleUK
| | - Rebecca Whear
- NIHR CLAHRC South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolExeterUK
| | - Morwenna Rogers
- NIHR PenCLAHRC, Institute of Health ResearchUniversity of Exeter Medical SchoolExeterUK
| | - Anthea Sutton
- Health Economics and Decision Science, ScHARRUniversity of SheffieldSheffieldUK
| | | | - Jane Barlow
- Department of Social Policy and InterventionUniversity of OxfordCoventryUK
| | - Richard Sharpe
- Public Health, Cornwall CouncilUniversity of Exeter Medical SchoolSt. AustellUK
| | - Stuart Cohen
- NHS Kernow Clinical Commissioning GroupSt. AustellUK
| | | | - Joanna Thompson‐Coon
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| |
Collapse
|
9
|
Sugg HVR, Richards DA, Russell AM, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Iles-Smith H, Kent M, Logan PA, Morgan LM, Morley N, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Nurses' strategies for overcoming barriers to fundamental nursing care in patients with COVID-19 caused by infection with the SARS-COV-2 virus: Results from the 'COVID-NURSE' survey. J Adv Nurs 2023; 79:1003-1017. [PMID: 35467757 PMCID: PMC9111453 DOI: 10.1111/jan.15261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS To identify strategies used by registered nurses and non-registered nursing care staff in overcoming barriers when providing fundamental nursing care for non-invasively ventilated inpatients with COVID-19. DESIGN Online survey with open-ended questions to collect qualitative data. METHODS In August 2020, we asked UK-based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non-invasively ventilated patients with COVID-19. We analysed data using Framework Analysis. RESULTS A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non-verbal communication with patients, using information technology to enable patients' significant others to communicate with staff and patients, and establishing clear information-sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self-care and using 'runners' and interdisciplinary input. 3) Addressing patients' well-being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients' wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks. CONCLUSIONS Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well-being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing. IMPACT As these strategies are unlikely to be exclusive to the COVID-19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.
Collapse
Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, Exeter, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Sarah Burnett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, Exeter, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Salford, UK.,Northern Care Alliance NHS Group, Salford, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical centre, Nottingham, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Maggie H Shepherd
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
10
|
Whear R, Bethel A, Abbott R, Rogers M, Orr N, Manzi S, Ukoumunne OC, Stein K, Coon JT. Systematic reviews of convalescent plasma in COVID-19 continue to be poorly conducted and reported: a systematic review. J Clin Epidemiol 2022; 151:53-64. [PMID: 35934268 PMCID: PMC9351208 DOI: 10.1016/j.jclinepi.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/18/2022] [Accepted: 07/07/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To suggest possible approaches to combatting the impact of the COVID-19 infodemic to prevent research waste in future health emergencies and in everyday research and practice. STUDY DESIGN AND SETTING Systematic review. The Epistemonikos database was searched in June 2021 for systematic reviews on the effectiveness of convalescent plasma for COVID-19. Two reviewers independently screened the retrieved references with disagreements resolved by discussion. Data extraction was completed by one reviewer with a proportion checked by a second. We used the Assessment of Multiple Systematic Reviews to assess the quality of conduct and reporting of included reviews. RESULTS Fifty one systematic reviews are included with 193 individual studies included within the systematic reviews. There was considerable duplication of effort; multiple reviews were conducted at the same time with inconsistencies in the evidence included. The reviews were of low methodological quality, poorly reported, and did not adhere to preferred reporting items for systematic reviews and meta-analysis guidance. CONCLUSION Researchers need to conduct, appraise, interpret, and disseminate systematic reviews better. All in the research community (researchers, peer-reviewers, journal editors, funders, decision makers, clinicians, journalists, and the public) need to work together to facilitate the conduct of robust systematic reviews that are published and communicated in a timely manner, reducing research duplication and waste, increasing transparency and accessibility of all systematic reviews.
Collapse
Affiliation(s)
- Rebecca Whear
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK,Corresponding author. St Lukes Campus, University of Exeter, 3.09 South Cloisters, Heavitree Road, Exeter EX1 2LU. Tel.: +1392 726064
| | - Alison Bethel
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Rebecca Abbott
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Morwenna Rogers
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Noreen Orr
- Evidence Synthesis Team, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Sean Manzi
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Obioha C. Ukoumunne
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Ken Stein
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Jo Thompson Coon
- Evidence Synthesis Team, National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| |
Collapse
|
11
|
Abbott R, Bethel A, Rogers M, Whear R, Orr N, Shaw L, Stein K, Thompson Coon J. Characteristics, quality and volume of the first 5 months of the COVID-19 evidence synthesis infodemic: a meta-research study. BMJ Evid Based Med 2022; 27:169-177. [PMID: 34083212 PMCID: PMC9132873 DOI: 10.1136/bmjebm-2021-111710] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The academic and scientific community has reacted at pace to gather evidence to help and inform about COVID-19. Concerns have been raised about the quality of this evidence. The aim of this review was to map the nature, scope and quality of evidence syntheses on COVID-19 and to explore the relationship between review quality and the extent of researcher, policy and media interest. DESIGN AND SETTING A meta-research: systematic review of reviews. INFORMATION SOURCES PubMed, Epistemonikos COVID-19 evidence, the Cochrane Library of Systematic Reviews, the Cochrane COVID-19 Study Register, EMBASE, CINAHL, Web of Science Core Collection and the WHO COVID-19 database, searched between 10 June 2020 and 15 June 2020. ELIGIBILITY CRITERIA Any peer-reviewed article reported as a systematic review, rapid review, overview, meta-analysis or qualitative evidence synthesis in the title or abstract addressing a research question relating to COVID-19. Articles described as meta-analyses but not undertaken as part of a systematic or rapid review were excluded. STUDY SELECTION AND DATA EXTRACTION Abstract and full text screening were undertaken by two independent reviewers. Descriptive information on review type, purpose, population, size, citation and attention metrics were extracted along with whether the review met the definition of a systematic review according to six key methodological criteria. For those meeting all criteria, additional data on methods and publication metrics were extracted. RISK OF BIAS For articles meeting all six criteria required to meet the definition of a systematic review, AMSTAR-2 ((A MeaSurement Tool to Assess systematic Reviews, version 2.0) was used to assess the quality of the reported methods. RESULTS 2334 articles were screened, resulting in 280 reviews being included: 232 systematic reviews, 46 rapid reviews and 2 overviews. Less than half reported undertaking critical appraisal and a third had no reproducible search strategy. There was considerable overlap in topics, with discordant findings. Eighty-eight of the 280 reviews met all six systematic review criteria. Of these, just 3 were rated as of moderate or high quality on AMSTAR-2, with the majority having critical flaws: only a third reported registering a protocol, and less than one in five searched named COVID-19 databases. Review conduct and publication were rapid, with 52 of the 88 systematic reviews reported as being conducted within 3 weeks, and a half published within 3 weeks of submission. Researcher and media interest, as measured by altmetrics and citations, was high, and was not correlated with quality. DISCUSSION This meta-research of early published COVID-19 evidence syntheses found low-quality reviews being published at pace, often with short publication turnarounds. Despite being of low quality and many lacking robust methods, the reviews received substantial attention across both academic and public platforms, and the attention was not related to the quality of review methods. INTERPRETATION Flaws in systematic review methods limit the validity of a review and the generalisability of its findings. Yet, by being reported as 'systematic reviews', many readers may well regard them as high-quality evidence, irrespective of the actual methods undertaken. The challenge especially in times such as this pandemic is to provide indications of trustworthiness in evidence that is available in 'real time'. PROSPERO REGISTRATION NUMBER CRD42020188822.
Collapse
Affiliation(s)
- Rebecca Abbott
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Morwenna Rogers
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rebecca Whear
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Noreen Orr
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Liz Shaw
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ken Stein
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
12
|
Thompson‐Coon J, Campbell F, Sutton A, Whear R, Rogers M, Barlow J, Carter ER, Sharpe R, Cohen S, Wolstenholme L. PROTOCOL: Intergenerational interventions and their effect on social and mental wellbeing of both children and older people-A mapping review and evidence and gap map. Campbell Syst Rev 2022; 18:e1235. [PMID: 36911353 PMCID: PMC9107595 DOI: 10.1002/cl2.1235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: identify, appraise and bring together the evidence on the use of intergenerational practice.
Collapse
Affiliation(s)
- Joanna Thompson‐Coon
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Fiona Campbell
- School of Health and Related ResearchThe University of SheffieldSheffieldUK
| | | | - Rebecca Whear
- NIHR CLAHRC South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolExeterUK
| | - Morwenna Rogers
- NIHR PenCLAHRC, Institute of Health ResearchUniversity of Exeter Medical SchoolExeterUK
| | | | | | - Richard Sharpe
- Public Health, Cornwall Council & University of Exeter Medical SchoolSt. AustellUK
| | - Stuart Cohen
- NHS Kernow Clinical Commissioning GroupSt. AustellUK
| | | |
Collapse
|
13
|
Whear R, Abbott RA, Bethel A, Richards DA, Garside R, Cockcroft E, Iles‐Smith H, Logan PA, Rafferty AM, Shepherd M, Sugg HVR, Russell AM, Cruickshank S, Tooze S, Melendez‐Torres GJ, Thompson Coon J. Impact of COVID-19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: systematic review. J Adv Nurs 2022; 78:78-108. [PMID: 34554585 PMCID: PMC8657334 DOI: 10.1111/jan.15047] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/02/2021] [Accepted: 09/05/2021] [Indexed: 01/28/2023]
Abstract
AIM This systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care. DESIGN Systematic review. DATA SOURCES In July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID-19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards. REVIEW METHODS We included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID-19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non-professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person. RESULTS Of 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub-themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership. CONCLUSION To prepare for continuation of the COVID-19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence-based care to be provided in future. IMPACT Our review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.
Collapse
Affiliation(s)
- Rebecca Whear
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Rebecca A. Abbott
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Alison Bethel
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - David A. Richards
- College of Medicine and HealthUniversity of ExeterExeterUK
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Ruth Garside
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Emma Cockcroft
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Heather Iles‐Smith
- School of Health and SocietyUniversity of SalfordSalfordUK
- Northern Care Alliance NHS GroupSalfordUK
| | - Pip A. Logan
- School of MedicineUniversity of NottinghamQueens Medical CentreNottinghamUK
| | - Ann Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative CareKing’s College LondonLondonUK
| | - Maggie Shepherd
- NIHR Exeter Clinical Research FacilityRoyal Devon and Exeter NHS Foundation TrustExeterUK
- Institute of Biomedical and Clinical ScienceCollege of Medicine and HealthUniversity of ExeterExeterUK
| | | | | | | | - Susannah Tooze
- College of Medicine and HealthUniversity of ExeterExeterUK
| | | | - Jo Thompson Coon
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| |
Collapse
|
14
|
Eke H, Hunt H, Ball S, Rogers M, Whear R, Allinson A, Melluish J, Lindsay C, Richardson D, Rogers J, Hutton E, Madden N, Wright A, Anderson R, Logan S, Thompson Coon J, Morris C. Improving continence in children and young people with neurodisability: a systematic review and survey. Health Technol Assess 2021; 25:1-258. [PMID: 34866570 DOI: 10.3310/hta25730] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Children and young people with neurodisability often need help to achieve socially acceptable bladder and bowel control. Approaches vary depending on whether or not the impairment results from spinal cord pathology that impairs motor control and sensation of the bladder and bowel. Currently, there is uncertainty about which interventions are effective. OBJECTIVE The objective was to summarise the available evidence on and current practice for improving continence in children and young people with neurodisability. DESIGN A systematic review of the effectiveness, cost-effectiveness and factors that modify intervention implementation, alongside a cross-sectional, online survey of current practice with health professionals, parent carers, school and care staff and young people with neurodisability. RESULTS Twelve databases were searched in the review, resulting in 5756 references; 71 studies (72 papers) were included in the analyses. Most of the evidence was for children with spinal cord pathology, which involved evaluations of pharmacological approaches and surgical techniques, whereas the evidence pertaining to those with non-spinal-cord-related pathology tended to be for behavioural interventions. The methodological quality of studies was rated as being moderate to poor. There were three robust qualitative studies about the experience of continence among children with spinal cord pathology. We found substantial heterogeneity across the interventions that we evaluated in terms of quality, study design and outcomes measured. No economic studies were found. The results were synthesised narratively and reported in text and tables. We did not find any eligible studies evaluating interventions using toilet and clothing adaptations in the review, although the survey highlighted that these types of interventions are frequently used and considered. In total, 949 people responded to the survey: 202 health professionals, 605 parent carers, 122 school and social care staff, and 20 young people. The survey results illustrated the different roles that professionals have in improving continence, highlighting the importance of a multidisciplinary approach to supporting children and young people and their families. Clinicians employ a range of assessments and interventions to improve continence or independent toileting, depending on the needs of the child. LIMITATIONS Quantitative studies in the review were not methodologically robust. The survey had a risk of response bias. CONCLUSIONS Our research found a dearth of good-quality evidence for many of the interventions currently in use, and no evidence of experiences of implementing interventions for children with non-spinal-cord-related pathology. There was also no evidence of cost-effectiveness of any of the interventions. FUTURE WORK There is a need to involve young people and families in the design of high-quality evaluative research for interventions that aim to improve continence. This is especially the case for children with autism and learning disability, who have been neglected in previous evaluative and qualitative research. We recommend better training for health, education and care professionals about toileting, informed by evidence and the lived experiences of children and their families. We recommend a joined-up multidisciplinary and holistic approach to improving continence to maximise independence, dignity and comfort. It is vital that children and young people with neurodisability have early access to regular, integrated assessment of their bladder and bowel health, and are fully supported with appropriate personalised treatment. STUDY REGISTRATION This study is registered as PROSPERO CRD42018100572. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 73. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Helen Eke
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Harriet Hunt
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Susan Ball
- Health Statistics Group, University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Morwenna Rogers
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Rebecca Whear
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Annette Allinson
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Julia Melluish
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Claire Lindsay
- Paediatric Bladder and Bowel Care Team, Northern Devon Healthcare NHS Trust, Exeter, UK
| | | | - June Rogers
- Bladder & Bowel UK, Disabled Living, Manchester, UK
| | - Eve Hutton
- School of Allied Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Nicholas Madden
- Children's Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Anne Wright
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rob Anderson
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Stuart Logan
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Jo Thompson Coon
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Christopher Morris
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| |
Collapse
|
15
|
Sugg HVR, Russell AM, Morgan LM, Iles-Smith H, Richards DA, Morley N, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Kent M, Logan PA, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Fundamental nursing care in patients with the SARS-CoV-2 virus: results from the 'COVID-NURSE' mixed methods survey into nurses' experiences of missed care and barriers to care. BMC Nurs 2021; 20:215. [PMID: 34724949 PMCID: PMC8558545 DOI: 10.1186/s12912-021-00746-5] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Patient experience of nursing care is associated with safety, care quality, treatment outcomes, costs and service use. Effective nursing care includes meeting patients’ fundamental physical, relational and psychosocial needs, which may be compromised by the challenges of SARS-CoV-2. No evidence-based nursing guidelines exist for patients with SARS-CoV-2. We report work to develop such a guideline. Our aim was to identify views and experiences of nursing staff on necessary nursing care for inpatients with SARS-CoV-2 (not invasively ventilated) that is omitted or delayed (missed care) and any barriers to this care. Methods We conducted an online mixed methods survey structured according to the Fundamentals of Care Framework. We recruited a convenience sample of UK-based nursing staff who had nursed inpatients with SARS-CoV-2 not invasively ventilated. We asked respondents to rate how well they were able to meet the needs of SARS-CoV-2 patients, compared to non-SARS-CoV-2 patients, in 15 care categories; select from a list of barriers to care; and describe examples of missed care and barriers to care. We analysed quantitative data descriptively and qualitative data using Framework Analysis, integrating data in side-by-side comparison tables. Results Of 1062 respondents, the majority rated mobility, talking and listening, non-verbal communication, communicating with significant others, and emotional wellbeing as worse for patients with SARS-CoV-2. Eight barriers were ranked within the top five in at least one of the three care areas. These were (in rank order): wearing Personal Protective Equipment, the severity of patients’ conditions, inability to take items in and out of isolation rooms without donning and doffing Personal Protective Equipment, lack of time to spend with patients, lack of presence from specialised services e.g. physiotherapists, lack of knowledge about SARS-CoV-2, insufficient stock, and reluctance to spend time with patients for fear of catching SARS-CoV-2. Conclusions Our respondents identified nursing care areas likely to be missed for patients with SARS-CoV-2, and barriers to delivering care. We are currently evaluating a guideline of nursing strategies to address these barriers, which are unlikely to be exclusive to this pandemic or the environments represented by our respondents. Our results should, therefore, be incorporated into global pandemic planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00746-5.
Collapse
Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Allerton Building, Frederick Rd, Salford, M6 6PU, UK.,Northern Care Alliance NHS Group, Stott Lane, Salford, M6 8HD, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sarah Burnett
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, SE1 8WA, UK
| | - Maggie H Shepherd
- NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.,Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, University Road, Leicester, LE1 7RH, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| |
Collapse
|
16
|
Richards DA, Sugg HV, Cockcroft E, Cooper J, Cruickshank S, Doris F, Hulme C, Logan P, Iles-Smith H, Melendez-Torres GJ, Rafferty AM, Reed N, Russell AM, Shepherd M, Singh SJ, Thompson Coon J, Tooze S, Wootton S, Abbott R, Bethel A, Creanor S, Quinn L, Tripp H, Warren FC, Whear R, Bollen J, Hunt HA, Kent M, Morgan L, Morley N, Romanczuk L. COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus-protocol for a cluster randomised controlled trial. BMJ Open 2021; 11:e046436. [PMID: 34039574 PMCID: PMC8159671 DOI: 10.1136/bmjopen-2020-046436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 10/29/2020] [Accepted: 04/21/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Patient experience of nursing care is correlated with safety, clinical effectiveness, care quality, treatment outcomes and service use. Effective nursing care includes actions to develop nurse-patient relationships and deliver physical and psychosocial care to patients. The high risk of transmission of the SARS-CoV-2 virus compromises nursing care. No evidence-based nursing guidelines exist for patients infected with SARS-CoV-2, leading to potential variations in patient experience, outcomes, quality and costs. METHODS AND ANALYSIS: we aim to recruit 840 in-patient participants treated for infection with the SARS-CoV-2 virus from 14 UK hospitals, to a cluster randomised controlled trial, with embedded process and economic evaluations, of care as usual and a fundamental nursing care protocol addressing specific areas of physical, relational and psychosocial nursing care where potential variation may occur, compared with care as usual. Our coprimary outcomes are patient-reported experience (Quality from the Patients' Perspective; Relational Aspects of Care Questionnaire); secondary outcomes include care quality (pressure injuries, falls, medication errors); functional ability (Barthell Index); treatment outcomes (WHO Clinical Progression Scale); depression Patient Health Questionnaire-2 (PHQ-2), anxiety General Anxiety Disorder-2 (GAD-2), health utility (EQ5D) and nurse-reported outcomes (Measure of Moral Distress for Health Care Professionals). For our primary analysis, we will use a standard generalised linear mixed-effect model adjusting for ethnicity of the patient sample and research intensity at cluster level. We will also undertake a planned subgroup analysis to compare the impact of patient-level ethnicity on our primary and secondary outcomes and will undertake process and economic evaluations. ETHICS AND DISSEMINATION Research governance and ethical approvals are from the UK National Health Service Health Research Authority Research Ethics Service. Dissemination will be open access through peer-reviewed scientific journals, study website, press and online media, including free online training materials on the Open University's FutureLearn web platform. TRIAL REGISTRATION NUMBER ISRCTN13177364; Pre-results.
Collapse
Affiliation(s)
- David A Richards
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Holly Vr Sugg
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma Cockcroft
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Joanne Cooper
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Faye Doris
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Claire Hulme
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Phillipa Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | | | - G J Melendez-Torres
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Nigel Reed
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne-Marie Russell
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Maggie Shepherd
- NIHR Clinical Research Facility, University of Exeter, Exeter, UK
| | - Sally J Singh
- Cardiac/Pulmonary Rehabilitation, Leicester Royal Infirmary, Leicester, UK
| | - Jo Thompson Coon
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susannah Tooze
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Stephen Wootton
- Insitute of Human Nutrition, University of Southampton, Southampton, UK
| | - Rebecca Abbott
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Alison Bethel
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Lynne Quinn
- Clinical Trials Unit, University of Exeter, Exeter, UK
| | - Harry Tripp
- Clinical Trials Unit, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Harriet A Hunt
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Merryn Kent
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Leila Morgan
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Naomi Morley
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lidia Romanczuk
- NIHR Clinical Research Facility, University of Exeter, Exeter, UK
| |
Collapse
|
17
|
Whear R, Thompson‐Coon J, Rogers M, Abbott RA, Anderson L, Ukoumunne O, Matthews J, Goodwin VA, Briscoe S, Perry M, Stein K. Patient-initiated appointment systems for adults with chronic conditions in secondary care. Cochrane Database Syst Rev 2020; 4:CD010763. [PMID: 32271946 PMCID: PMC7144896 DOI: 10.1002/14651858.cd010763.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Missed hospital outpatient appointments is a commonly reported problem in healthcare services around the world; for example, they cost the National Health Service (NHS) in the UK millions of pounds every year and can cause operation and scheduling difficulties worldwide. In 2002, the World Health Organization (WHO) published a report highlighting the need for a model of care that more readily meets the needs of people with chronic conditions. Patient-initiated appointment systems may be able to meet this need at the same time as improving the efficiency of hospital appointments. OBJECTIVES To assess the effects of patient-initiated appointment systems compared with consultant-led appointment systems for people with chronic or recurrent conditions managed in secondary care. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and six other databases. We contacted authors of identified studies and conducted backwards and forwards citation searching. We searched for current/ongoing research in two trial registers. Searches were run on 13 March 2019. SELECTION CRITERIA We included randomised trials, published and unpublished in any language that compared the use of patient-initiated appointment systems to consultant-led appointment systems for adults with chronic or recurrent conditions managed in secondary care if they reported one or more of the following outcomes: physical measures of health status or disease activity (including harms), quality of life, service utilisation or cost, adverse effects, patient or clinician satisfaction, or failures of the 'system'. DATA COLLECTION AND ANALYSIS Two review authors independently screened all references at title/abstract stage and full-text stage using prespecified inclusion criteria. We resolved disagreements though discussion. Two review authors independently completed data extraction for all included studies. We discussed and resolved discrepancies with a third review author. Where needed, we contacted authors of included papers to provide more information. Two review authors independently assessed the risk of bias using the Cochrane Effective Practice and Organisation of Care 'Risk of bias' tool, resolving any discrepancies with a third review author. Two review authors independently assessed the certainty of the evidence using GRADE. MAIN RESULTS The 17 included randomised trials (3854 participants; mean age 41 to 76 years; follow-up 12 to 72 months) covered six broad health conditions: cancer, rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, psoriasis and inflammatory bowel disease. The certainty of the evidence using GRADE ratings was mainly low to very low. The results suggest that patient-initiated clinics may make little or no difference to anxiety (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.68 to 1.12; 5 studies, 1019 participants; low-certainty evidence) or depression (OR 0.79 95% CI 0.51 to 1.23; 6 studies, 1835 participants; low-certainty evidence) compared to the consultant-led appointment system. The results also suggest that patient-initiated clinics may make little or no difference to quality of life (standardised mean difference (SMD) 0.12, 95% CI 0.00 to 0.25; 7 studies, 1486 participants; low-certainty evidence) compared to the consultant-led appointment system. Results for service utilisation (contacts) suggest there may be little or no difference in service utilisation in terms of contacts between the patient-initiated and consultant-led appointment groups; however, the effect is not certain as the rate ratio ranged from 0.68 to 3.83 across the studies (median rate ratio 1.11, interquartile (IQR) 0.93 to 1.37; 15 studies, 3348 participants; low-certainty evidence). It is uncertain if service utilisation (costs) are reduced in the patient-initiated compared to the consultant-led appointment groups (8 studies, 2235 participants; very low-certainty evidence). The results suggest that adverse events such as relapses in some conditions (inflammatory bowel disease and cancer) may have little or no reduction in the patient-initiated appointment group in comparison with the consultant-led appointment group (MD -0.20, 95% CI -0.54 to 0.14; 3 studies, 888 participants; low-certainty evidence). The results are unclear about any differences the intervention may make to patient satisfaction (SMD 0.05, 95% CI -0.41 to 0.52; 2 studies, 375 participants) because the certainty of the evidence is low, as each study used different questions to collect their data at different time points and across different health conditions. Some areas of risk of bias across all the included studies was consistently high (i.e. for blinding of participants and personnel and blinding of outcome assessment, other areas were largely of low risk of bias or were affected by poor reporting making the assessment unclear). AUTHORS' CONCLUSIONS Patient-initiated appointment systems may have little or no effect on patient anxiety, depression and quality of life compared to consultant-led appointment systems. Other aspects of disease status and experience also appear to show little or no difference between patient-initiated and consultant-led appointment systems. Patient-initiated appointment systems may have little or no effect on service utilisation in terms of service contact and there is uncertainty about costs compared to consultant-led appointment systems. Patient-initiated appointment systems may have little or no effect on adverse events such as relapse or patient satisfaction compared to consultant-led appointment systems.
Collapse
Affiliation(s)
- Rebecca Whear
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusUniversity of ExeterExeterDevonUKEX1 2LU
| | - Joanna Thompson‐Coon
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusUniversity of ExeterExeterDevonUKEX1 2LU
| | - Morwenna Rogers
- University of Exeter Medical SchoolNIHR PenCLAHRC, Institute of Health ResearchExeterDevonUKEX1 2LU
| | - Rebecca A Abbott
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusUniversity of ExeterExeterDevonUKEX1 2LU
| | - Lindsey Anderson
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
| | - Obioha Ukoumunne
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusUniversity of ExeterExeterDevonUKEX1 2LU
| | - Justin Matthews
- University of Exeter Medical SchoolNIHR PenCLAHRC, Institute of Health ResearchExeterDevonUKEX1 2LU
| | - Victoria A Goodwin
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusUniversity of ExeterExeterDevonUKEX1 2LU
| | - Simon Briscoe
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusUniversity of ExeterExeterDevonUKEX1 2LU
| | - Mark Perry
- Derriford HospitalRheumatologyPlymouthDevonUKPL6 8DH
| | - Ken Stein
- University of Exeter Medical School, University of ExeterPeninsula Technology Assessment Group (PenTAG)Salmon Pool LaneExeterUKEX2 4SG
| | | |
Collapse
|
18
|
Abbott R, Orr N, McGill P, Whear R, Bethel A, Garside R, Stein K, Thompson‐Coon J. How do "robopets" impact the health and well-being of residents in care homes? A systematic review of qualitative and quantitative evidence. Int J Older People Nurs 2019; 14:e12239. [PMID: 31070870 PMCID: PMC6766882 DOI: 10.1111/opn.12239] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Robopets are small animal-like robots which have the appearance and behavioural characteristics of pets. OBJECTIVE To bring together the evidence of the experiences of staff, residents and family members of interacting with robopets and the effects of robopets on the health and well-being of older people living in care homes. DESIGN Systematic review of qualitative and quantitative research. DATA SOURCES We searched 13 electronic databases from inception to July 2018 and undertook forward and backward citation chasing. METHODS Eligible studies reported the views and experiences of robopets from residents, family members and staff (qualitative studies using recognised methods of qualitative data collection and analysis) and the effects of robopets on the health and well-being of care home residents (randomised controlled trials, randomised crossover trials and cluster randomised trials). Study selection was undertaken independently by two reviewers. We used the Wallace criteria and the Cochrane Risk of Bias tool to assess the quality of the evidence. We developed a logic model with stakeholders and used this as a framework to guide data extraction and synthesis. Where appropriate, we used meta-analysis to combine effect estimates from quantitative studies. RESULTS Nineteen studies (10 qualitative, 2 mixed methods and 7 randomised trials) met the inclusion criteria. Interactions with robopets were described as having a positive impact on aspects of well-being including loneliness, depression and quality of life by residents and staff, although there was no corresponding statistically significant evidence from meta-analysis for these outcomes. Meta-analysis showed evidence of a reduction in agitation with the robopet "Paro" compared to control (-0.32 [95% CI -0.61 to -0.04, p = 0.03]). Not everyone had a positive experience of robopets. CONCLUSIONS Engagement with robopets appears to have beneficial effects on the health and well-being of older adults living in care homes, but not all chose to engage. Whether the benefits can be sustained are yet to be investigated. IMPLICATIONS FOR PRACTICE Robopets have the potential to benefit people living in care homes, through increasing engagement and interaction. With the robopet acting as a catalyst, this engagement and interaction may afford comfort and help reduce agitation and loneliness.
Collapse
Affiliation(s)
- Rebecca Abbott
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Noreen Orr
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Paige McGill
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Rebecca Whear
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Alison Bethel
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Ruth Garside
- European Centre for Environment and Human HealthUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Ken Stein
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Jo Thompson‐Coon
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| |
Collapse
|
19
|
Hunt H, Abbott R, Boddy K, Whear R, Wakely L, Bethel A, Morris C, Prosser S, Collinson A, Kurinczuk J, Thompson-Coon J. “They’ve walked the walk”: A systematic review of quantitative and qualitative evidence for parent-to-parent support for parents of babies in neonatal care. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jnn.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
20
|
Thompson-Coon J, Abbott R, Orr N, McGill P, Whear R, Bethel A, Garside R, Stein K. 45HOW DO ‘ROBOPETS’ IMPACT THE HEALTH AND WELLBEING OF RESIDENTS IN CARE HOMES? A SYSTEMATIC REVIEW OF QUALITATIVE AND QUANTITATIVE EVIDENCE. Age Ageing 2019. [DOI: 10.1093/ageing/afz075.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Thompson-Coon
- NIHR Collaboration for Applied Health Research and Care (South West Peninsula)
| | - R Abbott
- NIHR Collaboration for Applied Health Research and Care (South West Peninsula)
| | - N Orr
- NIHR Collaboration for Applied Health Research and Care (South West Peninsula)
| | - P McGill
- University of Exeter, College of Medicine and Health
| | - R Whear
- NIHR Collaboration for Applied Health Research and Care (South West Peninsula)
| | - A Bethel
- NIHR Collaboration for Applied Health Research and Care (South West Peninsula)
| | - R Garside
- European Centre for Environment and Human Health, University of Exeter
| | - K Stein
- NIHR Collaboration for Applied Health Research and Care (South West Peninsula)
| |
Collapse
|
21
|
Hunt H, Whear R, Boddy K, Wakely L, Bethel A, Morris C, Abbott R, Prosser S, Collinson A, Kurinczuk J, Thompson-Coon J. Parent-to-parent support interventions for parents of babies cared for in a neonatal unit-protocol of a systematic review of qualitative and quantitative evidence. Syst Rev 2018; 7:179. [PMID: 30382886 PMCID: PMC6211448 DOI: 10.1186/s13643-018-0850-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents of babies admitted to neonatal units experience an arduous emotional journey. Feelings of helplessness, fear, sadness, guilt, grief and anger are common. These feelings can lead to anxiety, depression and post-traumatic stress which may persist long after discharge from the unit. Support from a parent with first-hand experience able to empathise with problems and challenges may help. This systematic review will identify quantitative and qualitative evidence to address the role of parent-to-parent support interventions for families of babies cared for in neonatal units, and combine the findings in an integrated synthesis. METHODS We are working in collaboration with a study-specific Parent Advisory Group (PAG) of parents who have relevant and varied lived experience of having a baby in neonatal care and those who have been involved in providing peer support. With the PAG, we will carry out a systematic review bringing together all existing research on parent-to-parent support for parents of babies cared for in neonatal units. This will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension (PRISMA-P). We have co-produced a plain language protocol summary with the PAG which details the different stages of the project, and this is available via our website ( http://clahrc-peninsula.nihr.ac.uk/research/parent-to-parent-support ) for anyone interested in learning more about the detail of the project. DISCUSSION All outputs will be available on the NIHR CLAHRC South West Peninsula (PenCLAHRC) website and promoted via PenCLAHRC networks as well as organisations that have been contacted throughout the project. PAG members will be involved in writing and reviewing the academic paper and final report and in co-producing dissemination products such as plain language summaries. The PAG will influence the main conclusions of the systematic review, aid interpretation and help to communicate results in the most appropriate ways. We will hold an impact conference with representatives from neonatal units, national neonatal networks, commissioners of services and parents to discuss what the findings mean for clinical practice and service provision. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018090569.
Collapse
Affiliation(s)
- Harriet Hunt
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 1TE, UK.
| | - Rebecca Whear
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 1TE, UK
| | - Kate Boddy
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 1TE, UK
| | - Leanna Wakely
- SNUG (Supporting Neonatal Users and Graduates) and Royal Devon & Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Alison Bethel
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 1TE, UK
| | - Christopher Morris
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 1TE, UK
| | - Rebecca Abbott
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 1TE, UK
| | - Susan Prosser
- Royal Devon & Exeter Neonatal Unit, Royal Devon & Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Andrew Collinson
- Paediatrics and Neonatology, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, TR1 3LJ, UK
| | - Jennifer Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Jo Thompson-Coon
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 1TE, UK
| |
Collapse
|
22
|
Abstract
BACKGROUND This is an update of the original Cochrane review, last published in 2009 (Huertas-Ceballos 2009). Recurrent abdominal pain (RAP), including children with irritable bowel syndrome, is a common problem affecting between 4% and 25% of school-aged children. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Many dietary inventions have been suggested to improve the symptoms of RAP. These may involve either excluding ingredients from the diet or adding supplements such as fibre or probiotics. OBJECTIVES To examine the effectiveness of dietary interventions in improving pain in children of school age with RAP. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE, Embase, eight other databases, and two trials registers, together with reference checking, citation searching and contact with study authors, in June 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing dietary interventions with placebo or no treatment in children aged five to 18 years with RAP or an abdominal pain-related, functional gastrointestinal disorder, as defined by the Rome III criteria (Rasquin 2006). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We grouped dietary interventions together by category for analysis. We contacted study authors to ask for missing information and clarification, when needed. We assessed the quality of the evidence for each outcome using the GRADE approach. MAIN RESULTS We included 19 RCTs, reported in 27 papers with a total of 1453 participants. Fifteen of these studies were not included in the previous review. All 19 RCTs had follow-up ranging from one to five months. Participants were aged between four and 18 years from eight different countries and were recruited largely from paediatric gastroenterology clinics. The mean age at recruitment ranged from 6.3 years to 13.1 years. Girls outnumbered boys in most trials. Fourteen trials recruited children with a diagnosis under the broad umbrella of RAP or functional gastrointestinal disorders; five trials specifically recruited only children with irritable bowel syndrome. The studies fell into four categories: trials of probiotic-based interventions (13 studies), trials of fibre-based interventions (four studies), trials of low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diets (one study), and trials of fructose-restricted diets (one study).We found that children treated with probiotics reported a greater reduction in pain frequency at zero to three months postintervention than those given placebo (standardised mean difference (SMD) -0.55, 95% confidence interval (CI) -0.98 to -0.12; 6 trials; 523 children). There was also a decrease in pain intensity in the intervention group at the same time point (SMD -0.50, 95% CI -0.85 to -0.15; 7 studies; 575 children). However, we judged the evidence for these outcomes to be of low quality using GRADE due to an unclear risk of bias from incomplete outcome data and significant heterogeneity.We found that children treated with probiotics were more likely to experience improvement in pain at zero to three months postintervention than those given placebo (odds ratio (OR) 1.63, 95% CI 1.07 to 2.47; 7 studies; 722 children). The estimated number needed to treat for an additional beneficial outcome (NNTB) was eight, meaning that eight children would need to receive probiotics for one to experience improvement in pain in this timescale. We judged the evidence for this outcome to be of moderate quality due to significant heterogeneity.Children with a symptom profile defined as irritable bowel syndrome treated with probiotics were more likely to experience improvement in pain at zero to three months postintervention than those given placebo (OR 3.01, 95% CI 1.77 to 5.13; 4 studies; 344 children). Children treated with probiotics were more likely to experience improvement in pain at three to six months postintervention compared to those receiving placebo (OR 1.94, 95% CI 1.10 to 3.43; 2 studies; 224 children). We judged the evidence for these two outcomes to be of moderate quality due to small numbers of participants included in the studies.We found that children treated with fibre-based interventions were not more likely to experience an improvement in pain at zero to three months postintervention than children given placebo (OR 1.83, 95% CI 0.92 to 3.65; 2 studies; 136 children). There was also no reduction in pain intensity compared to placebo at the same time point (SMD -1.24, 95% CI -3.41 to 0.94; 2 studies; 135 children). We judged the evidence for these outcomes to be of low quality due to an unclear risk of bias, imprecision, and significant heterogeneity.We found only one study of low FODMAP diets and only one trial of fructose-restricted diets, meaning no pooled analyses were possible.We were unable to perform any meta-analyses for the secondary outcomes of school performance, social or psychological functioning, or quality of daily life, as not enough studies included these outcomes or used comparable measures to assess them.With the exception of one study, all studies reported monitoring children for adverse events; no major adverse events were reported. AUTHORS' CONCLUSIONS Overall, we found moderate- to low-quality evidence suggesting that probiotics may be effective in improving pain in children with RAP. Clinicians may therefore consider probiotic interventions as part of a holistic management strategy. However, further trials are needed to examine longer-term outcomes and to improve confidence in estimating the size of the effect, as well as to determine the optimal strain and dosage. Future research should also explore the effectiveness of probiotics in children with different symptom profiles, such as those with irritable bowel syndrome.We found only a small number of trials of fibre-based interventions, with overall low-quality evidence for the outcomes. There was therefore no convincing evidence that fibre-based interventions improve pain in children with RAP. Further high-quality RCTs of fibre supplements involving larger numbers of participants are required. Future trials of low FODMAP diets and other dietary interventions are also required to facilitate evidence-based recommendations.
Collapse
Affiliation(s)
- Tamsin V Newlove‐Delgado
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Alice E Martin
- Royal Devon and Exeter HospitalPaediatricsBarrack RoadExeterEnglandUKEX2 5DW
| | - Rebecca A Abbott
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Alison Bethel
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Joanna Thompson‐Coon
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Rebecca Whear
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Stuart Logan
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | | |
Collapse
|
23
|
Martin AE, Newlove‐Delgado TV, Abbott RA, Bethel A, Thompson‐Coon J, Whear R, Logan S. Pharmacological interventions for recurrent abdominal pain in childhood. Cochrane Database Syst Rev 2017; 3:CD010973. [PMID: 28262913 PMCID: PMC6464549 DOI: 10.1002/14651858.cd010973.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 12/12/2022]
Abstract
BACKGROUND Between 4% and 25% of school-aged children at some stage complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with their daily lives. When no clear organic cause is found, the children are managed with reassurance and simple measures; a large range of pharmacological interventions have been recommended for use in these children. OBJECTIVES To determine the effectiveness of pharmacological interventions for RAP in children of school age. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and eight other electronic databases up to June 2016. We also searched two trials registers and contacted researchers of published studies. SELECTION CRITERIA Randomised controlled trials involving children aged five to 18 years old with RAP or an abdominal pain-related functional gastrointestinal disorder, as defined by the Rome III criteria (Rasquin 2006). The interventions were any pharmacological intervention compared to placebo, no treatment, waiting list, or standard care. The primary outcome measures were pain intensity, pain duration or pain frequency, and improvement in pain. The secondary outcome measures were school performance, social or psychological functioning, and quality of daily life. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts, and potentially relevant full-text reports for eligible studies. Two review authors extracted data and performed a 'Risk of bias' assessment. We used the GRADE approach to rate the overall quality of the evidence. We deemed a meta-analysis to be not appropriate as the studies were significantly heterogeneous. We have consequently provided a narrative summary of the results. MAIN RESULTS This review included 16 studies with a total of 1024 participants aged between five and 18 years, all of whom were recruited from paediatric outpatient clinics. Studies were conducted in seven countries: seven in the USA, four in Iran, and one each in the UK, Switzerland, Turkey, Sri Lanka, and India. Follow-up ranged from two weeks to four months. The studies examined the following interventions to treat RAP: tricyclic antidepressants, antibiotics, 5-HT4 receptor agonists, antispasmodics, antihistamines, H2 receptor antagonists, serotonin antagonists, selective serotonin re-uptake inhibitors, a dopamine receptor antagonist, and a hormone. Although some single studies reported that treatments were effective, all of these studies were either small or had key methodological weaknesses with a substantial risk of bias. None of these 'positive' results have been reproduced in subsequent studies. We judged the evidence of effectiveness to be of low quality. No adverse effects were reported in these studies. AUTHORS' CONCLUSIONS There is currently no convincing evidence to support the use of drugs to treat RAP in children. Well-conducted clinical trials are needed to evaluate any possible benefits and risks of pharmacological interventions. In practice, if a clinician chooses to use a drug as a 'therapeutic trial', they and the patient need to be aware that RAP is a fluctuating condition and any 'response' may reflect the natural history of the condition or a placebo effect, rather than drug efficacy.
Collapse
Affiliation(s)
- Alice E Martin
- Royal Devon and Exeter HospitalPaediatricsBarrack RoadExeterEnglandUKEX2 5DW
| | - Tamsin V Newlove‐Delgado
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Rebecca A Abbott
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Alison Bethel
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Joanna Thompson‐Coon
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Rebecca Whear
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | - Stuart Logan
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)St Luke's CampusExeterEnglandUKEX1 2LU
| | | |
Collapse
|
24
|
Abstract
BACKGROUND This review supersedes the original Cochrane review first published in 2008 (Huertas-Ceballos 2008).Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities. No organic cause for this pain can be found on physical examination or investigation for the majority of such children. Although many children are managed by reassurance and simple measures, a large range of psychosocial interventions involving cognitive and behavioural components have been recommended. OBJECTIVES To determine the effectiveness of psychosocial interventions for reducing pain in school-aged children with RAP. SEARCH METHODS In June 2016 we searched CENTRAL, MEDLINE, Embase, eight other databases, and two trials registers. We also searched the references of identified studies and relevant reviews. SELECTION CRITERIA Randomised controlled trials comparing psychosocial therapies with usual care, active control, or wait-list control for children and adolescents (aged 5 to 18 years) with RAP or an abdominal pain-related functional gastrointestinal disorder defined by the Rome III criteria were eligible for inclusion. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Five review authors independently selected studies, assessed them for risk of bias, and extracted relevant data. We also assessed the quality of the evidence using the GRADE approach. MAIN RESULTS This review includes 18 randomised controlled trials (14 new to this version), reported in 26 papers, involving 928 children and adolescents with RAP between the ages of 6 and 18 years. The interventions were classified into four types of psychosocial therapy: cognitive behavioural therapy (CBT), hypnotherapy (including guided imagery), yoga, and written self-disclosure. The studies were carried out in the USA, Australia, Canada, the Netherlands, Germany, and Brazil. The majority of the studies were small and short term; only two studies included more than 100 participants, and only five studies had follow-up assessments beyond six months. Small sample sizes and the degree of assessed risk of performance and detection bias in many studies led to the overall quality of the evidence being rated as low to very low for all outcomes.For CBT compared to control, we found evidence of treatment success postintervention (odds ratio (OR) 5.67, 95% confidence interval (CI) 1.18 to 27.32; Z = 2.16; P = 0.03; 4 studies; 175 children; very low-quality evidence), but no evidence of treatment success at medium-term follow-up (OR 3.08, 95% CI 0.93 to 10.16; Z = 1.85; P = 0.06; 3 studies; 139 children; low-quality evidence) or long-term follow-up (OR 1.29, 95% CI 0.50 to 3.33; Z = 0.53; P = 0.60; 2 studies; 120 children; low-quality evidence). We found no evidence of effects of intervention on pain intensity scores measured postintervention (standardised mean difference (SMD) -0.33, 95% CI -0.74 to 0.08; 7 studies; 405 children; low-quality evidence), or at medium-term follow-up (SMD -0.32, 95% CI -0.85 to 0.20; 4 studies; 301 children; low-quality evidence).For hypnotherapy (including studies of guided imagery) compared to control, we found evidence of greater treatment success postintervention (OR 6.78, 95% CI 2.41 to 19.07; Z = 3.63; P = 0.0003; 4 studies; 146 children; low-quality evidence) as well as reductions in pain intensity (SMD -1.01, 95% CI -1.41 to -0.61; Z = 4.97; P < 0.00001; 4 studies; 146 children; low-quality evidence) and pain frequency (SMD -1.28, 95% CI -1.84 to -0.72; Z = 4.48; P < 0.00001; 4 studies; 146 children; low-quality evidence). The only study of long-term effect reported continued benefit of hypnotherapy compared to usual care after five years, with 68% reporting treatment success compared to 20% of controls (P = 0.005).For yoga therapy compared to control, we found no evidence of effectiveness on pain intensity reduction postintervention (SMD -0.31, 95% CI -0.67 to 0.05; Z = 1.69; P = 0.09; 3 studies; 122 children; low-quality evidence).The single study of written self-disclosure therapy reported no benefit for pain.There was no evidence of effect from the pooled analyses for any type of intervention on the secondary outcomes of school performance, social or psychological functioning, and quality of daily life.There were no adverse effects for any of the interventions reported. AUTHORS' CONCLUSIONS The data from trials to date provide some evidence for beneficial effects of CBT and hypnotherapy in reducing pain in the short term in children and adolescents presenting with RAP. There was no evidence for the effectiveness of yoga therapy or written self-disclosure therapy. There were insufficient data to explore effects of treatment by RAP subtype.Higher-quality, longer-duration trials are needed to fully investigate the effectiveness of psychosocial interventions. Identifying the active components of the interventions and establishing whether benefits are sustained in the long term are areas of priority. Future research studies would benefit from employing active control groups to help minimise potential bias from wait-list control designs and to help account for therapist and intervention time.
Collapse
Affiliation(s)
- Rebecca A Abbott
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)South CloistersSt Luke's CampusExeterEnglandUKEX1 2LU
| | - Alice E Martin
- Royal Devon and Exeter HospitalPaediatricsBarrack RoadExeterEnglandUKEX2 5DW
| | - Tamsin V Newlove‐Delgado
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)South CloistersSt Luke's CampusExeterEnglandUKEX1 2LU
| | - Alison Bethel
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)South CloistersSt Luke's CampusExeterEnglandUKEX1 2LU
| | - Joanna Thompson‐Coon
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)South CloistersSt Luke's CampusExeterEnglandUKEX1 2LU
| | - Rebecca Whear
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)South CloistersSt Luke's CampusExeterEnglandUKEX1 2LU
| | - Stuart Logan
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)South CloistersSt Luke's CampusExeterEnglandUKEX1 2LU
| | | |
Collapse
|
25
|
Thompson Coon J, Abbott R, Coxon G, Day J, Lang I, Lourida I, Pearson M, Reed N, Rogers M, Stein K, Sugavanam P, Whear R. OP68 Implementing and disseminating best practice in the care home setting: A systematic scoping review. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
26
|
Richardson M, Moore DA, Gwernan-Jones R, Thompson-Coon J, Ukoumunne O, Rogers M, Whear R, Newlove-Delgado TV, Logan S, Morris C, Taylor E, Cooper P, Stein K, Garside R, Ford TJ. Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research. Health Technol Assess 2016; 19:1-470. [PMID: 26129788 DOI: 10.3310/hta19450] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by age-inappropriate levels of inattention, impulsivity and hyperactivity. School can be particularly challenging for children with ADHD. Few reviews have considered non-pharmacological interventions in school settings. OBJECTIVES To assess the effectiveness of non-pharmacological interventions delivered in school settings for pupils with, or at risk of, ADHD and to explore the factors that may enhance, or limit, their delivery. DATA SOURCES Twenty electronic databases (including PsycINFO, MEDLINE, EMBASE, Education Resources Information Centre, The Cochrane Library and Education Research Complete) were searched from 1980 to February-August 2013. Three separate searches were conducted for four systematic reviews; they were supplemented with forward and backwards citation chasing, website searching, author recommendations and hand-searches of key journals. REVIEW METHODS The systematic reviews focused on (1) the effectiveness of school-based interventions for children with or at risk of ADHD; (2) quantitative research that explores attitudes towards school-based non-pharmacological interventions for pupils with ADHD; (3) qualitative research investigating the attitudes and experiences of children, teachers, parents and others using ADHD interventions in school settings; and (4) qualitative research exploring the experience of ADHD in school among pupils, their parents and teachers more generally. Methods of synthesis included a random-effects meta-analysis, meta-regression and narrative synthesis for review 1, narrative synthesis for review 2 and meta-ethnography and thematic analysis for reviews 3 and 4. RESULTS For review 1, 54 controlled trials met the inclusion criteria. For the 36 meta-analysed randomised controlled trials, beneficial effects (p < 0.05) were observed for several symptom and scholastic outcomes. Mean weighted effect sizes ranged from very small (d + < 0.20) to large (d + ≥ 0.80), but substantial heterogeneity in effect size estimates across studies was reported. Moderator analyses were not able to clarify which intervention features were linked with effectiveness. For review 2, 28 included studies revealed that educators' attitudes towards interventions ranged in positivity. Most interventions were rated positively or neutrally across different studies. The only intervention that consistently recorded positive attitudes from educators was daily report cards. For review 3, 33 studies met the inclusion criteria. Key findings included tensions regarding the preferred format of interventions, particularly how structured interventions were and the extent to which they are tailored to the child with ADHD. There were mixed views about the impact of interventions, although it was clear that interventions both influence and are influenced by the relationships held by children with ADHD and participants' attitudes towards school and ADHD. For review 4, 34 studies met the inclusion criteria. Key findings included the importance of causal attributions that teachers, parents and pupils made about ADHD symptoms, the decisions teachers made about treatment, the self-perceptions pupils developed about themselves, the role of the classroom environment and stigma in aggravating ADHD symptoms, and the significant barrier to treatment posed by the common presence of conflict in relationships between pupils-teachers, parents-teachers and pupils-peers in relation to ADHD. An overarching synthesis of the four reviews highlighted the importance of the context affecting interventions. It suggested that ADHD psychoeducation and relationship-building skills are potential implications for interventions. LIMITATIONS The breadth of both interventions and outcomes in the reviewed studies presented a challenge for categorisation, analysis and interpretation in reviews 1-3. Across reviews, relatively few studies were conducted in the UK, limiting the applicability of findings to UK education. In reviews 1 and 2, the poor methodological quality of some included studies was identified as a barrier to establishing effectiveness or comparing attitudes. In review 3 the descriptive analysis used by the majority of studies constrained theorising during synthesis. Studies in review 4 lacked detail regarding important issues like gender, pupil maturity and school level. CONCLUSION Findings suggest some beneficial effects of non-pharmacological interventions for ADHD used in school settings, but substantial heterogeneity in effect sizes was seen across studies. The qualitative reviews demonstrate the importance of the context in which interventions are used. Future work should consider more rigorous evaluation of interventions, as well as focus on what works, for whom and in which contexts. Gaps in current research present opportunities for the development and testing of standardised tools to describe interventions, agreement on gold-standard outcome measures assessing ADHD behaviour and testing a range of potential moderators alongside intervention trials. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001716. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
| | - Darren A Moore
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Ruth Gwernan-Jones
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Jo Thompson-Coon
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Obioha Ukoumunne
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Rebecca Whear
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Tamsin V Newlove-Delgado
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Stuart Logan
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Christopher Morris
- Peninsula Cerebra Research Unit (PenCRU), University of Exeter Medical School, Exeter, UK
| | - Eric Taylor
- Institute of Psychiatry, King's College London, London, UK
| | - Paul Cooper
- Centre for Special Educational Needs and Inclusive Education (CSENIE), Hong Kong Institute of Education, Hong Kong, China
| | - Ken Stein
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- The European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Truro, UK
| | - Tamsin J Ford
- Child Health Group, University of Exeter Medical School, Exeter, UK
| |
Collapse
|
27
|
Abbott R, Whear R, Nikolaou V, Bethel A, Coon JT, Stein K, Dickens C. Tumour necrosis factor-α inhibitor therapy in chronic physical illness: A systematic review and meta-analysis of the effect on depression and anxiety. J Psychosom Res 2015; 79:175-84. [PMID: 25935351 DOI: 10.1016/j.jpsychores.2015.04.008] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [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] [Received: 01/23/2015] [Revised: 04/14/2015] [Accepted: 04/20/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Depression is more common among individuals with chronic physical illness than in the general population. New treatments for severe and chronic inflammatory conditions which inhibit tumour necrosis factor alpha (TNF-α), a pro-inflammatory cytokine, may be able to shed some light on the role of inflammatory mediators in depression. This systematic review and meta-analysis of randomised controlled trials determined the effects of TNF-α inhibitor therapy on depression and anxiety in people with chronic physical illness. METHODS Seven databases were searched from inception to January 2014: AMED, Central, Cochrane Database of Systematic Reviews, CINAHL, Embase, MEDLINE, and PsycINFO. Articles were screened for inclusion independently by two reviewers. Data extraction and appraisal were conducted by one reviewer and checked by a second. Random-effects meta-analyses were performed. RESULTS Six randomised controlled trials (reported in seven articles) met eligibility criteria and were included in the final review. In total 2540 participants were enrolled across the trials, with participants presenting with rheumatoid arthritis (n=3 trials), psoriasis (n=2) or ankylosing spondylitis (n=1). Meta-analyses, using standardised mean differences, showed evidence of small reductions in depression (-0.24; 95% CI -0.33 to -0.14; p<0.001), and anxiety (-0.17; 95% CI -0.31 to -0.02; p=0.02). CONCLUSION TNF-α inhibitor therapy reduces depression in people with chronic disease though the effects are small. Whilst this is consistent with inflammation contributing to the development of depression, further studies investigating a more detailed timeline of changes in depression, inflammatory biomarkers and disease activity status are required.
Collapse
Affiliation(s)
- Rebecca Abbott
- PenCLAHRC, University of Exeter Medical School, St. Luke's Campus, Exeter EX1 2LU, United Kingdom.
| | - Rebecca Whear
- PenCLAHRC, University of Exeter Medical School, St. Luke's Campus, Exeter EX1 2LU, United Kingdom
| | - Vasilis Nikolaou
- PenCLAHRC, University of Exeter Medical School, St. Luke's Campus, Exeter EX1 2LU, United Kingdom
| | - Alison Bethel
- PenCLAHRC, University of Exeter Medical School, St. Luke's Campus, Exeter EX1 2LU, United Kingdom
| | - Jo Thompson Coon
- PenCLAHRC, University of Exeter Medical School, St. Luke's Campus, Exeter EX1 2LU, United Kingdom
| | - Ken Stein
- PenCLAHRC, University of Exeter Medical School, St. Luke's Campus, Exeter EX1 2LU, United Kingdom
| | - Chris Dickens
- Mental Health Research Group, University of Exeter Medical School, St. Luke's Campus, Exeter EX1 2LU, United Kingdom
| |
Collapse
|
28
|
Whear R, Thompson‐Coon J, Boddy K, Papworth H, Frier J, Stein K. Establishing local priorities for a health research agenda. Health Expect 2015; 18:8-21. [PMID: 23216859 PMCID: PMC4864394 DOI: 10.1111/hex.12029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 11/28/2022] Open
Abstract
AIM/BACKGROUND To describe the two-stage prioritization process being used by the UK National Institute for Health Research's Collaboration for Leadership in Applied Health Research and Care for the South-West Peninsula (or PenCLAHRC) - a joint health service and university partnership and reflect on implications for the wider context of priority setting in health-care research. METHOD PenCLAHRC's process establishes the priorities of Stakeholders including service users across a regional health system for locally relevant health services research and implementation. Health research questions are collected from clinicians, academics and service users in Devon and Cornwall (UK) using a web-based question formulation tool. There is a two-stage prioritization process which uses explicit criteria and a wide Stakeholder group, including service users to identify important research questions relevant to the south-west peninsula locality. RESULTS To date, a wide variety of health research topics have been prioritized by the PenCLAHRC Stakeholders. The research agenda reflects the interests of academics, clinicians and service users in the local area. Potential challenges to implementation of the process include time constraints, variable quality of questions (including the language of research) and initiating and maintaining engagement in the process. Shared prioritization of local health research needs can be achieved between Stakeholders from a wide range of perspectives. CONCLUSIONS The processes developed have been successful and, with minor changes, will continue to be used during subsequent rounds of prioritization. Engagement of Stakeholders in establishing a research agenda encourages the most relevant health questions to be asked and may improve implementation of research findings and take up by service users.
Collapse
Affiliation(s)
- Rebecca Whear
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC)University of ExeterExeter
| | - Jo Thompson‐Coon
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC)University of ExeterExeter
| | - Kate Boddy
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC)University of ExeterExeter
| | - Helen Papworth
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC)University of ExeterExeter
| | - Julie Frier
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC)University of ExeterExeter
| | | |
Collapse
|
29
|
Parker C, Whear R, Ukoumunne OC, Bethel A, Thompson-Coon J, Stein K, Ford T. School exclusion in children with psychiatric disorder or impairing psychopathology: a systematic review. Emotional and Behavioural Difficulties 2014. [DOI: 10.1080/13632752.2014.945741] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
30
|
Whear R, Coon JT, Bethel A, Abbott R, Stein K, Garside R. What is the impact of using outdoor spaces such as gardens on the physical and mental well-being of those with dementia? A systematic review of quantitative and qualitative evidence. J Am Med Dir Assoc 2014; 15:697-705. [PMID: 25037168 DOI: 10.1016/j.jamda.2014.05.013] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [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: 04/07/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the impact of gardens and outdoor spaces on the mental and physical well-being of people with dementia who are resident in care homes and understand the views of people with dementia, their carers, and care home staff on the value of gardens and outdoor spaces. DESIGN Systematic review. METHODS Fourteen databases were searched from inception to February 2013. Forward and backward citation chasing of included articles was conducted; 38 relevant organizations were contacted to identify unpublished reports. Titles, abstracts, and full texts were screened independently by 2 reviewers in a 2-stage process and were discussed with a third reviewer where necessary. Results were synthesized narratively. RESULTS Seventeen studies were included: 9 quantitative, 7 qualitative, and 1 mixed methods. The quantitative studies were of poor quality but suggested decreased levels of agitation were associated with garden use. The views and experiences of the garden are discussed in relation to themes of how the garden was used, nature of interactions, impact/effect of the gardens, mechanisms/how the garden was thought to have an effect, and negatives (such as perception of the garden as a hazard and the limited staff time). CONCLUSION There are promising impacts on levels of agitation in care home residents with dementia who spend time in a garden. Future research would benefit from a focus on key outcomes measured in comparable ways with a separate focus on what lies behind limited accessibility to gardens within the residential care setting.
Collapse
Affiliation(s)
- Rebecca Whear
- Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - Jo Thompson Coon
- Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rebecca Abbott
- Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ken Stein
- Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruth Garside
- European Centre for the Environment and Human Health and PenCLAHRC, University of Exeter Medical School, University of Exeter, Knowledge Spa, Truro, UK
| |
Collapse
|
31
|
Lang I, Rogers M, Abbott R, Whear R, Pearson S, Cartmell N, Thompson‐Coon J, Stein K. P3‐290: HOW CAN WE REDUCE INAPPROPRIATE PRESCRIBING OF ANTIPSYCHOTIC MEDICATIONS FOR PEOPLE WITH DEMENTIA IN RESIDENTIAL CARE SETTINGS? A SYSTEMATIC REVIEW OF IMPLEMENTATION STRATEGIES. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Iain Lang
- University of Exeter Medical SchoolExeterUnited Kingdom
| | | | | | | | | | | | | | - Ken Stein
- University of Exeter Medical SchoolExeterUnited Kingdom
| |
Collapse
|
32
|
Abbott RA, Whear R, Rodgers LR, Bethel A, Thompson Coon J, Kuyken W, Stein K, Dickens C. Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: A systematic review and meta-analysis of randomised controlled trials. J Psychosom Res 2014; 76:341-51. [PMID: 24745774 DOI: 10.1016/j.jpsychores.2014.02.012] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [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] [Received: 11/29/2013] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on psychological and physical outcomes for people with vascular disease. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES AMED, CINAHL, EMBASE, British Nursing Index, Medline, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews, Central, Social Sciences Citation Index, Social Policy and Practice, and HMIC from inception to January 2013. REVIEW METHODS Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Random-effects meta-analyses were performed. RESULTS Nine articles (from eight original randomised controlled trials) met eligibility criteria and were included in the final review. In total, 578 participants were enrolled across the trials, with participants presenting with prehypertension/hypertension (n=3 trials), type 1 or 2 diabetes (n=2), heart disease (n=2) and stroke (n=1). Meta-analyses, using standardised mean differences, showed evidence of reductions in stress (-0.36; 95% CI -0.67 to -0.09; p=0.01), depression (-0.35; 95% CI -0.53 to -0.16; p=0.003) and anxiety (-0.50; 95% CI -0.70 to -0.29; p<0.001). Effects on physical outcomes (blood pressure, albuminuria, stress hormones) were mixed. CONCLUSION Whilst populations with vascular disease appear to derive a range of psychological benefits from MBSR/MBCT intervention, the effects on physical parameters of disease are not yet established. More robust studies, with longer term follow-up, are required to ascertain full effectiveness of such intervention.
Collapse
Affiliation(s)
- Rebecca A Abbott
- PenCLAHRC, University of Exeter Medical School, Exeter EX2 4SG, United Kingdom.
| | - Rebecca Whear
- PenCLAHRC, University of Exeter Medical School, Exeter EX2 4SG, United Kingdom
| | - Lauren R Rodgers
- PenCLAHRC, University of Exeter Medical School, Exeter EX2 4SG, United Kingdom
| | - Alison Bethel
- PenCLAHRC, University of Exeter Medical School, Exeter EX2 4SG, United Kingdom
| | - Jo Thompson Coon
- PenCLAHRC, University of Exeter Medical School, Exeter EX2 4SG, United Kingdom
| | - Willem Kuyken
- Mood Disorders Centre, College of Life and Environmental Sciences, University of Exeter, EX4 4QG, United Kingdom
| | - Ken Stein
- PenCLAHRC, University of Exeter Medical School, Exeter EX2 4SG, United Kingdom
| | - Chris Dickens
- Psychology, University of Exeter Medical School, Exeter EX2 4SG, United Kingdom
| |
Collapse
|
33
|
Whear R, Abbott R, Thompson-Coon J, Bethel A, Rogers M, Hemsley A, Stahl-Timmins W, Stein K. Effectiveness of Mealtime Interventions on Behavior Symptoms of People With Dementia Living in Care Homes: A Systematic Review. J Am Med Dir Assoc 2014; 15:185-193. [DOI: 10.1016/j.jamda.2013.10.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/30/2013] [Accepted: 10/25/2013] [Indexed: 10/25/2022]
|
34
|
Goodwin VA, Abbott RA, Whear R, Bethel A, Ukoumunne OC, Thompson-Coon J, Stein K. Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis. BMC Geriatr 2014; 14:15. [PMID: 24495705 PMCID: PMC3928080 DOI: 10.1186/1471-2318-14-15] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/03/2014] [Indexed: 11/18/2022] Open
Abstract
Background Limited attention has been paid in the literature to multiple component fall prevention interventions that comprise two or more fixed combinations of fall prevention interventions that are not individually tailored following a risk assessment. The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations. Methods Medline, EMBASE, CINAHL, PsychInfo, Cochrane, AMED, UK Clinical Research Network Study Portfolio, Current Controlled Trials register and Australian and New Zealand Clinical Trials register were systematically searched to August 2013 for randomised controlled trials targeting those aged 60 years and older with any medical condition or in any setting that compared multiple component interventions with no intervention, placebo or usual clinical care on the outcomes reported falls, number that fall or fall-related injuries. Included studies were appraised using the Cochrane risk of bias tool. Estimates of fall rate ratio and risk ratio were pooled across studies using random effects meta-analysis. Data synthesis took place in 2013. Results Eighteen papers reporting 17 trials were included (5034 participants). There was a reduction in the number of people that fell (pooled risk ratio = 0.85, 95% confidence interval (95% CI) 0.80 to 0.91) and the fall rate (pooled rate ratio = 0.80, 95% CI 0.72 to 0.89) in favour of multiple component interventions when compared with controls. There was a small amount of statistical heterogeneity (I2 = 20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell. Conclusions This systematic review and meta-analysis of randomised controlled trials found evidence that multiple component interventions that are not tailored to individually assessed risk factors are effective at reducing both the number of people that fall and the fall rate. This approach should be considered as a service delivery option.
Collapse
Affiliation(s)
- Victoria A Goodwin
- PenCLAHRC, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter EX2 4SF, UK.
| | | | | | | | | | | | | |
Collapse
|
35
|
Whear R, Marlow R, Boddy K, Ukoumunne OC, Parker C, Ford T, Thompson-Coon J, Stein K. Psychiatric disorder or impairing psychology in children who have been excluded from school: A systematic review. School Psychology International 2013. [DOI: 10.1177/0143034313517451] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
When children with special educational needs are excluded from school, it should raise the concern that these children are not receiving adequate help and support. This systematic review aims to identify the prevalence of psychiatric disorder or impairing psychopathology among children who are excluded from school compared to children who are not excluded from school. The review follows the guidelines set out by the Centre of Research and Dissemination ( Centre for Reviews and Dissemination, 2009 ). We used broad search terms (across 16 databases) in order to avoid missing papers, our initial screening stage involved 3712 titles and abstracts. Five studies finally met our inclusion criteria. The results from these studies suggest that the odds of children who have been excluded from school having some kind of impairing psychological or behavioural impairment is increased in comparison to children who have not been excluded (odds ratios ranging from 1.13–31.9). However, the paucity of primary research in this area, combined with methodological weaknesses in the identified studies makes it difficult to draw firm conclusions. The need for education and mental health professionals to work together to provide the appropriate support for all children at risk of exclusion is of great and immediate concern.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Ken Stein
- University of Exeter Medical School, UK
| |
Collapse
|
36
|
Whear R, Thompson-Coon J, Rogers M, Abbott RA, Ukoumunne O, Perry M, Stein K. Patient-initiated appointment systems for people with chronic conditions in secondary care. Hippokratia 2013. [DOI: 10.1002/14651858.cd010763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rebecca Whear
- University of Exeter; Peninsula CLAHRC, University of Exeter Medical School; Veysey Building Salmon Pool Lane Exeter Devon UK EX2 4SG
| | - Joanna Thompson-Coon
- University of Exeter; Peninsula CLAHRC, University of Exeter Medical School; Veysey Building Salmon Pool Lane Exeter Devon UK EX2 4SG
| | - Morwenna Rogers
- University of Exeter; Peninsula CLAHRC, University of Exeter Medical School; Veysey Building Salmon Pool Lane Exeter Devon UK EX2 4SG
| | - Rebecca A Abbott
- University of Exeter; Peninsula CLAHRC, University of Exeter Medical School; Veysey Building Salmon Pool Lane Exeter Devon UK EX2 4SG
| | - Obioha Ukoumunne
- University of Exeter Medical School, University of Exeter; Peninsula CLAHRC; Veysey Building Salmon Pool Lane Exeter Devon UK EX2 4SG
| | - Mark Perry
- Derriford Hospital; Rheumatology; Plymouth Devon UK PL6 8DH
| | - Ken Stein
- Peninsular Medical School; PenTAG; Noy Scott House Barrack Road Exeter UK EX2 5DW
| |
Collapse
|
37
|
Whear R, Abdul-Rahman AK, Thompson-Coon J, Boddy K, Perry MG, Stein K. Patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review of patient reported outcomes and patient and clinician satisfaction. BMC Health Serv Res 2013; 13:501. [PMID: 24289832 PMCID: PMC3879028 DOI: 10.1186/1472-6963-13-501] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/15/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cost to the NHS of missed or inappropriate hospital appointments is considerable. Alternative methods of appointment scheduling might be more flexible to patients' needs without jeopardising health and service quality. The objective was to systematically review evidence of patient initiated clinics in secondary care on patient reported outcomes among patients with chronic/recurrent conditions. METHODS Seven databases were searched from inception to June 2013. Hand searching of included studies references was also conducted. Studies comparing the effects of patient initiated clinics with traditional consultant led clinics in secondary care for patients with long term chronic or recurrent diseases on health related quality of life and/or patient satisfaction were included. Data was extracted by one reviewer and checked by a second. Results were synthesised narratively. RESULTS Seven studies were included in the review, these covered a total of 1,655 participants across three conditions: breast cancer, inflammatory bowel disease and rheumatoid arthritis. Quality of reporting was variable. Results showed no significant differences between the intervention and control groups for psychological and health related quality of life outcomes indicating no evidence of harm. Some patients reported significantly more satisfaction using patient-initiated clinics than usual care (p < 0.001). CONCLUSIONS The results show potential for patient initiated clinics to result in greater patient and clinician satisfaction. The patient-consultant relationship appeared to play an important part in patient satisfaction and should be considered an important area of future research as should the presence or absence of a guidebook to aid self-management. Patient initiated clinics fit the models of care suggested by policy makers and so further research into long term outcomes for patients and service use in this area of practice is both relevant and timely.
Collapse
Affiliation(s)
- Rebecca Whear
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), University of Exeter, Veysey Building, Salmon Pool Road, Exeter, Devon EX2 4SG, England
| | - Abdul-Kareem Abdul-Rahman
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), University of Exeter, Veysey Building, Salmon Pool Road, Exeter, Devon EX2 4SG, England
| | - Jo Thompson-Coon
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), University of Exeter, Veysey Building, Salmon Pool Road, Exeter, Devon EX2 4SG, England
| | - Kate Boddy
- Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), Peninsula College of Medicine and Dentistry, Veysey Building, Salmon Pool Road, Exeter, Devon EX2 4SG, England
| | - Mark G Perry
- Rheumatology Plymouth Healthcare NHS Trust, Veysey Building, Salmon Pool Road, Exeter, Devon EX2 4SG, England
| | - Ken Stein
- Public Health, University of Exeter, Veysey Building, Salmon Pool Road, Exeter, Devon EX2 4SG, England
| |
Collapse
|
38
|
Whear R, Abdul-Rahman AK, Boddy K, Thompson-Coon J, Perry M, Stein K. The clinical effectiveness of patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review. PLoS One 2013; 8:e74774. [PMID: 24116009 PMCID: PMC3792120 DOI: 10.1371/journal.pone.0074774] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 08/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Missed or inappropriate hospital appointments cost the UK National Health Service millions of pounds each year and delay treatment for other patients. Innovative methods of appointment scheduling that are more flexible to patient needs, may improve service quality and preserve resources. METHODS A systematic review of the evidence for the clinical effectiveness of patient initiated clinics in managing long term care for people with chronic or recurrent conditions in secondary care. Seven databases were searched including MEDLINE, Embase and PsycINFO (using the OVID interface), the Cochrane Library of Systematic Reviews and CENTRAL, Science Citation Index Expanded, Social Sciences Citation Index, and Conference Proceedings Citation Index (via the Web of Science interface) from inception to June 2013. Studies comparing patient initiated clinics with traditional consultant-led clinics in secondary care for people with long term chronic or recurrent diseases were included. Included studies had to provide data on clinical or resource use outcomes. Data were extracted and checked by two reviewers using a piloted, standardised data extraction form. RESULTS Eight studies (n = 1927 individuals) were included. All were conducted in the UK. There were few significant differences in clinical outcomes between the intervention and control groups. In some instances, using the patient initiated clinics model was associated with savings in time and resource use. The risk of harm from using the patient initiated clinic model of organising outpatient care is low. Studies with longer follow-up periods are needed to assess the long term costs and the ongoing risk of potential harms. CONCLUSIONS The UK policy context is ripe for evidence-based, patient-centred services to be implemented, especially where the use of health care resources can be optimised without reducing the quality of care. Implementation of patient initiated clinics should remain cautious, with importance placed on ongoing evaluation of long term outcomes and costs.
Collapse
Affiliation(s)
- Rebecca Whear
- Peninsula Collaboration for Leadership in Applied Health Research and Care, Institute of Health Research, University of Exeter, Exeter, Devon, United Kingdom
- * E-mail:
| | - Abdul-Kareem Abdul-Rahman
- Peninsula Collaboration for Leadership in Applied Health Research and Care, Institute of Health Research, University of Exeter, Exeter, Devon, United Kingdom
| | - Kate Boddy
- Peninsula Collaboration for Leadership in Applied Health Research and Care, Institute of Health Research, University of Exeter, Exeter, Devon, United Kingdom
| | - Jo Thompson-Coon
- Peninsula Collaboration for Leadership in Applied Health Research and Care, Institute of Health Research, University of Exeter, Exeter, Devon, United Kingdom
| | - Mark Perry
- Rheumatlogy Department, Plymouth Healthcare National Health Service Trust, Plymouth, Devon, United Kingdom
| | - Ken Stein
- Peninsula Collaboration for Leadership in Applied Health Research and Care, Institute of Health Research, University of Exeter, Exeter, Devon, United Kingdom
| |
Collapse
|
39
|
Abbott RA, Whear R, Thompson-Coon J, Ukoumunne OC, Rogers M, Bethel A, Hemsley A, Stein K. Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis. Ageing Res Rev 2013; 12:967-81. [PMID: 23811415 DOI: 10.1016/j.arr.2013.06.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 11/26/2022]
Abstract
The need to improve the nutrition of the elderly living in long term care has long been recognised, but how this can best be achieved, and whether (and which) intervention is successful in reducing morbidity is less well understood. The aim of this systematic review was to determine the effectiveness of mealtime interventions for the elderly living in residential care. Mealtime interventions were considered as those that aimed to change/improve the mealtime routine, practice, experience or environment. Following comprehensive searches, review and appraisal, 37 articles were included. Inadequate reporting in over half of the articles limited data quality appraisal. Mealtime interventions were categorised into five types: changes to food service, food improvement, dining environment alteration, staff training and feeding assistance. Meta-analysis found inconsistent evidence of effects on body weight of changes to food service (0.5 kg; 95% CI: -1.1 to 2.2; p=0.51), food improvement interventions (0.4 kg; 95% CI: -0.8 to 1.7; p=0.50) or alterations to dining environment (1.5 kg; 95% CI: -0.7 to 2.8; p=0.23). Findings from observational studies within these intervention types were mixed, but generally positive. Observational studies also found positive effects on food/caloric intake across all intervention types, though meta-analyses of randomised studies showed little evidence of any effects on food/caloric intake in food improvement studies (-5 kcal; 95% CI: -36 to 26; p=0.74). There was some evidence of an effect on daily energy intakes within dining environment studies (181 kcal/day, 95% CI: -5 to 367, p=0.06). The need to improve the nutrition of the elderly living in residential long term care is well recognised. This review found some evidence that simple intervention around various aspects of mealtime practices and the mealtime environment can result in favourable nutritional outcomes. Further large scale pragmatic trials, however, are still required to establish full efficacy of such interventions.
Collapse
|
40
|
Coon JT, Abbott R, Rogers M, Whear R, Pearson S, Lang I, Cartmell N, Stein K. PP24 Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications to People with Dementia Living in Residential Care: A Systematic Review. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
41
|
Thompson-Coon J, Abdul-Rahman AK, Whear R, Bethel A, Vaidya B, Gericke CA, Stein K. Telephone consultations in place of face to face out-patient consultations for patients discharged from hospital following surgery: a systematic review. BMC Health Serv Res 2013; 13:128. [PMID: 23561005 PMCID: PMC3626714 DOI: 10.1186/1472-6963-13-128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 03/25/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Routine follow-up following uncomplicated surgery is being delivered by telephone in some settings. Telephone consultations may be preferable to patients and improve outpatient resource use. We aimed to compare the effectiveness of telephone consultations with face to face follow-up consultations, in patients discharged from hospital following surgery. METHODS Seven electronic databases (including Medline, Embase and PsycINFO) were searched from inception to July 2011. Comparative studies of any design in which routine follow-up via telephone was compared with face to face consultation in patients discharged from hospital after surgery were included. Study selection, data extraction and quality appraisal were performed independently by two reviewers with consensus reached by discussion and involvement of a third reviewer where necessary. RESULTS Five papers (four studies; 865 adults) met the inclusion criteria. The studies were of low methodological quality and reported dissimilar outcomes precluding any formal synthesis. CONCLUSIONS There has been very little comparative evaluation of different methods of routine follow-up care in patients discharged from hospital following surgery. Further work is needed to establish a role for telephone consultation in this patient group.
Collapse
Affiliation(s)
- Jo Thompson-Coon
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| | - Abdul-Kareem Abdul-Rahman
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| | - Rebecca Whear
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| | - Alison Bethel
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon & Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Christian A Gericke
- PenCLAHRC, National Institute for Health Research, Peninsula College of Medicine and Dentistry, University of Plymouth, Portland Square, Plymouth, PL4 8AA, UK
- The Wesley Research Institute and Queenland University of Technology, Brisbane, QLD, 4068, Australia
| | - Ken Stein
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| |
Collapse
|
42
|
Coon JT, Martin A, Abdul-Rahman AK, Boddy K, Whear R, Collinson A, Stein K, Logan S. Interventions to reduce acute paediatric hospital admissions: a systematic review. Arch Dis Child 2012; 97:304-11. [PMID: 22294664 DOI: 10.1136/archdischild-2011-301214] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the effectiveness of interventions aimed at reducing the rate of acute paediatric hospital admissions. DESIGN Systematic review. DATA SOURCES Medline, Embase, PsychINFO, The Cochrane Library, Science Citation Index Expanded from inception to September 2010; hand searches of the reference lists of included papers and other review papers identified in the search. REVIEW METHODS Controlled trials were included. Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. RESULTS Seven papers were included. There is some evidence to suggest that short stay units may reduce admission rates. However, there is a general lack of detail in the reporting of interventions and the methods used in their evaluation which precludes detailed interpretation and extrapolation of the results. The authors found no evidence that the use of algorithms and guidelines to manage the admission decision was effective in reducing acute admission rates. Furthermore, the authors were unable to locate any eligible papers reporting the effects on admission rates of admission decision by paediatric consultant, telephone triage by paediatric consultant or the establishment of next day emergency paediatric clinics. CONCLUSION There is little published evidence upon which to base an optimal strategy for reducing paediatric admission rates. The evidence that does exist is subject to substantial bias. There is a pressing need for high quality, well conducted research to enable informed service change.
Collapse
Affiliation(s)
- Jo Thompson Coon
- PenCLAHRC, Peninsula College of Medicine and Dentistry, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, UK.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Coon JT, Boddy K, Stein K, Whear R, Barton J, Depledge M. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Journal of Epidemiology & Community Health 2011. [DOI: 10.1136/jech.2011.143586.85] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
44
|
Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environ Sci Technol 2011; 45:1761-1772. [PMID: 21291246 DOI: 10.1021/es102947t] [Citation(s) in RCA: 552] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Our objective was to compare the effects on mental and physical wellbeing, health related quality of life and long-term adherence to physical activity, of participation in physical activity in natural environments compared with physical activity indoors. We conducted a systematic review using the following data sources: Medline, Embase, Psychinfo, GreenFILE, SportDISCUS, The Cochrane Library, Science Citation Index Expanded, Social Sciences Citation Index, Arts and Humanities Citation Index, Conference Proceedings Citation Index--Science and BIOSIS from inception to June 2010. Internet searches of relevant Web sites, hand searches of relevant journals, and the reference lists of included papers and other review papers identified in the search were also searched for relevant information. Controlled trials (randomized and nonrandomized) were included. To be eligible trials had to compare the effects of outdoor exercise initiatives with those conducted indoors and report on at least one physical or mental wellbeing outcome in adults or children. Screening of articles for inclusion, data extraction, and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Due to the heterogeneity of identified studies a narrative synthesis was performed. Eleven trials (833 adults) were included. Most participants (6 trials; 523 adults) were young students. Study entry criteria and methods were sparsely reported. All interventions consisted of a single episode of walking or running indoors with the same activity at a similar level conducted outdoors on a separate occasion. A total of 13 different outcome measures were used to evaluate the effects of exercise on mental wellbeing, and 4 outcome measures were used to assess attitude to exercise. Most trials (n = 9) showed some improvement in mental wellbeing on one or other of the outcome measures. Compared with exercising indoors, exercising in natural environments was associated with greater feelings of revitalization and positive engagement, decreases in tension, confusion, anger, and depression, and increased energy. However, the results suggested that feelings of calmness may be decreased following outdoor exercise. Participants reported greater enjoyment and satisfaction with outdoor activity and declared a greater intent to repeat the activity at a later date. None of the identified studies measured the effects of physical activity on physical wellbeing or the effect of natural environments on exercise adherence. The hypothesis that there are added beneficial effects to be gained from performing physical activity outdoors in natural environments is very appealing and has generated considerable interest. This review has shown some promising effects on self-reported mental wellbeing immediately following exercise in nature which are not seen following the same exercise indoors. However, the interpretation and extrapolation of these findings is hampered by the poor methodological quality of the available evidence and the heterogeneity of outcome measures employed. The review demonstrates the paucity of high quality evidence on which to base recommendations and reveals an undoubted need for further research in this area. Large, well designed, longer term trials in populations who might benefit most from the potential advantages of outdoor exercise are needed to fully elucidate the effects on mental and physical wellbeing. The influence of these effects on the sustainability of physical activity initiatives also awaits investigation.
Collapse
Affiliation(s)
- J Thompson Coon
- PenCLAHRC, Peninsula College of Medicine and Dentistry, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United Kingdom.
| | | | | | | | | | | |
Collapse
|
45
|
|