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Clarke Z. Implementation of a simulation free palliative Radiation Therapy pathway: An inter-professional collaborative project. J Med Imaging Radiat Sci 2024:S1939-8654(24)00050-X. [PMID: 38653677 DOI: 10.1016/j.jmir.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
The Western New South Wales Local Health District (WNSWLHD) has a significant footprint within the state of New South Wales (NSW). Due to the significant size of the WNSWLHD, patients residing in the local health district face many barriers to receiving Radiation Therapy. The inter-professional collaboration behind the successful implementation and evaluation of a simulation free pathway for palliative Radiation Therapy in WNSWLHD will be explored within this narrative. The process known in WNSWLHD as Medical Imaging Simulated Radiation Therapy (MISRT) removes the need for a computed tomography (CT) simulation and allows for palliative Radiation Therapy to be planned on previously acquired diagnostic CT imaging. The implementation of MISRT has required significant inter-professional collaboration. This also extends to inter-centre partnership, intra-district cooperation with Medical Imaging and inter-discipline teamwork amongst Radiation Oncologists, Radiation Oncology Medical Physicists, Radiation Oncology Nursing and Radiation Therapists. The impact and involvement of the inter-disciplinary teamwork will be explored. The methods of implementing MISRT will be outlined covering changes to standard workflow, educational requirements and inclusion criteria. The evaluation of the implementation will also be covered with two evaluation surveys being conducted. Inter-professional communication, education, teamwork and collaboration is highlighted to demonstrate improving access to quality care in a rural and regional healthcare setting whilst reducing known barriers to accessing Radiation Oncology.
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Affiliation(s)
- Zoe Clarke
- Western Cancer Centre, Dubbo, New South Wales, Australia.
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Woodrow N, Gillespie D, Kitchin L, O'Brien M, Chapman S, Chng NR, Passey A, Aquino MRJ, Clarke Z, Goyder E. Reintroducing face-to-face support alongside remote support to form a hybrid stop smoking service in England: a formative mixed methods evaluation. BMC Public Health 2024; 24:718. [PMID: 38448869 PMCID: PMC10916048 DOI: 10.1186/s12889-024-18235-0] [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] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, United Kingdom (UK) stop smoking services had to shift to remote delivery models due to social distancing regulations, later reintroducing face-to-face provision. The "Living Well Smokefree" service in North Yorkshire County Council adopted a hybrid model offering face-to-face, remote, or a mix of both. This evaluation aimed to assess the hybrid approach's strengths and weaknesses and explore potential improvements. METHODS Conducted from September 2022 to February 2023, the evaluation consisted of three components. First, qualitative interviews involved 11 staff and 16 service users, analysed thematically. Second, quantitative data from the QuitManager system that monitored the numbers and proportions of individuals selecting and successfully completing a 4-week quit via each service option. Third, face-to-face service expenses data was used to estimate the value for money of additional face-to-face provision. The qualitative findings were used to give context to the quantitative data via an "expansion" approach and complementary analysis. RESULTS Overall, a hybrid model was seen to provide convenience and flexible options for support. In the evaluation, 733 individuals accessed the service, with 91.3% selecting remote support, 6.1% face-to-face, and 2.6% mixed provision. Remote support was valued by service users and staff for promoting openness, privacy, and reducing stigma, and was noted as removing access barriers and improving service availability. However, the absence of carbon monoxide monitoring in remote support raised accountability concerns. The trade-off in "quantity vs. quality" of quits was debated, as remote support reached more users but produced fewer carbon monoxide-validated quits. Primarily offering remote support could lead to substantial workloads, as staff often extend their roles to include social/mental health support, which was sometimes emotionally challenging. Offering service users a choice of support options was considered more important than the "cost-per-quit". Improved dissemination of information to support service users in understanding their options for support was suggested. CONCLUSIONS The hybrid approach allows smoking cessation services to evaluate which groups benefit from remote, face-to-face, or mixed options and allocate resources accordingly. Providing choice, flexible provision, non-judgmental support, and clear information about available options could improve engagement and match support to individual needs, enhancing outcomes.
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Affiliation(s)
- Nicholas Woodrow
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK.
| | - Duncan Gillespie
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Liz Kitchin
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Mark O'Brien
- Living Well Smokefree Service, North Yorkshire Council, York, UK
| | - Scott Chapman
- Living Well Smokefree Service, North Yorkshire Council, York, UK
| | - Nai Rui Chng
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Passey
- School of Health, Leeds Beckett University, LS1 3HE, Leeds, UK
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Zoe Clarke
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
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Burton R, Fryers PT, Sharpe C, Clarke Z, Henn C, Hydes T, Marsden J, Pearce-Smith N, Sheron N. The independent and joint risks of alcohol consumption, smoking, and excess weight on morbidity and mortality: a systematic review and meta-analysis exploring synergistic associations. Public Health 2024; 226:39-52. [PMID: 38000113 DOI: 10.1016/j.puhe.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Alcohol consumption, smoking, and excess weight independently increase the risk of morbidity/mortality. Less is known about how they interact. This research aims to quantify the independent and joint associations of these exposures across health outcomes and identify whether these associations are synergistic. STUDY DESIGN The protocol for this systematic review and meta-analysis was pre-registered (PROSPERO CRD42021231443). METHODS Medline and Embase were searched between 1 January 2010 and 9 February 2022. Eligible peer-reviewed observational studies had to include adult participants from Organisation for Co-Operation and Development countries and report independent and joint associations between at least two eligible exposures (alcohol, smoking, and excess weight) and an ICD-10 outcome (or equivalent). For all estimates, we calculated the synergy index (SI) to identify whether joint associations were synergistic. Meta-analyses were conducted for outcomes with sufficiently homogenous data. RESULTS The search returned 26,290 studies, of which 98 were included. Based on 138,130 participants, the combined effect (SI) of alcohol and smoking on head and neck cancer death/disease was 3.78 times greater than the additive effect of each exposure (95% confidence interval [CI] = 2.61, 5.48). Based on 2,603,939 participants, the combined effect of alcohol and excess weight on liver disease/death was 1.55 times greater than the additive effect of each exposure (95% CI = 1.33, 1.82). CONCLUSION Synergistic associations suggest the true population-level risk may be underestimated. In the absence of bias, individuals with multiple risks would experience a greater absolute risk reduction from an intervention that targets a single exposure than individuals with a single risk.
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Affiliation(s)
- R Burton
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom; Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, England, United Kingdom.
| | - P T Fryers
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - C Sharpe
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - Z Clarke
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - C Henn
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - T Hydes
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University Hospital Aintree NHS Foundation Trust, University of Liverpool, Liverpool, England, United Kingdom
| | - J Marsden
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, England, United Kingdom
| | - N Pearce-Smith
- Knowledge and Library Services, UK Health Security Agency, London, England, United Kingdom
| | - N Sheron
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom; Institute of Liver Studies, Kings College London School of Medicine at King's College Hospital, London, England, United Kingdom
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Lewis R, Boydell N, Blake C, Clarke Z, Kernaghan K, McMellon C. Involving young people in sexual health research and service improvement: conceptual analysis of patient and public involvement (PPI) in three projects. BMJ Sex Reprod Health 2023; 49:76-86. [PMID: 36307186 PMCID: PMC10176375 DOI: 10.1136/bmjsrh-2022-201611] [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] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/16/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Although increasingly recognised as valuable within sexual and reproductive health (SRH) research and service improvement, examples of patient and public involvement (PPI) are underdocumented, including specific issues relating to young people's involvement. This article aims to contribute to greater transparency about the practical, methodological and ethical considerations of SRH-related PPI with young people, and to offer recommendations for their meaningful involvement. METHODS Guided by a conceptual tool for evaluating youth participation (the '7P' framework), we analysed learning from PPI within three projects (two academic studies and one service improvement project) that worked with young people to shape sexual health research and practice in Scotland. ANALYSIS Cross-project analysis of seven interconnected domains (purpose, positioning, perspectives, power relations, protection, place and process) generated productive dialogue about the nuances of meaningfully involving young people in shaping SRH research and services. Key learning includes the importance of: young people's early involvement in agenda-setting for SRH improvement; developing trusting partnerships that can support involvement of diverse groups of young people; creating multiple ways for young people to contribute, including those that do not rely on direct conversation; and formative evaluation of young people's experiences of involvement. CONCLUSIONS Mainstreaming young people's meaningful involvement in shaping SRH research and services requires systems-level change. Resources are required to support SRH researchers and practitioners to share learning and build sustainable multi-sector partnerships, which in turn can increase opportunities for young people from diverse groups to engage with SRH-related PPI activities.
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Affiliation(s)
- Ruth Lewis
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Nicola Boydell
- Centre for Biomedicine Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Carolyn Blake
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Zoe Clarke
- Health Opportunities Team, Edinburgh, UK
- Office for Health Improvement and Disparities, London, UK
| | | | - Christina McMellon
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
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Regan M, Smolar M, Burton R, Clarke Z, Sharpe C, Henn C, Marsden J. Policies and interventions to reduce harmful gambling: an international Delphi consensus and implementation rating study. The Lancet Public Health 2022; 7:e705-e717. [DOI: 10.1016/s2468-2667(22)00137-2] [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] [Received: 09/30/2021] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 10/16/2022] Open
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Reed H, Langley J, Stanton A, Heron N, Clarke Z, Judge S, McCarthy A, Squire G, Quinn A, Wells O, Tindale W, Baxter S, Shaw PJ, McDermott CJ. Head-Up; An interdisciplinary, participatory and co-design process informing the development of a novel head and neck support for people living with progressive neck muscle weakness. J Med Eng Technol 2015; 39:404-10. [DOI: 10.3109/03091902.2015.1088092] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Clarke Z. Equinox Project- Summary of Results. LIR 2013. [DOI: 10.29173/lirg291] [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: 12/01/2022] Open
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Barone P, Lamb J, Ellis A, Clarke Z. Sumanirole versus placebo or ropinirole for the adjunctive treatment of patients with advanced Parkinson's disease. Mov Disord 2007; 22:483-9. [PMID: 17115380 DOI: 10.1002/mds.21191] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aims of this study were to assess the safety, tolerability, and efficacy of sumanirole, a highly selective D(2) dopamine receptor agonist, versus placebo in subjects with advanced Parkinson's disease (PD), and to demonstrate noninferiority of sumanirole to ropinirole. In this flexible-dose, randomized, double-blind, double-dummy, parallel-group study, 948 subjects were treated with sumanirole 1 to 48 mg/day, ropinirole 0.75 to 24 mg/day, or placebo. Treatment consisted of 13 weeks of dose escalation, 26 weeks of maintenance, and 1 week of tapering. Approximately 70% of subjects treated with either sumanirole or ropinirole completed the study. Statistical significance (P < 0.0001) was achieved when both sumanirole and ropinirole groups were compared with placebo, with mean differences of -7.7 and -8.8 on combined sum of the Unified Parkinson's Disease Rating Scale (UPDRS) part II (average on and off) and part III total scores at the end of maintenance. Noninferiority of sumanirole to ropinirole was also demonstrated, with a sumanirole minus ropinirole difference of 1.17 (90% CI: -0.56 to 2.89). Both dopamine agonists, sumanirole and ropinirole, were statistically superior compared with placebo as adjunctive therapy for patients with advanced Parkinson's disease, based on UPDRS II + III total score. Noninferiority of sumanirole to ropinirole was established, with comparable tolerability profiles.
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Affiliation(s)
- Paolo Barone
- Department of Neurological Sciences, University "Federico II," Napoli, Italy.
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Clarke Z. On becoming a vet. . . part 3. IN PRACTICE 2004. [DOI: 10.1136/inpract.26.2.107] [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]
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Clarke Z, Lambert S. Management information and decision support for libraries in Europe: a concerted action. Performance Measurement and Metrics 2000. [DOI: 10.1108/eum0000000007222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management information for decision making is an essential tool for library managers. This paper outlines the European Commission Libraries Programme decision support projects that were brought together under the CAMILE concerted action. The three common themes to emerge from the CAMILE projects are then discussed. The themes are: information for decision making, systems for decision support, and the future challenges of measuring impact and developing performance measures for the elec‐tronic library. To conclude, recommendations for future research in the field of decision support in European libraries are considered.
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Wynne PM, Clarke Z. Towards an inclusive methodology for the measurement of in house use. Journal of Librarianship and Information Science 2000. [DOI: 10.1177/096100060003200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduces the background to the EQLIPSE (Evaluation and Quality in Library Performance: System for Europe) project and the work done in compiling a core set of performance indicators for evaluating libraries. Describes the collection of in house library use data at the University of Central Lancashire Library test site, where EQLIPSE staff gathered data as part of the data collection exercise to test the feasibility of the indicators and to accumulate data in the EQLIPSE system. Some of the difficulties encountered in the process are noted along with the measures taken to address them. In addition to measuring actual use, attempts were also made to establish whether users habitually reshelve items they consult, both when at the shelf and when working at study spaces. Unobtrusive direct observation eventually formed the mainstay of the methods used to measure this. Results suggest that users consulting items at the shelf would change every 10 minutes on average and that the number of users would fall or rise gradually during the two hours between counts. Future developments to the EQLIPSE methodology are discussed.
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Affiliation(s)
- Peter M. Wynne
- Centre for Research in Library and Information Management (CERLIM) at Manchester Metropolitan University,
| | - Zoe Clarke
- Centre for Research in Library and Information Management (CERLIM) at Manchester Metropolitan University,
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Wynne P, Clarke Z. Towards an inclusive methodology for the measurement of inhouse use. Journal of Librarianship and Information Science 2000. [DOI: 10.1177/0961000004244686] [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: 11/15/2022]
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