• Does intentional asphyxiation by strangulation have addictive properties?

      Chater, Angel M.; University of Bedfordshire (Wiley, 2020-09-04)
      Background and aims Intentional asphyxiation leads to cerebral hypoxia, starving the brain of oxygen and inducing hypoxic euphoria, but carries a serious risk of accidental death, especially if practised alone. This article raises the question as to whether it could usefully be regarded as having addictive properties. Methods and results A review of the literature, together with eight case study vignettes, are presented. Intentional asphyxiation can occur with or without sexual activity. Initiation often occurs in adolescence, with development in some cases of an entrenched behaviour pattern, driven by a strong euphoriant effect, without adequate safeguarding from serious harm, and being undertaken by people with co‐morbidities. There does not appear to be strong evidence of seeking support for cessation of the practice. Discussion Intentional asphyxiation behaviours may have addictive properties and understanding this aspect of the problem may be fruitful in guiding research and interventions aimed at addressing it.
    • A systematic review of the factors - barriers and enablers - affecting the implementation of clinical commissioning policy to reduce health inequalities in the National Health Service (NHS), UK

      Regmi, Krishna; Mudyarabikwa, Oliver; University of Bedfordshire; University of Dundee; Coventry University (Elsevier, 2020-08-29)
      Objective: The aim of the present study is two-fold. First, it attempts to identify the barriers and enablers of implementing clinical commissioning policy. Second, it synthesises how these barriers and enablers affect the success of National Health Service (NHS) efforts to reduce health inequalities in the UK. Methods: A systematic review was conducted. We searched large biomedical bibliographic databases, namely MEDLINE, EMBASE, CINAHL, Allied & Complementary Medicine, DH-DATA, Global Health and CINAHL for primary studies, conducted in the UK, that assessed the factors - barriers and enablers related to health inequalities, published from 2010 onwards and in English, and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We used Joanna Briggs Institute (JBI) Critical Appraisal and Mixed Methods Appraisal tools to assess the methodological qualities, and synthesised by performing thematic analysis. Two reviewers independently screened the articles and extracted data. Results: We included six primary studies (including a total of 1155 participants) in the final review. The studies reported two broad categories, under four separate themes: (1) the agenda of health inequalities has not been given priority; (2) there was very little evidence for reducing health inequalities through the clinical commissioning (CC) process; (3) CC was positively associated with the restructuring of NHS; and (4) CC brings better collaboration and engagement, which led to some improvements in health services access, utilisation and delivery at the local level. Conclusion: This study provides useful factors e barriers and enablers e to implement and deliver clinical commissioning policy in improving health and well-being. These factors could be assessed in future to develop objective measures and interventions to establish the link between commissioning and health inequalities.
    • A qualitative study exploring the experiences of bereavement after stillbirth in Pakistani, Bangladeshi and White British mothers living in Luton, UK

      Garcia, Rebecca; Ali, Nasreen; Griffiths, Malcolm; Randhawa, Gurch; Open University; University of Bedfodshire; Luton & Dunstable University Hospital NHS Foundation Trust (Elsevier, 2020-08-29)
      This study aims to explore the experiences of bereavement after stillbirth of Pakistani, Bangladeshi and White British mothers in a town with multi-ethnic populations in England. A purposive sample of Pakistani, Bangladeshi and White British mothers aged over 16 (at time of infant birth), who suffered a stillbirth in the preceding 6-24 months and residing in a specified postcode area were invited to take part in the study, by an identified gatekeeper (audit midwife) from the local National Health Service Trust, in addition to local bereavement charities. Qualitative methods using face-to-face semi-structured interviews were undertaken, recorded and transcribed verbatim. Using framework analysis, several themes were identified. There were three main themes identified from the data; 1. knowledge and information of pregnancy and perinatal mortality; 2. attitudes and perceptions to pregnancy and perinatal mortality and 3. experiences with maternity care. The findings revealed mostly similarities in the bereavement experiences of the Pakistani, Bangladeshi and White British mothers. A few cultural and religious differences were identified. This study found important similarities in bereavement experiences of Pakistani, Bangladeshi and White British mothers and highlights considerations for policy makers and maternity services in how the timing of bereavement after care is provided, including advice surrounding the infant post-mortem.
    • Using a blended format (videoconference and face to face) to deliver a group psychosocial intervention to parents of autistic children

      Lodder, Annemarie; Papadopoulos, Chris; Randhawa, Gurch; University of Bedfordshire (Elsevier, 2020-08-26)
      Background Parents and carers of autistic children report poor mental health. Autism stigma is a strong contributing factor to poor parental mental health, yet there are currently no interventions available that are evidenced to improve parents' mental health in part through increasing resilience to stigma. Childcare and travel are well known barriers to attendance and attrition rates for this population are high. Methods A blended format psychosocial group support intervention was developed with the aim to improve parental mental health. Three sessions were delivered face to face, and five sessions via videoconference. A secret Facebook group was set up to support the intervention and increase retention rates. Mixed methods were used to assess the feasibility and acceptability of this mode of delivery for both the facilitator and service users. Attendance rates, fidelity and implementation issues are discussed. A qualitative focus group was conducted (n = 9) to explore the acceptability to the participants. Framework analysis was used to analyse the findings. Results Attendance rates were high with the online sessions having significantly higher attendance rates than the face to face sessions. The findings of the qualitative evaluation suggest that participants are positive about videoconferencing for a group support intervention. The facilitator reported sound quality, background distractions and late arrivals as challenges; the participants on the other hand, reported that the benefits far outweighed the negatives. Suggestions for improvement are made. Conclusions The results suggest that videoconference is a well-received method to provide a group support intervention to parents. Only preliminary conclusions can be drawn, owing to the small sample size.
    • Influences on antibiotic prescribing by non-medical prescribers for respiratory tract infections: a systematic review using the theoretical domains framework

      Chater, Angel M.; Family, Hannah; Lim, Rosemary; Courtenay, Molly; University of Bedfordshire; University of Bristol; University of Reading; Cardiff University (Oxford University Press, 2020-08-07)
      Background The need to conserve antibiotic efficacy, through the management of respiratory tract infections (RTIs) without recourse to antibiotics, is a global priority. A key target for interventions is the antibiotic prescribing behaviour of healthcare professionals including non-medical prescribers (NMPs: nurses, pharmacists, paramedics, physiotherapists) who manage these infections. Objectives To identify what evidence exists regarding the influences on NMPs’ antimicrobial prescribing behaviour and analyse the operationalization of the identified drivers of behaviour using the Theoretical Domains Framework (TDF). Methods The search strategy was applied across six electronic bibliographic databases (eligibility criteria included: original studies; written in English and published before July 2019; non-medical prescribers as participants; and looked at influences on prescribing patterns of antibiotics for RTIs). Study characteristics, influences on appropriate antibiotic prescribing and intervention content to enhance appropriate antibiotic prescribing were independently extracted and mapped to the TDF. Results The search retrieved 490 original articles. Eight papers met the review criteria. Key issues centred around strategies for managing challenges experienced during consultations, managing patient concerns, peer support and wider public awareness of antimicrobial resistance. The two most common TDF domains highlighted as influences on prescribing behaviour, represented in all studies, were social influences and beliefs about consequences. Conclusions The core domains highlighted as influential to appropriate antibiotic prescribing should be considered when developing future interventions. Focus should be given to overcoming social influences (patients, other clinicians) and reassurance in relation to beliefs about negative consequences (missing something that could lead to a negative outcome).
    • Acute exposure to a hot ambient temperature reduces energy intake but does not affect gut hormones in men during rest

      Zakrzewski-Fruer, Julia K.; Horsfall, Rachel; Cottrill, Diane; Hough, John; (Cambridge University Press, 2020-07-22)
      This study examined the effect of ambient temperature on energy intake, perceived appetite and gut hormone responses during rest in men. Thirteen men (age 21.5 (SD 1.4) years; BMI 24.7 (SD 2.2) kg∙m-2) completed three, 5.5-h conditions in different ambient temperatures: i) cold (10˚C), ii) thermoneutral (20˚C), and iii) hot (30˚C). A standardised breakfast was consumed after fasting measures, and an ad libitum lunch provided at 4 to 4.5 h. Blood samples (analysed for plasma acylated ghrelin, total peptide tyrosine-tyrosine (PYY) and total glucagon-like peptide (GLP-1) concentrations), perceived appetite and thermoregulatory responses were collected throughout. Linear mixed models were used for statistical analyses. Ad libitum energy intake was 1243 (SD 1342) kJ higher in 10˚C and 1189 (SD 1219) kJ higher in 20˚C versus 30C (P = 0.002). Plasma acylated ghrelin, total PYY and GLP-1 concentrations did not differ significantly between the conditions (P ≥ 0.303). Sensitivity analyses for the 4-h pre-lunch period showed that perceived overall appetite was lower in both 30˚C and 10C when compared with 20˚C (P ≤ 0.019). In conclusion, acutely resting in a hot compared with a thermoneutral and cold ambient temperature reduced lunchtime ad libitum energy intake in healthy men. Suppressed perceived appetite may have contributed to the reduced energy intake in the hot compared with thermoneutral ambient temperature, whereas gut hormones did not appear to play an important role.
    • A qualitative study of healthcare professionals’ experiences of providing maternity services for Muslim women in the UK

      Hassan, Shaima Mohamed; Leavey, Conan; Rooney, Jane S.; Puthussery, Shuby (Biomed Central, 2020-07-10)
      Background: A growing Muslim population in the UK suggests the need for healthcare professionals (HCPs) to gain a better understanding of how the Islamic faith influences health related perceptions and healthcare seeking behaviour. Although some researchers have explored the experiences of Muslim women as recipients of healthcare, little attention has been paid to the challenges HCPs face as service providers on a day-to-day basis whilst caring for Muslim women. The aim of this study was to investigate HPCs lived experiences of providing maternity care for Muslim women. Method: Data was collected through twelve semi-structured one-to-one qualitative interviews with HCPs in a large National Health Service (NHS) maternity unit located in the North West of England. Interview participants included Community and specialist clinic (e.g. clinic for non-English speakers), Midwives in a variety of specialist roles (7), Gynaecology Nurses (2), Breastfeeding Support Workers (2) and a Sonographer (1). The audio-recorded interviews were transcribed and analysed thematically. Results: The majority of participants expressed an understanding of some religious values and practices related to Muslim women, such as fasting the month of Ramadhan and that pregnant and breastfeeding women are exempt from this. However, HCPs articulated the challenges they faced when dealing with certain religious values and practices, and how they tried to respond to Muslim women’s specific needs. Emerging themes included: 1) HCPs perceptions about Muslim women; 2) HCPs understanding and awareness of religious practices; 3) HCPs approaches in addressing and supporting Muslim women’s religious needs; 4) Importance of training in providing culturally and religiously appropriate woman-centred care. Conclusion: Through this study we gained insight into the day-to-day experiences of HCPs providing care provision for Muslim women. HCPs showed an understanding of the importance of religious and cultural practices in addressing the needs of Muslim women as part of their role as maternity care providers. However, they also identified a need to develop training programmes that focus on cultural and religious practices and their impact on women’s health care needs. This will help support HCPs in overcoming the challenges faced when dealing with needs of women from different backgrounds.
    • Knowledge and attitude of healthcare professionals to frailty screening in primary care: a systematic review protocol

      Okpechi, Ijeoma; Randhawa, Gurch; Hewson, David; University of Bedfordshire (BMJ Publishing Group, 2020-07-02)
      Introduction Frailty is an increasingly common condition in which physiological decline as a result of accumulated deficits renders older people more vulnerable to adverse outcomes. An increasing range of frailty screening programmes have been introduced in primary care to identify frail older people in order to deliver appropriate interventions. However, limited information on the knowledge and attitude of healthcare professionals (HCPs) with respect to frailty screening is known. The aim of this systematic review is to provide evidence on the knowledge and attitude of HCP in terms of frailty screening, and potentially identify barriers and facilitators to frailty screening to improve implementation of frailty screening in primary care. Methods/design A systematic review of qualitative research will be conducted. Databases searched will be MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Web of Science from January 2001 to August 2019. Methods will be reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Population, interest, context and study design methodology was used to develop inclusion and exclusion criteria with HCPs as population, frailty screening as interest and knowledge or attitude of HCPs to frailty screening as context. Studies with a qualitative methodology or a mixed-method design where the qualitative component is analysed separately will also be included. Quality appraisal will be carried out using the Joanna Briggs Institute appraisal tool for qualitative studies. Data will be extracted from each selected study with thematic framework analysis used to synthesise findings. Ethics and dissemination This systematic review does not require ethical approval as primary data will not be collected. The findings will be disseminated at conferences and in a relevant academic journal. This review will assist HCPs and relevant stakeholders to tackle the challenges of frailty screening in primary care. PROSPERO registration number CRD42019159007.
    • Impact of Covid-19 on the experiences of parents and family carers of autistic children and young people in the UK

      Pavlopoulou, Georgia; Wood, Rebecca; Papadopoulos, Chris; UCL Institute of Education; University of East London; University of Bedfordshire (UCL Institute of Education, 2020-07-01)
      A new study led by the Institute of Education at University College London, in collaboration with the University of East London and the University of Bedfordshire, has shed light on the experiences of the parents and carers of autistic children and young people during lockdown in the UK. The findings reveal that many families feel let down by the government and that they have had to face the lockdown tackling new struggles, often with significantly reduced support. However, parents and carers also experienced a number of positives, providing important lessons for support and health services and education providers in the future.
    • The Sign 4 Little Talkers intervention to improve listening, understanding, speaking, and behavior in hearing preschool children: outcome evaluation

      Davidson, Rosemary; Randhawa, Gurch; University of Bedfordshire (JMIR Publications, 2020-06-30)
      Gaining age-appropriate proficiency in speech and language in the early years is crucial to later life chances; however, a significant proportion of children fail to meet the expected standards in these early years outcomes when they start school. Factors influencing the development of language and communication include low income, gender, and having English as an additional language (EAL). This study aimed to determine whether the Sign 4 Little Talkers (S4LT) program improves key developmental outcomes in hearing preschool children. S4LT was developed to address gaps in the attainment of vocabulary and communication skills in preschool children, identified through routine monitoring of outcomes in early years. Signs were adapted and incorporated into storybooks to improve vocabulary, communication, and behavior in hearing children. An evaluation of S4LT was conducted to measure key outcomes pre- and postintervention in 8 early years settings in Luton, United Kingdom. A total of 118 preschool children were tested in 4 early years outcomes domains-listening, speaking, understanding, and managing feelings and behavior-as well as Leuven well-being scales and the number of key words understood and spoken. Statistically significant results were found for all measures tested: words spoken (P<.001) and understood (P<.001), speaking (P<.001), managing feelings and behavior (P<.001), understanding (P<.001), listening and attention (P<.001), and well-being (P<.001). Approximately two-thirds of the children made expected or good progress, often progressing multiple steps in educational attainment after being assessed as developmentally behind at baseline. The findings reported here suggest that S4LT may help children to catch up with their peers at a crucial stage in development and become school ready by improving their command of language and communication as well as learning social skills. Our analysis also highlights specific groups of children who are not responding as well as expected, namely boys with EAL, and who require additional, tailored support.
    • Improving access to organ donor registration in general practice: a feasibility study

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; Asghar, Zeeshan; (Royal College of General Practitioners, 2020-06-25)
      Background Organ donor registration helps guide decision making for families. UK general practice provides the facility to register on the NHS Organ Donor Register, but only to new patients. An intervention was developed to present a registration opportunity to existing patients in this setting. Aim To assess the feasibility and acceptability of an organ donation intervention implemented in UK general practice. Design and setting The intervention ran in a large practice in Luton in the UK, for 3 months in 2018. A single practice feasibility study was conducted using an embedded experimental mixed methods design. Method Staff were trained to ask patients in consultations if they wished to join the register, and leaflets and posters were displayed in the waiting room. Data on feasibility and acceptability were captured using SystmONE questionnaires, surveys, and focus groups. Results Over 3 months, in 12.4% of face-to-face consultations, patients were asked if they would like to join the register (812 of 6569), and 244 (30.0%) of these patients joined the register. Common reasons staff did not ask patients were due to telephone consultations, lack of time, and it not being appropriate. Nurses and healthcare assistants performed prompted choice more than doctors (23.4%, 17.1%, and 1.6% respectively). Certain clinic types, such as phlebotomy or routine clinics, facilitated asking compared to those where patients presented with unknown or more serious issues. Conclusion The intervention was found to be feasible and acceptable by some staff and patients. Feasibility criteria were met; therefore, the intervention can progress to further testing.
    • Factors in implementation of clinical commissioning policy in improving health and wellbeing and/or reducing health inequalities in the English NHS: a systematic review of the evidence

      Regmi, Krishna; Mudyarabikwa, Oliver; University of Bedfordshire; Coventry University (Research Square, 2020-06-25)
      This is a preprint. Preprints are preliminary reports that have not undergone peer review. They should not be considered conclusive, used to inform clinical practice, or referenced by the media as validated information. Objective: This study aimed to identify and synthesise the factors in implementing clinical commissioning policy in improving health and/or reducing health inequalities in the English NHS. Methods: Systematic review was conducted. We searched Medline, EMBASE, CINAHL, Allied & Complementary Medicine, DH-DATA, Global Health and CINAHL for primary studies that assessed the enablers and barriers, and reported in accordance with PRISMA statement. Methodological quality was appraised using JBI Critical Appraisal tools and Mixed Methods Appraisal Tool [MMAT] to assess the methodological qualities, and synthesised performing thematic analysis. Two reviewers independently screened the papers and extracted data. Results: We included six primary studies (including a total of 1155 participants) in the final review. The studies reported two broad categories, under four separate themes: agenda of health inequalities not fully addressed; poor evidence for reducing health inequalities; reform through restructuring of organisations, and strategic approaches. Conclusion: This study provides useful factors – enablers and barriers – to implement and deliver clinical commissioning policy in improving health and wellbeing. These factors could be assessed in future to develop objective measures and interventions to establish the link between commissioning and health inequalities improving equitable access, health outcomes and effective partnerships.
    • An economic–business approach to clinical risk management

      Comite, Ubaldo; Dong, Kechen; Li, Rita Yi Man; Crabbe, M. James C.; Shao, Xue-Feng; Yue, Xiao-Guang; University Giustino Fortunato; University of South Australia; Hong Kong Shue Yan University; Oxford University; et al. (MDPI, 2020-06-23)
      This paper introduces risk factors in the field of healthcare and discusses the clinical risks, identification, risk management methods, and tools as well as the analysis of specific situations. Based on documentary analysis, an ecient and coherent methodological choice of an informative and non-interpretative approach, it relies on “unobtrusive” and “non-reactive” information sources, such that the research results are not influenced by the research process itself. To ensure objective and systematical analysis, our research involved three macro-phases: (a) the first involved a skimming (a superficial examination) of the documents collected; (b) the second reading (a thorough examination) allowed a selection of useful information; (c) the third phase involved classification and evaluation of the collected data. This iterative process combined the elements of content and thematic analysis that categorised the information into di erent categories which were related to the central issues for research purposes. Finally, from the perspective of safety analysis and risk management, we suggest that comprehensive control and operation should be conducted in a holistic way, including patient safety, cost consumption, and organizational responsibility. An organizational strategy that revolves around a constant and gradual risk management process is an important factor in clinical governance which focuses on the safety of patients, operators, and organizations.
    • Factors impacting social distancing measures for preventing coronavirus disease 2019 [COVID-19]: a systematic review

      Regmi, Krishna; Lwin, Cho Mar (Research Square, 2020-06-23)
      This is a preprint. Preprints are preliminary reports that have not undergone peer review. They should not be considered conclusive, used to inform clinical practice, or referenced by the media as validated information. Background: Social distancing measures (SDMs) protect the health of the public from coronavirus 2019 (COVID-19) infection. However, the impact of SDMs has been inconsistent and unclear. This study aims to review the factors impacting SDMs (e.g. isolation, quarantine) for reducing the transmission of COVID-19. Methods: A systematic review was conducted. We searched MEDLINE, EMBASE, Allied & Complementary Medicine, COVID-19 Research and WHO database on COVID-19 for primary studies assessing the enablers and barriers associated with SDMs, and reported in accordance with PRISMA statement. We used JBI Critical Appraisal Checklist for the cross-sectional survey and Qualitative Research to assess the methodological qualities and synthesised performing thematic analysis. Two reviewers independently screened the papers and extracted data. Results: A total of 1235 citations were identified, of which 16 were found to be relevant. The studies reported in two broad categories, under seven separate themes: positive impact of SDMs, effective public health interventions, positive change in people’s behaviour, worries and concerns about COVID-19, roles of mass media, physical and psychological impacts, and ethnicity/age associated with COVID-19. Conclusion: The identified evidence signals that SDMs are generally effective for preventing or reducing transmission. There is a scope and need to find the best methods and approaches at the primary healthcare level in terms of developing objective measures and interventions to establish the link between different factors and SDMs and reducing transmission of COVID-19 trend effectively, efficiently and equitably.
    • Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis - protocol

      Vincent, Britzer Paul; Randhawa, Gurch; Cook, Erica Jane; University of Bedfordshire (BMJ Publishing Group, 2020-06-21)
      Introduction The need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a lower number of organ donors. Studies have been carried out among people of Indian origin living globally to understand the reasons for the low donation rate, but there has been no systematic review that has integrated all of these studies to synthesise the current literature. Therefore, the purpose of this review is to examine the barriers towards organ donor registration and consent among Indians living globally. Methods and analysis A systematic search will be conducted using the following relevant databases namely CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Grey literature. Studies from 1994 that satisfy our inclusion criteria will be included. Two reviewers will conduct the screening, data extraction and quality assessment of the studies; in event of any disagreement between the two reviewers at any stage, the third reviewer will reconcile any disagreements and consensus will be made. Ethics and dissemination As this study includes only secondary data, ethical approval for secondary data usage has been sought. This study will use Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to report and the study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various non-governmental organisations globally which are working with this particular community; following which further research can be developed based on this evidence and also helps in building a culturally competent strategy. PROSPERO registration number CRD42019155274.
    • 'Would you like to join the NHS Organ Donor Register?' a general practice feasibility study

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; Asghar, Zeeshan; ; University of Bedfordshire; NHS Blood and Transplant (Royal College of General Practitioners, 2020-06-18)
      BACKGROUND: A shortage of organ donors exists in the UK and targeting family consent is key for increasing donation consent rates. Registration on the NHS Organ Donor Register (NHS ODR) facilitates this, as it guides families on their loved ones donation preference. In general practice, an opportunity to register is provided, however only to new patients. To improve access to registration opportunities, an intervention was designed where general practice staff asked their patients if they wished to register as an organ donor. AIM: To assess an organ donation registration intervention for feasibility and acceptability in a UK general practice setting. METHOD: One general practice, in Luton, UK, conducted the intervention for 3 months (April to July 2018). Training was held in March 2018, and leaflets and posters were displayed for the 3-month period. An embedded experimental mixed-methods design was used, with data collected via SystmONE questionnaires, surveys and focus groups. RESULTS: The intervention was found to be feasible and acceptable to conduct with some patients by some staff members. During the 3 months, patients were asked in 12.4% of face-to-face consultations (n=812). Nurses and healthcare assistants were more able to conduct the intervention than doctors. Lack of time, telephone consultations, and it not being appropriate were the most common reasons for not asking. Finally, 244 patients joined the NHS ODR; 30.4% of those asked. CONCLUSION: This study demonstrates that general practice could be a feasible location in which an intervention designed to increase NHS ODR registration could be conducted.
    • Impact of social distancing measures for preventing coronavirus disease 2019 [COVID-19]: a systematic review and meta-analysis protocol

      Regmi, Krishna; Lwin, Cho Mar (medRxiv, 2020-06-16)
      This article is a preprint and has not been peer-reviewed. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice. Introduction: Social distancing measures (SDMs) protect public health from the outbreak of coronavirus disease 2019 (COVID-19). However, the impact of SDMs has been inconsistent and unclear. This study aims to assess the effects of SDMs (e.g. isolation, quarantine) for reducing the transmission of COVID-19. Methods and analysis: We will conduct a systematic review meta-analysis research of both randomised controlled trials and non-randomised controlled trials. We will search MEDLINE, EMBASE, Allied & Complementary Medicine, COVID-19 Research and WHO database on COVID-19 for primary studies assessing the enablers and barriers associated with SDMs, and will be reported in accordance with PRISMA statement. The PRISMA-P checklist will be used while preparing this protocol. We will use Joanna Briggs Institute guidelines (JBI Critical Appraisal Checklists) to assess the methodological qualities and synthesised performing thematic analysis. Two reviewers will independently screen the papers and extracted data. If sufficient data are available, the random-effects model for meta-analysis will be performed to measure the effect size of SDMs or the strengths of relationships. To assess the heterogeneity of effects, I2 together with the observed effects (Q-value, with degrees of freedom) will be used to provide the true effects in the analysis. Ethics and dissemination: Ethics approval and consent will not be required for this systematic review of the literature as it does not involve human participation. We will be able to disseminate the study findings using the following strategies: we will be publishing at least one paper in peer-reviewed journals, and an abstract will be presented at suitable national/international conferences or workshops. We will also share important information with public health authorities as well as with the World Health Organization.
    • Socially assistive robots, older adults and research ethics: the case for case-based ethics training

      Battistuzzi, Linda; Papadopoulos, Chris; Hill, Tetiana; Castro, Nina; Bruno, Barbara; Sgorbissa, Antonio (Springer, 2020-05-27)
      Most studies on socially assistive robots (SARs) in elder care are conducted in care homes and recruit participants with some degree of cognitive impairment. The ethical dimension in these studies thus requires careful attention, suggesting that the researchers involved should be offered specific research ethics training. To meet this need in CARESSES—an international multidisciplinary project that aims to design and evaluate the first culturally competent SAR for the care of older adults—a research ethics training module for the project researchers was developed. The training module is largely based on case-based learning (CBL), a widely recognized approach to learning and instruction that is regarded as highly effective across multiple disciplines. In this paper, we argue that research ethics training should be offered to robotics investigators involved in research on SARs in elder care, and we provide an overview of the ethical issues involved in conducting research with SARs and older adults in care homes. Finally, we show how CBL can be used for research ethics training in this context.
    • Personalised adherence support for maintenance treatment of inflammatory bowel disease: a tailored digital intervention to change adherence-related beliefs and barriers

      Chapman, Sarah; Sibelli, Alice; St-Clair Jones, Anja; Forbes, Alastair; Chater, Angel M.; Horne, Robert; UCL School of Pharmacy; University of Bath; King’s College London; Brighton and Sussex University Hospitals NHS Trust; et al. (Oxford University Press, 2020-05-07)
      Background and aims: Interventions to improve adherence to medication may be more effective if tailored to the individual, addressing adherence-related beliefs about treatment and overcoming practical barriers to daily use. We evaluated whether an algorithm tailoring support to address perceptual and practical barriers to adherence reduced barriers and was acceptable to patients with IBD. Methods: Participants with IBD, prescribed azathioprine and/or mesalazine were recruited via patient groups, social media and hospital clinics and allocated to Intervention or Control Groups. The online intervention comprised messages tailored to address beliefs about IBD and maintenance treatment and provide advice on overcoming practical difficulties with taking regular medication. The content was personalised to address specific perceptual and practical barriers identified by a pre-screening tool. Validated questionnaires assessed barriers to adherence and related secondary outcomes at baseline, one and three months of follow-up. Results: 329 participants were allocated to the Intervention (n=153) and Control (n=176) Groups; just under half (46.2%) completed follow-up. At one and three months the Intervention Group had significantly fewer concerns about IBD medication (p≤.01); and, at three months only, fewer doubts about treatment need, fewer reported practical barriers and lower nonadherence (p<.05). Relative to controls at follow-up, the Intervention Group were more satisfied with information about IBD medicines, and viewed pharmaceuticals in general more positively. Questionnaires, interviews and intervention usage indicated the intervention was acceptable. Conclusions: Personalised adherence support using a digital algorithm can help patients overcome perceptual (doubts about treatment necessity and medication concerns) and practical barriers to adherence.
    • Capturing debriefing and enhancing reflection within simulated clinical learning environments

      Wareing, Mark; England, Jacqueline A.; Mathew, David; Ball, Carla; Willetts, Amanda; Kemp, Jane; Clifford, Kelly; Thompson, Andrea; Dove, Ian; Adams, Louise; et al. (National Association of Educators in Practice, 2020-05-05)
      This article presents findings from an evaluation of a new A3-size learner notes sheet designed for use by healthcare students engaging in clinical simulation and clinical skills sessions. The notes sheet consists of an adapted form of the SBAR (situation, background, assessment, response) tool, whilst capturing post-simulation oral debriefing provided by a facilitator. Additionally, the Driscoll (2007) model is used to provide students with an opportunity to reflect on their engagement in clinical simulation. Two cohorts of students, who engaged in separate simulation sessions, completed the A3 sheet. The study featured 33 midwifery and 21 operating department practitioner (ODP) students undertaking a simulation. Documentary analysis was undertaken to identify the depth of reflective writing of both groups of students. Midwifery student participants reflected on their experiences of simulation at a slightly deeper level than their ODP counterparts. All students adhered to the structure of the notes sheet when receiving their briefing from the facilitator and when asked to write their reflective accounts. This study has sought to explore an under-researched area of clinical simulation: the extent to which healthcare students can utilise reflection when engaging with a clinical scenario within a simulated learning environment.