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Patient and surgeon perspectives of a large-scale system for automated, real-time monitoring and feedback of shared decision-making integrated into surgical practice: a qualitative study
Get PDFObjective To explore patient and healthcare professional perceptions about the acceptability and impact of a large-scale system for automated, real-time monitoring and feedback of shared decision-making (SDM) that has been integrated into surgical care pathways.
Design Qualitative, semistructured interviews were conducted with patients and healthcare professionals between June and November 2021. Data were analysed using deductive and inductive approaches.
Setting Large-scale monitoring of SDM has been integrated in NHS surgical care across two large UK National Health Service Trusts.
Participants Adult surgical patients (N=18, 56% female), following use of an SDM real-time monitoring and feedback system, and healthcare professionals (N=14, 36% female) involved in their surgical care. Patient recruitment was conducted through hospital research nurses and professionals by direct approach from the study team to sample individuals purposively from seven surgical specialties (general, vascular, urology, orthopaedics, breast, gynaecology and urgent cardiac).
Results 10 themes were identified within three areas of exploration that described factors underpinning: (1) the acceptability of large-scale automated, real-time monitoring of SDM experiences, (2) the acceptability of real-time feedback and addressing SDM deficiencies and (3) the impact of real-time monitoring and feedback. There was general support for real-time monitoring and feedback because of its perceived ability to efficiently address deficiencies in surgical patients’ SDM experience at scale, and its perceived benefits to patients, surgeons and the wider organisation. Factors potentially influencing acceptability of large-scale automated, real-time monitoring and feedback were identified for both stakeholder groups, for example, influence of survey timing on patient-reported SDM scores, disease-specific risks, patients’ dissatisfaction with hospital processes. Factors particularly important for patients included concerns over digital exclusion exacerbated by electronic real-time monitoring. Factors unique to professionals included the need for detailed, qualitative feedback of SDM to contextualise patient-reported SDM scores.
Conclusions This study explored factors influencing the acceptability of automated, real-time monitoring and feedback of patients’ experiences of SDM integrated into surgical practice, at scale among key stakeholders. Findings will be used to guide refinement and implementation of SDM monitoring and feedback prior to formal development, evaluation and implementation of an SDM intervention in the NHS
Rapid reviews methods series (paper 7): guidance on rapid scoping, mapping and evidence and gap map (‘Big Picture Reviews’)
Get PDFScoping, mapping and evidence and gap map reviews (‘Big Picture Reviews’ (BPRs)) are evidence synthesis methods that address broad research questions. They provide an overview of existing evidence, identify gaps in knowledge and priorities for research. Unlike systematic reviews (SRs) of effectiveness, they do not seek to synthesise findings but to provide a description of the evidence. There has been a growth in the production of rapid BPRs to meet commissioners’ and knowledge users’ (KUs) needs for timely outputs. No guidance currently exists for the use of rapid approaches in BPRs, and the purpose of this paper is to address this lack. Rapid reviews include simplifying or omitting a variety of methods; however, the approaches may have varying impacts on processes and findings in different types of reviews and should be done with reference to the standard approaches for that particular methodology. BPRs differ from SRs of effectiveness, in terms of their purpose, addressing a broad research question, rather than a specific question which fits a population, intervention, comparator and outcome (PICO) framework. Developing and refining the research question and search strategy may need more time than in a SR. Search yields are typically larger with a greater proportion of time spent on identifying evidence for inclusion when compared with SRs. They do not involve a synthesis of included studies, so the impact of missing data may have less influence on the rigour of the findings than in SRs of the effect of an intervention where a pooled estimate is reported. This paper addresses these differences, and the implications of rapid approaches to BPRs, with recommendations for practice that aim to increase efficiency while maintaining rigour
CSF biomarkers are differentially linked to brain areas high and low in noradrenaline, dopamine and serotonin across the Alzheimer’s disease spectrum
Get PDFNeurotransmitter systems of noradrenaline, dopamine, serotonin and acetylcholine are implicated in cognitive functions such as memory, learning and attention and are known to be altered in neurodegenerative diseases like Alzheimer’s disease. Specific brain structures involved in these systems, e.g. the locus coeruleus, the main source of noradrenaline in the cortex, are in fact affected earliest by Alzheimer’s disease tau pathology. Preserved volumetric neurotransmitter specific brain areas could therefore be an important neural resource for cognitive reserve in ageing. The aim of this study was to determine whether volumes of brain areas known to be high in neurotransmitter receptors are relatively preserved in individuals with lower levels of Alzheimer’s disease pathology.
Based on the Human Protein Atlas for neurotransmitter receptor distribution, we distinguished between ‘areas high and low’ in noradrenaline, dopamine, serotonin and acetylcholine and assessed associations of atrophy in those areas with CSF amyloid-ß 42/40, CSF phosphorylated tau protein, and cognitive function across healthy controls (n = 122), individuals with subjective cognitive decline (n = 156), mild cognitive impairment or mild Alzheimer’s disease dementia (n = 126) using structural equation modeling.
CSF pathology markers were inversely correlated and showed a stronger association with disease severity, suggesting distinguishable interrelatedness of these biomarkers depending on the stage of Alzheimer’s disease dementia. Across groups, amyloid pathology was linked to atrophy in areas high as well as low in neurotransmitter receptor densities, while tau pathology did not show any significant link to brain area volumes for any of the neurotransmitters. Within disease severity groups, individuals with more amyloid pathology showed more atrophy only in ‘areas high in noradrenaline’, whereas for dopamine tau pathology was linked to higher volumes in areas low in receptor density possibly indicating compensatory mechanisms. Furthermore, individuals with more tau pathology showed a selective decrease in memory function while amyloid pathology was related to a decline in executive function, language capacity as well as memory function.
In summary, our analyses highlight the benefits of investigating disease-relevant factors in Alzheimer’s disease using a multivariate multigroup approach. Assessing multivariate dependencies in different disease stages and across individuals revealed selective links of pathologies, cognitive decline and atrophy in particular for areas modulated by noradrenaline, dopamine and serotonin
Marshallian agglomeration, labour pooling and skills matching
Get PDFBetter skills matching has long been proposed as one of the key advantages of agglomeration economies. Yet, support for this improved matching has remained largely founded upon indirect proxies for skills such as wages and education. This paper contributes to the literature by offering novel empirical evidence on the relationship between specific measures of localised skills deficiencies and agglomeration economies, in the form of industrial density. Developing an instrumental variable approach and controlling for unobserved heterogeneity and other region-industry idiosyncratic effects across a panel dataset for the period 2009–2019 in England and Wales, our analysis reveals a positive effect of agglomeration economies in reducing both skills gaps within the employed workforce and skills shortages in the labour market external to the firm. We consider these findings in the context of persistent regional imbalances and the importance of strengthening skills provision within current regional industrial strategies
Self-optimising continuous-flow hydrothermal reactor for nanoparticle synthesis
Get PDFAn autonomous continuous-flow, hydrothermal synthesis reactor, capable of self-optimising nanoparticle size using an in-line characterisation technique and machine learning is presented. The developed system is used for synthesis of hematite (α-Fe2O3) nanoparticles across three process variables, optimising for a target particle size. Optimisation is achieved in under 7 h with only 500 ml of 0.1 M Fe(NO3)3·9H2O aqueous stock solution used, and without human intervention
DON’T CANCEL ME: Investigating How Perceived Luxury Safeguards Brands from Cancellation Movements
No full textBrand cancellation movements present a significant threat to businesses, serving as a form of consumer activism where individuals publicly shame a brand for its misbehavior. Drawing on the appraisal theory and the signaling theory, we demonstrate that as the perceived level of luxury associated with a brand increases, consumer participation in cancellation movements decreases
An app-based intervention with behavioural support to promote brisk walking in people diagnosed with breast, prostate, and colorectal cancer (APPROACH): A Process Evaluation (Preprint)
Get PDFBackground:
The APPROACH pilot study explored the feasibility and acceptability of an app (NHS Active 10) with brief, habit-based, behavioral support calls and print materials intended to increase brisk walking in people diagnosed with cancer.
Objective:
Following UK Medical Research Council guidelines, this study assessed the implementation of the intervention, examined the mechanisms of impact, and identified contextual factors influencing engagement.
Methods:
Adults (aged ≥18 y) with breast, prostate, or colorectal cancer who reported not meeting the UK guidelines for moderate-to-vigorous physical activity (≥150 min/wk) were recruited from a single hospital site in Yorkshire, United Kingdom. They were randomly assigned to the intervention or control (usual care) arm and assessed via quantitative surveys at baseline (time point 0 [T0]) and 3-month follow-up (time point 1 [T1]) and qualitative exit interviews (36/44, 82%) at T1. The process evaluation included intervention participants only (n=44). Implementation was assessed using data from the T1 questionnaire exploring the use of the intervention components. The perceived usefulness of the app, leaflet, and behavioral support call was rated from 0 to 5. Behavioral support calls were recorded, and the fidelity of delivery of 25 planned behavior change techniques was rated from 0 to 5 using an adapted Dreyfus scale. Mechanisms of impact were identified by examining T0 and T1 scores on the Self-Reported Behavioural Automaticity Index and feedback on the leaflet, app, call, and planner in the T1 questionnaire and qualitative interviews. Contextual factors influencing engagement were identified through qualitative interviews.
Results:
The implementation of the intervention was successful: 98% (43/44) of the participants received a behavioral support call, 78% (32/41) reported reading the leaflet, 95% (39/41) reported downloading the app, and 83% (34/41) reported using the planners. The mean perceived usefulness of the app was 4.3 (SD 0.8) in participants still using the app at T1 (n=33). Participants rated the leaflet (mean 3.9, SD 0.6) and the behavioral support call (mean 4.1, SD 1) as useful. The intended behavior change techniques in the behavioral support calls were proficiently delivered (overall mean 4.2, SD 1.2). Mechanisms of impact included habit formation, behavioral monitoring, and support and reassurance from the intervention facilitator. Contextual factors impacting engagement included barriers, such as the impact of cancer and its treatment, and facilitators, such as social support.
Conclusions:
The APPROACH intervention was successfully implemented and shows promise for increasing brisk walking, potentially through promoting habit formation and enabling self-monitoring. Contextual factors will be important to consider when interpreting outcomes in the larger APPROACH randomized controlled trial.
International Registered Report Identifier (IRRID):
RR2-10.1186/s40814-022-01028-
Content creation within the algorithmic environment:A systematic review
Get PDFWhile research on platform work has grown exponentially in recent years, the power dynamics between creators and algorithms on digital platforms, as well as their role in shaping online visibility, are yet to be fully understood. Against this backdrop, we ask: How does algorithmic power maintain its dominance and shape the nature of work for content creators? Through a systematic review of the literature on the relationship between algorithms and content creators, this article identified four core themes, namely (i) market rationality underpinning visibility, (ii) potential power dislocation caused by folk theories, (iii) neo-normative control of creators through algorithms and (iv) subversion of beatific fantasies. Drawing from Tirapani and Willmott’s (2023) framework to theorise the power relations framing interactions between algorithms and creators, we argue that the fantasies fabricated by neoliberalism justify, endorse and ultimately support the dominance and dynamic power of algorithms over creators in content creative platforms
Integrating population-level effects into the regulatory assessment of endocrine disrupting substances
Get PDFPopulation modeling, field studies, and monitoring approaches have all been proposed for assessing the relevance of adverse effects of endocrine disrupting chemicals (EDCs) at the population level for nontarget (wild) vertebrates, but how these approaches should be used in the regulatory hazard assessment is unclear and not detailed in the relevant European Guidance Document. A literature review focused on identifying published approaches assessing the population relevance of adverse effects from EDCs was performed, and, subsequently, 47 primary research papers were evaluated. By extracting from these sources, a novel approach was developed with guiding principles for assessing adverse effects of EDCs at the population level considering (i) choice of focal species, scenarios (and models), (ii) the individual level apical endpoints to be considered, (iii) the magnitude of effect to be imposed, (iv) for what duration effects should be imposed, (v) whether individuals repairing the damage from exposure should be included, (vi) the population-level endpoints to be considered, and (vii) what threshold to set for defining an adverse effect at this level. Recommendations for modeling and field and monitoring studies are included. Case studies are also presented to demonstrate how the proposed approach might be implemented. Although some aspects (e.g., choice of focal species, model/experimental scenario, monitoring study assessment) require further consideration, this should not prevent the use of this approach in a regulatory EDC assessment context. As such, we propose that the approach be used immediately to implement population modeling and perform field studies within this regulatory context. We envisage that consistent application of these principles will encourage regulatory developments in this critical area to provide a much needed level of clarity in the EDC assessment for all stakeholders
A randomized controlled trial of self‐help cognitive behavioural therapy for depression in adults with pulmonary hypertension
Get PDFObjectives
Pulmonary hypertension (PH) is a progressive, life-reducing group of conditions associated with an elevated risk of depression. To meet this clinical need, we developed an unguided self-help intervention targeting depression in PH based on cognitive behavioural therapy (CBT) and tested its acceptability, feasibility, and effectiveness.
Design
A randomized controlled trial (RCT) design was utilized with a wait-list control group. Acceptability was assessed using content analysis.
Methods
Adults self-reporting difficulties with depression were recruited from global Pulmonary Hypertension Associations. Participants were randomly assigned to the intervention (n = 33) or the wait-list control group (n = 35). Depression was the primary outcome; secondary outcomes included anxiety, health-related quality of life, pain self-efficacy, fatigue, and cognitions and behaviours associated with mood difficulties. Change from baseline to post-intervention (4 weeks) and follow-up (1 month later) was measured.
Results
We found a significant reduction in depression and HRQoL in the intervention group compared with the control group, with medium effect sizes. No significant changes were observed in other outcomes (p > .05). Overall, 72% of individuals in the treatment arm scored above the clinical level of depression, compared with 28% at post-intervention and 36% at follow-up. The intervention was judged to be acceptable and feasible, with the main benefits including tools to support, increased motivation, and understanding of depression. No adverse events were reported. Change in cognitions and behaviours did not mediate the relationship between the intervention group and change in depression (p > .05).
Conclusions
Results support the use of CBT for depression in PH and provide evidence for the delivery of self-help at scale via PHA-UK, the UK's leading charity for PH
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