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Comparing factors associated with overall satisfaction for different forms of remote breastfeeding support in the UK
Get PDFBackground: Remote forms of breastfeeding support, such as helplines and social media, offer a flexible and convenient form of support to offer help at critical points, e.g., when the risk of breastfeeding cessation is high. Currently, there is little known about who accesses different forms of remote breastfeeding support and what factors impact overall satisfaction. As part of an evaluation of the UK National Breastfeeding Helpline (NBH) (which offers breastfeeding support via a helpline and online media), we aimed to (a) understand who accesses different forms of NBH support, and (b) identify key factors associated with overall satisfaction for helpline and online media support. Methods: All service users who contacted the NBH between November 2021 and March 2022 were invited to participate in the evaluation via an online survey. Survey questions explored the type and timing of support, reasons for the contact, attitudes towards the help and support received, impact of the support on breastfeeding experiences and demographic factors. Chi-squared and Mann–Whitney tests explored variations in who accessed the helpline or online media. Multiple linear regression models were fitted to explore the factors related to the service users’ ‘overall satisfaction’. The quantitive data were combined with qualitative comments into descriptive themes. Results: Overall, online media users were significantly more likely to be younger, White, multiparous, less educated and have English as a first language compared to those who contact the helpline. Similar factors that significantly influenced overall satisfaction for both support models were the service being easy to access, receiving helpful information that met expectations, resolving breastfeeding issues, and feeling reassured and more confident. Significant factors for the helpline were callers feeling understood and more knowledgeable about breastfeeding following the call, being able to put into practice the information provided, feeling encouraged to continue breastfeeding, feeling that the volunteer gave the support that was needed, and seeking out additional support. Conclusions: Online and helpline forms of breastfeeding support suit different demographics and call purposes. While optimal breastfeeding support needs to be accessible, flexible and instrumental, helpline users need real-time relational support to deal with more complex challenges
Elements of organisation of integrated maternity care and their associations with outcomes: a scoping review protocol
Get PDFIntroduction Integrated care is seen as an enabling strategy in organising healthcare to improve quality, finances, personnel and sustainability. Developments in the organisation of maternity care follow this trend. The way care is organised should support the general aims and outcomes of healthcare systems. Organisation itself consists of a variety of smaller ‘elements of organisation’. Various elements of organisation are implemented in different organisations and networks. We will examine which elements of integrated maternity care are associated with maternal and neonatal health outcomes, experiences of women and professionals, healthcare spending and care processes.
Methods and analysis We will conduct this review using the JBI methodology for scoping reviews and the reporting guideline PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews). We will undertake a systematic search in the databases PubMed, Scopus, Cochrane and PsycINFO. A machine learning tool, ASReview, will be used to select relevant papers. These papers will be analysed and classified thematically using the framework of the Rainbow Model of Integrated Care (RMIC). The Population Concept Context framework for scoping reviews will be used in which ‘Population’ is defined as elements of the organisation of integrated maternity care, ‘Context’ as high-income countries and ‘Concepts’ as outcomes stated in the objective of this review. We will include papers from 2012 onwards, in Dutch or English language, which describe both ‘how the care is organised’ (elements) and ‘outcomes’.
Ethics and dissemination Since this is a scoping review of previously published summary data, ethical approval for this study is not needed. Findings will be published in a peer-reviewed international journal, discussed in a webinar and presented at (inter)national conferences and meetings of professional associations.
The findings of this scoping review will give insight into the nature and effectiveness of elements of integrated care and will generate hypotheses for further research
Classroom to escape room: an innovative experience to prepare and test students
Get PDFParamedicine is a rapidly evolving profession and teaching strategies need to be creative and forward thinking to meet the ever-changing demands of the role. Educational escape rooms incorporate a variety of learning environments in which students participate in a range of simulation-based activities based on solving puzzles and retrieving codes, which result in finding a prize. A mixed methods action research study was undertaken to ascertain whether an escape room approach can increase engagement and attainment in year-one paramedic science degree students at a UK university. The results showed that 100% (n=52) stated they would recommend this activity, 100% (n=52) agreed it helped them to review their teamwork skills and 98% (n=51) said that it improved their communication techniques. Non-technical skills enable the development of technical skills and knowledge within the workplace and are an overarching factor in providing good practice and reducing errors. An escape room approach is arguably an effective teaching method when the activities are based on learning outcomes
Criteria and indicators for Centers of Clinical Excellence in stroke recovery and rehabilitation: A global consensus facilitated by ISRRA
Get PDFBackground
The aim of the International Stroke Recovery and Rehabilitation Alliance is to create a world where worldwide collaboration brings major breakthroughs for the millions of people living with stroke. A key pillar of this work is to define globally relevant criteria for centers that aspire to deliver excellent clinical rehabilitation and generate exceptional outcomes for patients.
Objectives
This paper presents consensus work conducted with an international group of expert stroke recovery and rehabilitation researchers, clinicians, and people living with stroke to identify and define criteria and measurable indicators for Centers of Clinical Excellence (CoCE) in stroke recovery and rehabilitation. These were intentionally developed to be ambitious and internationally relevant, regardless of a country’s development or income status, to drive global improvement in stroke services.
Methods
Criteria and specific measurable indicators for CoCE were collaboratively developed by an international panel of stroke recovery and rehabilitation experts from 10 countries and consumer groups from 5 countries.
Results
The criteria and associated indicators, ranked in order of importance, focused upon (i) optimal outcome, (ii) research culture, (iii) working collaboratively with people living with stroke, (iv) knowledge exchange, (v) leadership, (vi) education, and (vii) advocacy. Work is currently underway to user-test the criteria and indicators in 14 rehabilitation centers in 10 different countries.
Conclusions
We anticipate that use of the criteria and indicators could support individual organizations to further develop their services and, more widely, provide a mechanism by which clinical excellence can be articulated and shared to generate global improvements in stroke care
School Scoliosis Screening: The Influence of Dominant Limbs and Gender
Get PDFThis study aimed to examine whether (a) there is an association of the dominant hand (DH) and leg (DL) with the side of the primary angle of trunk rotation (ATR A) and (b) there are any differences between boys and girls in the degree of the angle of trunk rotation (ATR) and the dominant hand and leg. One thousand sixty-five (age: 14 ± 3 years; height: 162 ± 13 cm; weight: 56 ± 18.7 kg; BMI: 21.18 ± 5.07) secondary school children participated in this study. Of the participants, 52.5% (n = 559) were male students (age: 14 ± 2 years; height: 166 ± 16 cm; weight: 58.7 ± 22.6 kg; BMI: 21.41 ± 5.61), and 47.5% (n = 506) were female students (age: 14 ± 3 years; height: 159.5 ± 8.5 cm; weight: 53.9 ± 14.8 kg; BMI: 21.03 ± 4.38). The ATR was measured with a scoliometer. Boys were taller and heavier (p = 0.001) and had more left DLs (p = 0.039) than girls. Girls were biologically more mature (p = 0.002), also having higher measurements for the ATR A (p = 0.004) and secondary angle of trunk rotation (ATR B) (p = 0.023) degrees compared to boys. In the general sample, only in boys, there was a significant association between the DH (p = 0.012) and DL (p = 0.001) with the ATR A side. Also, within the scoliotic group, only in boys, there was a significant association between the DH (p = 0.048) and DL (p = 0.024) with the ATR A. In conclusion, girls had higher measurements for the ATR than boys, but cross laterality was found only in boys. The results suggest different progression patterns of ATR between genders during their growth. Future research should focus on examining other possible progression mechanisms
P556 Immunomodulator and advanced therapies for Induction of clinical remission and response in Crohn’s disease: A systematic review and network meta-analysis
No full textBackground
Several effective advanced therapies have been approved for the treatment of Crohn’s disease (CD) in the past two decades. Many have used synthesis techniques to study this area, but these rarely consider both advanced and immunomodulator therapy together in the same analysis. Network meta-analysis enables the direct and indirect comparison of these different therapeutic agents, aiding in determining their relative positioning within the treatment algorithm.
Methods
We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials between inception and October 2023 for randomised controlled trials (RCTs). The outcomes included were clinical remission and response, adverse events (AE), withdrawal due to AE, total and serious AE. We performed random-effects meta-analysis and network meta-analysis (frequentist approach), and estimated relative risk (RRs), 95%CI values. We used GRADE to ascertain certainty of evidence.
Results
A total of 83 RCTs comprising 19214 patients were eligible. A total of 28 interventions were included in the analysis. Combination of anti-tumor necrosis factor (TNF) and immunomodulators, anti-TNF monotherapy (adalimumab [ADA], infliximab [IFX], BI695501), IL-23 antagonists (ustekinumab [UST], guselkumab, risankizumab [RIS], mirikizumab), anti-integrins (vedolizumab, natalizumab) and upadacitinib were effective in inducing clinical remission compared to placebo (Figure 1). There was moderate certainty of evidence for combination of ADA and azathioprine (AZA) (RR 3.1, 95%CI [2.0-4.8]; risk difference [RD]: 40.1%), IFX+AZA (RR 2.5, 95%CI [1.7-3.8]; RD: 28.9%), ADA (RR 2.5, 95%CI [1.8-3.5]; RD:28.5%), and UST (RR 2.0 95%CI, [1.6-2.5]; RD: 19.2%) in induction of clinical remission compared to placebo. For induction of clinical response, there was moderate certainty of evidence for IFX+AZA (RR 2.8, 95%CI [1.6-4.8]), ADA (RR 2.5, 95%CI [1.7-3.9]), IFX (RR 2.8, 95%CI [1.6-4.8]), RIS (RR 1.9, 95%CI [1.3-2.6]). On analysis of serious adverse events all therapies were of no difference to placebo (very low certainty). On sensitivity analysis, the impact of concomitant immunomodulator use and the biological naivety of patients had little effect on these results.
Conclusion
On network meta-analysis, combination of anti-TNFs and immunomodulators followed by anti-TNF monotherapy had large effect size with moderate certainty for the induction of clinical remission. More novel therapies appear to have examples of similarly important effect sizes, but are currently limited due to the imprecision of the limited evidence base at present and future research should target these therapies in study
P1043 Immunomodulator and advanced therapies for prevention of clinical relapse and loss of response during maintenance phase in Crohn’s disease: A systematic review and network meta-analysis
No full textBackground
Several effective advanced therapies have been approved for the treatment of Crohn’s disease (CD) in the past two decades. Given lack of adequate head-to head clinical trials it is challenging to position these therapies in the management algorithm. Therefore we performed this network meta-analysis to inform therapeutic decisions.
Methods
We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials between inception and October 2023 for randomised controlled trials (RCTs). Outcomes assessed were clinical relapse (loss of clinical remission), loss of clinical response, adverse events (AE), withdrawal due to AE, and serious AE. We performed random-effects meta-analysis and network meta-analysis (using a frequentist approach), and estimated relative risk (RRs), 95%CI values. We used GRADE to ascertain certainty of evidence.
Results
A total of 32 RCTs comprising 10,924 patients were included in the analysis. On network meta-analysis of 15 interventions based on prevention of clinical relapse, combination of infliximab (IFX) and azathioprine (AZA) (RR 0.31, 95%CI [0.17-0.56]), IFX (RR 0.62, 95%CI [0.5-0.76], moderate certainty), and adalimumab (RR 0.68, 95%CI [0.55-0.84], moderate certainty) were the only agents that were effective compared to placebo (Figure 1). Methotrexate (RR 0.57, 95%CI [0.32-1.03], low certainty) and azathioprine (RR 0.82, 95%CI [0.62-1.1]), very low certainty) were not effective. On analysis based on prevention of clinical response for nine interventions, there was high certainty evidence for ustekinumab (RR 0.73, 95%CI [0.61-0.86]), upadacitinib (RR 0.64, 95%CI [0.57-0.72]), and moderate certainty of evidence for infliximab (RR 0.71, 95%CI [0.59-0.84]), adalimumab (RR 0.68, 95%CI [0.61-0.75]), certolizumab (RR 0.57, 95%CI [0.47-0.7]), CTP13 (RR 0.46, 95%CI [0.38-0.57]), vedolizumab (RR 0.82, 95%CI [0.68-0.99]), natalizumab (RR 0.54, 95%CI [0.43-0.68]). Tofacitinib was not effective and there was no data available for immunomodulators and combination therapies for this outcome. On analysis of serious adverse events advanced therapies were of no difference to placebo (very low certainty).
Conclusion
On network meta-analysis immunomodulators and advanced therapies for maintenance phase, combination of anti-TNFs and immunomodulators followed by anti-TNF monotherapy had large effect size with moderate certainty for prevention of clinical relapse. There was moderate to high certainty evidence to suggest newer advanced therapies are effective in prevention of loss of clinical response
On the Scarcity of Dense Cores ( n > 10 5 cm −3 ) in High-latitude Planck Galactic Cold Clumps
Get PDFHigh-latitude (∣b∣ > 30°) molecular clouds have virial parameters that exceed 1, but whether these clouds can form stars has not been studied systematically. Using JCMT SCUBA-2 archival data, we surveyed 70 fields that target high-latitude Planck Galactic cold clumps (HLPCs) to find dense cores with density of 105–106 cm−3 and size of 1 × 1021 cm−2). At an average rms of 15 mJy beam−1, we detected Galactic dense cores in only one field, G6.04+36.77 (L183) while also identifying 12 extragalactic objects and two young stellar objects. Compared to the low-latitude clumps, dense cores are scarce in HLPCs. With synthetic observations, the densities of cores are constrained to be n c ≲ 105 cm−3 should they exist in HLPCs. Low-latitude clumps, Taurus clumps, and HLPCs form a sequence where a higher virial parameter corresponds to a lower dense-core detection rate. If HLPCs were affected by the Local Bubble, the scarcity should favor turbulence-inhibited rather than supernova-driven star formation. Studies of the formation mechanism of the L183 molecular cloud are warranted
Towards equitable healthspan extension: balancing innovations with the social determinants of health
Get PDFComparing the effectiveness of computer-aided-design/computer-aided-manufacture (CAD/CAM) insoles manufactured from foam-box cast versus direct scans on patient reported outcome measures: A protocol for a double-blinded, randomised controlled trial
Get PDFIntroduction
Custom insoles are a routine treatment for many foot pathologies, and the use of computer aided design and manufacture (CAD/CAM) is well established within clinical practice in the UK. The method of foot shape capture used to produce insoles varies throughout orthotic services. This trial aims to investigate the effectiveness of two common shape capture techniques on patient reported outcomes in people who require insoles for a foot or ankle pathology.
Methods and analysis
This double blinded randomised controlled trial will consider two intervention groups recruited from a National Health Service orthotic service. Participants will be randomly assigned to receive a pair of custom CAD/CAM insoles, manufactured either from a direct-digital scan or a foam-box cast of their feet and asked to wear the insoles for 12-weeks. The primary outcome measure will be the Foot Health Status Questionnaire (FHSQ) Pain sub domain, recorded at baseline (immediately after receiving the intervention), 4-weeks, 8-weeks, and 12-weeks post-intervention. Secondary outcome measures will include FHSQ foot function and foot health sub domains recorded at baseline, 4-weeks, 8-weeks, and 12-weeks. The Prosthetic and Orthotic User Survey Satisfaction with Device Survey recorded after 12-weeks. Transit times associated with each arm measured as the number of days for each insole to be delivered after foot shape capture. Tertiary outcome measures will include participant recruitment and dropout rates, and intervention adherence measured as the daily usage of the insoles over 12-weeks. The change in FHSQ scores for the sub-domains and insole usage will be compared between the groups and time points, and between group differences in time-in-transit, cost-time analysis and environmental impact will be compared.
Ethics and Dissemination
Ethical approval was obtained from the Health Research Authority, London Stanmore Research Ethics Committee (22/LO/0579). Study findings will be submitted for publication in peer-reviewed journals, conference presentations and webinars.
Protocol version: Version 2, 08/092022
Trial registration: ClinicalTrials.gov (Trial number NCT05444192)
Strengths and limitations
• This trial aims to investigate routine interventions that are used within the NHS, therefore the outcomes have the potential to impact on the decision making within orthotic services across the UK and beyond.
• The double blinded design reduces the risk of bias from the participant and the investigator.
• Single centre design may limit the cohort.
• The multiple follow-up points may lead to drop outs