1,721,210 research outputs found
The effectiveness of psychological interventions for fatigue in cancer survivors: Systematic review of randomised controlled trials
No full textProtocol for a systematic review of psychological interventions for cancer-related fatigue in post-treatment cancer survivors
No full textBACKGROUND: Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase. Some evidence has been reported for interventions for fatigue during active treatment. However, to date, there is no systematic review on psychological interventions for fatigue after the completion of curative treatment for cancer. This is a protocol for a systematic review that aims to evaluate the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database.METHODS/DESIGN: We will search the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library), PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and relevant sources of grey literature. Randomised controlled trials (RCTs) which have evaluated psychological interventions in adult cancer patients after the completion of treatment, with fatigue as an outcome measure, will be included. Two review authors will independently extract data from the selected studies and assess the methodological quality using the Cochrane Collaboration Risk of Bias Tool.DISCUSSION: Most existing evidence on cancer-related fatigue is from those in active cancer treatment. This systematic review and meta-analysis will build upon previous evaluations of psychological interventions in people during and after cancer treatment. With the growing need for stage-specific research in cancer, this review seeks to highlight a gap in current practice and to strengthen the evidence base of randomised controlled trials in the area.SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014015219.</p
Cerebral palsy in the West of Ireland and the application of the international criteria for the identification of acute intrapartum hypoxia: a cohort study.
No full textAbstract Background Cerebral palsy is one of the most severe disabilities in childhood and occurs in 1-3 per 1,000 live births in Europe. This epidemiological study looked at a cohort of children with cerebral palsy to establish if their demographics, clinical characteristics and risk profiles are similar to those of other children with cerebral palsy described in the literature. The prevalence of variables associated with intrapartum hypoxia was also explored. Methods A retrospective cohort study was conducted. Data were extracted from maternal and neonatal records using a standardised data extraction form. Data analysis was conducted using SPSS (Statistical Package for the Social Sciences) version 18 and the Cochrane Review Manager Software (RevMan) (The Nordic Cochrane Centre, 2008). Findings One hundred children with cerebral palsy participated in the study. Singleton births accounted for 89% of the cohort and 11% were from multiple births. The gestational ages ranged from 24 to 42 weeks with 61% of the children being born at term and 39% born prematurely. Birth weights ranged from 780 grams to 4990 grams with 60% of the children having a normal birth weight and 40% being low birth weight. 84% of the children had a spastic subtype of cerebral palsy including, 34% with a spastic hemiplegia, 26% with a spastic diplegia and 24% with a spastic quadriplegia. Dyskinetic cerebral palsy occurred in 10% of the children and ataxic cerebral palsy in the remaining 6%. Many of the children had other impairments in addition to their motor difficulties. Among those additional impairments are, walking impairments (84%), intellectual impairments (62%), feeding difficulties (56%), epilepsy (44%), visual impairments (20%) and hearing impairments (13%). The likely time of origin of the cerebral damage was not classifiable in 13% of cases, antenatal in 38%, related to prematurity in 28%, neonatal and post-neonatal in 6% and followed intrapartum hypoxia in 15% of cases. Conclusion The distribution of antenatal, intrapartum and neonatal factors associated with cerebral palsy are similar to that found in other populations of children with cerebral palsy. The children have a distribution of cerebral palsy subtypes and associated impairments similar to other cerebral palsy cohorts. The study also found that the ACOG criteria for identifying acute intrapartum hypoxia sufficient to cause cerebral palsy were deficient
The effectiveness of a structured educational reminiscence-based programme for staff in long-stay units on the quality of life of residents with dementia.
No full textBackground
There is a growing appreciation of the potential use of psychosocial interventions in maintaining or improving the quality of life of people with dementia residing in long-stay care settings. Reminiscence is a psychosocial intervention commonly used in dementia and involves the discussion of past activities, events and experiences with another person or group of people, usually with the aid of tangible prompts such as photographs or other familiar items. However, despite being widely used in dementia care, evidence on the effectiveness of reminiscence as a psychosocial intervention for people with dementia residing in long-stay settings is uncertain.
Aims
The aim of this study was to evaluate the effectiveness of a structured educational reminiscence-based programme for staff in long-stay units on the quality of life of residents with dementia.
Methods
The DARES study was a two-group, single-blind cluster randomised trial (ISRCTN99651465), conducted in public and private long-stay residential settings in Ireland. Randomisation to control and intervention was at the level of the long-stay residential unit. Sample size calculations suggested that 18 residential units each containing 17 people with dementia were required for randomisation to control and intervention groups to achieve power of at least 80% with alpha levels of 0.05. Each resident in the intervention group was linked with a nurse and care assistant who had completed the structured reminiscence-based education programme. Residents allocated to the control group received usual care. The primary outcome was quality of life of residents as measured by the Quality of Life-AD instrument. Secondary outcomes included staffs\u27 perception of the residents\u27 quality of life, residents\u27 perceived levels of agitation, depression and staffs\u27 perceived burden of care. Blinded outcome assessment was undertaken at baseline and at 18-22 weeks post-randomisation.
Findings
Using an intention to treat complete case analysis, on average, there was no statistical significant difference, between residents allocated to the SERPS and residents allocated to usual care. Estimated effect of the intervention on the quality of life of residents was 3.54 (95% CI -0.83 to 7.90, p=0.10), expressed as the difference in mean improvement between intervention and control group. When the three sites that did not implement the intervention to residents as prescribed were removed for the analysis, per-protocol analysis yielded a significant effect. Estimated effect of the intervention on the quality of life of residents was 5.22 (95% CI 0.11 to 10.34, p=0.04), exceeding the 4-point minimal clinical important difference defined at the outset of the trial.
Conclusion
Reminiscence may be an effective care option for people with dementia in long-stay settings with potential to impact positively on the quality of life of residents
Cerebral palsy in the West of Ireland and the application of the international criteria for the identification of acute intrapartum hypoxia: a cohort study.
No full textAbstract
Background
Cerebral palsy is one of the most severe disabilities in childhood and occurs in 1-3 per 1,000 live births in Europe. This epidemiological study looked at a cohort of children with cerebral palsy to establish if their demographics, clinical characteristics and risk profiles are similar to those of other children with cerebral palsy described in the literature. The prevalence of variables associated with intrapartum hypoxia was also explored.
Methods
A retrospective cohort study was conducted. Data were extracted from maternal and neonatal records using a standardised data extraction form. Data analysis was conducted using SPSS (Statistical Package for the Social Sciences) version 18 and the Cochrane Review Manager Software (RevMan) (The Nordic Cochrane Centre, 2008).
Findings
One hundred children with cerebral palsy participated in the study. Singleton births accounted for 89% of the cohort and 11% were from multiple births. The gestational ages ranged from 24 to 42 weeks with 61% of the children being born at term and 39% born prematurely. Birth weights ranged from 780 grams to 4990 grams with 60% of the children having a normal birth weight and 40% being low birth weight. 84% of the children had a spastic subtype of cerebral palsy including, 34% with a spastic hemiplegia, 26% with a spastic diplegia and 24% with a spastic quadriplegia. Dyskinetic cerebral palsy occurred in 10% of the children and ataxic cerebral palsy in the remaining 6%. Many of the children had other impairments in addition to their motor difficulties. Among those additional impairments are, walking impairments (84%), intellectual impairments (62%), feeding difficulties (56%), epilepsy (44%), visual impairments (20%) and hearing impairments (13%). The likely time of origin of the cerebral damage was not classifiable in 13% of cases, antenatal in 38%, related to prematurity in 28%, neonatal and post-neonatal in 6% and followed intrapartum hypoxia in 15% of cases.
Conclusion
The distribution of antenatal, intrapartum and neonatal factors associated with cerebral palsy are similar to that found in other populations of children with cerebral palsy. The children have a distribution of cerebral palsy subtypes and associated impairments similar to other cerebral palsy cohorts. The study also found that the ACOG criteria for identifying acute intrapartum hypoxia sufficient to cause cerebral palsy were deficient
Monitoring the fetal heart for the assessment of fetal wellbeing. Systematic reviews of the evidence and the design, conduct and preliminary findings of a multi-centre randomised trial THE ADCAR TRIAL
No full textTHESIS 9116The assessment of fetal wellbeing throughout pregnancy, labour and birth, is essential in achieving maternity care that optimises fetal outcomes. Monitoring of the fetal heart rate (FHR), using either intermittent auscultation (1A) (i.e. listening to the FHR at regular intervals using a Pinard stethoscope or hand-held Doppler device) or electronic fetal monitoring (EFM), (i.e. recording of the FHR by a special electronic machine) is one practice central to the assessment of fetal wellbeing. Admission cardiotocography (ACTG), a form of EFM, is a routine screening test consisting of a twenty minute electronic recording of the FHR and uterine activity performed on women on admission to the labour ward or labour assessment room with signs of possible labour. The premise for the use of ACTG is that it may identify those babies, from the onset of possible labour, who might benefit from continuous EFM during labour
Thinking critically about cancer misinformation: The Informed Health Choice-Cancer (IHC-C) programme
No full textIntroduction
Cancer remains one of the leading causes of death worldwide, with incidence rates expected to continue to rise. As digital technology evolves, those impacted by cancer increasingly turn to online resources to support their health choices, with approximately one in three people actively seeking health-related information online. However, amid the ongoing ‘infodemic’ where false or misleading content circulates widely, the quality of cancer-related information has become a major concern. Evidence suggests that nearly one in three pieces of cancer-related content contains misinformation, posing significant challenges to individuals’ ability to access trustworthy and accurate health content. This undermines informed decision-making, influences health behaviours, and erodes public trust. Limited public health literacy and a general lack of skills in critically appraising health claims further amplifies the risks posed by misinformation. At the individual level, misinformation can delay appropriate treatment and lead to avoidable harm, including death; at the population level, it can distort public attitudes, behaviours, and health policies, ultimately undermining the collective capacity to make informed health choices.
In response, there is an urgent need for accessible interventions that strengthen health literacy and critical thinking, both of which are essential for navigating an increasingly complex health information landscape and mitigating the harmful effects of misinformation.
Aim and Objectives
This research aims to develop and test an online educational programme called Informed Health Choices-Cancer, designed to equip individuals impacted by cancer with the skills and knowledge necessary to think critically about the reliability of health claims and make well-informed choices. The research objectives are to: 1) prioritise and identify the most relevant Key Concepts from the Informed Health Choices framework for those impacted by cancer; 2) based on the prioritised Key Concepts, create a plain-language, cancer-centred learning resource through an iterative process that incorporates input from individuals impacted by cancer; and 3) design a pilot randomised trial to assess the feasibility and acceptability of the learning resource as an intervention to enhance health literacy, critical thinking, and decision-making regarding cancer and health information.
Methods
A mixed-method approach was used to address the research objectives.
To address objective one, a structured two-round prioritisation process was conducted to identify the most relevant Key Concepts for those impacted by cancer, collaborating with key stakeholders from both a patient and public involvement group (including cancer patients, survivors, caregivers, and loved ones) and a multidisciplinary steering group (composed of healthcare professionals, educationalists, and researchers). Participants received pre-reading materials and attended training sessions to familiarise themselves with the Key Concepts and the prioritisation process. Each concept was evaluated using a standardised judgement form. Quantitative and qualitative data from each prioritisation round were analysed to reach a consensus on the final set of concepts selected for inclusion.
To address objective two, a human-centred design approach incorporating iterative refinement was used to co-develop the learning resource. Guided by the prioritised Key Concepts, structured templates were initially developed to define the overall architecture of the learning resource, including unit structure, learning outcomes, the need for tailored cancer-specific content, and appropriate multimedia formats. One prioritised Key Concept was expanded into a prototype unit, and an iterative cycle of drafting, reviewing, revising, and refining was conducted to ensure rigorous educational standards and effective communication of intended learning outcomes. The prototype was then pilot tested with key stakeholders from the prioritisation phase to assess accessibility, usability, and real-life relevance. Feedback was systematically incorporated to refine both the prototype unit and the templates. Subsequently, the remaining units were developed using the refined templates as a guide. The same iterative cycle of drafting, reviewing, revising, and refining was conducted, and the complete learning resource was integrated into an online learning platform. It was further evaluated through two successive pilot tests: first with small stakeholder groups and subsequently with a broader sample, including newly recruited patient and public involvement participants. Quantitative ratings and qualitative feedback were collected and used to assess and enhance the accessibility, usability, and practical relevance of the learning resource.
To address objective three, a pilot randomised trial was designed to evaluate the feasibility and acceptability of delivering the Informed Health Choices-Cancer learning resource and to inform the design of a future definitive trial. The trial design defines participant recruitment strategies, randomisation procedures, control group allocation, the selection of primary and secondary outcomes, demographic data collection, and data analysis methods.
Findings
Objective one: Thirty-five participants, including those impacted by cancer, healthcare professionals, educationalists, and researchers, took part in five training sessions and two rounds of a structured prioritisation process. Through two consensus meetings, the original list of 49 Key Concepts was initially narrowed down to 21 and ultimately reduced to a final set of nine. These nine concepts were identified as the most relevant to the needs and experiences of those impacted by cancer.
Objective two: Structured templates were created to guide the design of the learning resource and its individual units. Fourteen participants who were impacted by cancer, completed the initial pilot testing of the prototype unit. The results showed alignment of the learning resource with intended learning outcomes, clarity of content, and relevance to users’ needs. Qualitative feedback indicated a need for further simplification of language, prompting refinements to both the prototype and the templates. The revised templates were then used to develop all remaining units. Nineteen individuals impacted by cancer participated in two rounds of pilot testing. Over 80% of participants found the overall learning resource ‘very well aligned’ with the learning outcomes, ‘very easy to understand’, ‘very relevant’ to the needs of individuals impacted by cancer, and ‘very easy to navigate’. The final version of the resource was also perceived as useful in supporting critical thinking, facilitating informed decision-making, and reflecting the real-world experiences of individuals impacted by cancer.
Objective three: The pilot randomised trial has been designed and is ongoing. Participants are being recruited through both traditional and online channels and randomised to either the Informed Health Choices-Cancer intervention or a waitlist control group. Primary outcomes include feasibility metrics such as recruitment and retention rates, while secondary outcomes assess acceptability, such as participant satisfaction and perceived usefulness. Demographic and cancer-related data are being collected to characterise the cohort and support future recruitment planning. Preliminary measures of health literacy, critical thinking, and decision-making skills are also being gathered to inform outcome selection for the future trial.
Conclusion
The findings from this research demonstrate the development, feasibility, accessibility, and acceptability of the Informed Health Choices-Cancer learning resource as an educational intervention for individuals impacted by cancer. The structured prioritisation process effectively identified Key Concepts most relevant to this population. The iterative user-centred design approach resulted in a structured learning resource that was well received for its clarity, usability, and relevance to users’ real-world needs. Pilot testing is planned to provide preliminary evidence on the resource’s potential to improve health literacy and critical thinking, empower informed health choices, and reducing vulnerability to cancer-related misinformation. As a practical, accessible, and evidence-informed tool, the Informed Health Choices-Cancer programme offers a novel approach to integrate health literacy and critical thinking education into cancer care, supporting more informed health choices. These findings provide a solid foundation for a future definitive trial to evaluate the effectiveness of the Informed Health Choices-Cancer learning programme on critical thinking, eHealth literacy, and decision-making skills
COHESION core outcomes in neonatal encephalopathy
No full textNeonatal encephalopathy is a complex neurological syndrome in newborn infants characterised by depression in tone and consciousness, impaired reflexes, and often seizures. The main subtype of neonatal encephalopathy is hypoxic-ischemic encephalopathy (HIE), caused by a lack of oxygen in the blood reaching the brain and other organs of the body. Therapeutic hypothermia is commonly used to treat HIE in high-income countries, showing evidence of reducing the risk of death and improving outcomes such as neurodevelopmental disability. However, the beneficial effects of therapeutic hypothermia were not replicated in low- to middle-income countries, instead leading to increased death and adverse events in infants. New treatments are now being investigated in randomised trials for the treatment of neonatal encephalopathy. However, researchers cannot compare the findings of trials because different outcomes are measured and reported. One way to minimise the heterogeneity in outcomes reported is to develop a core outcome set (COS). A core outcome set is a standardised set of outcomes agreed by key stakeholders that should be measured and reported in all studies for a health condition as a minimum. The work presented in this thesis (The COHESION Study) aims to develop a COS for interventions for the treatment of neonatal encephalopathy2024-10-2
COSUTI: a protocol for the development of a core outcome set (COS) for interventions for the treatment of uncomplicated urinary tract infection (UTI) in adults
No full textBackground: Urinary tract infections (UTIs) are the second most common infection presenting in the community. Clinical guidelines and decision aids assist health practitioners to treat a UTI; however, treatment practices vary due to patient needs and context of presentation. Numerous trials have evaluated the effectiveness of treatment interventions for UTI; however, it is difficult to compare the results between trials due to inconsistencies between reported outcomes. Poor choice of outcome measures can lead to impairment of evidence synthesis due to the inability to compare outcomes between trials with similar aims. Transparency in selecting and reporting outcomes can be mitigated through the development of an agreed minimum set of outcomes that should be reported in clinical trials, referred to as a core outcome set (COS). This paper presents the protocol for the development of a COS for interventions in the treatment of uncomplicated UTI in adults. Methods: This COS development consists of three phases. Phase 1 is a systematic review, which aims to identify the core outcomes that have been reported in trials and systematic reviews of interventions treating uncomplicated UTI in adults. Phase 2 consists of a three-round online Delphi survey with stakeholders in the area of treatment interventions for UTI. The aim of this online Delphi survey is to achieve consensus on the importance of the outcomes emerging from Phase 1 of this research. Phase 3 is a consensus meeting to finalise the COS that should be reported in trials evaluating the effectiveness of interventions for the treatment of UTI. Discussion: It is hoped that the development of a COS for interventions for the treatment of uncomplicated UTI in adults will be adopted as a minimum set of outcomes that should be reported and measured within this context. If the findings from clinical trials related to treatment interventions for UTI are to impact on policy and practice, it is important that the findings from different treatment interventions are comparable across trials.</p
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