1,721,066 research outputs found
FERN: is it possible to conduct a randomised controlled trial of intervention or expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy - protocol for a prospective multicentre mixed-methods feasibility study
No full textIntroduction: selective fetal growth restriction (sFGR) in monochorionic twin pregnancy, defined as an estimated fetal weight (EFW) of one twin <10th centile and EFW discordance ≥25%, is associated with stillbirth and neurodisability for both twins. The condition poses unique management difficulties: on the one hand, continuation of the pregnancy carries a risk of death of the smaller twin, with a high risk of co-twin demise (40%) or co-twin neurological sequelae (30%). On the other, early delivery to prevent the death of the smaller twin may expose the larger twin to prematurity, with the associated risks of long-term physical, emotional and financial costs from neurodisability, such as cerebral palsy.When there is severe and early sFGR, before viability, delivery is not an option. In this scenario, there are currently three main management options: (1) expectant management, (2) selective termination of the smaller twin and (3) placental laser photocoagulation of interconnecting vessels. These management options have never been investigated in a randomised controlled trial (RCT). The best management option is unknown, and there are many challenges for a potential RCT. These include the rarity of the condition resulting in a small number of eligible pregnancies, uncertainty about whether pregnant women will agree to participate in such a trial and whether they will agree to be randomised to expectant management or active fetal intervention, and the challenges of robust and long-term outcome measures. Therefore, the main objective of the FERN study is to assess the feasibility of conducting an RCT of active intervention vs expectant management in monochorionic twin pregnancies with early-onset (prior to 24 weeks) sFGR.Methods and analysis: the FERN study is a prospective mixed-methods feasibility study. The primary objective is to recommend whether an RCT of intervention vs expectant management of sFGR in monochorionic twin pregnancy is feasible by exploring women’s preference, clinician’s preference, current practice and equipoise and numbers of cases. To achieve this, we propose three distinct work packages (WPs). WP1: A Prospective UK Multicentre Study, WP2A: a Qualitative Study Exploring Parents’ and Clinicians’ Views and WP3: a Consensus Development to Determine Feasibility of a Trial. Eligible pregnancies will be recruited to WP1 and WP2, which will run concurrently. The results of these two WPs will be used in WP3 to develop consensus on a future definitive study. The duration of the study will be 53 months, composed of 10 months of setup, 39 months of recruitment, 42 months of data collection, and 5 months of data analysis, report writing and recommendations. The pragmatic sample size for WP1 is 100 monochorionic twin pregnancies with sFGR. For WP2, interviews will be conducted until data saturation and sample variance are achieved, that is, when no new major themes are being discovered. Based on previous similar pilot studies, this is anticipated to be approximately 15–25 interviews in both the parent and clinician groups. Engagement of at least 50 UK clinicians is planned for WP3.Ethics and dissemination: this study has received ethical approval from the Health Research Authority (HRA) South West—Cornwall and Plymouth Ethics Committee (REC reference 20/SW/0156, IRAS ID 286337). All participating sites will undergo site-specific approvals for assessment of capacity and capability by the HRA. The results of this study will be published in peer-reviewed journals and presented at national and international conferences. The results from the FERN project will be used to inform future studies.Trial registration number: this study is included in the ISRCTN Registry (ISRCTN16879394) and the NIHR Central Portfolio Management System (CPMS), CRN: Reproductive Health and Childbirth Specialty (UKCRN reference 47201)
Leveraging Social Media to Promote EvidenceBased Continuing Medical Education
Full text linkImportance
New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME).
Objective
To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME.
Design
We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different “hooks” (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians.
Setting
The National Physicians Alliance (NPA) membership.
Participants
NPA e-mail recipients, Facebook followers and friends, and Twitter followers.
Main Outcomes and Measures
Clicks to the NPA’s CME landing site.
Results
On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (p
Conclusions
Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email
An exploration of identity, loneliness, and psychosocial functioning in autistic people.
Full text linkAn investigation into psychological outcomes and experiences of adjustment for children and parents following paediatric epilepsy surgery
Full text linkUnderstanding the experiences of parents in paediatric emergency departments
No full textChapter One: Systematic Review Abstract
Objective: Parents present with various psychological responses while visiting the ED with their child, which can have a detrimental impact on the parent and their child both in the short- and long-term, particularly when left unsupported. To date, there has been no systematic review exploring the psychological responses of parents, particularly anxiety, stress, depression, and distress in this setting. This review summarises the evidence base to explore and understand these responses and how they can be supported within EDs.
Methods: Five electronic databases (PsychInfo, Medline, CINAHL, Web of Science, and Scopus) were searched in March 2024. The references of the eligible studies and google scholar were also hand-searched. Extracted data from the eligible studies were thematically synthesised and the quality of the studies were critically evaluated using the Critical Appraisal Skills Programme (CASP, 2018) qualitative studies checklist.
Results: A total of 15 papers pertaining to parents’ psychological responses within the ED were identified. Three themes were developed: (1) Psychological responses; (2) Coping strategies, and (3) Future changes. Parents experienced anxiety, stress, and distress, and spoke about contributing factors such as lack of communication, uncertainty regarding their child’s health, and witnessing their child’s procedure. Parents reported existing coping strategies and discussed future changes they would like to see in the support provided to parents in EDs.
Conclusion: Parents presented with various psychological responses from a range of stressful experiences within the ED. This review offers a deeper understanding of those parental psychological responses and coping strategies, and has implications for staff training, parental support and coping, as well as child recovery and return visits.
Chapter Two: Empirical Abstract
Objective: Whilst the evidence base exploring parental distress is increasing over time, studies are yet to focus on understanding parental distress from the perspectives of parents and staff in UK-based paediatric emergency departments (PEDs). This study aims to explore parent and PED staff experiences of parental distress and the support provided, with the further aim of providing recommendations for clinical practice and training within PEDs.
Method: A qualitative approach was adopted. A total of 15 parents took part in online semi-structured interviews and six PED staff took part in an online focus group. All data were analysed using reflexive thematic analysis.
Findings: Three main themes were developed, which were inclusive of both parent and staff perspectives. The first theme outlined the various presentations of parental distress. The second theme described how parental distress can be experienced, before, during, and after a visit to the PED, and included experiences that were found to contribute to parental distress, such as wait times, uncertainty, staff approaches and communication, the ED environment, and a lack of follow-up support. The final theme highlighted future changes that parents and staff would like to see in PEDs for parental distress to be better understood and supported.
Conclusion: This study provided a deeper understanding of parental distress in PEDs including how and when distress can present and the contributary experiences. The findings and resulting recommendations have implications for clinical practice, specifically staff-parent communication and support provided in PEDs, as well as staff training and support
Developing Social Media Guidelines for Health Research: A Mixed Methods Study
Full text linkTitle: Developing Social Media Guidelines for Health Research: A Mixed Methods Study
Background: Social media platforms have become increasingly adopted across society and implemented into health research fields. Existing literature has demonstrated that social media platforms can potentially benefit research by increasing access to populations, offering additional recruitment methods, additional data collection techniques and improved dissemination. However, there are concerns regarding the use of social media in health research including ethical considerations related to public privacy and confidentiality.
Methods: To help address these concerns, this PhD used a mixed methods design to review the relevant literature before describing the three-staged SOLACE study. The first stage comprised semi- structured interviews with health research professionals and members of the public to explore their experiences of social media use within health research. Interview transcripts were analysed through thematic analysis and a set of social media guidelines to inform the use of social media use within health research was drafted. The second stage involved focus groups with the same populations to review the drafted guidelines. The third stage gathered feedback from health research professionals via an online survey following their reviewing and implementing the guideline recommendations in health research studies.
Setting: The SOLACE study was based in the UK but was open to participants globally. The study was conducted during the COVID-19 pandemic.
Results: I interviewed 26 participants (n=10 professional group, n=16 public group) for the first stage of the SOLACE study, I conducted 6 focus groups with a total of 26 participants (n=12 professional group, n=14 public group) for the second stage and the third stage included survey responses from 27 participants (health researchers). Health research professionals highlighted several functions that social media platforms can be used for, including recruitment, data collection and dissemination. Most members of the public perceived the use of social media for health research as positive, however some highlighted a lack of trust in social media. Some health researchers felt pressure to use social media for research with little or no guidance and were concerned about following ethical guidelines and policies. Findings include recommendations on implementing social media into a research study such as ethical considerations, recruitment, data collection and dissemination techniques. The set of guidelines also aim to help improve the replicability of social media use within research study methodologies therefore helping to improve research validity and reliability.
Conclusion: Synthesis of findings from the interviews, focus groups and survey, provide health researchers with seven main recommendations (PEPPERD) of using social media for a research study; Plan, Ethics, Presence, Preparation, Execute, Recruit (and collect data), and Disseminate. Further systematic evaluation of these guidelines is required. Future research could focus on how novel or changing social media platforms can be implemented into research studies
Exploring Stigma and empowerment amongst parents of children diagnosed with a congenital craniofacial anomaly: a qualitative study
Full text linkBarriers to and Facilitators of Physical Activity Promotion and Participation for People Living With and Beyond Head and Neck Cancer: A Mixed Methods Study Using Behaviour Change Theory
Full text link
Timing of neonatal stoma closure: a survey of health professional perspectives and current practice
No full textOptimal timing for neonatal stoma closure remains unclear. In this study, we aimed to establish current practice and illustrate multidisciplinary perspectives on timing of stoma closure using an online survey sent to all 27 UK neonatal surgical units, as part of a research programme to determine the feasibility of a clinical trial comparing ‘early’ and ‘late’ stoma closure. 166 responses from all 27 units demonstrated concordance of opinion in target time for closure (6 weeks most commonly stated across scenarios), although there was a high variability in practice. A sizeable proportion (41%) of respondents use weight, rather than time, to determine when to close a neonatal stoma. Thematic analysis of free text responses identified nine key themes influencing decision-making; most related to nutrition, growth and stoma complications. These data provide an overview of current practice that is critical to informing an acceptable trial design.<br/
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