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Beyond coping: The role of supportive relationships and meaning making in youth well‐being

Abstract

Introduction

The purpose of this study was to identify coping strategies, resources, and strengths that predict well-being in a community-based sample of youth with varying levels of adversity.

Design

Grounded in the resilience portfolio model, we used a mixed methods approach with data from a cross-sectional sample of 231 youth ages 8–17.

Materials and Methods

Data were collected using a survey, participant-generated timeline activity, and brief interview. Measures included assessments of coping and appraisal, resilience resources and assets, and subjective well-being and depression.

Results

Active and passive coping strategies predicted subjective well-being and depression. Controlling for demographics and coping, meaning making strengths and supportive relationships were significant predictors of subjective well-being and lower depression, and decreased the impact of adversity on these outcomes.

Discussion

The results of this study provide support for the resilience portfolio model in a community-based sample of youth, with relationships as predicted for subjective well-being and symptoms of depression. For both outcomes, family relationships held the strongest associations with positive well-being and lower symptoms of depression. Supportive relationships with peers, meaning making strengths, interpersonal strengths, less passive coping, and fewer adverse life events were also associated with better outcomes.

Conclusions

These findings underscore the need to assess youth resources and strengths and to design interventions that target these protective factors for all youth, regardless of exposure to adversity.

Clinical Relevance

A theory-informed understanding of resources and strengths that predict youth well-being is essential to inform strengths-based interventions for pediatric research and practice. The resilience portfolio model is a useful framework for understanding predictors of youth well-being.

Interaction among health workers and trans men: Findings from a qualitative study in Chile

Abstract

Purpose

To explore trans men's access and use of healthcare services in Chile, based on the experiences of the trans men themselves, as well as of healthcare professionals.

Methods

A qualitative study with an ethnographic approach was carried out with 30 participants: 14 trans men and 16 healthcare professionals. Semi-structured one-on-one interviews with open-ended questions were used to collect the data. A thematic analysis was carried out with the NVivo Software.

Results

Three main themes were identified: (1) failures in the recognition of trans identity, (2) challenges with patient-centered care, and (3) use of other (“non-trans”) health services.

Conclusions

The results suggest that not all transition processes are the same, individuals seek different ways; therefore, it is necessary to consider different body types and identities when planning programs and care for men in transition. Moreover, the accompaniment provided during the gender transition process should contemplate emotional and mental support.

Clinical Relevance

The study outlines the need for all healthcare professionals to have training and knowledge about the transgender population, regardless of whether they are part of the teams supporting gender transition processes. The role of nurses and the contributions that can be made from nursing discipline in this research field are fundamental.

Family engagement in paediatric acute care settings: A realist review

Abstract

Aim

To create a programme theory of family engagement in paediatric acute care to explicate the relationships between contexts and mechanisms of family engagement that align with family, direct care providers and healthcare organization outcomes.

Design

Realist review and synthesis.

Data Sources

PubMed, CINAHL, PsycINFO and Web of Science searches for the 2.5-year period (July 2019–December 2021) following our 2021 scoping review.

Review Methods

Following methods described by Pawson and Rycroft-Malone, we defined the scope of the review, searched for and appraised the evidence, extracted and synthesized study findings and developed a supporting narrative of our results.

Results

Of 316 initial citations, 101 were included in our synthesis of the final programme theory. Contexts included family and direct care provider individualism, and the organizational care philosophy and environment. Mechanisms were family presence, family enactment of a role in the child's care, direct care providers facilitating a family role in the child's care, unit/organizational promotion of a family role, relationship building and mutually beneficial partnerships. Outcomes were largely family-focussed, with a paucity of organizational outcomes studied. We identified four context–mechanism–outcome configurations.

Conclusion

This realist review uncovered underlying contexts and mechanisms between patients, direct care providers and organizations in the family engagement process and key components of a mutually beneficial partnership. Given that successful family engagement requires direct care provider and organizational support, future research should expand beyond family outcomes to include direct care providers, particularly nurses and healthcare organization outcomes.

Impact

The final programme theory of family engagement in paediatric acute care provides a roadmap for clinicians to develop complex interventions to engage families and evaluate their impact. The components of our final programme theory reflect family engagement concepts that have been evolving for decades.

Patient or Public Contribution

The team conducting this review included members from the practice setting (JT & KG). In the future, as we and others use this model in practice, we will seek input for refinement from clinicians, patients and caregivers.

Barriers and facilitators associated with the implementation of surgical safety checklists: A qualitative systematic review

Aim

Despite the documented benefits of the World Health Organisation Patient Safety Checklist compliance rates with implementation continue to cause risk to patient safety. This qualitative systematic review aimed to explore the reported factors that impact compliance and implementation processes related to surgical safety checklists in perioperative settings.

Design

A qualitative systematic review.

Methods

A systematic review using the Joanna Briggs Institute (JBI) approach to synthesize qualitative studies was conducted and reported according to PRISMA guidelines. Electronic databases were expansively searched using keywords and subject headings. Articles were assessed using a pre-selected eligibility criterion. Data extraction and quality appraisal was undertaken for all included studies and a meta-aggregation performed.

Data Sources

The CINAHL, Medline and Scopus databases were searched in August 2022 and the search was repeated in June 2023.

Results

34 studies were included. Following the synthesis of the findings there were multiple interrelating barriers to checklist compliance that impacted implementation. There were more barriers than enablers reported in existing studies. Enablers included effective leadership, education and training, timely use of audit and feedback, local champions, and the option for local modifications to the surgical checklist. Further research should focus on targeted interventions that improve observed compliance rates to optimize patient safety.

Conclusion

This qualitative systematic review identified multiple key factors that influenced the uptake of the Surgical Safety Checklist in operating theatres.

Implications for the profession and/or patient care

Surgeon participation, hierarchical culture, complacency, and duplication of existing safety processes were identified which impacted the use and completion of the checklist.

Perceived organisation support would buffer the impact of work frustration on burn-out among intensive care unit nurses

Por: Saravanabavan · L. · Poongavanam · V.

Commentary on: Yanbei R, Dongdong M, Yun L, Ning W, Fengping Q. Does perceived organization support moderate the relationships between work frustration and burnout among intensive care unit nurses? A cross-sectional survey. BMC Nurs. 2023 Jan 23;22(1):22. doi: 10.1186/s12912-023-01180-5.

Commentary

Implications for practice and research

  • Providing intensive care unit (ICU) nurses with organisational supports by showcasing that the organisation cares about their well-being, gives importance to their opinions, is proud of their achievements will decrease their work frustration.

  • Future research and auditing of programmes and events to monitor organisational support to ICU nurses in reduction of work frustration and burn-out. Such monitoring systems could translate into better patient outcome.

  • Context

    The psychological strain of caring for very ill patients causes significant mental stress for all ICU healthcare professionals. When stress is prolonged, it might eventually cause burn-out and deterioration of patient...

    Protocol for validating an algorithm to identify neurocognitive disorders in Canadian Longitudinal Study on Aging participants: an observational study

    Por: Mayhew · A. J. · Hogan · D. · Raina · P. · Wolfson · C. · Costa · A. P. · Jones · A. · Kirkland · S. · O'Connell · M. · Taler · V. · Smith · E. E. · Liu-Ambrose · T. · Ma · J. · Thompson · M. · Wu · C. · Chertkow · H. · Griffith · L. E. · On behalf of the CLSA Memory Study Working Grou
    Introduction

    In population-based research, disease ascertainment algorithms can be as accurate as, and less costly than, performing supplementary clinical examinations on selected participants to confirm a diagnosis of a neurocognitive disorder (NCD), but they require cohort-specific validation. To optimise the use of the Canadian Longitudinal Study on Aging (CLSA) to understand the epidemiology and burden of NCDs, the CLSA Memory Study will validate an NCD ascertainment algorithm to identify CLSA participants with these disorders using routinely acquired study data.

    Methods and analysis

    Up to 600 CLSA participants with equal numbers of those likely to have no NCD, mild NCD or major NCD based on prior self-reported physician diagnosis of a memory problem or dementia, medication consumption (ie, cholinesterase inhibitors, memantine) and/or self-reported function will be recruited during the follow-up 3 CLSA evaluations (started August 2021). Participants will undergo an assessment by a study clinician who will also review an informant interview and make a preliminary determination of the presence or absence of an NCD. The clinical assessment and available CLSA data will be reviewed by a Central Review Panel who will make a final categorisation of participants as having (1) no NCD, (2) mild NCD or, (3) major NCD (according to fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria). These will be used as our gold standard diagnosis to determine if the NCD ascertainment algorithm accurately identifies CLSA participants with an NCD. Weighted Kappa statistics will be the primary measure of agreement. Sensitivity, specificity, the C-statistic and the phi coefficient will also be estimated.

    Ethics and dissemination

    Ethics approval has been received from the institutional research ethics boards for each CLSA Data Collection Site (Université de Sherbrooke, Hamilton Integrated Research Ethics Board, Dalhousie University, Nova Scotia Health Research Ethics Board, University of Manitoba, McGill University, McGill University Health Centre Research Institute, Memorial University of Newfoundland, University of Victoria, Élisabeth Bruyère Research Institute of Ottawa, University of British Columbia, Island Health (Formerly the Vancouver Island Health Authority, Simon Fraser University, Calgary Conjoint Health Research Ethics Board).

    The results of this work will be disseminated to public health professionals, researchers, health professionals, administrators and policy-makers through journal publications, conference presentations, publicly available reports and presentations to stakeholder groups.

    Examining the health and functioning status of medical laboratory professionals in Ontario, Canada: an exploratory study during the COVID-19 pandemic

    Por: Joncic · G. · Jain · M. · Chattu · V. K. · Gohar · B. · Nowrouzi-Kia · B.
    Objectives

    This study aims to explore the overall and specific aspects of the functioning of medical laboratory professionals (MLPs) in Ontario, Canada during the COVID-19 pandemic.

    Design

    A cross-sectional analysis where a questionnaire was used to assess the mental status of MLPs.

    Setting

    An online questionnaire administered in Ontario, Canada.

    Participants

    632 MLPs (medical laboratory technologists, technicians and assistants) were included.

    Main outcome measures

    We employed the WHO Disability Assessment Schedule V.2.0 (WHODAS V.2.0) Questionnaire to assess functioning/disability and Copenhagen Psychosocial Questionnaire, third edition for psychosocial workplace factors. Multiple regression analysis examined the relationship between overall and specific domain functioning scores and psychosocial workplace factors.

    Results

    Of the total 632 participants, the majority were female gender and Caucasian. It was found that health (β=2.25, p

    Conclusion

    This study provides preliminary evidence of the overall and specific aspects of functioning among the MLPs during the COVID-19 pandemic. Besides, these findings can support and guide the improvement of workplace practices and policies among MLPs in the future.

    Dismantling and personalising task-sharing psychosocial interventions for common mental disorders: a study protocol for an individual participant data component network meta-analysis

    Por: Papola · D. · Karyotaki · E. · Purgato · M. · Sijbrandij · M. · Tedeschi · F. · Cuijpers · P. · Orestis · E. · Furukawa · T. A. · Patel · V. · Barbui · C.
    Introduction

    Common mental disorders, including depression, anxiety and related somatic health symptoms, are leading causes of disability worldwide. Especially in low-resource settings, psychosocial interventions delivered by non-specialist providers through task-sharing modalities proved to be valid options to expand access to mental healthcare. However, such interventions are usually eclectic multicomponent interventions consisting of different combinations of evidence-based therapeutic strategies. Which of these various components (or combinations thereof) are more efficacious (and for whom) to reduce common mental disorder symptomatology is yet to be substantiated by evidence.

    Methods and analysis

    Comprehensive search was performed in electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Register of Controlled Trials—CENTRAL from database inception to 15 March 2023 to systematically identify all randomised controlled trials that compared any single component or multicomponent psychosocial intervention delivered through the task-sharing modality against any active or inactive control condition in the treatment of adults suffering from common mental disorders. From these trials, individual participant data (IPD) of all measured outcomes and covariates will be collected. We will dismantle psychosocial interventions creating a taxonomy of components and then apply the IPD component network meta-analysis (IPD-cNMA) methodology to assess the efficacy of individual components (or combinations thereof) according to participant-level prognostic factors and effect modifiers.

    Ethics and dissemination

    Ethics approval is not applicable for this study since no original data will be collected. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.

    Evaluation of variation in special educational needs provision and its impact on health and education using administrative records for England: umbrella protocol for a mixed-methods research programme

    Por: Zylbersztejn · A. · Lewis · K. · Nguyen · V. · Matthews · J. · Winterburn · I. · Karwatowska · L. · Barnes · S. · Lilliman · M. · Saxton · J. · Stone · A. · Boddy · K. · Downs · J. · Logan · S. · Rahi · J. · Black-Hawkins · K. · Dearden · L. · Ford · T. · Harron · K. · De Stavola · B. · Gilb
    Introduction

    One-third of children in England have special educational needs (SEN) provision recorded during their school career. The proportion of children with SEN provision varies between schools and demographic groups, which may reflect variation in need, inequitable provision and/or systemic factors. There is scant evidence on whether SEN provision improves health and education outcomes.

    Methods

    The Health Outcomes of young People in Education (HOPE) research programme uses administrative data from the Education and Child Health Insights from Linked Data—ECHILD—which contains data from all state schools, and contacts with National Health Service hospitals in England, to explore variation in SEN provision and its impact on health and education outcomes. This umbrella protocol sets out analyses across four work packages (WP). WP1 defined a range of ‘health phenotypes’, that is health conditions expected to need SEN provision in primary school. Next, we describe health and education outcomes (WP1) and individual, school-level and area-level factors affecting variation in SEN provision across different phenotypes (WP2). WP3 assesses the impact of SEN provision on health and education outcomes for specific health phenotypes using a range of causal inference methods to account for confounding factors and possible selection bias. In WP4 we review local policies and synthesise findings from surveys, interviews and focus groups of service users and providers to understand factors associated with variation in and experiences of identification, assessment and provision for SEN. Triangulation of findings on outcomes, variation and impact of SEN provision for different health phenotypes in ECHILD, with experiences of SEN provision will inform interpretation of findings for policy, practice and families and methods for future evaluation.

    Ethics and dissemination

    Research ethics committees have approved the use of the ECHILD database and, separately, the survey, interviews and focus groups of young people, parents and service providers. These stakeholders will contribute to the design, interpretation and communication of findings.

    Estimating the value of repositioning timing to streamline pressure injury prevention efforts in nursing homes: A cost‐effectiveness analysis of the ‘TEAM‐UP’ clinical trial

    Abstract

    Pressure injury (PrI) prevention guidelines recommend 2-h repositioning intervals in healthcare settings, requiring significant nursing time investment. We analysed the cost-effectiveness of PrI prevention protocols with 2-, 3- and 4-h repositioning intervals in US nursing homes according to ‘Turn Everyone and Move for Ulcer Prevention’ (TEAM-UP) randomized controlled trial findings. Markov modelling compared 2-, 3- and 4-h repositioning intervals, controlling for other practice guidelines, to prevent PrIs in nursing home residents from a US health sector perspective over one year using TEAM-UP trial data for model structure, sampling and parameterization. Costs, captured in 2020 US dollars, and quality-adjusted life years (QALYs) were used to derive an incremental cost-effectiveness ratio and net monetary benefit (NMB) at $50 000/QALY-$150 000/QALY cost-effectiveness thresholds. Sensitivity analyses tested model uncertainty. Repositioning intervals between 3 and 4 h were cost-effective based on reduced costs at slightly lower QALYs than 2 h at a $50 000/QALY threshold, and the NMB of 4-h repositioning was also more efficient than at 3 h ($9610). Repositioning labour cost and prevention routines were among the most sensitive parameters. Sensitivity analyses demonstrated that 3- and 4-h intervals were cost-effective in over 65% of simulations at any cost-effectiveness threshold. Repositioning intervals of 3 to 4 h have potential to reduce nursing time costs without significant decrements in clinical benefits to nursing home residents. Clinical guidelines for PrI prevention should be updated to reflect TEAM-UP clinical and economic findings. Facilities can use cost-savings recuperated from nursing time to deploy to other patient safety priorities without seriously jeopardizing PrI safety.

    Experiences and lessons learned from community-engaged recruitment for the South Asian breast cancer study in New Jersey during the COVID-19 pandemic

    by Jaya M. Satagopan, Tina Dharamdasani, Shailja Mathur, Racquel E. Kohler, Elisa V. Bandera, Anita Y. Kinney

    Background

    South Asians are a rapidly growing population in the United States. Breast cancer is a major concern among South Asian American women, who are an understudied population. We established the South Asian Breast Cancer (SABCa) study in New Jersey during early 2020 to gain insights into their breast cancer-related health attitudes. Shortly after we started planning for the study, the COVID-19 disease spread throughout the world. In this paper, we describe our experiences and lessons learned from recruiting study participants by partnering with New Jersey’s community organizations during the COVID-19 pandemic.

    Methods

    We used a cross-sectional design. We contacted 12 community organizations and 7 (58%) disseminated our study information. However, these organizations became considerably busy with pandemic-related needs. Therefore, we had to pivot to alternative recruitment strategies through community radio, Rutgers Cancer Institute of New Jersey’s Community Outreach and Engagement Program, and Rutgers Cooperative Extension’s community health programs. We recruited participants through these alternative strategies, obtained written informed consent, and collected demographic information using a structured survey.

    Results

    Twenty five women expressed interest in the study, of which 22 (88%) participated. Nine (41%) participants learned about the study through the radio, 5 (23%) through these participants, 1 (4.5%) through a non-radio community organization, and 7 (32%) through community health programs. Two (9%) participants heard about the study from their spouse. All participants were born outside the US, their average age was 52.4 years (range: 39–72 years), and they have lived in the US for an average of 26 years (range: 5–51 years).

    Conclusion

    Pivoting to alternative strategies were crucial for successful recruitment. Findings suggest the significant potential of broadcast media for community-based recruitment. Family dynamics and the community’s trust in our partners also encouraged participation. Such strategies must be considered when working with understudied populations.

    Design and evaluation of a digital health intervention with proactive follow-up by nurses to improve healthcare and outcomes for patients with breast cancer in Mexico: protocol for a randomised clinical trial

    Introduction

    Nearly 30 000 Mexican women develop breast cancer annually, frequently presenting unmet supportive care needs. In high-income countries, incorporating electronic patient-reported outcomes (ePROs) into cancer care has demonstrated potential for increasing patient-centred care and reducing unmet needs. No such ePRO interventions have been implemented in Mexico. This paper presents the study protocol for designing and evaluating an ePRO digital health application combined with proactive follow-up by nurses.

    Methods and analysis

    We designed a two-component intervention for women receiving breast cancer treatment: a responsive web application for monitoring ePROs and clinical algorithms guiding proactive follow-up by nurses. We will conduct a pilot test of the intervention with 50 patients with breast cancer for 6 weeks to assess feasibility and adjust the application. We will conduct a parallel arm randomised controlled trial assigning 205 patients each to intervention and control in one of Mexico’s largest public oncology hospitals. The intervention will be provided for 6 months, with additional 3 months of post-intervention observation. The control group will receive usual healthcare and a list of breast cancer information sources. Women diagnosed with stages I, II or III breast cancer who initiate chemotherapy and/or radiotherapy will be invited to participate. The primary study outcome will be supportive care needs; secondary outcomes include global quality of life and breast symptoms. Information on the outcomes will be obtained through web-based self-administered questionnaires collected at baseline, 1, 3, 6 and 9 months.

    Ethics and dissemination

    The National Research and Ethics Committees of the Mexican Institute of Social Security approved the study (R-2021-785-059). Participants will sign an informed consent form prior to their inclusion. Findings will be disseminated through a policy brief to the local authorities, a webinar for patients, publications in peer-reviewed journals and presentations at national and international conferences.

    Trial registration number

    NCT05925257.

    Long-term follow-up study of work status among patients with work-related mental disorders referred to departments of occupational medicine in Denmark

    Por: Kyndi · M. · Willert · M. V. · Vestergaard · J. M. · Andersen · J. H. · Christiansen · D. H. · Dalgaard · V. L.
    Objectives

    To describe the 5 year work status in patients referred for suspected work-related common mental disorders. To develop a prognostic model.

    Design

    Register-based nationwide longitudinal follow-up study.

    Setting

    All departments of occupational medicine in Denmark.

    Participants

    17 822 patients aged 18–67 years, seen for the first time at a Department of Occupational Medicine in Denmark from 2000 to 2013 and diagnosed with stress, depression, post-traumatic stress disorder, anxiety or other mental disorders.

    Interventions

    All patients were seen for diagnostic assessment and causal evaluation of the work-relatedness of their disorders. Some departments offered patients with stress disorders psychological treatment, which, however, was not organised according to patient selection or type of treatment.

    Primary and secondary outcome measures

    Register data were collected for 5 year periods before and after the patients’ first assessment at a department. Weekly percentages of patients are presented according to work status. The outcome in the prognostic model was a high Work Participation Score (ie, working>75% of potential work weeks/year) at 5 year follow-up.

    Results

    For all subgroups of patients, a high proportion were working (>75%) 1–5 years before assessment, and all experienced a large reduction in work status at time of assessment. At 1 year follow-up, almost 60% of patients with stress were working, whereas in the other patient subgroups, less than 40% were working. In the following years, practically no increase was observed in the percentage of patients working in any of the subgroups. Based on these 5 year follow-up data, we developed a work participation model with only moderate discrimination and calibration.

    Conclusions

    In Denmark, not all return to previous work status 5 years after a referral due to a suspected work-related common mental disorder. We developed a prognostic model with only moderate discrimination and calibration for long-term work participation after suggested work-related common mental disorders.

    Danish Prostate Cancer Consortium Study 1 (DPCC-1) protocol: Multicentre prospective validation of the urine-based three-microRNA biomarker model uCaP

    Por: Fredsoe · J. · Glud · E. · Boesen · L. · Logager · V. · Poulsen · M. H. · Pedersen · B. G. · Borre · M. · Sorensen · K. D.
    Introduction

    The primary objective of the Danish Prostate Cancer Consortium Study 1 (DPCC-1) is to provide validation for a novel urine-based microRNA biomarker, called uCaP, for a diagnosis of prostate cancer.

    Methods and analysis

    Eligible participants are biopsy naïve men aged ≥18 years with prostate-specific antigen (PSA) levels ≥3 ng/mL, who are referred to prostate MRI due to suspicion of PC at one of the following three major urology/uroradiology centers: Aarhus University Hospital, Herlev & Gentofte University Hospital, or Odense University Hospital, where MRI and targeted biopsy are implemented in clinical use. Exclusion criteria include previous diagnosis of urogenital cancer, contraindication to MRI, gender reassignment treatment or PSA level >20 ng/mL. The participants will be asked to donate a urine sample in connection with their MRI. The study is observational, uses a diagnostic accuracy testing setup and will integrate into the current diagnostic pathway.

    We will measure the levels of the three microRNAs in the uCaP model (miR-222–3 p, miR-24–3 p and miR-30c-5p) in extracellular vesicle-enriched cell-free urine samples, to assess if uCaP can improve specificity and retain sensitivity for International Society of Urological Pathology Grade Group ≥2 PC, when used as a reflex test to PSA ≥3 ng/mL. We hypothesise that uCaP can improve selection for prostate MRI and reduce the number of unnecessary scans and biopsies.

    Ethics and dissemination

    This study is approved by the Central Denmark Region Committee on Health Research Ethics (reference number: 1-10-72-85-22). All participants will provide written informed consent. Study results will be published in peer-reviewed journals and presented in scientific meetings.

    Trial registration number

    NCT05767307 at clinicaltrials.gov.

    What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

    Por: Gangathimmaiah · V. · Drever · N. · Evans · R. · Moodley · N. · Sen Gupta · T. · Cardona · M. · Carlisle · K.
    Objectives

    Low-value care can harm patients and healthcare systems. Despite a decade of global endeavours, low value care has persisted. Identification of barriers and enablers is essential for effective deimplementation of low-value care. This scoping review is an evidence summary of barriers, enablers and features of effective interventions for deimplementation of low-value care in emergency medicine practice worldwide.

    Design

    A mixed-methods scoping review was conducted using the Arksey and O’Malley framework.

    Data sources

    Medline, CINAHL, Embase, EMCare, Scopus and grey literature were searched from inception to 5 December 2022.

    Eligibility criteria

    Primary studies which employed qualitative, quantitative or mixed-methods approaches to explore deimplementation of low-value care in an EM setting and reported barriers, enablers or interventions were included. Reviews, protocols, perspectives, comments, opinions, editorials, letters to editors, news articles, books, chapters, policies, guidelines and animal studies were excluded. No language limits were applied.

    Data extraction and synthesis

    Study selection, data collection and quality assessment were performed by two independent reviewers. Barriers, enablers and interventions were mapped to the domains of the Theoretical Domains Framework. The Mixed Methods Appraisal Tool was used for quality assessment.

    Results

    The search yielded 167 studies. A majority were quantitative studies (90%, 150/167) that evaluated interventions (86%, 143/167). Limited provider abilities, diagnostic uncertainty, lack of provider insight, time constraints, fear of litigation, and patient expectations were the key barriers. Enablers included leadership commitment, provider engagement, provider training, performance feedback to providers and shared decision-making with patients. Interventions included one or more of the following facets: education, stakeholder engagement, audit and feedback, clinical decision support, nudge, clinical champions and training. Multifaceted interventions were more likely to be effective than single-faceted interventions. Effectiveness of multifaceted interventions was influenced by fidelity of the intervention facets. Use of behavioural change theories such as the Theoretical Domains Framework in the published studies appeared to enhance the effectiveness of interventions to deimplement low-value care.

    Conclusion

    High-fidelity, multifaceted interventions that incorporated education, stakeholder engagement, audit/feedback and clinical decision support, were administered daily and lasted longer than 1 year were most effective in achieving deimplementation of low-value care in emergency departments. This review contributes the best available evidence to date, but further rigorous, theory-informed, qualitative and mixed-methods studies are needed to supplement the growing body of evidence to effectively deimplement low-value care in emergency medicine practice.

    Delphi consensus study to develop guidelines for the management of adults with borderline personality disorder in the emergency department: a protocol

    Por: Prosser · A. · Hong · V. · Helfer · B. · Fudge · D. · Patterson · J. · Rosebush · P. · Frey · B. N. · Links · P.
    Introduction

    Clinicians caring for adults with borderline personality disorder (BPD) in acute settings such as the emergency department (ED) have little evidence/guidance to base decisions on. Specific/detailed guidance for managing BPD in the ED is needed given the morbidity and mortality risks, high service utilisation, unique challenges and risk of iatrogenic interventions. The primary objective of this study is to use a consensus method to develop a guideline for managing adults with BPD in the ED. This protocol and the key questions for the guideline were developed with the advice of people with BPD and their family members/support persons.

    Methods and analysis

    We will perform a four-phase Delphi study of an expert panel of clinicians, researchers, adults with BPD and their family members/support persons. Various disciplines (psychiatry, psychology, emergency medicine, nursing, social work) and treatment approaches will be included in the expert panel. An online questionnaire will be developed from systematic reviews, qualitative assessments of pivotal literature, and opinions suggested by the panel (phase 1). The panel will rate their agreement on opinions for each key question covering areas of emergency care of adults with BPD using two rounds of this questionnaire (phases 2 and 3). Opinions meeting predefined thresholds for consensus will be brought to consensus meetings moderated by an independent chair (phase 4). The purpose of these meetings is to finalise the set and phrasing of the opinions for each area of emergency care. These final opinions will be the recommendations in the guideline. If there are significant differences of opinion, the guideline will present both recommendations alongside one another.

    Ethics and dissemination

    This study has received ethics approval by the Hamilton Integrated Research Ethics Board in Hamilton, Ontario, Canada. The results of this study will be disseminated through peer-reviewed publications, conferences and national professional and patient/family/support associations.

    Impact of a short online course on the accuracy of non-ophthalmic diabetic retinopathy graders in recognising glaucomatous optic nerves in Vietnam

    Por: Olawoye · O. O. · Ha · T. H. · Pham · N. · Nguyen · L. · Cherwek · D. H. · Fowobaje · K. R. · Ross · C. · Coote · M. · Chan · V. F. · Kahook · M. · Peto · T. · Azuara-Blanco · A. · Congdon · N.
    Purpose

    To test an online training course for non-ophthalmic diabetic retinopathy (DR) graders for recognition of glaucomatous optic nerves in Vietnam.

    Methods

    This was an uncontrolled, experimental, before-and-after study in which 43 non-ophthalmic DR graders underwent baseline testing on a standard image set, completed a self-paced, online training course and were retested using the same photographs presented randomly. Twenty-nine local ophthalmologists completed the same test without the training course. DR graders then underwent additional one–to-one training by a glaucoma specialist and were retested. Test performance (% correct, compared with consensus grades from four fellowship-trained glaucoma experts), sensitivity, specificity, positive and negative predictive value, and area under the receiver operating (AUC) curve, were computed.

    Results

    Mean age of DR graders (32.6±5.5 years) did not differ from ophthalmologists (32.3±7.3 years, p=0.13). Online training required a mean of 297.9 (SD 144.6) minutes. Graders’ mean baseline score (33.3%±14.3%) improved significantly after training (55.8%±12.6%, p

    Conclusion

    Non-ophthalmic DR graders can be trained to recognise glaucoma using a short online course in this setting, with no additional benefit from more expensive one–to-one training. After 5-hour online training in recognising glaucomatous optic nerve head, scores of non-ophthalmic DR graders doubled, and did not differ from local ophthalmologists. Intensive one-to-one training did not further improve performance

    Intravenous immunoglobulin treatment in childhood encephalitis (IgNiTE): a randomised controlled trial

    Por: Hill · M. · Iro · M. · Sadarangani · M. · Absoud · M. · Cantrell · L. · Chong · K. · Clark · C. · Easton · A. · Gray · V. · Kneen · R. · Lim · M. · Liu · X. · Pike · M. · Solomon · T. · Vincent · A. · Willis · L. · Yu · L.-M. · Pollard · A. J. · The IgNiTE study team · Pollard · Lim · Solomon
    Objective

    To investigate whether intravenous immunoglobulin (IVIG) improves neurological outcomes in children with encephalitis when administered early in the illness.

    Design

    Phase 3b multicentre, double-blind, randomised placebo-controlled trial.

    Setting

    Twenty-one hospitals in the UK.

    Participants

    Children aged 6 months to 16 years with a diagnosis of acute or subacute encephalitis, with a planned sample size of 308.

    Intervention

    Two doses (1 g/kg/dose) of either IVIG or matching placebo given 24–36 hours apart, in addition to standard treatment.

    Main outcome measure

    The primary outcome was a ‘good recovery’ at 12 months after randomisation, defined as a score of≤2 on the Paediatric Glasgow Outcome Score Extended.

    Secondary outcome measures

    The secondary outcomes were clinical, neurological, neuroimaging and neuropsychological results, identification of the proportion of children with immune-mediated encephalitis, and IVIG safety data.

    Results

    18 participants were recruited from 12 hospitals and randomised to receive either IVIG (n=10) or placebo (n=8) between 23 December 2015 and 26 September 2017. The study was terminated early following withdrawal of funding due to slower than anticipated recruitment, and therefore did not reach the predetermined sample size required to achieve the primary study objective; thus, the results are descriptive. At 12 months after randomisation, 9 of the 18 participants (IVIG n=5/10 (50%), placebo n=4/8 (50%)) made a good recovery and 5 participants (IVIG n=3/10 (30%), placebo n=2/8 (25%)) made a poor recovery. Three participants (IVIG n=1/10 (10%), placebo n=2/8 (25%)) had a new diagnosis of epilepsy during the study period. Two participants were found to have specific autoantibodies associated with autoimmune encephalitis. No serious adverse events were reported in participants receiving IVIG.

    Conclusions

    The IgNiTE (ImmunoglobuliN in the Treatment of Encephalitis) study findings support existing evidence of poor neurological outcomes in children with encephalitis. However, the study was halted prematurely and was therefore underpowered to evaluate the effect of early IVIG treatment compared with placebo in childhood encephalitis.

    Trial registration number

    Clinical Trials.gov NCT02308982; ICRCTN registry ISRCTN15791925.

    Protocol for a mixed-method study to assess chronic cough in patients with renal cell carcinoma: the prevalence, impact on quality of life, trigger and potential clinical application of chronic cough as an early screening tool in patients with kidney canc

    Por: Smith · W. · Loizidou · M. · Mazzone · S. · Mumtaz · F. · Gurusamy · K. · Ranieri · V. · Tran · M. G.
    Introduction

    Cough as a symptom of renal cell carcinoma (RCC) was first described by Creevy in 1935, and despite one (unpublished) study suggesting it may affect 31% of these patients, as well as cough being discussed in forums for patients with kidney cancer, few clinicians are aware of this association. The cough has been described as unusual in nature, resolving rapidly after treatment with nephrectomy/embolisation but returning if the tumour recurs.

    Methods and analysis

    A prospective study using a questionnaire will identify the prevalence of cough in patients with suspected or confirmed RCC attending the Specialist Centre for Kidney Cancer (London, UK). A longitudinal study in a representative sample of these patients, using EQ-5D-5L and Leicester Cough Questionnaires, together with the use of semi-structured interviews with patients, will identify the impact of cough in addition to having a diagnosis of suspected or confirmed RCC on quality of life. To investigate cough mechanisms, a pilot study using cough hypersensitivity testing will be performed on patients with RCC, with and without a cough. Clinical samples (urine, blood, phlegm and breath condensate) from patients with RCC, with and without a cough, will be collected and analysed for the presence of substances known to trigger or enhance cough and compared with the results obtained from healthy volunteers.

    Ethics and dissemination

    Ethical approval has been granted (UK HR REC 22/PR/0791 dated 25/08/2022). Study outputs will be presented and published nationally and internationally at relevant conferences. This study will establish the prevalence of cough in patients with suspected or confirmed kidney cancer and support the education of clinicians to consider this diagnosis in patients with chronic cough (eg, recommending protocols to include both kidneys when investigating respiratory symptoms with chest CT scans). If substances known to trigger or enhance cough are identified and elevated in clinical samples, this research could offer potential targets for treatment for this distressing symptom.

    Trial registration number

    NIHR CRN portfolio CPMS ID:53 372.

    Time trends and patterns in opioid prescription use following orthopaedic surgery in Ontario, Canada, from 2004/2005 to 2017/2018: a population-based study

    Por: Canizares · M. · Power · J. D. · Perruccio · A. V. · Veillette · C. · Mahomed · N. · Rampersaud · Y. R.
    Objectives

    Increased use of opioids and their associated harms have raised concerns around prescription opioid use for pain management following surgery. We examined trends and patterns of opioid prescribing following elective orthopaedic surgery.

    Design

    Population-based study.

    Setting

    Ontario, Canada.

    Participants

    Ontario residents aged 66+ years who had elective orthopaedic surgery from April 2004 to March 2018.

    Primary and secondary outcome measures

    Postoperative opioid use (short term: within 90 days of surgery, prolonged: within 180 days and chronic: within 1 year), specific opioids prescribed, average duration (days) and amount (morphine milligram equivalents) of the initial prescription by year of surgery.

    Results

    We included 464 460 elective orthopaedic surgeries in 2004/2005–2017/2018: 80% of patients used opioids within 1 year of surgery—25.1% were chronic users. There was an 8% increase in opioid use within 1 year of surgery, from 75.1% in 2004/2005 to 80.9% in 2017/2018: a 29% increase in short-term use and a decline in prolonged (9%) and chronic (22%) use. After 2014/2015, prescribed opioid amounts initially declined sharply, while the duration of the initial prescription increased substantially. Across categories of use, there was a steady decline in coprescription of benzodiazepines and opioids.

    Conclusions

    Most patients filled opioid prescriptions after surgery, and many continued filling prescriptions after 3 months. During a period of general increase in awareness of opioid harms and dissemination of guidelines/policies aimed at opioid prescribing for chronic pain, we found changes in prescribing practices following elective orthopaedic surgery. Findings illustrate the potential impact of guidelines/policies on shaping prescription patterns in the surgical population, even in the absence of specific guidelines for surgical prescribing.

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