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Interventions to improve the quality of cataract services: protocol for a global scoping review

Por: Yoshizaki · M. · Ramke · J. · Furtado · J. M. · Burn · H. · Gichuhi · S. · Gordon · I. · Aghaji · A. · Marques · A. P. · Dean · W. H. · Congdon · N. · Buchan · J. · Burton · M. J.
Introduction

Cataract is the leading cause of blindness globally and a major cause of vision impairment. Cataract surgery is an efficacious intervention that usually restores vision. Although it is one of the most commonly conducted surgical interventions worldwide, good quality services (from being detected with operable cataract to undergoing surgery and receiving postoperative care) are not universally accessible. Poor quality understandably reduces the willingness of people with operable cataract to undergo surgery. Therefore, it is critical to improve the quality of care to subsequently reduce vision loss from cataract. This scoping review aims to summarise the nature and extent of the published literature on interventions to improve the quality of services for primary age-related cataract globally.

Methods and analysis

We will search MEDLINE, Embase and Global Health for peer-reviewed manuscripts published since 1990, with no language, geographic or study design restrictions. To define quality, we have used the elements adopted by the WHO—effectiveness, safety, people-centredness, timeliness, equity, integration and efficiency—to which we have added the element of planetary health. We will exclude studies focused on the technical aspects of the surgical procedure and studies that only involve children (

Ethics and dissemination

Ethical approval was not sought, as our review will only include published and publicly accessible information. We will publish our findings in an open-access peer-reviewed journal and develop an accessible summary of the results for website posting. A summary of the results will be included in the ongoing Lancet Global Health Commission on Global Eye Health.

Registration details

Open Science Framework (https://osf.io/8gktz).

Seizure First Aid Training For people with Epilepsy (SAFE) frequently attending emergency departments and their significant others: results of a UK multi-centre randomised controlled pilot trial

Por: Noble · A. J. · Snape · D. · Nevitt · S. · Holmes · E. A. · Morgan · M. · Tudur-Smith · C. · Hughes · D. A. · Buchanan · M. · McVicar · J. · MacCallum · E. · Goodacre · S. · Ridsdale · L. · Marson · A. G.
Objective

To determine the feasibility and optimal design of a randomised controlled trial (RCT) of Seizure First Aid Training For Epilepsy (SAFE).

Design

Pilot RCT with embedded microcosting.

Setting

Three English hospital emergency departments (EDs).

Participants

Patients aged ≥16 with established epilepsy reporting ≥2 ED visits in the prior 12 months and their significant others (SOs).

Interventions

Patients (and their SOs) were randomly allocated (1:1) to SAFE plus treatment-as-usual (TAU) or TAU alone. SAFE is a 4-hour group course.

Main outcome measures

Two criteria evaluated a definitive RCT’s feasibility: (1) ≥20% of eligible patients needed to be consented into the pilot trial; (2) routine data on use of ED over the 12 months postrandomisation needed securing for ≥75%. Other measures included eligibility, ease of obtaining routine data, availability of self-report ED data and comparability, SAFE’s effect and intervention cost.

Results

Of ED attendees with a suspected seizure, 424 (10.6%) patients were eligible; 53 (12.5%) patients and 38 SOs consented. Fifty-one patients (and 37 SOs) were randomised. Routine data on ED use at 12 months were secured for 94.1% patients. Self-report ED data were available for 66.7% patients. Patients reported more visits compared with routine data. Most (76.9%) patients randomised to SAFE received it and no related serious adverse events occurred. ED use at 12 months was lower in the SAFE+TAU arm compared with TAU alone, but not significantly (rate ratio=0.62, 95% CI 0.33 to 1.17). A definitive trial would need ~674 patient participants and ~39 recruitment sites. Obtaining routine data was challenging, taking ~8.5 months.

Conclusions

In satisfying only one predetermined ‘stop/go’ criterion, a definitive RCT is not feasible. The low consent rate in the pilot trial raises concerns about a definitive trial’s finding’s external validity and means it would be expensive to conduct. Research is required into how to optimise recruitment from the target population.

Trial registration number

ISRCTN13871327

Using population-wide administrative and laboratory data to estimate type- and subtype-specific influenza vaccine effectiveness: a surveillance protocol

Por: Scott · A. N. · Buchan · S. A. · Kwong · J. C. · Drews · S. J. · Simmonds · K. A. · Svenson · L. W.
Introduction

The appropriateness of using routinely collected laboratory data combined with administrative data for estimating influenza vaccine effectiveness (VE) is still being explored. This paper outlines a protocol to estimate influenza VE using linked laboratory and administrative data which could act as a companion to estimates derived from other methods.

Methods and analysis

We will use the test-negative design to estimate VE for each influenza type/subtype and season. Province-wide individual-level records of positive and negative influenza tests at the Provincial Laboratory for Public Health in Alberta will be linked, by unique personal health numbers, to administrative databases and vaccination records held at the Ministry of Health in Alberta to determine covariates and influenza vaccination status, respectively. Covariates of interests include age, sex, immunocompromising chronic conditions and healthcare setting. Cases will be defined based on an individual’s first positive influenza test during the season, and potential controls will be defined based on an individual’s first negative influenza test during the season. One control for each case will be randomly selected based on the week the specimen was collected. We will estimate VE using multivariable logistic regression.

Ethics and dissemination

Ethics approval was obtained from the University of Alberta’s Health Research Ethics Board—Health Panel under study ID Pro00075997. Results will be disseminated by public health officials in Alberta.

Should I stay or should I go? A retrospective propensity score-matched analysis using administrative data of hospital-at-home for older people in Scotland

Por: Tsiachristas · A. · Ellis · G. · Buchanan · S. · Langhorne · P. · Stott · D. J. · Shepperd · S.
Objectives

To compare the characteristics of populations admitted to hospital-at-home services with the population admitted to hospital and assess the association of these services with healthcare costs and mortality.

Design

In a retrospective observational cohort study of linked patient level data, we used propensity score matching in combination with regression analysis.

Participants

Patients aged 65 years and older admitted to hospital-at-home or hospital.

Interventions

Three geriatrician-led admission avoidance hospital-at-home services in Scotland.

Outcome measures

Healthcare costs and mortality.

Results

Patients in hospital-at-home were older and more socioeconomically disadvantaged, had higher rates of previous hospitalisation and there was a greater proportion of women and people with several chronic conditions compared with the population admitted to hospital. The cost of providing hospital-at-home varied between the three sites from £628 to £2928 per admission. Hospital-at-home was associated with 18% lower costs during the follow-up period in site 1 (ratio of means 0.82; 95% CI: 0.76 to 0.89). Limiting the analysis to costs during the 6 months following index discharge, patients in the hospital-at-home cohorts had 27% higher costs (ratio of means 1.27; 95% CI: 1.14 to 1.41) in site 1, 9% (ratio of means 1.09; 95% CI: 0.95 to 1.24) in site 2 and 70% in site 3 (ratio of means 1.70; 95% CI: 1.40 to 2.07) compared with patients in the control cohorts. Admission to hospital-at-home was associated with an increased risk of death during the follow-up period in all three sites (1.09, 95% CI: 1.00 to 1.19 site 1; 1.29, 95% CI: 1.15 to 1.44 site 2; 1.27, 95% CI: 1.06 to 1.54 site 3).

Conclusions

Our findings indicate that in these three cohorts, the populations admitted to hospital-at-home and hospital differ. We cannot rule out the risk of residual confounding, as our analysis relied on an administrative data set and we lacked data on disease severity and type of hospitalised care received in the control cohorts.

Strategies occupational therapists employ to facilitate work-related transitions for persons with hand injuries: a study protocol for a scoping review

Por: Uys · M. E. · Buchanan · H. · Van Niekerk · L.
Introduction

Hands make it possible to be employable and productive, to communicate non-verbally and to perform fine motor tasks required in day-to-day activities. Sustaining a hand injury can be detrimental to function including the ability to work. As the literature on work-related transitions is scattered across a range of journals, it is difficult to get a sense of how much literature there is, what is known and where the gaps lie. This scoping study will provide a single source of up-to-date evidence to inform health professionals about the strategies occupational therapists employ to facilitate work-related transitions for people with hand injuries.

Methods and analysis

The methodological framework by Arksey and O’Malley (2005) will form the structure of the scoping review. The search strategy has been developed in collaboration with a subject librarian. The following databases will be searched: EBSCOhost including only Medline, CINAHL and Health Source: Nursing/Academic Edition; PubMed, Scopus, The Cochrane library and Web of Science. Reference lists will be examined, and grey literature sources will be searched to ensure that literature missed in the database searches is included. Covidence will be used to manage the project. Full-texts will be uploaded for literature that meets the inclusion criteria. A process of blind review will be used to ensure that consistency and rigour is upheld.

Ethics and dissemination

The findings of the scoping review will be disseminated in an article, within 2019, to be published in a peer-reviewed journal. The findings will be presented at conferences to ensure the optimal dissemination of the scoping review’s conclusions.

How do specialist trainee doctors acquire skills to practice patient-centred care? A qualitative exploration

Por: Patel · V. · Buchanan · H. · Hui · M. · Patel · P. · Gupta · P. · Kinder · A. · Thomas · H.
Objectives

The importance of patient-centred care (PCC) has been increasingly recognised. However, there is limited work exploring what doctors actually understand by PCC, and how they perceive they acquire PCC skills in the workplace. The objectives of our study were to explore (1) what UK doctors, in specialist training, perceive to be the essential components of PCC, (2) if/how they acquire these skills, (3) any facilitators/barriers for engaging in PCC and (4) views on their PCC training.

Design

Qualitative study using in-depth individual semi-structured interviews with UK specialist trainees. Interview transcripts were thematically analysed.

Setting and participants

Thirty-one specialist trainee doctors, with at least 4 years postgraduate experience, were interviewed. Participants worked in various medical specialities within the Medical Directorate of an acute hospital in the East Midlands of England.

Results

Interview data were transcribed verbatim and categorised into three main themes. The first theme was ‘Understanding PCC’ where the doctors gave varied perspectives on what they understood by PCC. Although many were able to highlight key components of PCC, there were also some accounts which demonstrated a lack of understanding. The second theme was ‘Learning PCC skills: A work in progress’. Learning to be patient-centred was perceived to be an ongoing process. Within this, trainee doctors reported ‘on-the-job’ learning as the main means of acquiring PCC skills, but they also saw a place for formal training (eg, educational sessions focussing on PCC, role play). ‘Delivering PCC: Beyond the physician’ referred to the many influences the doctors reported in learning and delivering PCC including patients, the organisation and colleagues. Observing consultants taking a patient-centred approach was cited as an important learning tool.

Conclusions

Our findings may assist clinical educators in understanding how trainee doctors perceive PCC, and the factors that influence their learning, thereby helping them shape PCC skills training.

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