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Hoy — Abril 13th 2021Tus fuentes RSS

A direct comparison of theory-driven and machine learning prediction of suicide: A meta-analysis

by Katherine M. Schafer, Grace Kennedy, Austin Gallyer, Philip Resnik

Theoretically-driven models of suicide have long guided suicidology; however, an approach employing machine learning models has recently emerged in the field. Some have suggested that machine learning models yield improved prediction as compared to theoretical approaches, but to date, this has not been investigated in a systematic manner. The present work directly compares widely researched theories of suicide (i.e., BioSocial, Biological, Ideation-to-Action, and Hopelessness Theories) to machine learning models, comparing the accuracy between the two differing approaches. We conducted literature searches using PubMed, PsycINFO, and Google Scholar, gathering effect sizes from theoretically-relevant constructs and machine learning models. Eligible studies were longitudinal research articles that predicted suicide ideation, attempts, or death published prior to May 1, 2020. 124 studies met inclusion criteria, corresponding to 330 effect sizes. Theoretically-driven models demonstrated suboptimal prediction of ideation (wOR = 2.87; 95% CI, 2.65–3.09; k = 87), attempts (wOR = 1.43; 95% CI, 1.34–1.51; k = 98), and death (wOR = 1.08; 95% CI, 1.01–1.15; k = 78). Generally, Ideation-to-Action (wOR = 2.41, 95% CI = 2.21–2.64, k = 60) outperformed Hopelessness (wOR = 1.83, 95% CI 1.71–1.96, k = 98), Biological (wOR = 1.04; 95% CI .97–1.11, k = 100), and BioSocial (wOR = 1.32, 95% CI 1.11–1.58, k = 6) theories. Machine learning provided superior prediction of ideation (wOR = 13.84; 95% CI, 11.95–16.03; k = 33), attempts (wOR = 99.01; 95% CI, 68.10–142.54; k = 27), and death (wOR = 17.29; 95% CI, 12.85–23.27; k = 7). Findings from our study indicated that across all theoretically-driven models, prediction of suicide-related outcomes was suboptimal. Notably, among theories of suicide, theories within the Ideation-to-Action framework provided the most accurate prediction of suicide-related outcomes. When compared to theoretically-driven models, machine learning models provided superior prediction of suicide ideation, attempts, and death.

Investigating correlates of athletic identity and sport-related injury outcomes: a scoping review

Por: Renton · T. · Petersen · B. · Kennedy · S.
Objectives

To conduct a scoping review that (1) describes what is known about the relationship between athletic identity and sport-related injury outcomes and (2) describes the relationship that an injury (as an exposure) has on athletic identity (as an outcome) in athletes.

Design

Scoping review.

Participants

A total of n=1852 athletes from various sport backgrounds and levels of competition.

Primary and secondary outcome measures

The primary measure used within the studies identified was the Athletic Identity Measurement Scale. Secondary outcome measures assessed demographic, psychosocial, behavioural, physical function and pain-related constructs.

Results

Twenty-two studies were identified for inclusion. Samples were dominated by male, Caucasian athletes. The majority of studies captured musculoskeletal injuries, while only three studies included sport-related concussion. Athletic identity was significantly and positively associated with depressive symptom severity, sport performance traits (eg, ego-orientation and mastery-orientation), social network size, physical self-worth, motivation, rehabilitation overadherence, mental toughness and playing through pain, as well as injury severity and functional recovery outcomes. Findings pertaining to the association that an injury (as an exposure) had on athletic identity (as an outcome) were inconsistent and limited.

Conclusions

Athletic identity was most frequently associated with psychosocial, behavioural and injury-specific outcomes. Future research should seek to include diverse athlete samples (eg, women, athletes of different races, para-athletes) and should continue to reference theoretical injury models to inform study methodologies and to specify variables of interest for further exploration.

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Quantitative Results of Perfusion Utilising Hyperspectral Imaging on Non‐diabetics and Diabetics: A Pilot Study

Abstract

There is a paucity of quantitative measures of microvascular perfusion values in the skin. Newly developed, handheld hyperspectral imaging devices identify unique spectral fingerprints of oxygenated and deoxygenated haemoglobin in the superficial microvasculature. Establishing value ranges for healthy patients without vascular complications will subsequently help standardise assessments for perfusion defects. In particular, diabetics who are prone to vascular calcifications and lower extremity wounds may benefit. A total of 73 subjects were enrolled in the study and split in two cohorts: 36 ‘non‐diabetic’ non‐vascularly compromised patients and 37 ‘diabetic’ patients with a formal diagnosis of diabetes but without history of pedal ulceration. Values of oxygenated haemoglobin (HT‐Oxy) and deoxygenated haemoglobin (HT‐DeOxy) from both devices are analysed.

Bridging anticoagulation therapy with low molecular weight heparin in patients with atrial fibrillation following a stroke is associated with adverse events

Por: Kennedy · R.

Commentary on: Altavilla R, Caso V, Bandini F, et al. Anticoagulation after stroke in patients with atrial fibrillation. Stroke 2019;508:2093–100.

Implications for practice and research

  • Healthcare professionals need to be aware that bridging anticoagulation therapy with low molecular weight heparin (LMWH) in patients with atrial fibrillation following a stroke is associated with a higher rate of recurrent ischaemic and haemorrhagic events compared with patients who do not receive bridging therapy.

  • Strategies to ensure adherence to the guidelines need to be devised and implemented within the clinical setting.

  • Context

    Patients with cardioembolic stroke and non-valvular atrial fibrillation are at a high risk of early stroke recurrence.1 Oral anticoagulation therapy (OAC) in the form of vitamin K antagonists (VKAs) and non–vitamin-K oral anticoagulants (NOACs) are the medical therapy of choice in the secondary prevention of stroke. American Stroke guidelines2 recommend the initiation...

    Collaboration between patient organisations and a clinical research sponsor in a rare disease condition: learnings from a community advisory board and best practice for future collaborations

    Por: Roennow · A. · Sauve · M. · Welling · J. · Riggs · R. J. · Kennedy · A. T. · Galetti · I. · Brown · E. · Leite · C. · Gonzalez · A. · Portales Guiraud · A. P. · Houÿez · F. · Camp · R. · Gilbert · A. · Gahlemann · M. · Moros · L. · Luna Flores · J. L. · Schmidt · F. · Sauter · W. · Finne

    Introduction Transparent collaborations between patient organisations (POs) and clinical research sponsors (CRS) can identify and address the unmet needs of patients and caregivers. These insights can improve clinical trial participant experience and delivery of medical innovations necessary to advance health outcomes and standards of care. We share our experiences from such a collaboration undertaken surrounding the SENSCIS® clinical trial (NCT02597933), and discuss its impact during, and legacy beyond, the trial.

    Summary We describe the establishment of a community advisory board (CAB): a transparent, multiyear collaboration between the scleroderma patient community and a CRS. We present shared learnings from the collaboration, which is split into three main areas: (1) the implementation and conduct of the clinical trial; (2) analysis and dissemination of the results; and (3) aspects of the collaboration not related to the trial.

    1. The scleroderma CAB reviewed and provided advice on trial conduct and reporting. This led to the improvement and optimisation of trial procedures; meaningful, patient-focused adaptations were made to address challenges relevant to scleroderma-associated interstitial lung disease patients.

    2. To ensure that results of the trial were accessible to lay audiences and patients, written lay summaries were developed by the trial sponsor with valuable input from the CAB to ensure that language and figures were understandable.

    3. The CAB and the CRS also collaborated to co-develop opening tools for medication blister packs and bottles. In addition, to raise disease awareness among physicians, patients and caregivers, educational materials to improve diagnosis and management of scleroderma were co-created and delivered by the CAB and CRS.

    Conclusions This collaboration between POs and a CRS, in a rare disease condition, led to meaningful improvements in patient safety, comfort and self-management and addressed information needs. This collaboration may serve as a template of best practice for future collaborations between POs, research sponsors and other healthcare stakeholders.

    Nursing Journal Policies on Disclosure and Management of Conflicts of Interest

    Abstract

    Purpose

    Concerns about conflicts of interest (COIs) in research and health care are well known, but recent reports of authors failing to disclose potential COIs in journal articles threatens the integrity of the scholarly literature. While many nursing journals have published editorials on this topic, review of nursing journal policies on and experiences with COIs has not been reported. The purposes of this study were to examine the extent to which nursing journals have COI policies and require disclosures by authors, peer reviewers, editorial board members, and editors who have a role in journal content decisions.

    Design

    This cohort study addressed top‐ranked nursing journal policies about and experiences with COIs in scholarly publications.

    Methods

    An analysis of COI policies in the instructions for authors of 118 journals listed in the nursing category of Clarivate Analytics Journal Citation Reports was completed in 2019. An electronic survey of the editors was also conducted to determine their awareness and experience with COI policies for their journals. Characteristics of the journals and policies were assessed. Information on polices about COIs for editors and peer reviewers were also reviewed. A content analysis of the policies included assessment of best practices and gaps in requirements.

    Findings

    For the journal policy assessment, 116 journals that publish only in the English language were eligible. The majority (n = 113; 97.4%) of journals had a statement on COI policies for authors, but only 42 (36.2%) had statements for peer reviewers and only 37 (31.9%) had statements for editors. A total of 117 journal editors were sent the survey. One declined to participate, leaving a total of 116 eligible editors; 82 (70.6%) responded and 34 did not respond. Sixty‐seven (81.7%) of the 82 editors indicated that their journal had a policy about COIs for authors. Seventy‐four editors (63.7%) responded to the question about their journal having a policy about COIs for peer reviewers and editors. Thirty‐three (44.5%) of the respondents indicated their journal had a COI policy for peer reviewers, and 29 (39.1%) stated they had a policy for editors. Few editors (n = 7; 9%) indicated that they had encountered problems pertaining to author COIs.

    Conclusions

    Findings from this study may help promote ethical publication practices through comprehensive policies on disclosure and management of nursing journal authors, peer reviewers, and editors.

    Clinical Relevance

    Declarations of potential conflicts of interest promote transparency and allows the consumer of research to take that into consideration when considering the findings of a study.

    Delirium prevention and treatment in the emergency department (ED): a systematic review protocol

    Por: Dahlstrom · E. B. · Han · J. H. · Healy · H. · Kennedy · M. · Arendts · G. · Lee · J. · Carpenter · C. · Lee · S.
    Introduction

    Delirium is a dangerous syndrome of acute brain dysfunction that is common in the emergency department (ED), especially among the geriatric population. Most systematic reviews of interventions for delirium prevention and treatment have focused on inpatient settings. Best practices of effective delirium care in ED settings have not been established. The primary objective of this study is to identify pharmacologic and non-pharmacologic interventions as applied by physicians, nursing staff, pharmacists and other ED personnel to prevent incident delirium and to shorten the severity and duration of prevalent delirium in a geriatric population within the ED.

    Methods and analysis

    Searches using subject headings and keywords will be conducted from database inception through June 2020 in MEDLINE, EMBASE, Web of Science, PsychINFO, CINAHL, ProQuest Dissertations and Theses Global and Cochrane CENTRAL as well as grey literature. Database searches will not be limited by date or language. Two reviewers will identify studies describing any interventions for delirium prevention and/or treatment in the ED. Disagreements will be settled by a third reviewer. Pooled data analysis will be performed where possible using Review Manager. Risk ratios and weighted difference of means will be used for incidence of delirium and other binary outcomes related to delirium, delirium severity or duration of symptoms, along with 95% CIs. Heterogeneity will be measured by calculating I2, and a forest plot will be created. If significant heterogeneity is identified, metaregression is planned using OpenMeta to identify possible sources of heterogeneity.

    Ethics and dissemination

    This is a systematic review of previously conducted research; accordingly, it does not constitute human subjects research needing ethics review. This review will be prepared as a manuscript and submitted for publication to a peer-reviewed journal, and the results will be presented at conferences.

    PROSPERO trial registration number

    CRD42020169654.

    Quantitative Results of Perfusion Utilising Hyperspectral Imaging on Non‐diabetics and Diabetics: A Pilot Study

    Abstract

    There is a paucity of quantitative measures of microvascular perfusion values in the skin. Newly developed, handheld hyperspectral imaging devices identify unique spectral fingerprints of oxygenated and deoxygenated haemoglobin in the superficial microvasculature. Establishing value ranges for healthy patients without vascular complications will subsequently help standardise assessments for perfusion defects. In particular, diabetics who are prone to vascular calcifications and lower extremity wounds may benefit. A total of 73 subjects were enrolled in the study and split in two cohorts: 36 ‘non‐diabetic’ non‐vascularly compromised patients and 37 ‘diabetic’ patients with a formal diagnosis of diabetes but without history of pedal ulceration. Values of oxygenated haemoglobin (HT‐Oxy) and deoxygenated haemoglobin (HT‐DeOxy) from both devices are analysed.

    Effect of RaceRunning on cardiometabolic disease risk factors and functional mobility in young people with moderate-to-severe cerebral palsy: protocol for a feasibility study

    Por: Ryan · J. · Theis · N. · Koufaki · P. · Phillips · S. · Anokye · N. · Andreopoulou · G. · Kennedy · F. · Jagadamma · K. C. · vanSchie · P. · Dines · H. · van der Linden · M. L.
    Introduction

    There is consistent evidence that people with cerebral palsy (CP) do not engage in the recommended physical activity guidelines for the general population from a young age. Participation in moderate-to-vigorous physical activity is particularly reduced in people with CP who have a moderate-to-severe disability. RaceRunning is a growing disability sport that provides an opportunity for people with moderate-to-severe disability to participate in physical activity in the community. It allows those who are unable to walk independently to propel themselves using a RaceRunning bike, which has a breastplate for support but no pedals. The aim of this study is to examine the feasibility and acceptability of RaceRunning for young people with moderate-to-severe CP and the feasibility of conducting a definitive study of the effect of RaceRunning on cardiometabolic disease risk factors and functional mobility.

    Methods and analysis

    Twenty-five young people (age 5–21 years) with CP or acquired brain injury affecting coordination will be included in this single-arm intervention study. Participants will take part in one RaceRunning session each week for 24 weeks. Outcomes assessed at baseline, 12 and 24 weeks include body mass index, waist circumference, blood pressure, muscle strength, cardiorespiratory fitness, physical activity and sedentary behaviour, functional mobility, activity competence and psychosocial impact. Adverse events will be systematically recorded throughout the 24 weeks. Focus groups will be conducted with participants and/or parents to explore their views and experiences of taking part in RaceRunning.

    Ethics and dissemination

    Approval has been granted by Queen Margaret University Research Ethics Committee (REC) and the South East of Scotland REC. Results will be disseminated through peer-reviewed journals and distributed to people with CP and their families through RaceRunning and Athletic Clubs, National Health Service trusts and organisations for people with disabilities.

    Trial registration number

    NCT04034342; pre-results.

    Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial

    Por: Hong · K. L. · Babiolakis · C. · Zile · B. · Bullen · M. · Haseeb · S. · Halperin · F. · Hohl · C. M. · Magee · K. · Sandhu · R. K. · Tian · S. Y. · Kennedy · A. · Lobban · T. · Mariano · Z. · Dorian · P. · Angaran · P. · Evans · M. · Leong-Sit · P. · Glover · B. M.
    Objectives

    The primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF).

    Design

    Appropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively. Random effects logistic regression was performed to estimate the OR of inappropriate ED attendance based on clinically relevant patient characteristics.

    Participants

    Participants ≥18 years with a documented history of AF were approached in one of eight centres partaking in the study across Canada (Ontario, Nova Scotia, Alberta and British Columbia).

    Results

    Of the 356 patients enrolled (67±13, 45% female), the majority (271/356, 76%) had inappropriate reasons for presentation and did not require urgent ED treatment. Approximately 50% of patients(172/356, 48%) were driven to the ED due to symptoms, while the remainder presented on the basis of general fear or anxiety (67/356, 19%) or prior medical advice (117/356, 33%). Random effects logistic regression analysis showed that patients with a history of congestive heart failure were significantly more likely to seek urgent care for appropriate reasons (p=0.03). Likewise, symptom-related concerns for ED presentation were significantly less likely to result in inappropriate visitation (p=0.02). When patients were surveyed on alternatives to ED care, the highest proportion of responses among both groups was in favour of specialised rapid assessment outpatient clinics (186/356, 52%). Qualitative content analysis confirmed these results.

    Conclusions

    Improved education focused on symptom management and alleviating disease-related anxiety as well as the institution of rapid access arrhythmias clinics may reduce the need for unnecessary healthcare utilisation in the ED and subsequent hospitalisation.

    Trial registration number

    NCT03127085

    School-based interventions for preventing substance use in indigenous children ages 7-13: a scoping review protocol

    Por: Maina · G. · Phaneuf · T. · Kennedy · M. · Mclean · M. · Gakumo · A. · Nguemo · J. · King · A. · Mcharo · S. K.
    Introduction

    Throughout the world, indigenous peoples share traumatic colonial experiences that have caused gross inequalities for them and continue to impact every aspect of their lives. The effect of intergenerational trauma and other health disparities have been remarkable for Indigenous children and adolescents, who are at a greater risk of adverse mental health and addiction outcomes compared with non-indigenous people of the same age. Most indigenous children are exposed to addictive substances at an early age, which often leads to early initiation of substance use and is associated with subsequent physical and mental health issues, poor social and relational functioning, and occupational and legal problems. The aim of this paper is to report the protocol for the scoping review of school-based interventions for substance use prevention in Indigenous children ages 7–13 living in Canada, the USA, Australia and New Zealand. This scoping review seeks to answer the following questions: (1) What is known about indigenous school-based interventions for preventing substance use and (2) What are the characteristics and outcomes of school-based interventions for preventing substance use?

    Methods and analysis

    This scoping review will use steps described by Arksey and O’Malley and Levac: (1) identifying the research question(s); (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; (5) collating, summarising and reporting the results and (6) consulting with experts. Our findings will be reported according to the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

    Ethics and dissemination

    Ethics review approval is not required for this project. Findings from this study will be presented to lay public, at scientific conferences and published in a peer-reviewed journal.

    Are adverse events in newly trained home dialysis patients related to learning styles? A single-centre retrospective study from Toronto, Canada

    Por: Auguste · B. L. · Girsberger · M. · Kennedy · C. · Srithongkul · T. · McGrath-Chong · M. · Bargman · J. · Chan · C. T.
    Objectives

    Home haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients’ learning styles are associated with differing risk of adverse events in both home HD and PD patients.

    Design

    Retrospective cohort study.

    Setting

    Tertiary care hospital in Toronto, Ontario, Canada.

    Participants

    One hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study.

    Interventions

    Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles.

    Primary and secondary outcome measures

    Home HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles.

    Results

    Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694).

    Conclusions

    Different learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.

    Instruments for assessing nurses’ palliative care knowledge and skills in specialised care setting: An integrative review

    Abstract

    Aims and objectives

    To examine the content and reported psychometric properties of instruments for assessing nurses’ palliative care knowledge and skills in specialised healthcare units.

    Background

    Knowledge of palliative care, and competence in the delivery of care, is essential. Assessment of competence is an important means of evaluating the knowledge and skills of practitioners in order to improve the quality of care provided for patients and their families.

    Design

    An integrative review.

    Methods

    A systematic literature search was conducted in November 2018 in five databases: CINAHL, PubMed (Medline), Cochrane, Scopus and Web of Science. The quality assessment was conducted using the Joanna Briggs Institute's (JBI) Checklist for Analytical Cross‐Sectional Studies. The data were analysed using content analysis. PRISMA guidelines were followed to ensure explicit reporting.

    Results

    Overall, 5,413 studies were identified and 23 met the inclusion criteria. Nurses’ knowledge and skills, as assessed by the instruments, were as follows: (a) care for the patient, (b) care for the patient's family and (c) professional requirements. Ten instruments were identified assessing nurses’ knowledge and skills through knowledge tests and skill evaluation self‐tests. The psychometric properties of the instruments were reported to varying degrees, mainly focusing on internal consistency and content validation.

    Conclusions

    Nurses’ knowledge and skills were seen to contribute to the holistic care of the patient and his or her family, and the possession of adequate information and skills is essential when dealing with death and dying. The instruments are commonly available and potentially reliable, although reliability must be determined with caution, so validation studies in other cultures are recommended.

    Relevance to clinical practice

    These results could be utilised to improve the quality of palliative care by evaluating the knowledge and skills of nursing staff or when considering the needs of palliative care education.

    Shared decision aids in pregnancy care: A scoping review

    Decision aids (DAs), also known as client-centred decision tools (Vlemmix et al., 2013; Joseph-Williams et al., 2017; Stacey et al., 2017), clinical decision-making tools (Trevana et al., 2014), patient decision aids (Sepucha et al., 2018), shared decision-making tools (Elwyn et al., 2010), and decision support technologies (Elwyn et al., 2009), are interventions that support health consumers by making their decisions explicit, providing information about options and associated benefits/harms, and helping to clarify congruence between decisions and personal values (Stacey et al., 2017).

    Rare but heard: using asynchronous virtual focus groups, interviews and roundtable discussions to create a personalised psychological intervention for primary sclerosing cholangitis: a protocol

    Por: Ranieri · V. · Kennedy · E. · Walmsley · M. · Thorburn · D. · McKay · K.
    Introduction

    Primary sclerosing cholangitis (PSC) is a rare and chronic disease characterised by inflammation and fibrosis of the liver’s bile ducts. There is no known cause or cure for the illness, which often progresses to end-stage liver disease requiring liver transplantation. Symptoms of PSC can be very burdensome on those living with the illness, leading to restrictions in daily living, as well as a greater risk of colorectal and biliary tract cancers. Limited voices from lived experience suggest that living with PSC can cause considerable psychological distress. This study, therefore, aims to explore how the illness impacts the psychological well-being of those living with the illness, and those supporting them. It also aims to create a personalised psychological intervention to support all groups.

    Methods and analysis

    This project will take a layered qualitative approach to understanding the ways in which people experience living with PSC within their day-to-day lives. There will be two stages to this study, which will pilot a unique methodological process using online resources. The first stage will consist of asynchronous virtual focus groups (AVFGs) with those living with PSC and those who provide support for those diagnosed with PSC, and narrative interviews with both groups and health professionals. Both the AVFGs and the narrative interviews will be analysed using thematic narrative analysis. The second stage will comprise a roundtable discussion where the researchers and health professionals will devise a personalised psychological intervention to help to support those living with PSC and their supporters. The study duration is expected to be 18 months.

    Ethics and dissemination

    The proposed study has been approved by the UK Health Research Authority and London—Queen Square Research Ethics Committee as application 18/LO/1075. Results from the AVFGs and the narrative interviews will be submitted for peer-reviewed publication. The findings of the study will also be presented nationally to PSC and medical communities, and a summary of the findings will be shared with participants.

    Evaluating the effectiveness of the NHS Health Check programme in South England: a quasi-randomised controlled trial

    Por: Kennedy · O. · Su · F. · Pears · R. · Walmsley · E. · Roderick · P.
    Objective

    To evaluate uptake, risk factor detection and management from the National Health Service (NHS) Health Check (HC).

    Design

    This is a quasi-randomised controlled trial where participants were allocated to five cohorts based on birth year. Four cohorts were invited for an NHS HC between April 2011 and March 2015.

    Setting

    151 general practices in Hampshire, England, UK.

    Participants

    366 005 participants born 1 April 1940–31 March 1976 eligible for an NHS HC.

    Intervention

    NHS HC invitation.

    Main outcome measures

    HC attendance and absolute percentage changes and ORs of (1) detecting cardiovascular disease (CVD) 10-year risk >10% and >20%, smokers, and total cholesterol (TC) >5.5 mmol/L and >7.5 mmol/L; (2) diagnosing hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD) and atrial fibrillation (AF); and (3) new interventions with statins, antihypertensives, antiglycaemics and nicotine replacement therapy (NRT).

    Results

    HC attendance rose from 12% to 30% between 2011/2012 and 2014/2015 (p10% (2.0%–3.6, p20% (0.1%–0.6%, p5.5 mmol/L (4.1%–7.0%, p7.5 mmol/L (0.3%–0.4% p10% (OR 8.01, 95% CI 7.34 to 8.73) and >20% (5.86, 4.83 to 7.10), TC >5.5 mmol/L (3.72, 3.57 to 3.89) and >7.5 mmol/L (2.89, 2.46 to 3.38), and diagnoses of hypertension (1.33, 1.20 to 1.47) and diabetes (1.34, 1.12 to 1.61). OR of CVD risk >10% plus statin and >20% plus statin, respectively, was 2.90 (2.36 to 3.57) and 2.60 (1.92 to 3.52), and for hypertension plus antihypertensive was 1.33 (1.18 to 1.50). There were no associations with AF, CKD, antiglycaemics or NRT. Detection of several risk factors varied inversely by deprivation.

    Conclusions

    HC invitation increased detection of cardiovascular risk factors, but corresponding increases in evidence-based interventions were modest.

    The experiences of older adults with a diagnosed functional mental illness, their carers and healthcare professionals in relation to mental health service delivery: An integrative review

    Abstract

    Aims and objectives

    To analyse the experiences of older people with a diagnosed functional mental illness and their carers in relation to mental health service delivery and analyse the experiences of health and social care professionals who care for and treat older people who have a diagnosed functional mental illness.

    Background

    The prevalence of functional mental illness in older adults is notable but to date has received less research attention than dementia. Older adults with functional mental illness have life expectancy of up to 20 years less than the rest of the population. Therefore, the experiences of older adults with functional mental illness, their carers and healthcare professionals, in relation to mental health services, need further exploration.

    Design

    Integrative literature review.

    Methods

    A five‐stage process was informed by Whittemore and Knafl. MeSH was used. Keyword searches of MEDLINE, CINAHL, Cochrane Library, PsycINFO, EMBASE and AMED were conducted between January 2000–October 2017. Titles were screened, and data were extracted manually and analysed using narrative synthesis. The PRISMA checklist was used.

    Results

    A total of 342 articles were deemed potentially relevant to this review. Once inclusion and exclusion criteria were applied, 28 articles were included. The literature presented an overarching theme “determinants influencing older people with functional mental illness use of services.” The overarching theme is supported by two main themes: inevitable consequences of ageing and variations of the availability of healthcare services for older people with functional mental illness.

    Conclusion

    Several determinants influence use of services by older people with functional mental illness. Older people with functional mental illness often perceived they did not have a mental health need. Within the literature, there was little acknowledgement of the experiences of older people with functional mental illness regarding their support needs.

    Relevance to clinical practice

    This integrative review has highlighted that some older people with functional mental illness do not seek mental health support because they believe that functional mental illness is an inevitable consequence of ageing; this is mirrored at times by healthcare professionals and carers. In addition to this finding, different views prevail regarding the impact that ageless and age‐defined mental health service delivery models have on the needs of older people with functional mental illness. Further research is required to understand these findings.

    Optimising computerised decision support to transform medication safety and reduce prescriber burden: study protocol for a mixed-methods evaluation of drug-drug interaction alerts

    Por: Baysari · M. T. · Zheng · W. Y. · Li · L. · Westbrook · J. · Day · R. O. · Hilmer · S. · Van Dort · B. A. · Hargreaves · A. · Kennedy · P. · Monaghan · C. · Doherty · P. · Draheim · M. · Nair · L. · Samson · R.
    Introduction

    Drug–drug interaction (DDI) alerts in hospital electronic medication management (EMM) systems are generated at the point of prescribing to warn doctors about potential interactions in their patients’ medication orders. This project aims to determine the impact of DDI alerts on DDI rates and on patient harm in the inpatient setting. It also aims to identify barriers and facilitators to optimal use of alerts, quantify the alert burden posed to prescribers with implementation of DDI alerts and to develop algorithms to improve the specificity of DDI alerting systems.

    Methods and analysis

    A controlled pre-post design will be used. Study sites include six major referral hospitals in two Australian states, New South Wales and Queensland. Three hospitals will act as control sites and will implement an EMM system without DDI alerts, and three as intervention sites with DDI alerts. The medical records of 280 patients admitted in the 6 months prior to and 6 months following implementation of the EMM system at each site (total 3360 patients) will be retrospectively reviewed by study pharmacists to identify potential DDIs, clinically relevant DDIs and associated patient harm. To identify barriers and facilitators to optimal use of alerts, 10–15 doctors working at each intervention hospital will take part in observations and interviews. Non-identifiable DDI alert data will be extracted from EMM systems 6–12 months after system implementation in order to quantify alert burden on prescribers. Finally, data collected from chart review and EMM systems will be linked with clinically relevant DDIs to inform the development of algorithms to trigger only clinically relevant DDI alerts in EMM systems.

    Ethics and dissemination

    This research was approved by the Hunter New England Human Research Ethics Committee (18/02/21/4.07). Study results will be published in peer-reviewed journals and presented at local and international conferences and workshops.

    Caring for an older person with dementia in the Emergency Department (ED): An Appreciative Inquiry exploring family member and ED nurse experiences

    Abstract

    Aims and objectives

    To generate insights about what matters and is valued by family members of older people with dementia in the emergency department. To explore the experiences of emergency nurses looking after older people with dementia in an episode of care.

    Background

    In the emergency department, older people with dementia are at risk of suboptimal care. Little is known of the experiences of family members of being with an older person with dementia in the emergency department or the experiences of emergency nurses looking after older people with dementia in this environment.

    Design and methods

    Phase 1 Data Analysis of the Discovery Phase of an Appreciative Inquiry study. Study participants were family members of older people with dementia and emergency nurses. Data collection methods included interviews with family members of older people with dementia and 30 hr of participant observation working alongside emergency nurses. This study was guided by the Standards for Reporting Qualitative Research.

    Results

    Two themes emerged from the analysis: What matters to family members with four subthemes and challenges for family members and nurses in the emergency department with two subthemes.

    Conclusion

    This study demonstrates that some emergency nurses are connecting with family members even in the briefest of clinical encounters. It is feasible for more emergency nurses to do the same more of the time.

    Relevance to clinical practice

    The older person with dementia must be given a triage category of no less than 3 (to be seen by the doctor within the hour) on arrival in the department. Further education is needed to assist emergency nurses to establish rapport and incorporate family member insights as part of care planning and assessment of the needs of the older person with dementia.

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