Abstract Background In recent years, robotic rehabilitation devices have often been used for motor training. However, to date, no systematic reviews of qualitative studies exploring the end-user experiences of robotic devices in motor rehabilitation have been published. The aim of this study was to review end-users’ (patients, carers and healthcare professionals) experiences with robotic devices in motor rehabilitation, by conducting a systematic review and thematic meta-synthesis of qualitative studies concerning the users’ experiences with such robotic devices. Methods Qualitative studies and mixed-methods studies with a qualitative element were eligible for inclusion. Nine electronic databases were searched from inception to August 2020, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review. Results The search strategy identified a total of 13,556 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 30 studies were included. All studies were considered of acceptable quality. We developed six analytical themes: logistic barriers; technological challenges; appeal and engagement; supportive interactions and relationships; benefits for physical, psychological, and social function(ing); and expanding and sustaining therapeutic options. Conclusions Despite experiencing technological and logistic challenges, participants found robotic devices acceptable, useful and beneficial (physically, psychologically, and socially), as well as fun and interesting. Having supportive relationships with significant others and positive therapeutic relationships with healthcare staff were considered the foundation for successful rehabilitation and recovery.
Problem:
Guillain-Barre Syndrome (GBS) is a rare inflammatory peripheral nerves disorder with variable recovery and variant or chronic forms. Previous qualitative studies have been published of GBS sufferers’ experiences but survey evidence on the experiences and needs of people with GBS or its variants particularly in a UK context is limited. We aimed to develop and validate a survey to quantify the experiences and health and social care needs of people with GBS and its variants in the UK.
Approach:
We developed a self-administered anonymous online questionnaire survey to explore patients’ experiences of care and recovery from GBS. Questionnaire items were based on a systematic review and metasynthesis of qualitative studies and an interview study of people with the condition. After gaining ethical approval, the survey was publicised via a national GBS charity website and social media. Participants with a diagnosis of GBS consented and completed the questionnaire online. Question domains included experiences of the GBS and its care, symptom severity at various stages, and factors that supported or hindered recovery. We conducted descriptive statistical analyses and developed a multiple regression model exploring the relationship between experiences, demographic and disease factors.
Findings:
Of 291 responders who completed the survey within 6 weeks of its launch, 140 (51.9%) were male, 130 (48.1%) female; 178 (65.9%) married or in civil partnership whereas 57 (21.1%) were single; 252 (86.6%) were from the UK. Most participants (116; 43%) were diagnosed between 2015 and 2019. Time to diagnosis was usually 1-7 days (161, 61.7%). First medical help was sought more often from a general practitioner (163; 62.2%) than from the Emergency Department (67; 25.6%). Improvement in symptoms was associated with younger age (≤ 39 years vs older), patients who were married (vs civil partnership or single), and those who presented to medical care early within the first 4 weeks compared with later. Improvement in symptoms was also better in responders who had a good response to immunoglobulins and/or plasma exchange therapy, those who were treated in a hospital intensive care unit and those who were positive about occupational therapy. Responders expressed a preference for information from health care staff compared with charities or social media but were more likely to experience better information from the latter. Analysis also showed high completion rates, scale reliabilities and construct validity in relation to previous studies, such as greater symptom improvement in younger people and those who received early intensive treatment.
Consequences:
The survey showed good evidence of face and construct validity and internal consistency. It could be used to explore experiences and how these could be improved in a larger population of people with GBS, and to evaluate the effect of interventions designed to improve experiences.
Funding acknowledgement: We acknowledge the GAIN Charity for funding the project
Background We previously reported on a randomised trial demonstrating the effectiveness and cost-effectiveness of a pharmacist-led information technology intervention (PINCER). We sought to investigate whether PINCER was effective in reducing hazardous prescribing when rolled out at scale in UK general practices. Methods and findings We used a multiple interrupted time series design whereby successive groups of general practices received the PINCER intervention between September 2015 and April 2017. We used 11 prescribing safety indicators to identify potentially hazardous prescribing and collected data over a maximum of 16 quarterly time periods. The primary outcome was a composite of all the indicators; a composite for indicators associated with gastrointestinal (GI) bleeding was also reported, along with 11 individual indicators of hazardous prescribing. Data were analysed using logistic mixed models for the quarterly event numbers with the appropriate denominator, and calendar time included as a covariate. PINCER was implemented in 370 (94.1%) of 393 general practices covering a population of almost 3 million patients in the East Midlands region of England; data were successfully extracted from 343 (92.7%) of these practices. For the primary composite outcome, the PINCER intervention was associated with a decrease in the rate of hazardous prescribing of 16.7% (adjusted odds ratio (aOR) 0.83, 95% confidence interval (CI) 0.80 to 0.86) at 6 months and 15.3% (aOR 0.85, 95% CI 0.80 to 0.90) at 12 months postintervention. The unadjusted rate of hazardous prescribing reduced from 26.4% (22,503 patients in the numerator/853,631 patients in the denominator) to 20.1% (11,901 patients in the numerator/591,364 patients in the denominator) at 6 months and 19.1% (3,868 patients in the numerator/201,992 patients in the denominator). The greatest reduction in hazardous prescribing associated with the intervention was observed for the indicators associated with GI bleeding; for the GI composite indicator, there was a decrease of 23.9% at both 6 months (aOR 0.76, 95% CI 0.73 to 0.80) and 12 months (aOR 0.76, 95% CI 0.70 to 0.82) postintervention. The unadjusted rate of hazardous prescribing reduced from 31.4 (16,185 patients in the numerator/515,879 patients in the denominator) to 21.2% (7,607 patients in the numerator/358,349 patients in the denominator) at 6 months and 19.5% (2,369 patients in the numerator/121,534 patients in the denominator). We adjusted for calendar time and practice, but since this was an observational study, the findings may have been influenced by unknown confounding factors or behavioural changes unrelated to the PINCER intervention. Data were also not collected for all practices at 6 months and 12 months postintervention. Conclusions The PINCER intervention, when rolled out at scale in routine clinical practice, was associated with a reduction in hazardous prescribing by 17% and 15% at 6 and 12 months postintervention. The greatest reductions in hazardous prescribing were for indicators associated with risk of GI bleeding. These findings support the wider national rollout of PINCER in England.
Introduction
Tinnitus is the perception of sound (ringing or buzzing) in the absence of external/electrical stimulation. It affects about 10% of people in the United Kingdom, with rates of comorbid sleep problems ranging from 50 to 77%. Our aim was to systematically review the literature relating to the effectiveness of cognitive behavioural therapy (CBT) interventions on insomnia in patients with tinnitus.
Methods
A systematic literature search of seven scientific databases (Cochrane Library/CENTRAL, PROSPERO, HTA/DARE, Medline, CINAHL, Web of science, ClinicalTrials.gov) was performed, covering literature published up to August 2018. Database searching was supplemented with internet searching and forward/backward citation tracking from systematic reviews and included studies. Studies were considered eligible for inclusion if they involved: adult patients (living at home or in a care setting) with tinnitus; CBT interventions for tinnitus and/or insomnia; any comparator (i.e. usual care, alternative intervention); randomised controlled trials or quasi-randomised controlled trials that reported sleep outcomes. The primary outcome was a mean difference in sleep. The quality of the included studies was assessed according to the Cochrane Risk of Bias assessment tool. Two reviewers independently reviewed title/abstracts initially and then full-text papers, before proceeding with data extractions. Any discrepancies were resolved through discussion, or where required a third reviewer.
Results
Four studies (427 participants) were included in the meta-analysis. The majority of the interventions were internet-based and targeted tinnitus distress with insomnia reported as a secondary outcome. Sleep management and/or guidance was an additional optional module in three studies. Results demonstrated a significant reduction in insomnia as measured by the insomnia severity index [-3.28; 95% CI=-4.51,-2.05; I2=0%]), which equates to a moderate effect size (0.05). Risk of bias was considered low in all categories except blinding (participants and personnel and/or outcome assessment), which was not always possible due to study design.
Conclusion
This systematic review and meta-analysis showed that CBT-based interventions can improve insomnia in people diagnosed with tinnitus. Further research into interventions specifically targeting sleep problems would be advantageous, especially exploring which components of CBT are the most effective for alleviating sleep problems in patients with tinnitus.
"'Hypos' can strike twice" (HS2) is a pragmatic, leaflet-based referral intervention designed for administration by clinicians of the emergency medical services (EMS) to people they have attended and successfully treated for hypoglycaemia. Its main purpose is to encourage the recipient to engage with their general practitioner or diabetic nurse in order that improvements in medical management of their diabetes may be made, thereby reducing their risk of recurrent hypoglycaemia. Herein we build a de novo economic model for purposes of incremental analyses to compare, in 2018-19 prices, HS2 against standard care for recurrent hypoglycaemia in the fortnight following the initial attack from the perspective of the UK National Health Service (NHS). We found that per patient NHS costs incurred by people receiving the HS2 intervention over the fortnight following an initial hypoglycaemia average £49.79, and under standard care costs average £40.50. Target patient benefit assessed over that same period finds the probability of no recurrence of hypoglycaemia averaging 42.4% under HS2 and 39.4% under standard care, a 7.6% reduction in relative risk. We find that implementing HS2 will cost the NHS an additional £309.36 per episode of recurrent hypoglycaemia avoided. Contrary to the favourable support offered in Botan et al., we conclude that in its current form the HS2 intervention is not a cost-effective use of NHS resources when compared to standard NHS care in reducing the risk of hypoglycaemia recurring within a fortnight of an initial attack that was resolved at-scene by EMS ambulance clinicians.
Abstract Purpose To synthesize the qualitative literature exploring the experiences of people living with lung cancer in rural areas. Methods Searches were performed in MEDLINE, CINAHL, and PsycINFO. Articles were screened independently by two reviewers against pre-determined eligibility criteria. Data were synthesized using Thomas and Harden’s framework for the thematic synthesis of qualitative research. The CASP qualitative checklist was used for quality assessment and the review was reported in accordance with the ENTREQ and PRISMA checklists. Results Nine articles were included, from which five themes were identified: (1) diagnosis and treatment pathways, (2) travel and financial burden, (3) communication and information, (4) experiences of interacting with healthcare professionals, (5) symptoms and health-seeking behaviors. Lung cancer diagnosis was unexpected for some with several reporting treatment delays and long wait times regarding diagnosis and treatment. Accessing treatment was perceived as challenging and time-consuming due to distance and financial stress. Inadequate communication of information from healthcare professionals was a common concern expressed by rural people living with lung cancer who also conveyed dissatisfaction with their healthcare professionals. Some were reluctant to seek help due to geographical distance and sociocultural factors whilst others found it challenging to identify symptoms due to comorbidities. Conclusions This review provides a deeper understanding of the challenges faced by people with lung cancer in rural settings, through which future researchers can begin to develop tailored support to address the existing disparities that affect this population.
Background Hypoglycaemia is a common complication of diabetes therapy needing prompt recognition and treatment. It often results in ambulance attendance incurring health services costs and patient morbidity. Patient education is important for maintaining glycaemic control and preventing recurrent hypoglycaemia. We aimed to investigate the effect of an intervention in which ambulance staff were trained to provide advice supported by a booklet – ‘Hypos can strike twice’- issued following a hypoglycaemic event to prevent future attendances. Methods We used a non-randomised stepped wedge-controlled design. The intervention was introduced at different times (steps) in different areas (clusters) of operation of East Midlands Ambulance Service NHS Trust (EMAS). During the first step (T0) no clusters were exposed to the intervention and during the last step (T3) all clusters were exposed. The main outcome was the number of unsuccessful ambulance attendances (i.e. attendances followed by a repeat attendance). Data were analysed using a general linear mixed model (GLMM) and an interrupted-time series analysis (ITSA). Results The study included 4825 patients (mean age= 65.42, SD=19.42; 2166 females) experiencing hypoglycaemic events attended by EMAS. GLMM indicated a reduction in the number of unsuccessful attendances in the final step of the intervention when compared to the first (OR: 0.50, 95%CI: 0.33-0.76, p=0.001). ITSA indicated a significant decrease in repeat ambulance attendances for hypoglycaemia – relative to the pre-intervention trend (p=0.008). The hypoglycaemia care bundle (i.e. blood glucose recorded before and after treatment for hypoglycaemia) was delivered in 66% of attendances during the intervention period, demonstrating a significant level of practice change (χ2=30.16, p<0.001). Conclusions The ‘Hypos can strike twice’ intervention had a positive effect on reducing numbers of repeat attendances for hypoglycaemia and in achieving the care bundle. The study supports the use of informative booklets by ambulance clinicians to prevent future attendances for recurrent hypoglycaemic events.
The Recorded Consultation Assessment (RCA) was developed rapidly during the COVID-19 pandemic to replace the Clinical Skills Assessment (CSA) for UK general practice licensing. Our aim was to evaluate examiner perceptions of the RCA.
Background The global impact of COVID-19 has been profound, with efforts to manage and contain the virus placing increased pressure on healthcare systems and Emergency Medical Services (EMS) in particular. There has been no previous review of studies investigating EMS interventions or experiences during pandemics. The aim of this scoping review was to identify and present published quantitative and qualitative evidence of EMS pandemic interventions, and how this translates into practice. Methods Six electronic databases were searched from inception to July 2022, supplemented with internet searches and forward and backward citation tracking from included studies and review articles. A narrative synthesis of all eligible quantitative studies was performed and structured around the aims, key findings, as well as intervention type and content, where appropriate. Data from the qualitative studies were also synthesised narratively and presented thematically, according to their main aims and key findings. Results The search strategy identified a total of 22,599 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 90 studies were included. The quantitative narrative synthesis included seven overarching themes, describing EMS pandemic preparedness plans and interventions implemented in response to pandemics. The qualitative data synthesis included five themes, detailing the EMS workers’ experiences of providing care during pandemics, their needs and their suggestions for best practices moving forward. Conclusions Despite concerns for their own and their families’ safety and the many challenges they are faced with, especially their knowledge, training, lack of appropriate Personal Protective Equipment (PPE) and constant protocol changes, EMS personnel were willing and prepared to report for duty during pandemics. Participants also made recommendations for future outbreak response, which should be taken into consideration in order for EMS to cope with the current pandemic and to better prepare to respond to any future ones. Trial registration The review protocol was registered with the Open Science Framework ( osf.io/2pcy7 ).
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