scholarly journals Protocol for a feasibility study of OnTrack: a digital system for upper limb rehabilitation after stroke

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e034936
Author(s):  
Gianpaolo Fusari ◽  
Ella Gibbs ◽  
Lily Hoskin ◽  
Daniel Dickens ◽  
Melanie Leis ◽  
...  
Keyword(s):  
Mixed Method ◽  
Arm Movement ◽  
Randomised Control Trial ◽  
Smart Devices ◽  
Management Skills ◽  
Upper Limb Rehabilitation ◽  
Motivational Messages ◽  
Ethical Approval ◽  
Registration Number ◽  
The Uk

IntroductionArm weakness is a common problem after stroke (affecting 450 000 people in the UK) leading to loss of independence. Repetitive activity is critical for recovery but research shows people struggle with knowing what or how much to do, and keeping track of progress. Working with more than 100 therapists (occupational therapists and physiotherapists) and patients with stroke, we codeveloped the OnTrack intervention—consisting of software for smart devices and coaching support—that has the potential to address this problem. This is a protocol to assess the feasibility of OnTrack for evaluation in a randomised control trial.Methods and analysisA mixed-method, single-arm study design will be used to evaluate the feasibility of OnTrack for hospital and community use. A minimum sample of 12 participants from a stroke unit will be involved in the study for 14 weeks. During week 1, 8 and 14 participants will complete assessments relating to their arm function, arm impairment and activation. During weeks 2–13, participants will use OnTrack to track their arm movement in real time, receive motivational messages and face-to-face sessions to address problems, gain feedback on activity and receive self-management skills coaching. All equipment will be loaned to study participants. A parallel process evaluation will be conducted to assess the intervention’s fidelity, dose and reach, using a mixed-method approach. A public and patient involvement group will oversee the study and help with interpretation and dissemination of qualitative and quantitative data findings.Ethics and disseminationEthical approval granted by the National Health Service Health Research Authority, Health and Care Research Wales, and the London—Surrey Research Ethics Committee (ref. 19/LO/0881). Trial results will be submitted for publication in peer review journals, presented at international conferences and disseminated among stroke communities. The results of this trial will inform development of a definitive trial.Trial registration numberNCT03944486.

scholarly journals Development of the Carers’ Alert Thermometer for Young Carers (CAT-YC) to Identify and Screen the Support Needs of Young Carers: A Mixed Method Consensus Study

2021 ◽  
Author(s):  
Lynn Kettell ◽  
Mary R. O’Brien ◽  
Barbara A. Jack ◽  
Katherine Knighting
Keyword(s):  
Mixed Method ◽  
Quantitative Data ◽  
Action Plan ◽  
Ethics Committees ◽  
Young Carers ◽  
Education Professionals ◽  
Wide Range ◽  
Ethical Approval ◽  
Group A ◽  
The Uk

AbstractThis paper reports on a multi-phased, mixed-method consensus-based study conducted with young carers in the UK aged 11–18, and health, social care and education professionals from the UK, USA and Canada, to identify priority items for inclusion in a short screening tool for use with young carers of a family member with a progressive or long-term illness or disability. Following ethical approval from University and local Research Ethics Committees, qualitative and quantitative data were collected between 2017 and 2019 from 267 people (107 young carers; 160 professionals), through interviews, a focus group, a Delphi survey, consensus group meetings and consultations. Qualitative data were analysed thematically, and quantitative data were analysed using measures of central tendency, frequency and levels of dispersion. The resulting Carers’ Alert Thermometer (CAT-YC) contains an identification question followed by ten areas of need across two themes of ‘current caring situation’ and ‘carer’s health and wellbeing,’ along with guidance for possible next steps and space for an action plan to be jointly agreed between the screener and young carer. Preliminary piloting of the CAT-YC provides evidence of identifying and monitoring needs, and is expected to be useful for young carers, a wide range of professionals, and organisations that support young carers.

scholarly journals UTAH: Using Telemedicine to improve early medical Abortion at Home: a protocol for a randomised controlled trial comparing face-to-face with telephone consultations for women seeking early medical abortion

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046628
Author(s):  
John Joseph Reynolds-Wright ◽  
John Norrie ◽  
Sharon Tracey Cameron
Keyword(s):  
Controlled Trial ◽  
Medical Abortion ◽  
Is Success ◽  
Face To Face ◽  
Intention To Treat ◽  
Ethical Approval ◽  
Registration Number ◽  
Low Sensitivity ◽  
Randomised Controlled ◽  
The Uk

IntroductionEarly medical abortion (EMA) is a two-stage process of terminating pregnancy using oral mifepristone (a progesterone-receptor antagonist) followed usually 1–2 days later by sublingual, vaginal or buccal misoprostol (a prostaglandin analogue). There are no published randomised controlled trials (RCTs) on the use of telemedicine for EMA. Our proposed research will determine if telephone consultations for EMA (the most common method of abortion in the UK) is non-inferior to standard face-to-face consultations with regard to the efficacy of EMA.Methods and analysisThis study will be conducted as an RCT. The recruitment target is 1222 participants.The primary outcome is success of EMA (complete abortion rate). This will be determined based on a negative low-sensitivity urine pregnancy test result (2 weeks after misoprostol use) and absence of surgical intervention or diagnosis of ongoing pregnancy (within 6 weeks of misoprostol).Secondary outcomes include total time spent at a clinic appointment to receive EMA, self-reported preparedness for EMA, level of satisfaction with consultation and effective contraception uptake compared with when women attend for a face-to-face consultation.The main analysis will be a modified intention-to-treat analysis. This will include all randomised women (with a viable pregnancy) using EMA and follow-up for the main outcome. The study initiated on 13 January 2020 and is anticipated to finish in late 2021.Ethics and disseminationEthical approval was given by the South East Scotland NHS Research Ethics Committee, reference: 19/SS/0111. Results will be published in peer-reviewed journals, presented at clinical and academic meetings, and shared with participants via the clinic website.Trial registration numberNCT04139382.

Dual robot system for upper limb rehabilitation after stroke: The design process

2007 ◽  
Vol 221 (7) ◽  
pp. 845-857 ◽  
Author(s):  
A E Jackson ◽  
R J Holt ◽  
P R Culmer ◽  
S G Makower ◽  
M C Levesley ◽  
...  
Keyword(s):  
Upper Limb ◽  
Single Point ◽  
Three Dimensional ◽  
Arm Movement ◽  
Ease Of Use ◽  
Robot System ◽  
Upper Limb Rehabilitation ◽  
The Uk ◽  
The University ◽  
Limb Rehabilitation

Stroke is the most common cause of severe disability in the UK. Arm impairment is common and recovery is partly dependent on the intensity and frequency of rehabilitation intervention. However, physical therapy resources are often limited, so methods of supplementing traditional physiotherapy are essential. Robot assisted physiotherapy is one way to increase the duration patients spend participating in rehabilitation activities. A single robot system has been developed at the University of Leeds that actively assists patients undertaking therapeutic movements in a three-dimensional workspace. However, using only a single point of contact at the wrist to assist with therapeutic reaching movements does not allow control or support of the more proximal joints of the upper limb. This could lead to discomfort during assisted exercise. In addition, the design suffers from a restrictive workspace, limiting the range of therapeutic exercise that can be undertaken. To address these limitations, the intelligent Pneumatic Arm Movement system has been developed. A major aspect of the development process has been the continual involvement of physiotherapists and stroke patients; the end users of the system. Through inclusion of these stakeholders, a system has been developed that satisfies their requirements for workspace, comfort, safety, and ease of use.

scholarly journals ‘Care Under Pressure’: a realist review of interventions to tackle doctors’ mental ill-health and its impacts on the clinical workforce and patient care

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e021273 ◽  
Author(s):  
Daniele Carrieri ◽  
Simon Briscoe ◽  
Mark Jackson ◽  
Karen Mattick ◽  
Chrysanthi Papoutsi ◽  
...  
Keyword(s):  
Mental Health ◽  
Realist Review ◽  
Well Being ◽  
Career Stage ◽  
Dissemination Strategy ◽  
Good Mental Health ◽  
Ethical Approval ◽  
Registration Number ◽  
Being There ◽  
The Uk

IntroductionMental ill-health is prevalent across all groups of health professionals and this is of great concern in many countries. In the UK, the mental health of the National Health Service (NHS) workforce is a major healthcare issue, leading to presenteeism, absenteeism and loss of staff from the workforce. Most interventions targeting doctors aim to increase their ‘productivity’ and ‘resilience’, placing responsibility for good mental health with doctors themselves and neglecting the organisational and structural contexts that may have a detrimental effect on doctors’ well-being. There is a need for approaches that are sensitive to the contextual complexities of mental ill-health in doctors, and that do not treat doctors as a uniform body, but allow distinctions to account for particular characteristics, such as specialty, career stage and different working environments.Methods and analysisOur project aims to understand how, why and in what contexts support interventions can be designed to minimise the incidence of doctors’ mental ill-health. We will conduct a realist review—a form of theory-driven interpretative systematic review—of interventions, drawing on diverse literature sources. The review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence; (3) select articles; (4) extract and organise data and (5) synthesise evidence and draw conclusions. The analysis will summarise how, why and in what circumstances doctors’ mental ill-health is likely to develop and what can remediate the situation. Throughout the project, we will also engage iteratively with diverse stakeholders in order to produce actionable theory.Ethics and disseminationEthical approval is not required for our review. Our dissemination strategy will be participatory. Tailored outputs will be targeted to: policy makers; NHS employers and healthcare leaders; team leaders; support organisations; doctors experiencing mental ill-health, their families and colleagues.PROSPERO registration numberCRD42017069870.

scholarly journals Efficacy and safety of aliskiren combination therapy: a protocol for an umbrella review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043807
Author(s):  
Jiantong Shen ◽  
Wenming Feng ◽  
Yike Wang ◽  
Qiyuan Zhao ◽  
Billong Laura Flavorta ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Systematic Reviews ◽  
Cochrane Library ◽  
Umbrella Review ◽  
Quality Of Reporting ◽  
Ethical Approval ◽  
Registration Number ◽  
Third Person ◽  
Meta Analyses ◽  
The Impact

IntroductionEfficacy of aliskiren combination therapy with other antihypertensive has been evaluated in the treatment of patients with hypertension in recent systematic reviews. However, most previous reviews only focused on one single health outcome or one setting, none of them made a full summary that assessed the impact of aliskiren combination treatment comprehensively. As such, this umbrella review based on systematic reviews and meta-analyses is aimed to synthesise the evidences on efficacy, safety and tolerability of aliskiren-based therapy for hypertension and related comorbid patients.Methods and analysisA comprehensive search of PubMed, EMBASE, Cochrane Library, CNKI published from inception to August 2020 will be conducted. The selected articles are systematic reviews which evaluated efficacy, safety and tolerability of aliskiren combination therapy. Two reviewers will screen eligible articles, extract data and evaluate quality independently. Any disputes will be resolved by discussion or the arbitration of a third person. The quality of reporting evidence will be assessed using the Assessment of Multiple Systematic Reviews V.2 tool tool. We will take a mixed-methods approach to synthesising the review literatures, reporting summary of findings tables and iteratively mapping the results.Ethics and disseminationEthical approval is not required for the study, as we would only collect data from available published materials. This umbrella review will be also submitted to a peer-reviewed journal for publication after completion.PROSPERO registration numberCRD42020192131.

scholarly journals Exploring activity levels in physical education lessons in the UK: a cross-sectional examination of activity types and fitness levels

2021 ◽  
Vol 7 (1) ◽  
pp. e000924
Author(s):  
Nick Beale ◽  
Emma Eldridge ◽  
Anne Delextrat ◽  
Patrick Esser ◽  
Oliver Bushnell ◽  
...  
Keyword(s):  
Physical Activity ◽  
Physical Education ◽  
Multilevel Models ◽  
Activity Levels ◽  
Cross Sectional ◽  
Registration Number ◽  
Global Norms ◽  
Cross Sectional Design ◽  
The Uk ◽  
Fitness Levels

ObjectivesTo establish pupil fitness levels, and the relationship to global norms and physical education (PE) enjoyment. To measure and describe physical activity (PA) levels during secondary school PE lessons, in the context of recommended levels, and how levels vary with activity and lesson type.MethodsA cross-sectional design; 10 697 pupils aged 12.5 (SD 0.30) years; pupils who completed a multistage fitness test and wore accelerometers to measure PA during PE lessons. Multilevel models estimated fitness and PE activity levels, accounting for school and class-level clustering.ResultsCardiorespiratory fitness was higher in boys than girls (ß=−0.48; 95% CI −0.56 to −0.39, p<0.001), within absolute terms 51% of boys and 54% of girls above the 50th percentile of global norms. On average, pupils spent 23.8% of PE lessons in moderate-to-vigorous PA (MVPA), and 7.1% in vigorous PA (VPA). Fitness-focused lessons recorded most VPA in co-educational (ß=1.09; 95% CI 0.43 to 1.74) and boys-only lessons (ß=0.32; 95% CI −0.21 to 0.85). In girls-only lessons, track athletics recorded most VPA (ß=0.13; 95% CI −0.50 to 0.75) and net/wall/racket games (ß=0.97; 95% CI 0.12 to 1.82) the most MVPA. For all lesson types, field athletics was least active (ß=−0.85; 95% CI −1.33 to −0.36). There was a relationship of enjoyment of PE to fitness (ß=1.03; 95% CI 0.83 to 1.23), and this relationship did not vary with sex (ß=−0.14 to 0.23; 95% CI −0.16 to 0.60).ConclusionsPE lessons were inactive compared with current guidelines. We propose that if we are to continue to develop a range of sporting skills in schools at the same time as increasing levels of fitness and PA, there is a need to introduce additional sessions of PE activity focused on increasing physical activity.Trial registration numberNCT03286725.

scholarly journals Psychological resilience during COVID-19: a meta-review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e051417
Author(s):  
Katie Seaborn ◽  
Mark Chignell ◽  
Jacek Gwizdka
Keyword(s):  
Systematic Reviews ◽  
Well Being ◽  
Measurement Tool ◽  
Psychological Resilience ◽  
Key Points ◽  
Meta Review ◽  
Ethical Approval ◽  
Registration Number ◽  
Review Protocol

IntroductionThe global COVID-19 pandemic continues to have wide-ranging implications for health, including psychological well-being. A growing corpus of research reviews has emerged on the topic of psychological resilience in the context of the pandemic. However, this body of work has not been systematically reviewed for its quality, nor with respect to findings on the effectiveness of tools and strategies for psychological resilience. To this end, a meta-review protocol is proposed with the following objectives: (1) identify review work on the topic of psychological resilience during COVID-19; (2) assess the quality of this review work using A MeaSurement Tool to Assess systematic Reviews; (3) assess the risk of bias in this work; (4) generate a narrative summary of the key points, strengths and weaknesses; (5) identify the psychological resilience strategies that have been reviewed; (6) identify how these strategies have been evaluated for their effectiveness; (7) identify what outcomes were measured and (8) summarise the findings on strategies for psychological resilience so far, providing recommendations, if possible.Methods and analysisA systematic meta-review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews for Protocols and Joanna Briggs Institute umbrella review guidelines. Electronic searches of general databases, especially Web of Science, Scopus and PubMed, will be conducted. Only results from January 2020 onwards will be considered, coinciding with the COVID-19 pandemic. Only results in English will be included. Descriptive statistics, thematic analysis and narrative summaries describing the nature of the reviewed work and evaluation of psychological resilience strategies will be carried out.Ethics and disseminationEthical approval is not needed for systematic review protocols. The results of the meta-review will be published in an international peer-reviewed journal. The raw and summarised data will be shared in the journal or other open venues.PROSPERO registration numberCRD42021235288.

Advanced practice in ophthalmic nursing: A comparison of roles and the effects of policy on practice in the UK and New Zealand

2010 ◽  
Vol 18 (1) ◽  
pp. 7-18 ◽  
Author(s):  
Janet Marsden ◽  
Mary E. Shaw ◽  
Sue Raynel
Keyword(s):  
Health Policy ◽  
New Zealand ◽  
National Health ◽  
Mixed Method ◽  
Advanced Practice ◽  
National Health Policy ◽  
Minimal Effect ◽  
Questionnaire Data ◽  
Role Development ◽  
The Uk

This paper compares the results of studies of ophthalmic advanced practice in two similar but distinct health economies and integrates the effects of the setting, health policy and professional regulation on such roles. A mixed method questionnaire design was used, distributed at national ophthalmic nursing conferences in the UK and in New Zealand. Participants were nurses undertaking advanced practice who opted to return the questionnaire. Data were analysed separately, and are compared here, integrated with national health policy and role regulation to provide commentary on the findings. The findings suggest that health policy priorities stimulate the areas in which advanced practice roles in ophthalmic nursing emerge. The drivers of role development appear similar and include a lack of experienced doctors and an unmanageable rise in healthcare demand. Titles and remuneration are different in the two health economies, reflecting the organisation and regulation of nursing. In clinical terms, there are few differences between practice in the two settings and it appears that the distinct systems of regulation have minimal effect on role development. Ophthalmic nursing, as a reactive, needs based profession and in common with nursing in general, evolves in order that practice reflects what is needed by patients and services.

scholarly journals Ethical Regulation and Visual Methods: Making Visual Research Impossible or Developing Good Practice?

2012 ◽  
Vol 17 (1) ◽  
pp. 3-12 ◽  
Author(s):  
Rose Wiles ◽  
Amanda Coffey ◽  
Judy Robison ◽  
Jon Prosser
Keyword(s):  
Detrimental Effect ◽  
Social Research ◽  
Good Practice ◽  
Ethical Review ◽  
Visual Methods ◽  
Research Practice ◽  
Ethical Challenges ◽  
Visual Research ◽  
Ethical Approval ◽  
The Uk

The ethical regulation of social research in the UK has been steadily increasing over the last decade or so and comprises a form of audit to which all researchers in Higher Education are subject. Concerns have been raised by social researchers using visual methods that such ethical scrutiny and regulation will place severe limitations on visual research developments and practice. This paper draws on a qualitative study of social researchers using visual methods in the UK. The study explored their views, the challenges they face and the practices they adopt in relation to processes of ethical review. Researchers reflected on the variety of strategies they adopted for managing the ethical approval process in relation to visual research. For some this meant explicitly ‘making the case’ for undertaking visual research, notwithstanding the ethical challenges, while for others it involved ‘normalising’ visual methods in ways which delimited the possible ethical dilemmas of visual approaches. Researchers only rarely identified significant barriers to conducting visual research from ethical approval processes, though skilful negotiation and actively managing the system was often required. Nevertheless, the climate of increasing ethical regulation is identified as having a potential detrimental effect on visual research practice and development, in some instances leading to subtle but significant self-censorship in the dissemination of findings.

Obtaining Informed Consent in an Egyptian Research Study

2004 ◽  
Vol 11 (4) ◽  
pp. 394-399 ◽  
Author(s):  
Amina M Rashad ◽  
Fiona MacVane Phipps ◽  
Melanie Haith-Cooper
Keyword(s):  
Informed Consent ◽  
Academic Research ◽  
Codes Of Ethics ◽  
Theoretical Work ◽  
Ethical Principles ◽  
Arab Muslim ◽  
Ethical Approval ◽  
The Uk ◽  
Collection Phase ◽  
British Research

This article explores the concept of internationally acceptable codes of ethics within the context of an Egyptian nurse’s PhD studies. Theoretical work, including gaining ethical approval for the project, took place in the UK, while the data collection phase of the study was done in Egypt. This highlighted areas where the Arab Muslim interpretation of some ethical principles, especially around the issue of gaining informed consent, differed from that currently accepted in British research ethics. The authors argue that it may not be possible, or even desirable, to standardize codes of ethics globally in areas such as academic research. Ethical principles develop from a unique mix of culture and religion. It may be more important to develop cultural competence that includes the ability to understand and respect the way in which ethical principles are interpreted by various societies.

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