scholarly journals Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036192 ◽  
Author(s):  
Catrin Evans ◽  
Brenda Poku ◽  
Ruth Pearce ◽  
Jeanette Eldridge ◽  
Paul Hendrick ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Scoping Review ◽  
Health Workforce ◽  
Grey Literature ◽  
Evidence Base ◽  
Current Evidence ◽  
Multiprofessional Team ◽  
Wide Range ◽  
Current Evidence Base ◽  
The Uk

IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective.Methods and analysisThis scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework).DisseminationThe review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.

scholarly journals A systematic scoping review of psychological therapies for psychosis within acute psychiatric in-patient settings

2018 ◽  
Vol 213 (2) ◽  
pp. 490-497 ◽  
Author(s):  
Pamela Jacobsen ◽  
Kathleen Hodkinson ◽  
Emmanuelle Peters ◽  
Paul Chadwick
Keyword(s):  
Outcome Measures ◽  
Scoping Review ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Allocation Concealment ◽  
Current Evidence ◽  
Psychological Therapies ◽  
Affective Symptoms ◽  
Wide Range ◽  
Current Evidence Base

BackgroundPeople with psychotic disorders account for most acute admissions to psychiatric wards. Psychological therapies are a treatment adjunct to standard medication and nursing care, but the evidence base for such therapies within in-patient settings is unclear.AimsTo conduct a systematic scoping review of the current evidence base for psychological therapies for psychosis delivered within acute in-patient settings (PROSPERO: CRD42015025623).MethodAll study designs, and therapy models, were eligible for inclusion in the review. We searched PubMed, PsycINFO, EThOS, ProQuest, conference abstracts and trial registries.ResultsWe found 65 studies that met criteria for inclusion in the review, 21 of which were randomised controlled trials (RCTs). The majority of studies evaluated cognitive–behavioural interventions. Quality was variable across all study types. The RCTs were mostly small (n<25 in the treatment arm), and many had methodological limitations including poorly described randomisation methods, inadequate allocation concealment and non-masked outcome assessments. We found studies used a wide range of different outcome measures, and relatively few studies reported affective symptoms or recovery-based outcomes. Many studies described adaptations to treatment delivery within in-patient settings, including increased frequency of sessions, briefer interventions and use of single-session formats.ConclusionsBased on these findings, there is a clear need to improve methodological rigour within in-patient research. Interpretation of the current evidence base is challenging given the wide range of different therapies, outcome measures and models of delivery described in the literature.Declaration of interestNone.

Theraplay

2017 ◽  
pp. 42-59 ◽  
Author(s):  
Catherine Tucker ◽  
Sondra Smith-Adcock
Keyword(s):  
Behavioral Problems ◽  
Evidence Base ◽  
Emotional And Behavioral Problems ◽  
Current Evidence ◽  
Clinical Settings ◽  
Neuroscience Research ◽  
Wide Range ◽  
Current Evidence Base ◽  
Childhood Problems ◽  
Families With Children

Theraplay® is a brief, attachment-based parent-child psychotherapy approach that uses interactional play to establish ‘affectional' bonds between caregiver and child. Recent research related to Theraplay suggests it is an evidence-based practice for use in schools and clinical settings for a wide range of childhood problems, including those that are trauma-based. Of particular importance, Theraplay is emerging as an approach that is consistent with current neuroscience research on children's brain development and new understandings of attachment and disruption advanced by researchers. Young clients with some form of trauma-related symptoms comprise a large percentage of clinical cases, and present with complicated emotional and behavioral problems In this chapter, we will explore the basic theoretical underpinnings of Theraplay, the relevant mechanisms of change, and current evidence base. Although Theraplay can be used with a wide range of clients and problems, in this chapter, the focus will be on the applicatio with families with children who have experienced trauma.

scholarly journals Designing and using incentives to support recruitment and retention in clinical trials: a scoping review and a checklist for design

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Beth Parkinson ◽  
Rachel Meacock ◽  
Matt Sutton ◽  
Eleonora Fichera ◽  
Nicola Mills ◽  
...  
Keyword(s):  
Scoping Review ◽  
Pay For Performance ◽  
Evidence Base ◽  
Unintended Consequences ◽  
Current Evidence ◽  
Incentive System ◽  
Design Issues ◽  
Recruitment And Retention ◽  
Design Choice ◽  
Current Evidence Base

Abstract Background Recruitment and retention of participants are both critical for the success of trials, yet both remain significant problems. The use of incentives to target participants and trial staff has been proposed as one solution. The effects of incentives are complex and depend upon how they are designed, but these complexities are often overlooked. In this paper, we used a scoping review to ‘map’ the literature, with two aims: to develop a checklist on the design and use of incentives to support recruitment and retention in trials; and to identify key research topics for the future. Methods The scoping review drew on the existing economic theory of incentives and a structured review of the literature on the use of incentives in three healthcare settings: trials, pay for performance, and health behaviour change. We identified the design issues that need to be considered when introducing an incentive scheme to improve recruitment and retention in trials. We then reviewed both the theoretical and empirical evidence relating to each of these design issues. We synthesised the findings into a checklist to guide the design of interventions using incentives. Results The issues to consider when designing an incentive system were summarised into an eight-question checklist. The checklist covers: the current incentives and barriers operating in the system; who the incentive should be directed towards; what the incentive should be linked to; the form of incentive; the incentive size; the structure of the incentive system; the timing and frequency of incentive payouts; and the potential unintended consequences. We concluded the section on each design aspect by highlighting the gaps in the current evidence base. Conclusions Our findings highlight how complex the design of incentive systems can be, and how crucial each design choice is to overall effectiveness. The most appropriate design choice will differ according to context, and we have aimed to provide context-specific advice. Whilst all design issues warrant further research, evidence is most needed on incentives directed at recruiters, optimal incentive size, and testing of different incentive structures, particularly exploring repeat arrangements with recruiters.

scholarly journals Against the stream: early diagnosis of dementia, is it so desirable?

2019 ◽  
Vol 43 (3) ◽  
pp. 123-125 ◽  
Author(s):  
Carol Brayne ◽  
Sarah Kelly
Keyword(s):  
Clinical Practice ◽  
Early Diagnosis ◽  
Empirical Evidence ◽  
Treatment Options ◽  
Evidence Base ◽  
Current Evidence ◽  
Dementia Diagnosis ◽  
Case Identification ◽  
Current Evidence Base ◽  
Diagnosis Of Dementia

SummaryThe Prime Minister's challenge on dementia called for improved dementia diagnosis rates, based on assumptions of benefit to individuals and those who care for them. Subsequent policies have led to increased target drives for clinical practice to achieve early diagnosis of dementia through intense case identification. However, the current evidence base and treatment options do not support screening for dementia, and there is little empirical evidence that such intensive case identification and early diagnosis for dementia is justified without a better understanding of the benefits, costs and potential harms to individuals and services.Declaration of interestNone.

scholarly journals Epistaxis 2016: national audit of management

2017 ◽  
Vol 131 (12) ◽  
pp. 1131-1141 ◽  
Author(s):  
Keyword(s):  
Presentation Rate ◽  
Evidence Base ◽  
Current Evidence ◽  
Event Analysis ◽  
National Audit ◽  
Inclusion Criteria ◽  
Current Evidence Base ◽  
Consensus Guidance ◽  
The Uk ◽  
Audit Standards

AbstractBackground:Epistaxis is a common condition that can be associated with significant morbidity, and it places a considerable burden on our healthcare system. This national audit of management sought to assess current practice against newly created consensus recommendations and to expand our current evidence base.Methods:The management of epistaxis patients who met the inclusion criteria, at 113 registered sites across the UK, was compared with audit standards during a 30-day window. Data were further utilised for explorative analysis.Results:Data for 1826 cases were uploaded to the database, representing 94 per cent of all cases that met the inclusion criteria at participating sites. Sixty-two per cent of patients were successfully treated by ENT clinicians within 24 hours. The 30-day recurrent presentation rate across the dataset was 13.9 per cent. Significant event analysis revealed an all-cause 30-day mortality rate of 3.4 per cent.Conclusion:Audit findings demonstrate a varying alignment with consensus guidance, with explorative analysis countering some previously well-established tenets of management.

scholarly journals Realist evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Findings from a rapid realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051241
Author(s):  
Vanessa Abrahamson ◽  
Wenjing Zhang ◽  
Patricia M Wilson ◽  
William Farr ◽  
Venkat Reddy ◽  
...  
Keyword(s):  
Service Delivery ◽  
Grey Literature ◽  
Realist Review ◽  
Current Evidence ◽  
Diagnostic Model ◽  
High Quality ◽  
Current Evidence Base ◽  
The Uk ◽  
Diagnostic Pathways ◽  
Rapid Realist Review

ObjectivesWaiting times in the UK for an autism diagnostic assessment have increased rapidly in the last 5 years. This review explored research (including ‘grey’ literature) to uncover the current evidence base about autism diagnostic pathways and what works best, for whom and in what circumstances, to deliver high quality and timely diagnosis.DesignWe performed a Rapid Realist Review consistent with recognised standards for realist syntheses. We collected 129 grey literature and policy/guidelines and 220 articles from seven databases (January 2011–December 2019). We developed programme theories of how, why and in what contexts an intervention worked, based on cross comparison and synthesis of evidence. The focus was on identifying factors that contributed to a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within specific parameters (Autism diagnostic services in Paediatric and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group, including representatives from local parent forums, national advocacy groups and clinicians, was integral to the process.ResultsBased on 45 relevant articles, we identified 7 programme theories that were integral to the process of diagnostic service delivery. Four were related to the clinical pathway: initial recognition of possible autism; referral and triaging; diagnostic model; and providing feedback to parents. Three programme theories were pertinent to all stages of the referral and diagnostic process: working in partnership with families; interagency working; and training, service evaluation and development.ConclusionsThis theory informed review of childhood autism diagnostic pathways identified important aspects that may contribute to efficient, high quality and family-friendly service delivery. The programme theories will be further tested through a national survey of current practice and in-depth longitudinal case studies of exemplar services.Trial registration numberNCT04422483.

scholarly journals Cranial nerve non-invasive neuromodulation in adults with neurological conditions: a scoping review protocol (Preprint)

2021 ◽  
Author(s):  
Keaton Boughen ◽  
Tyler Neil ◽  
Ahmed Bilgasem ◽  
Kevin Lutowicz ◽  
Shayan Dullemond ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Scoping Review ◽  
Cranial Nerve ◽  
Grey Literature ◽  
Cranial Nerves ◽  
Current Evidence ◽  
Neurological Rehabilitation ◽  
Non Invasive ◽  
Current Evidence Base ◽  
Neurological Conditions

BACKGROUND Cranial nerve non-invasive neuromodulation (CN-NINM) via translingual nerve stimulation (TLNS) is a promising new intervention combined with neurological rehabilitation to improve outcomes for persons with neurological conditions. A portable neuromodulation stimulation (PoNSTM) device rests on the tongue stimulating cranial nerves V and VII (trigeminal and facial nerves). Emerging evidence suggests that CN-NINM using the PoNSTM device combined with targeted physical therapy (PT) improves balance and gait outcomes but has not yet been comprehensively reviewed. OBJECTIVE This review will describe cranial nerve non-invasive neuromodulation (CN-NINM) via translingual nerve stimulation (TLNS), its use, effects and implications for rehabilitation science in adult neurological populations. We will identify how CN-NINM via TLNS is currently being incorporated into neurological rehabilitation and identify gaps in the evidence with respect to this novel technology. METHODS Joanna Briggs Institute (JBI) methodology will be used to conduct this scoping review. Electronic databases MEDLINE, AMED, CINAHL, EMBASE and Web of Science will be searched as well as grey literature databases ProQuest, DuckDuckGo and Google. Studies published in English and French between 2000-present will be included. Two reviewers will independently screen all titles and abstracts and full-text studies that meet inclusion criteria. Data will be extracted and collated in a table to synthesize results. Extracted data will be reported in a comprehensive summary. RESULTS The final manuscript is planned for submission to an indexed journal in September 2021. CONCLUSIONS This scoping review will be the first review to address the current evidence base on CN-NINM. The results will inform the use of CN-NINM in neurological rehabilitation and the development of recommendations for future research. CLINICALTRIAL Open Science Framework (DOI): 10.17605/OSF.IO/XZQFM

scholarly journals Cognitive analytic therapy at 30

2014 ◽  
Vol 20 (4) ◽  
pp. 258-268 ◽  
Author(s):  
Anthony Ryle ◽  
Stephen Kellett ◽  
Jason Hepple ◽  
Rachel Calvert
Keyword(s):  
Public Mental Health ◽  
Evidence Base ◽  
Current Evidence ◽  
Personal Construct ◽  
List Type ◽  
National Guidelines ◽  
Wide Range ◽  
Current Evidence Base ◽  
Analytic Therapy ◽  
Cognitive Analytic Therapy

SummaryCognitive analytic therapy (CAT) was formalised in 1984 by Anthony Ryle. It facilitated the clinical integration of psychodynamic therapy and personal construct/cognitive psychology. It is a brief, user-friendly relational therapy, applicable to the wide range of psychological problems typically seen in public mental health settings. It has recently been included in national guidelines for the treatment of personality disorder in the National Health Service. CAT provides a coherent model of development and psychopathology, which centrally views the self as both socially formed and embedded. Owing to its core relational grounding, CAT is being increasingly applied to team contexts/systems, enabling a ‘common language’ for team formulation/practice. It is also being successfully delivered as a group therapy. This article describes the development and unique features of the CAT model, analyses the current evidence base and identifies potential future directions for the model.LEARNING OBJECTIVESBe able to describe the core principles of the CAT approach.Appreciate the evidence base for CAT.Understand CAT's place today among talking therapies.

784 Management of Paediatric Epistaxis: An Appraisal of Cautery Versus Topical Antiseptics in The Prevention of Rebleeding Events

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Sagua ◽  
S Fishpool
Keyword(s):  
Literature Review ◽  
Evidence Base ◽  
Current Evidence ◽  
Short Term ◽  
Recurrent Epistaxis ◽  
Significant Difference ◽  
Current Evidence Base ◽  
Minimal Difference ◽  
The Uk ◽  
New Treatments

Abstract Introduction Epistaxis is a common acute presentation in childhood that with recurrence often causes great distress for both parent and child alike. For recurrent epistaxis it is common practice in the UK to trial either a topical antiseptic (Naseptin) or silver nitrate cautery. A literature review was conducted to assess which treatment confers greater protection against rebleeding events. Method The literature review was performed via a search on Medline via Ovid. As both cautery and topical antiseptics are not new treatments, an age limit was not set to allow older research to be included and provide perspective. Results In all but one study included, there was no statistically significant difference between the use of Naseptin versus cautery in the reduction of rebleeding events. A higher incidence of complications such as septal perforation and pain were reported in patients who underwent cautery, whilst no adverse side effects were reported with Naseptin. Conclusions The current evidence base relies mostly on short term outcomes, with most patients not being followed up for more than 2 months. If further longitudinal studies provide evidence to support there being a minimal difference in treatment outcomes, using topical antiseptics before considering cautery would be better clinical practice in paediatric patients.

scholarly journals The current evidence base surrounding Bobath Concept (NDT) in adult neurorehabilitation: a scoping review update

2021 ◽  
Author(s):  
Sofia Marques ◽  
◽  
Julie Vaughan-Graham ◽  
Daniela Figueiredo ◽  
Rui Costa
Keyword(s):  
Scoping Review ◽  
Adult Population ◽  
Evidence Base ◽  
Current Evidence ◽  
Clear Understanding ◽  
Neurological Rehabilitation ◽  
Current Evidence Base ◽  
Rehabilitation Science ◽  
Different Types ◽  
Review Question

Review question / Objective: This scoping review aimed to gain a clear understanding of the current evidence base surrounding neurological rehabilitation based on the Bobath Concept (NDT) in adult population, by analyzing the different types of evidence that address and inform practice in this field and the way the research has been conducted. The specific questions, in regards to the available international published and unpublished literature, are: • What types of research are being conducted about the Bobath concept in adult neurorehabilitation? • How Bobath concept in adult neurorehabilitation is being studied, defined, conceptualized and operationalized? • What are the main knowledge gaps about the research involving the Bobath concept in adult neurorehabilitation and the implications for rehabilitation science? Condition being studied: The Bobath Concept approach in adult neuroreabilitation.

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