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

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037846
Author(s):  
Vanessa Abrahamson ◽  
Wenjing Zhang ◽  
Patricia Wilson ◽  
William Farr ◽  
Ian Male
Keyword(s):  
Service Delivery ◽  
Research Question ◽  
Waiting Times ◽  
Realist Review ◽  
Realist Evaluation ◽  
High Quality ◽  
Wide Range ◽  
Diagnostic Pathways ◽  
Rapid Realist Review

IntroductionThe National Health Service (NHS) Long-Term Plan (2019) acknowledges that children and young people with suspected autism wait too long for diagnostic assessment and sets out to reduce waiting times. However, diagnostic pathways vary with limited evidence on what model works best, for whom and in what circumstances. The National Autism Plan for Children (2003) recommended that assessment should be completed within 13 weeks but referral to diagnosis can take as long as 799 days.This Rapid Realist Review (RRR) is the first work package in a national programme of research: a Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD). We explore how particular approaches may deliver high-quality and timely autism diagnostic services for children with possible autism; high quality is defined as compliant with National Institute for Heath and Care Excellence (2011) guidelines, and timely as a pathway lasting no more than one calendar year, based on previous work.Methods and analysisRRR is a well-established approach to synthesising evidence within a compressed timeframe to identify models of service delivery leading to desired outcomes. RRR works backwards from intended outcomes, identified by NICE guidelines and the NHS England Long-Term Plan. The focus is a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within a particular set of parameters (Autism and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group consists of policymakers, content experts and knowledge users with a wide range of experience to supplement, tailor and expedite the process. The RRR is consistent with Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and includes identifying the research question, searching for information, quality appraisal, data extraction, synthesising the evidence, validation of findings with experts and dissemination.Ethics and disseminationEthical approval not required. Findings will inform the wider RE-ASCeD evaluation and be reported to NHS England.Trial registration numberNCT04422483. This protocol relates to Pre-results.

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 Rapid Realist Review of Group Psychological First Aid for Humanitarian Workers and Volunteers

2021 ◽  
Vol 18 (4) ◽  
pp. 1452
Author(s):  
Julia Corey ◽  
Frédérique Vallières ◽  
Timothy Frawley ◽  
Aoife De Brún ◽  
Sarah Davidson ◽  
...  
Keyword(s):  
Research Question ◽  
Grey Literature ◽  
Age Groups ◽  
Integrated Design ◽  
Realist Review ◽  
First Aid ◽  
Psychological Consequences ◽  
Post Traumatic Stress ◽  
Psychological First Aid ◽  
Rapid Realist Review

Humanitarian workers are at an elevated risk of occupational trauma exposure and its associated psychological consequences, and experience increased levels of anxiety, depression, and post-traumatic stress disorder (PTSD) compared to the general population. Psychological first aid (PFA) aims to prevent acute distress reactions from developing into long-term distress by instilling feelings of safety, calmness, self- and community efficacy, connectedness and hope. Group PFA (GPFA) delivers PFA in a group or team setting. This research sought to understand ‘What works, for whom, in what context, and why for group psychological first aid for humanitarian workers, including volunteers?’ A rapid realist review (RRR) was conducted. Initial theories were generated to answer the question and were subsequently refined based on 15 documents identified through a systematic search of databases and grey literature, in addition to the inputs from a core reference panel and two external experts in GPFA. The findings generated seven programme theories that addressed the research question and offered consideration for the implementation of GPFA for the humanitarian workforce across contexts and age groups. GPFA enables individuals to understand their natural reactions, develop adaptive coping strategies, and build social connections that promote a sense of belonging and security. The integrated design of GPFA ensures that individuals are linked to additional supports and have their basic needs addressed. While the evidence is sparce on GPFA, its ability to provide support to humanitarian workers is promising.

scholarly journals O4B.3 The impact of income support systems on healthcare quality and functional capacity in workers with LBP: a realist review

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A34.3-A35
Author(s):  
Michael Di Donato ◽  
Ross Iles ◽  
Tyler Lane ◽  
Alex Collie
Keyword(s):  
Functional Capacity ◽  
Work Disability ◽  
Support Systems ◽  
Grey Literature ◽  
Healthcare Quality ◽  
Realist Review ◽  
Current Evidence ◽  
Income Support ◽  
Context Dependent ◽  
The Impact

BackgroundLow back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers’ compensation or social security. Current evidence suggests that income support systems can influence recovery from LBP, but provides little evidence as to why and how these effects occur. This study examines how and in what contexts income support systems impact the healthcare quality and functional capacity of people with work disability and LBP.MethodsWe performed a realist review, a type of literature review that seeks to explain how social interventions and phenomena in certain contexts generate outcomes, rather than simply whether or not they do. Five initial theories about the mechanisms of the relationship were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented by grey literature searching for policy documents and legislative summaries, and semi-structured interviews with experts in income support, healthcare, and LBP.ResultsIncome support systems influence healthcare quality through healthcare funding restrictions, healthcare provider administrative burden, and allowing an employer to select healthcare providers. Income support systems influence worker functional capacity through the level of participation and share of income support funding required of employers, and through certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition.ConclusionIncome support systems impact the healthcare quality and functional capacity of people with work disability and LBP through context-dependent financial control, regulatory, and administrative mechanisms. Future policy design and research efforts should consider how income support systems may indirectly influence workers with LBP via the workplace.

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 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

Suicide prevention across the UK criminal justice system: an overview of current provision and future directions

2021 ◽  
Vol 23 (1) ◽  
pp. 53-62
Author(s):  
Stefanie Oliveira Antunes ◽  
Verity Wainwright ◽  
Neil Gredecki
Keyword(s):  
Criminal Justice ◽  
Criminal Justice System ◽  
Suicide Prevention ◽  
Justice System ◽  
Current Evidence ◽  
Future Research ◽  
Content Type ◽  
Current Evidence Base ◽  
The Uk ◽  
Current Provision

Purpose This paper aims to provide an overview of current suicide prevention across the UK criminal justice system (CJS). It considers shortcomings in current provision and how improvements could be made by drawing on international practice. Recommendations for practice going forward and suggestions for future research are made based on the literature. Design/methodology/approach This paper provides an overview of suicide prevention research to date. Relevant literature was identified through a basic journal article search, including terms such as “probation”, “criminal justice system”, “suicide”, “suicide prevention”, “UK” and “suicide theory”. Findings This paper highlights opportunities to improve practice based on the current evidence base, making several recommendations and suggestions for practice, including improving multi-agency cooperation through clearer distribution of responsibilities, simplifying data sharing and investing in trauma-focussed suicide training for staff. Practical implications This paper considers how research and psychological theory has informed suicide prevention practice in the UK. Limitations and challenges in applying theory to practice are explored, in the context of research with frontline staff who use such policies. This review proposes potential improvements to suicide prevention implementation to reduce suicide across the wider CJS. Originality/value This article represents an overview of the existing literature as well as possible future ideas for policy. It is therefore a piece that represents the viewpoint of all involved authors.

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 Pharmacological interventions for improving cannabis use and psychosis in dual diagnosis: a systematic review

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S290-S290
Author(s):  
Arundeep Singh Bharj ◽  
Katy Jones ◽  
Musa Sami
Keyword(s):  
Systematic Review ◽  
Dual Diagnosis ◽  
Pharmacological Treatment ◽  
Cannabis Use ◽  
Current Evidence ◽  
Antipsychotic Treatment ◽  
Inclusion Criteria ◽  
Pharmacological Interventions ◽  
High Quality ◽  
Current Evidence Base

AimsMany patients with psychosis symptoms and schizophrenia use cannabis as a recreational drug. Patients who use cannabis respond differently to antipsychotic treatment compared to those who do not. Despite this, there is a lack of evidence, and therefore clinical guidance, pertaining to the best pharmacological treatment to improve psychosis or cannabis use in this population. This systematic review was carried out to assess the current evidence base regarding the most effective pharmacological treatment for patients with psychosis who also have a background of using cannabis. Our specific question was: ‘in patients with a dual diagnosis of psychosis and cannabis use, which pharmacological interventions have the most efficacy in improving psychosis or reducing cannabis use?’.MethodA search of EMBASE, PsychINFO, and MEDLINE(R) databases was carried out on September 30, 2020. Bibliographies of other studies were also searched for relevant articles. After exclusion of any articles which did not meet inclusion criteria for this review, eleven full texts remained; a qualitative analysis was carried out on these, but there was no meta-analysis. Only randomised control trials (RCTs) whose interventions and controls were pharmacological therapies, and which included patients with a background of cannabis use and psychosis, and which measured clinical outcomes, were included.ResultWe found 11 articles which analysed 10 RCT studies (n = 363) investigating risperidone, olanzapine, clozapine, haloperidol, ziprasidone and imipramine. 6/11 were double blind. The studies were small in size, varied in their methodology, exact inclusion criteria, exact outcomes, and all had a high risk of bias. Few significant findings were found. There is limited evidence for clozapine having anti-craving effect however whether this is associated with reduction in use remains to be demonstrated. We found no studies of adjunctive anticonvulsant agents, which are often used in psychotic disorders.ConclusionThis review underlines the paucity of studies on which to make evidence-based decisions. No new studies have been undertaken since the last systematic review in this area in the last 7 years. Due to the lack of high-quality evidence found by this review, there remains a considerable need for interventional, high-quality RCTs in this comorbid patient group.

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