scholarly journals Cue-based versus scheduled feeding for preterm infants transitioning from tube to oral feeding: the Cubs mixed-methods feasibility study

2021 ◽  
Vol 25 (74) ◽  
pp. 1-146
Author(s):  
Alison McFadden ◽  
Bronagh Fitzpatrick ◽  
Shona Shinwell ◽  
Karen Tosh ◽  
Peter Donnan ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Preterm Infants ◽  
Outcome Measures ◽  
Feasibility Study ◽  
Intervention Development ◽  
Oral Feeding ◽  
Stakeholder Preferences ◽  
The Mean ◽  
The Uk ◽  
Future Evaluation

Background There is a lack of evidence of the effect of cue-based feeding compared with scheduled feeding on important outcomes for preterm infants. Objectives The objectives were as follows: (1) to describe the characteristics, components, theoretical basis and outcomes of approaches to feeding preterm infants transitioning from tube to oral feeding; (2) to identify operational policies, barriers and facilitators, and staff and parents’ educational needs in neonatal units implementing cue-based feeding; (3) to co-produce an intervention for feeding preterm infants in response to feeding cues; (4) to appraise the willingness of parents and staff to implement and sustain the intervention; (5) to assess associated costs of implementing cue-based feeding; (6) to determine the feasibility and acceptability of a future trial; (7) to scope existing data-recording systems and potential outcome measures; and (8) to determine stakeholders’ views of whether or not a randomised controlled trial of this approach is feasible. Design This was a mixed-methods intervention development and feasibility study comprising (1) a systematic review, case studies, qualitative research and stakeholder consensus; (2) the co-production of the intervention; (3) a mixed-methods feasibility study; and (4) an assessment of stakeholder preferences for a future evaluation. Setting Three neonatal units in the UK (two level 3 units and one level 2 unit). Participants Developmentally normal, clinically stable preterm infants receiving enteral feeds (n = 50), parents (n = 15 pre intervention development; n = 14 in the feasibility study) and health-care practitioners (n = 54 pre intervention development; n = 16 in the feasibility study). Intervention An evidence-informed multicomponent intervention comprising training, a feeding protocol, feeding assessment tools, supplementary training materials [including posters, a film and a narrated PowerPoint (Microsoft Corporation, Redmond, WA, USA) presentation] and the ‘Our Feeding Journey’ document. Main outcome measures The main outcome measures were recruitment and screening rates, infant weight gain, duration of the intervention, feeding outcomes, implementation outcomes (contextual facilitators and barriers, acceptability, adoption, appropriateness and fidelity) and stakeholder preferences for a future evaluation. Results The systematic review of 25 studies concluded that evidence in favour of cue-based feeding should be treated cautiously. The case studies and qualitative research highlighted contextual barriers to and facilitators of the implementation of cue-based feeding. The telephone survey found that many neonatal units are considering implementing cue-based feeding. We recruited 37% of eligible infants, and there was good retention in the study until discharge but a high loss to follow-up at 2 weeks post discharge. The mean number of days from intervention to transition to full oral feeding was 10.8, and the mean daily change in weight gain was 25 g. The intervention was acceptable to parents and staff, although there was dissatisfaction with the study documentation. Intervention training did not reach all staff. A cluster-randomised design with a composite outcome was suggested by stakeholders for a future study. Limitations The intervention was available only in English. Intervention training did not reach all staff. There was low recruitment to qualitative interviews and observations. Only a small number of medical staff engaged in either the training or the interviews. Conclusions It is feasible to implement a cue-based feeding intervention with improved training and documentation. Further work is needed to assess the feasibility of a future trial, noting evidence of existing lack of equipoise. Future work The next steps are to digitalise the intervention and conduct a survey of all neonatal units in the UK. Study registration This study is registered as PROSPERO CRD42018097317 and ISRCTN13414304. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 74. See the NIHR Journals Library website for further project information.

scholarly journals Continuous glucose monitoring in older people with diabetes and memory problems: a mixed-methods feasibility study in the UK

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032037 ◽  
Author(s):  
Katharina Mattishent ◽  
Kathleen Lane ◽  
Charlotte Salter ◽  
Ketan Dhatariya ◽  
Helen M May ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Adverse Events ◽  
Older People ◽  
Feasibility Study ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Data Capture ◽  
Secondary Outcome ◽  
Memory Problems ◽  
The Uk

ObjectivesOlder people with diabetes are at increased risk of harm from hypoglycaemia, particularly where there are coexisting memory problems. Continuous glucose monitoring (CGM) offers important benefits in terms of detecting hypoglycaemia, but the feasibility of use and extent of data capture has not been tested in this patient group. Our objective was to investigate the feasibility of trialling a CGM intervention in the community setting in older people with diabetes and memory problems.DesignMixed-methods feasibility study.SettingCommunity dwellings in the UK.ParticipantsPatients aged ≥65 with diabetes and abbreviated mental test score ≤8 or known dementia.InterventionFreeStyle Libre CGM.Primary and secondary outcome measuresFeasibility criteria were numbers of eligible patients, recruitment, attrition, extent of capture of glucose readings and adverse events. Qualitative interview.ResultsWe identified 49 eligible participants; 17 consented, but 5 withdrew before recording of data because they or their carers felt unable to manage study procedures. 12 participants (mean age 85 years) completed the study without adverse events. Data capture across 14 days ranged between 3% and 92% (mean 55%); 6 participants had <60% capture. Hypoglycaemic events were recorded in six out of nine insulin users. Qualitative interviews found: the device does not interfere with daily activities, usability and comfort was positive, and it was helpful for carers in monitoring participants’ glucose concentrations.ConclusionsThe device was acceptable to participants, and carers reported greater ease in monitoring the participant’s glucose concentrations. However, completeness of data capture varied considerably with this device due to the need for users to conduct ≥3 scans per day. Real-time devices with automated data transfer may be more suitable in older people with memory problems.

scholarly journals Improving access to organ donor registration in general practice: a feasibility study

2020 ◽  
Vol 70 (696) ◽  
pp. e497-e504
Author(s):  
Catrin P Penn-Jones ◽  
Chris Papadopoulos ◽  
Gurch Randhawa ◽  
Zeeshan Asghar
Keyword(s):  
Decision Making ◽  
General Practice ◽  
Mixed Methods ◽  
Focus Groups ◽  
Feasibility Study ◽  
Organ Donor ◽  
Mixed Methods Design ◽  
Waiting Room ◽  
Face To Face ◽  
The Uk

BackgroundOrgan donor registration helps guide decision making for families. UK general practice provides the facility to register on the NHS Organ Donor Register, but only to new patients. An intervention was developed to present a registration opportunity to existing patients in this setting.AimTo assess the feasibility and acceptability of an organ donation intervention implemented in UK general practice.Design and settingThe intervention ran in a large practice in Luton in the UK, for 3 months in 2018. A single practice feasibility study was conducted using an embedded experimental mixed methods design.MethodStaff were trained to ask patients in consultations if they wished to join the register, and leaflets and posters were displayed in the waiting room. Data on feasibility and acceptability were captured using SystmONE questionnaires, surveys, and focus groups.ResultsOver 3 months, in 12.4% of face-to-face consultations, patients were asked if they would like to join the register (812 of 6569), and 244 (30.0%) of these patients joined the register. Common reasons staff did not ask patients were due to telephone consultations, lack of time, and it not being appropriate. Nurses and healthcare assistants performed prompted choice more than doctors (23.4%, 17.1%, and 1.6% respectively). Certain clinic types, such as phlebotomy or routine clinics, facilitated asking compared to those where patients presented with unknown or more serious issues.ConclusionThe intervention was found to be feasible and acceptable by some staff and patients. Feasibility criteria were met; therefore, the intervention can progress to further testing.

scholarly journals 1031 A Mixed Methods Feasibility Study of Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Hitchman ◽  
J Totty ◽  
R Lathan ◽  
M Sidapra ◽  
G Smith ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mixed Methods ◽  
Feasibility Study ◽  
Randomised Control Trial ◽  
Eligibility Criteria ◽  
Serious Adverse Events ◽  
Patient Reported ◽  
The Mean

Abstract Aim The purpose of this mixed methods feasibility study was to assess the feasibility of delivering ESWT to patients with DFUs. It also aimed to explore any potential clinical effect of ESWT on wound healing and investigate whether ESWT may offer any patient reported benefits. Method A single centre mixed methods feasibility study. Patients with a DFU who met the eligibility criteria underwent ESWT 3 times in over 7 days. Primary outcome was feasibility of delivering the intervention. Secondary outcomes included wound size, number of DFU healed at 12 weeks and quality of life. Semi-structured interviews explored participants experience of undergoing ESWT. Results 22.6% (24/106) of patients screened were recruited. The mean attendance to clinic was 90.9% and 65.1% to follow up. The mean score for acceptability and tolerability was 9.86 (SD 0.48, 95% CI 9.62-10.01) and 9.15 (SD 2.57, 95% CI 7.87-10.42) respectively. There were no serious adverse events or side effects. 45.5% of DFU healed during follow up and quality of life scores improved until 8 weeks. Key themes identified from the qualitative interviews were desire for the fast healing, improved quality of life, new treatments must be flexible and accessible on transport. Conclusions This study has shown it is possible to recruit and retain patents into this research. This study supports development of a large randomised control trial to determine the clinical and cost effectiveness of ESWT for DFU healing.

scholarly journals Technology–supported guidance model to support the development of critical thinking among undergraduate nursing students in clinical practice: a flexible exploratory mixed methods feasibility study protocol. (Preprint)

2021 ◽  
Author(s):  
Jaroslav Zlamal ◽  
Edith Roth Gjevjon ◽  
Mariann Fossum ◽  
Simen Alexander Steindal ◽  
Andréa Aparecida Gonçalves Nes
Keyword(s):  
Critical Thinking ◽  
Nursing Education ◽  
Clinical Practice ◽  
Mixed Methods ◽  
Nursing Students ◽  
Feasibility Study ◽  
Quantitative Research ◽  
Intervention Development ◽  
Drop Out ◽  
Guidance Model

BACKGROUND Critical thinking is an essential set of skills in nursing education, and nursing education needs a sharper focus on effective ways to support the development of these skills, especially through the implementation of technological tools in nursing education. OBJECTIVE To assess the feasibility for nursing students in clinical practice of a technology–supported guidance model grounded in metacognition theory. METHODS Both quantitative (research questionnaires) and qualitative (focus group interviews) approaches will be used to collect data for a feasibility study with a flexible, exploratory, mixed methods design to test a newly developed intervention in clinical practice. RESULTS The intervention development was completed in December 2020. The intervention will be tested at three independent nursing homes in Norway. CONCLUSIONS By determining the feasibility of a technology–supported guidance model for nursing students in clinical practice, the results will provide information on the acceptability of the intervention and the suitability of the outcome measures and data collection strategy. They will also identify the causes of drop–out and the obstacles to retention and adherence.

scholarly journals Maturation of Esophageal Motility and Esophagogastric Junction in Preterm Infants

Neonatology ◽  
2020 ◽  
Vol 117 (4) ◽  
pp. 495-503 ◽  
Author(s):  
Maissa Rayyan ◽  
Taher Omari ◽  
Gunnar Naulaers ◽  
Raf Aerts ◽  
Karel Allegaert ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Repeated Measures ◽  
Esophageal Motility ◽  
Esophagogastric Junction ◽  
Oral Feeding ◽  
Preterm Neonates ◽  
Feeding Problems ◽  
High Resolution Manometry ◽  
Time Points ◽  
The Mean

<b><i>Background:</i></b> Preterm infants commonly present with oral feeding problems. The role of maturation of esophageal bolus transport mechanisms herein remains unclear. <b><i>Objectives:</i></b> To characterize esophageal motility and function of esophagogastric junction (EGJ) during deglutitive swallowing in healthy preterm infants and to describe maturational changes. <b><i>Methods:</i></b> Four consecutive high-resolution manometry studies with impedance studies were performed weekly to investigate esophageal motility and EGJ function. Esophageal pressure topography and pressure-impedance metrics were derived. Mixed models with repeated measures were used for statistical analysis. <b><i>Results:</i></b> We analyzed 137 nutritive swallows from 36 motility studies in 10 preterm infants. The mean gestational age was 30.17 ± 0.94 weeks; the mean postmenstrual age at time point 1 and 4 was 34.42 ± 0.86 and 37.45 ± 1.16 weeks, respectively. Esophageal peristaltic wave patterns in response to nutritive swallows were observed in all patients. At later time points, esophageal body peristalsis became more rapid, evidenced by a faster distal contractile velocity and shorter distal latency (<i>p</i> = 0.002 and <i>p</i> &#x3c; 0.0001, respectively). In addition, 4-s integrated relaxation pressures increased and distal contractile integral decreased at later time points (<i>p</i> = 0.003 and <i>p</i> = 0.021, respectively). Bolus clearance also improved at later age (<i>p</i> = 0.008). <b><i>Conclusions:</i></b> Preterm infants demonstrate peristaltic esophageal motility following nutritive swallows. However, alterations in esophageal bolus transport in relation to peristalsis are demonstrated. Peristaltic progression becomes more rapid, while deglutitive relaxation pressures increase with increasing age. These maturational changes may suggest further development of the enteric nervous system after birth in former preterm neonates.

scholarly journals Cross-sectional survey of the amount of sugar and energy in cakes and biscuits on sale in the UK for the evaluation of the sugar-reduction programme

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e019075 ◽  
Author(s):  
Kawther M Hashem ◽  
Feng J He ◽  
Sarah A Alderton ◽  
Graham A MacGregor
Keyword(s):  
Energy Content ◽  
Sugar Content ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Product Packaging ◽  
Nutrition Labelling ◽  
The Mean ◽  
Sugar Reduction ◽  
The Uk ◽  
Future Evaluation

ObjectivesTo investigate the variation in sugar and energy content of cakes and biscuits available in the UK.DesignWe carried out a cross-sectional survey in 2016 of 381 cakes and 481 biscuits available in nine main UK supermarkets.MethodsThe sugar and energy content was collected from product packaging and nutrition labelling of cake and biscuit products.ResultsThe average sugar content in cakes and biscuits was 36.6±7.6 and 30.0±9.2 g/100 g, respectively. The mean energy content was 406±37 for cakes and 484±38 kcal/100 g for biscuits. There was a large variation in sugar and energy content between different cake and biscuit categories and within the same category. 97% of cakes and 74% of biscuits would receive a ‘red’ (high) label for sugar.ConclusionsThis research makes available baseline data of the cakes and biscuits market in the UK for future evaluation of the recently launched sugar-reduction programme. The study showed that reductions in sugar and energy content of cakes and biscuits are possible, since there was a large variation in sugar and energy content between different cake and biscuit categories and within the same category. A reduction in sugar and energy content, and overall cake and biscuit consumption, can help reduce overall sugar and energy intake in the UK and thus reduce the risk of obesity and dental caries.

scholarly journals Mixed-methods process evaluation of SafeTea: a multimedia campaign to prevent hot drink scalds in young children and promote burn first aid

2020 ◽  
pp. injuryprev-2020-043909
Author(s):  
Laura Elizabeth Cowley ◽  
C Verity Bennett ◽  
Isabelle Brown ◽  
Alan Emond ◽  
Alison Mary Kemp
Keyword(s):  
Social Media ◽  
Mixed Methods ◽  
Young Children ◽  
Process Evaluation ◽  
Behavioural Change ◽  
First Aid ◽  
Multifaceted Intervention ◽  
Media Content ◽  
Educational Videos ◽  
The Uk

ObjectivesSafeTea is a multifaceted intervention delivered by community practitioners to prevent hot drink scalds to young children and improve parents’ knowledge of appropriate burn first aid. We adapted SafeTea for a national multimedia campaign, and present a mixed-methods process evaluation of the campaign.MethodsWe used social media, a website hosting downloadable materials and media publicity to disseminate key messages to parents/caregivers of young children and professionals working with these families across the UK. The SafeTea campaign was launched on National Burns Awareness Day (NBAD), October 2019, and ran for 3 months. Process evaluation measurements included social media metrics, Google Analytics, and quantitative and qualitative results from a survey of professionals who requested hard copies of the materials via the website.ResultsFindings were summarised under four themes: ‘reach’, ‘engagement’, ‘acceptability’ and ‘impact/behavioural change’. The launch on NBAD generated widespread publicity. The campaign reached a greater number of the target audience than anticipated, with over 400 000 views of the SafeTea educational videos. Parents and professionals engaged with SafeTea and expressed positive opinions of the campaign and materials. SafeTea encouraged parents to consider how to change their behaviours to minimise the risks associated with hot drinks. Reach and engagement steadily declined after the first month due to reduced publicity and social media promotion.ConclusionThe SafeTea campaign was successful in terms of reach and engagement. The launch on NBAD was essential for generating media interest. Future campaigns could be shorter, with more funding for additional social media content and promotion.

scholarly journals Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048772
Author(s):  
Toby O Smith ◽  
Pippa Belderson ◽  
Jack R Dainty ◽  
Linda Birt ◽  
Karen Durrant ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Study ◽  
Online Survey ◽  
Musculoskeletal Diseases ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Healthcare Provision ◽  
Social Restriction ◽  
The Uk ◽  
The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

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