Acceptability of a nurse-led non-pharmacological complex intervention for knee pain: Nurse and patient views and experiences

Objectives The overall purpose of this research programme is to develop and test the feasibility of a complex intervention for knee pain delivered by a nurse, and comprising both non-pharmacological and pharmacological interventions. In this first phase, we examined the acceptability of the non-pharmacological component of the intervention; issues faced in delivery, and resolved possible challenges to delivery. Methods Eighteen adults with chronic knee pain were recruited from the community. The intervention comprised holistic assessment, education, exercise, weight-loss advice (where appropriate) and advice on adjunctive treatments such as hot/cold treatments, footwear modification and walking aids. After nurse training, the intervention was delivered in four sessions spread over five weeks. Participants had one to one semi-structured interview at the end of the intervention. The nurse was interviewed after the last visit of the last participant. These were audio recorded and transcribed verbatim. Themes were identified by one author through framework analysis of the transcripts, and cross-checked by another. Results Most participants found the advice from the nurse easy to follow and were satisfied with the package, though some felt that too much information was provided too soon. The intervention changed their perception of managing knee pain, learning that it can be improved with self-management. However, participants thought that the most challenging part of the intervention was fitting the exercise regime into their daily routine. The nurse found discussion of goal setting to be challenging. Conclusion The nurse-led package of care is acceptable within a research setting. The results are promising and will be applied in a feasibility randomised-controlled trial.

Who published what on Somali health issues?

In this editorial we attempt to define additional rationales for SHAJ, the Somali Health Action Journal, further to those presented in our inaugural editorial. We recognize the health information divide as one of the three health gaps characterizing the global health inequality landscape. The SHAJ venture emerged from a joint Somali-Swedish initiative to revive a former collaborative research programme also recognizing the need for a Somali-based platform for research communication. The members of the SHAJ Editorial team decided to join forces in designing and carrying out an empirical bibliometric study to assess the state of the art of the published literature on Somali health issues over a 75-year period covering major societal development eras in Somali academic history. This editorial is basically presented in the form of a report from this study, concluding with a statement on the policy implications for SHAJ and Somali based research for health. The study raises concerns about the scarcity of research publications on Somali public health issues. This points to the need for research capacity strengthening in general and with special attention to the important role of the newly established Somali universities. We note a lack of balance regarding the topics and public health relevance of published papers in relation to the burden of prevailing health problems which calls for efforts to set research priorities in tune with the broad needs of the communities. Another observation is that the papers reviewed indicate a heavy dependence of the research agenda on external organisations and funders, which calls for active attention to research ownership issues in terms of Somali leadership and authorship. There is a lack of dissemination channels for Somali based health research and limited possibilities for young Somali scientists to publish their studies. As a Somali-owned journal, we envisage that SHAJ can play a catalytic role in the promotion and dissemination of "Essential Somali Health Research".

The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: a national observational study using hospital activity data

Background There was a national roll out of "COVID Virtual Wards" (CVW) during England's second COVID-19 wave (Autumn 2020 - Spring 2021). These services used remote pulse oximetry monitoring for COVID-19 patients following discharge from hospital. A key aim was to enable rapid detection of patient deterioration. It was anticipated that the services would support early discharge and avoid readmissions, reducing pressure on beds. This study is an evaluation of the impact of the CVW services on hospital activity. Methods Using retrospective patient-level hospital admissions data, we built multivariate models to analyse the relationship between the implementation of CVW services and hospital activity outcomes: length of COVID-19 related stays and subsequent COVID-19 readmissions within 28 days. We used data from more than 98% of recorded COVID-19 hospital stays in England, where the patient was discharged alive between mid-August 2020 and late February 2021. Findings We found a longer length of stay for COVID-19 patients discharged from hospitals where a CVW was available, when compared to patients discharged from hospitals where there was no CVW (adjusted IRR 1.05, 95% CI 1.01 to 1.09). We found no evidence of a relationship between the availability of CVW and subsequent rates of readmission for COVID-19 (adjusted OR 0.95, 95% CI 0.89 to 1.02). Interpretation We found no evidence of early discharges or reduced readmissions associated with the roll out of COVID Virtual Wards across England. Our analysis made pragmatic use of national-scale hospital data, but it is possible that a lack of specific data (for example, on which patients were enrolled) may have meant that true impacts, especially at a local level, were not ultimately discernible. Funding This is independent research funded by the National Institute for Health Research, Health Services & Delivery Research programme and NHSEI.

Review of the research programme on the Mortella III wreck (2010-2020, Corsica, France): A contribution to the knowledge of the Mediterranean naval architecture and material culture of the Renaissance.

The Mortella wrecks are the remains of two navi, Genoese seagoing merchant ships, sunk in 1527 in the Bay of Saint-Florent (Upper-Corsica, France) during the Seventh Italian War. A programme of archaeological excavations and historical research has been held on one of them, Mortella III, between 2010 and 2020. It has involved a multidisciplinary team around a European research project called ModernShip (Horizon 2020), whose objective is to shed light on Mediterranean shipbuilding during the Renaissance, a field still little known to this day. At the end of these 10 years, the aim of the present article is to conclude this research programme with the presentation of a scientific review that complements a recently published monograph on the Mortella III wreck. This study presents the latest results on the ship's architecture obtained during the excavation of the wreck in 2019, including a study of the wood of the framework. Finally, this article broadens our understanding of the nave presenting the results of a collaborative line of research on material culture with three studies in close connection with the ship architecture: artillery, anchors and ceramics.

Reaching into the basket of doom: Learning outcomes, discourse and information literacy

Learning outcomes form a type of arrangement that holds the practice of information literacy within higher education in place. This paper employs the theory of practice architectures and a discourse analytical approach to examine the learning goals of five recent English-language models of information literacy. Analysis suggests that the practice of information literacy within higher education is composed of 12 common dimensions, which can be grouped into two categories, Mapping and Applying. The Mapping category encompasses learning outcomes that introduce the learner to accepted ways of knowing or what is valued by and how things work within higher education. The Applying category encompasses learning outcomes that encourage the learner to implement or integrate ideas into their own practice, including to their own questions, to themselves or to their experience. Revealing what is prioritised as well as what is less valued within the field at the present time, these findings also raise questions about supposed epistemological differences between models, the influence of research, and the language employed within these documents. This paper represents the third and final piece of work in a research programme that is interrogating the epistemological premises and discourses of information literacy within higher education.

A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent

Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment.

Fostering Interdisciplinary Research Culture, Challenges and Way Forward: The Universiti Malaya Experience

Interdisciplinary research (IDR) exploring beyond the purview of a single discipline is critical for providing the requisite solutions to real-world issues. Furthermore, the process of translating research that could have a positive impact on and benefit the government, industry and society, typically requires a multipronged approach with inputs and solutions integrated from various disciplines. Therefore, IDR is vital in pushing the different disciplines forward and accelerating scientific discovery in innovative ways. Nonetheless, the move towards encouraging researchers to break away from working in silos to working together has been an extremely challenging task. Doubtlessly, interdisciplinary programmes demand much more involvement and exhaustive effort from researchers per se as they require not only academic scholarship but also soft skills to communicate, network and engage with other researchers from diversified disciplines, various stakeholders and beneficiaries. In addition to that, good leadership and all-rounded teamwork support are required in navigating and ensuring the success of the research programme to deliver its intended outcome and impact. In light of this, this opinion paper discusses some of the challenges confronted in fostering IDR at the Universiti Malaya and suggestions on approaches that could be adopted to garner the interest and move it forward.