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  • ItemEmbargo
    Taxation and social need: Lessons from the short-lived UK Health and Social Care Levy
    (Cambridge University Press, 2024-06-23) Ruane, Sally
    Meeting social need is usually associated in social policy with the provision of benefits and public services, with the role of taxation often confined to an acknowledgement of its revenue-raising function for the purpose of funding them. Against a backdrop of multiple concurrent challenges shared by many high income societies, including inadequate social care for an ageing population and unprecedented waiting lists of health care, the UK’s experience of the short-lived Health and Social Care Levy is used as a case study to reveal how the relationship between taxation and social need is complex, mediated by a range of factors, and how these contributed to its abolition. The article proposes five different relationships between taxation and social need evident in the story of the rise and fall of the Levy.
  • ItemOpen Access
    Briefing on National Audit Office Report entitled Progress with the New Hospital Programme (July 2023) and University Hospitals of Leicester reconfiguration scheme, Leicester
    (Institute of Health, Health Policy and Social Care, DMU, 2023-09) Ruane, Sally; Burnett, M.; Gross, A.
    This briefing paper highlights key messages in the National Audit Office's July 2023 report entitled Progress with the New Hospital Programme which investigated progress made by the New Hospital Programme team regarding the government's promises of "40 new hospitals by 2030". It identifies the key concerns of the National Audit Office (NAO), especially as they affect 'cohort 3' schemes. These include concerns about potentially unrealistic assumptions underpinning the national team's planning and potential problems with the evolving design of the new hospitals which the NAO fears could lead to hospitals which are too small to respond to future patient need. The report then considers the acute and maternity services reconfiguration plans of University Hospitals of Leicester in the light of the NAO's findings.
  • ItemEmbargo
    From godkin to oddkin: Love, friendship and kin making beyond the human family
    (Sage, 2024-07-10) Cudworth, E.
    Work within the sociology of the family and personal life has tended to proceed with little or no recognition of non-human members of the household. In the sociology of human–animal relations, however, ideas of multispecies families, multispecies households and animal companions (pets) as kin have been proposed in attempting to capture the close bonds between people and the animals they share their homes and lives with. Drawing on a UK ethnographic study, this article considers the emotional ties and affective relations people have with dog companions. The article argues that the sociological concept of the family is stretched in attempting to capture intra- species domestic relations. Haraway uses kin making to indicate that intimate relationality might be more widely drawn, beyond immediate human relatives to a range of people and beyond the human. Through a critical engagement with Haraway’s conception of ‘oddkin’, the article asks whether kin might be a more productive category in conceptualising intimate relations with animal companions.
  • ItemEmbargo
    Rural-Urban Dynamics of Police Corruption: Views of Ghanaian Police Officers
    (Springer Nature, 2024-06-24) Amagnya, Moses Agaawena
    Police corruption referring to police officers’ use or misuse of authority for private or organisational gain is a major obstacle to effective policing globally. The effect of police corruption is particularly grave in rural areas due to the remoteness of rural areas, inadequate frontline supervision, and people in rural areas being largely poor. Evidence shows that corruption denies people in rural areas of justice and contributes to increasing poverty levels. Despite the effect of police corruption in rural areas, studies hardly consider the rural-urban dynamics and perspectives. Addressing this gap, the current study explores the causes of corruption from the perspectives of police officers working in rural and urban areas. The study uses survey data from 616 Ghanaian police officers, which is analysed using proportions, correlations, and regression. Results show that the area where police officers work influences what factors they perceive as causes of corruption: officers working in rural areas are less likely to regard economic factors and institutional (in)actions as causes of police corruption. Also, officers’ gender is an important determinant of factors that are considered causes of corruption irrespective of whether they work in a rural or urban area. The results suggest that for anti-corruption policies addressing causes of police corruption to be effective, measures must factor in the rural-urban dynamics as different factors are regarded as causes of corruption among police officers working in rural and urban areas.
  • ItemOpen Access
    Briefing on National Audit Office Report entitled Progress with the New Hospital Programme (July 2023) and University Hospitals of Leicester reconfiguration scheme
    (Institute of Applied Health Research, DMU, 2023-09) Burnett, M.; Gross, A.; Ruane, Sally
    The briefing is divided into two parts. The first provides a guide to the key findings of the National Audit Office's July 2023 report on the progress of the New Hospital Programme which is designed to secure "40 new hospitals" by 2030. The second outlines some of the concerns arising from the New Hospital Programme and the NAO's findings for the University Hospitals of Leicester acute and maternity services reconfiguration scheme
  • ItemOpen Access
    Artificial intelligence and assisted reproductive technology: Applying a reproductive justice lens
    (Sage, 2024-06-05) Homanen, Riikka; McBride, Neil; Hudson, Nicky
    In recent years, health-data-driven artificial intelligence and machine learning applications have been introduced to many areas of medicine. In the field of assisted reproduction, artificial intelligence and machine learning applications and related technologies have been hailed as (potentially) significant and ground-breaking, not least because they promise standardisation and automation in in-vitro fertilisation clinics – a precondition for scaling up and branching out in the fertility bioindustry. Artificial intelligence data-driven algorithms promise time- and cost-effective selection of ‘high-quality’ reproductive cells and successful personalised treatments. In this essay, we aim to critically discuss artificial intelligence as a technological clinical practice, which is currently moving from bench to bedside internationally. Through an analytic framework of reproductive justice, we propose that introducing artificial intelligence into this already stratified context threatens to black-box health disparities and to generate what we refer to as ‘hyper-stratifications’ of reproduction in the context of rising health and social disparities in the European context. As feminist, social science and bioethics scholars, we are all too aware of how reproductive technologies reinforce normativities rather than unravel them. We cannot presume that artificial intelligence is an ethical technological agent or user of health data but, instead, need to keep a critical eye on the moral ambivalence of emerging and evolving artificial intelligence-assisted reproduction technologies practices and their gendered consequences. Given the current hype around artificial intelligence, but also with concerns around the fast development and deployment of artificial intelligence generally and in artificial intelligence-assisted reproduction technologies particularly in mind, there is an urgent need to engage in critical feminist discussion of such developments.
  • ItemEmbargo
    The Digital Desistance Manifesto
    (Taylor and Francis, 2024-06-07) Knight, Victoria; Sarah Elison-Davies; Helen Farley; James Tangen
    Desistance theories in criminology explore how individuals stop engaging in criminal behaviours and have gained increased attention since the 1990s. Desistance involves actively leaving criminality behind and rebuilding one's identity in contrast to rehabilitation's passive interventions. These theories are expanding to include societal perspectives, encompassing community reciprocity and moral reintegration. As society becomes more digital, the criminal justice system is also transforming, necessitating efforts to integrate digital skills into desistance strategies. This manifesto advocates for responsible digitisation in the penal system, aiming for a transformative approach that supports reintegration and leverages technology. It outlines how digital tools can facilitate desistance at different levels and emphasises the role of digital competencies in employment and education contexts for broader cognitive and social growth. The chapter serves as a call for positive change and reintegration in the evolving digital landscape within the criminal justice system.
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    Timely Digital Patient-Clinician Communication in Specialist Clinical Services for Young People: A Mixed-Methods Study (The LYNC Study)
    (JMIR, 2017-04-10) Griffiths, Frances; Bryce, Carol; Cave, Jonathan; Dritsaki, Melina; Fraser, Joseph; Hamilton, Kathryn; Huxley, Caroline; Ignatowicz, Agnieszka; Kim, Sung Wook; Kimani, Peter K.; Madan, Jason; Slowther, Anne-Marie; Sujan, Mark; Sturt, Jackie; X, Armoiry; Atherton, Helen; Karasouli, Eleni
    Background: Young people (aged 16-24 years) with long-term health conditions can disengage from health services, resulting in poor health outcomes, but clinicians in the UK National Health Service (NHS) are using digital communication to try to improve engagement. Evidence of effectiveness of this digital communication is equivocal. There are gaps in evidence as to how it might work, its cost, and ethical and safety issues. Objective: Our objective was to understand how the use of digital communication between young people with long-term conditions and their NHS specialist clinicians changes engagement of the young people with their health care; and to identify costs and necessary safeguards. Methods: We conducted mixed-methods case studies of 20 NHS specialist clinical teams from across England and Wales and their practice providing care for 13 different long-term physical or mental health conditions. We observed 79 clinical team members and interviewed 165 young people aged 16-24 years with a long-term health condition recruited via case study clinical teams, 173 clinical team members, and 16 information governance specialists from study NHS Trusts. We conducted a thematic analysis of how digital communication works, and analyzed ethics, safety and governance, and annual direct costs. Results: Young people and their clinical teams variously used mobile phone calls, text messages, email, and voice over Internet protocol. Length of clinician use of digital communication varied from 1 to 13 years in 17 case studies, and was being considered in 3. Digital communication enables timely access for young people to the right clinician at the time when it can make a difference to how they manage their health condition. This is valued as an addition to traditional clinic appointments and can engage those otherwise disengaged, particularly at times of change for young people. It can enhance patient autonomy, empowerment and activation. It challenges the nature and boundaries of therapeutic relationships but can improve trust. The clinical teams studied had not themselves formally evaluated the impact of their intervention. Staff time is the main cost driver, but offsetting savings are likely elsewhere in the health service. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information, and communication failures, which are mostly mitigated by young people and clinicians using common-sense approaches. Conclusions: As NHS policy prompts more widespread use of digital communication to improve the health care experience, our findings suggest that benefit is most likely, and harms are mitigated, when digital communication is used with patients who already have a relationship of trust with the clinical team, and where there is identifiable need for patients to have flexible access, such as when transitioning between services, treatments, or lived context. Clinical teams need a proactive approach to ethics, governance, and patient safety.
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    Systematic review of interventions to promote the performance of physical distancing behaviours during pandemics/epidemics of infectious diseases spread via aerosols or droplets
    (Elsevier, 2021-06-13) Epton, Tracy; Ghio, Daniela; Ballard, Lisa; Allen, Sarah; Kassianos, Angelos; Hewitt, Rachael; Swainston, Katherine; Fynn, Wendy; Rowland, Vickie; Westbrook, Juliette; Jenkinson, Elizabeth; Morrow, Alison; McGeechan, Grant James; Stanescu, Sabina; Yousuf, Aysha; Sharma, Nisha; Begum, Suhana; Karasouli, Eleni; Scanlan, Danie; Shorter, Gillian W.; Arden, Madelynne; Armitage, Chris; O'Connor, Daryl Brian; Kamal, Atiya; McBride, Emily; swanson, Vivien; Hart, Jo; Byrne-Davis, Lucie; Chater, Angel; Drury, John
    ObjectivesPhysical distancing, that is keeping 1-2m apart when co-located, can prevent cases of droplet or aerosol transmitted infectious diseases such as SARS-COV2. During the COVID-19 pandemic, distancing was a recommendation or a requirement in many countries. This systematic review aimed to determine which interventions and behaviour change techniques (BCTs) are effective in promoting adherence to distancing and through which potential mechanisms of action (MOAs). MethodsSix databases were searched. The review included studies that were (a) conducted on humans, (b) reported physical distancing interventions, (c) included any comparator (e.g., pre-intervention versus post-intervention; randomised controlled trial) and (d) reported actual distancing or predictors of distancing behaviour. Risk of bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention. ResultsSix moderate or high quality papers indicated that distancing interventions could successfully change MoAs and behaviour. Successful BCTs (MoAs) included feedback on behaviour (e.g., motivation); information about health consequences, salience of health consequences (e.g., beliefs about consequences), demonstration (e.g., beliefs about capabilities) and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems and posters with loss-framed messages that demonstrated the behaviours. ConclusionsThe evidence indicates several BCTs and potential MoAs that should be targeted in interventions and highlights the gaps that should be focused on in future research.
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    Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN): protocol for a multicentre randomised controlled trial
    (BMJ, 2020-11) Kearney, Rebecca Samantha; Dhanjal, Gurmit; Parsons, Nicholas; Ellard, David; Parsons, Helen; Haque, Aminul; Karasouli, Eleni; Mason, James; Nwankwo, Henry; Brown, Jaclyn; Liew, ZiHeng; Drew, Stephen; Modi, Chetan; Bush, Howard; Torgerson, David; Underwood, Martin
    Introduction First-time traumatic anterior shoulder dislocation (TASD) is predominantly managed non-operatively. People sustaining TASD have ongoing pain, disability and future risk of redislocation. There are no published randomised controlled trials (RCTs) comparing different non-operative rehabilitation strategies to ascertain the optimum clinically effective approach after TASD. Methods and analysis In this multicentre adaptive RCT, with internal pilot, adults with a radiologically confirmed first time TASD treated non-surgically will be screened at a minimum of 30 sites. People with neurovascular complications, bilateral dislocations or are unable to attend physiotherapy will be excluded. Randomisation will be on a 1:1 treatment allocation, stratified by age, hand dominance and site. Participants will receive a single session of advice; or a single session of advice plus offer of further physiotherapy (maximum 4 months). The primary analysis will be the difference in Oxford Shoulder Instability Score at 6 months. A sample size of a minimum of 478 participants will allow us to show a four point difference with 90% power. An embedded qualitative study will explore the participants’ experiences of the trial interventions.
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    Development of a single-session physiotherapy and self-management intervention for the treatment of primary traumatic anterior shoulder dislocation for the ‘Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN)’ multi centre RCT
    (Elsevier, 2021-06-16) Liew, ZiHeng; Mazuquin, Bruno; Ellard, David R.; Karasouli, Eleni; Drew, Stephen; Modi, Chetan; Bush, Howard; Underwood, Martin; Kearney, Rebecca S.
    Objective Optimum physiotherapy management for people with a conservatively managed primary traumatic anterior shoulder dislocation is not known. The purpose of the ARTISAN trial is to compare the clinical and cost-effectiveness of a course of usual care physiotherapy with a single session of physiotherapy and self-management, the ARTISAN intervention. ARTISAN is a UK multi-centre, two-arm, parallel group, randomised controlled trial with 1:1 treatment allocation. Design The intervention was developed following the Medical Research Council framework for developing and evaluating complex interventions and will be reported in line with the template for intervention description and replication checklist (TIDieR) and the Consensus on Exercise Reporting Template (CERT). It was informed by published research, national clinical guidelines, current clinical practice and patient and public involvement. Results The ARTISAN intervention comprises education (Phase 1), progressive exercise (Phase 2 and Phase 3) and an optional return to sport component (Phase 4). Behaviour change strategies are embedded throughout intervention. The single session of physiotherapy is delivered by a chartered physiotherapist, within the first six weeks of injury, in an NHS outpatient setting. At the end of the initial session, paper-based booklets and/or a patient website with the same content are provided to participants to aid self-management and progression though the four phases of the trial intervention. Conclusion The ARTISAN intervention was successfully implemented throughout the internal pilot and is suitable for testing in the subsequent definitive RCT ARTISAN trial.
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    Hospital care following emergency admission: a critical incident case study of the experiences of patients with advanced lung cancer and Chronic Obstructive Pulmonary Disease
    (Wiley, 2016-05-03) Bailey, Cara; Hewison, Alistair; Karasouli, Eleni; Staniszewska, Sophie; Munday, Daniel
    Aims and objectives To explore the experiences of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, their carers and healthcare professionals following emergency admission to acute care hospital. Background Emergency admissions of people with lung cancer and COPD have increased and there is global concern about the number of patients who die in hospital. The experience of patients with advanced lung cancer and COPD admitted to hospital as an emergency when nearing the end of life has not previously been investigated. Design Qualitative critical incident case study. Methods Semistructured interviews were conducted with 39 patients (15 with COPD and 24 with lung cancer), 20 informal carers and 50 healthcare professionals, exploring patients’ experiences of emergency hospital admission. Interviews took place after admission and following discharge. Participants nominated relatives and healthcare professionals for interview. Data were analysed thematically. Results Patients were satisfied with their ‘emergency’ care but not the care they received once their initial symptoms had been stabilised. The poorer quality care they experienced was characterised by a lack of attention to their fundamental needs, lack of involvement of the family, poor communication about care plans and a lack of continuity between primary and secondary care. A conceptual model of ‘spectacular’ and ‘subtacular’ trajectories of care was used to relate the findings to the wider context of health care provision. Conclusion The complex nature of illness for patients with advanced respiratory disease makes emergency hospital admissions likely. Whilst patients (with COPD and lung cancer) were satisfied with care in the acute ‘spectacular’ phase of their admission, more attention needs to be given to the continuing care needs of patients in the ‘subtacular’ phase. Relevance to Clinical Practice This is the first study to explore the patient experience of acute care following an emergency admission and identifies where there is potential for care to be improved.
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    Integrating service user and practitioner expertise within a web-based system for collaborative mental-health risk and safety management
    (Patient Education and Counseling, 2015-10) Buckingham, Christopher D.; Adams, Ann; Vail, Laura; Kumar, Ashish; Ahmed, Abu; Whelan, Annie; Karasouli, Eleni
    Objectives To develop a decision support system (DSS), myGRaCE, that integrates service user (SU) and practitioner expertise about mental health and associated risks of suicide, self-harm, harm to others, self-neglect, and vulnerability. The intention is to help SUs assess and manage their own mental health collaboratively with practitioners. Methods An iterative process involving interviews, focus groups, and agile software development with 115 SUs, to elicit and implement myGRaCE requirements. Results Findings highlight shared understanding of mental health risk between SUs and practitioners that can be integrated within a single model. However, important differences were revealed in SUs’ preferred process of assessing risks and safety, which are reflected in the distinctive interface, navigation, tool functionality and language developed for myGRaCE. A challenge was how to provide flexible access without overwhelming and confusing users. Conclusion The methods show that practitioner expertise can be reformulated in a format that simultaneously captures SU expertise, to provide a tool highly valued by SUs. A stepped process adds necessary structure to the assessment, each step with its own feedback and guidance.
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    Do pre-operative therapeutic interventions affect outcome in people undergoing hip and knee joint replacement? A systematic analysis of systematic reviews
    (Taylor and Francis, 2023-08-09) Sutton, Emma L.; Rahman, Usama; Karasouli, Eleni; MacKinnon, Heather J.; Radhakrishnan, Anand; Renna, Maxwell S.; Metcalfe, Andrew
    Background THR and TKR patients represent one of the largest groups of surgical patients globally, yet we do not know how to optimise pre-operative care to improve post-operative outcomes. Objective To clarify the effect of pre-operative prehabilitation interventions such as exercise, neuromuscular stimulation, and psychological therapies on outcomes for hip (THR) and knee (TKR) replacement patients. Methods We used PRISMA guidelines and guidelines by Smith and colleagues on conducting reviews of reviews. Searches were conducted on Medline, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE). Additional hand searches were also conducted. Articles were selected based on inclusion criteria and we report meta-analyses of data by outcome measures. Major Findings 6848 articles were screened and the full text of 33 reviews were obtained. Twenty systematic reviews were included, containing 67 unique randomised controlled trials. In 70% of the reviews (14/20), intervention fidelity was not reported. The components of prehabilitation that were tested were: exercise, education, nutrition, acupuncture and neuromuscular stimulation. Exercise alone did not affect functional outcome for TKR patients, but it did affect activity levels prior to THR, and pain prior to THR and TKR. Exercise alone may reduce Length of Stay (by between 0.8 and 4 days). Education when combined with exercise can reduce Length of Stay for TKR patients. Relaxation did not affect function or length of stay but gave a modest reduction of pain. Conclusions Providing education alongside exercise as a pre-operative intervention may reduce Length of Stay. One small RCT combined all three elements of exercise, education and dietary advice and there is no robust evidence to determine whether combining these elements can influence functional outcome.
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    A systematic review of the measurement properties of patient reported outcome measures used for adults with an ankle fracture
    (Springer, 2019-12-17) McKeown, Rebecca; Ellard, David R.; Rabiu, Abdul-Rasheed; Karasouli, Eleni; Kearney, Rebecca S.
    Background Ankle fractures are painful and debilitating injuries that pose a significant burden to society and healthcare systems. Patient reported outcome measures (PROMs) are commonly used outcome measures in clinical trials of interventions for ankle fracture but there is little evidence on their validity and reliability. This systematic review aims to identify and appraise evidence for the measurement properties of ankle specific PROMs used in adults with an ankle fracture using Consensus Based Standards for the Selection of Health Measurement Instrument (COSMIN) methodology. Methods We searched MEDLINE, Embase and CINAHL online databases for evidence of measurement properties of ankle specific PROMs. Articles were included if they assessed or described the development of the PROM in adults with ankle fracture. Articles were ineligible if they used the PROM to assess the measurement properties of another instrument. Abstracts without full articles and conference proceedings were ineligible, as were articles that adapted the PROM under evaluation without any formal justification of the changes as part of a cross-cultural validation or translation process. Two reviewers completed the screening. To assess methodological quality we used COSMIN risk of bias checklist and summarised evidence using COSMIN quality criteria and a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Two reviewers assessed the methodological quality and extracted the data for a sample of articles. Results The searches returned a total of 377 articles. From these, six articles were included after application of eligibility criteria. These articles evaluated three PROMs: A-FORM, OMAS and AAOS. The A-FORM had evidence of a robust development process within the patient population, however lacks post-formulation testing. The OMAS showed sufficient levels of reliability, internal consistency and construct validity. The AAOS showed low quality evidence of sufficient construct validity. Conclusions There is insufficient evidence to support the recommendation of a particular PROM for use in adult ankle fracture research based on COSMIN methodology. Further validation of these outcome measures is required in order to ensure PROMs used in this area are sufficiently valid and reliable to assess treatment effects. This would enable high quality, evidenced-based management of adults with ankle fracture.
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    The impact of chronic illness in suicidality: a qualitative exploration
    (Taylor and Francis, 2014-08-20) Karasouli, Eleni; Latchford, Gary; Owens, David
    Objectives: To explore the experiences of patients with chronic physical illness in relation to suicidal behaviours and ideas. Design: A qualitative study using semi-structured interviews. Methods: Fourteen patients with either multiple sclerosis or stage 5 chronic kidney disease were interviewed. Grounded theory was used to analyse the data. Results: Suicidal ideation was commonly reported by the study participants, and the relationship between the impact of a chronic physical illness, suicidality and risk factors was described. Several participants reported having planned suicide attempts as a consequence of finding living with their illness intolerable, and some had used non-adherence to treatment as a deliberate method to end their life. Conclusion: The findings suggest suicidality may be a relatively common experience in those with chronic illness facing a future of further losses, and that alongside passive thoughts of not being alive this may also include active thoughts about suicide. Health professionals should be alert to intentional non-adherence to treatment as an attempt to end one's life.
  • ItemOpen Access
    Maternal feeding practices and children's eating behaviours: A comparison of mothers with healthy weight versus overweight/obesity
    (Elsevier, 2017-05-25) Haycraft, Emma; Karasouli, Eleni; Meyer, Caroline
    This study aimed to explore differences between mothers with healthy weight versus overweight/obesity in a wide range of their reported child feeding practices and their reports of their children’s eating behaviours. Mothers (N=437) with a 2-6-year-old child participated. They comprised two groups, based on their BMI: healthy weight (BMI of 18.0 to 24.9, inclusive) or overweight/obese (BMI of 25.0 or more). All mothers provided demographic information and completed self-report measures of their child feeding practices and their child’s eating behaviour. In comparison to mothers with healthy weight, mothers who were overweight/obese reported giving their child more control around eating (p<.001), but encouraged less balance and variety around food (p=.029). They also had a less healthy home food environment (p=.021) and demonstrated less modelling of healthy eating in front of their children (p<.001). There were no significant differences in mothers’ use of controlling feeding practices, such as pressure to eat or restriction, based on their own weight status. Mothers with overweight/obesity reported their children to have a greater desire for drinks (p=.003), be more responsive to satiety (p=.007), and be slower eaters (p=.034). Mothers with overweight/obesity appear to engage in generally less healthy feeding practices with their children than mothers with healthy weight, and mothers with overweight/obesity perceive their children as more avoidant about food but not drinks. Such findings are likely to inform future intervention developments and help health workers and clinicians to better support mothers with overweight/obesity with implementing healthful feeding practices and promoting healthy eating habits in their children.
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    Examining Factors of Engagement With Digital Interventions for Weight Management: Rapid Review
    (JMIR, 2017-10-23) Sharpe, Emma Elizabeth; Karasouli, Eleni; Meyer, Caroline
    Background: Digital interventions for weight management provide a unique opportunity to target daily lifestyle choices and eating behaviors over a sustained period of time. However, recent evidence has demonstrated a lack of user engagement with digital health interventions, impacting on the levels of intervention effectiveness. Thus, it is critical to identify the factors that may facilitate user engagement with digital health interventions to encourage behavior change and weight management. Objective: The aim of this study was to identify and synthesize the available evidence to gain insights about users’ perspectives on factors that affect engagement with digital interventions for weight management. Methods: A rapid review methodology was adopted. The search strategy was executed in the following databases: Web of Science, PsycINFO, and PubMed. Studies were eligible for inclusion if they investigated users’ engagement with a digital weight management intervention and were published from 2000 onwards. A narrative synthesis of data was performed on all included studies. Results: A total of 11 studies were included in the review. The studies were qualitative, mixed-methods, or randomized controlled trials. Some of the studies explored features influencing engagement when using a Web-based digital intervention, others specifically explored engagement when accessing a mobile phone app, and some looked at engagement after text message (short message service, SMS) reminders. Factors influencing engagement with digital weight management interventions were found to be both user-related (eg, perceived health benefits) and digital intervention–related (eg, ease of use and the provision of personalized information). Conclusions: The findings highlight the importance of incorporating user perspectives during the digital intervention development process to encourage engagement. The review contributes to our understanding of what facilitates user engagement and points toward a coproduction approach for developing digital interventions for weight management. Particularly, it highlights the importance of thinking about user-related and digital tool–related factors from the very early stages of the intervention development process.
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    Engineering standards for trauma and orthopaedic implants worldwide: a systematic review protocol
    (BMJ, 2018-10) Henshaw, Frederick; Karasouli, Eleni; King, Richard; Rahman, Usama; Langton, David; Madete, June; Otsyeno, Fred; Mutiso, Vincent; Atinga, John; Underwood, Martin; Williams, Mark; Metcalfe, Andrew
    Introduction Despite multiple scandals in the medical implant sector, premarket testing has been the attention of little published research. Complications related to new devices, such as the DePuy Articular Surface Replacement (ASR, DePuy Synthes, USA), have raised the issue of how designs are tested and whether engineering standards remain up to date with our understanding of implant biomechanics. Despite much work setting up national joint registries to improve implant monitoring, there have been few academic studies examining the premarket engineering standards new implants must meet. Emerging global economies mean that the markets have changed, and it is unknown to what degree engineering standards vary around the world. Governments, industry and independent regulatory bodies all produce engineering standards; therefore, the comparison of surgical implants across different manufacturers and jurisdictions is difficult. In this review, we will systematically collate and compare engineering standards for trauma and orthopaedic implants around the world. This will help inform patient, hospital and surgeon choice and provide an evidence base for future research in this area. Methods and analysis This protocol is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. We will conduct a systematic review of trauma and orthopaedic engineering standards from four main sources of information as identified in our preliminary scoping searches: governments, industry, independent regulatory bodies and engineering and medical publications. Any current standard relevant to trauma and orthopaedic implants will be included. We will use a predefined search strategy and follow the recommendations of the Cochrane handbook where applicable. We will undertake a narrative synthesis with qualitative evaluation of homogeneity between engineering standards. Ethics and dissemination No ethics approval is required as no primary data are being collected. The results will be made available by peer-reviewed publication and reported according to PRISMA-P guidelines.
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    The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study
    (NIHR, 2018-02) Griffiths, Frances E.; Armoiry, Xavier; Atherton, Helen; Bryce, Carol; Buckle, Abigail; Cave, Jonathan A. K.; Court, Rachel; Hamilton, Kathryn; Dliwayo, Thandiwe R.; Dritsaki, Melina; Elder, Patrick; Forjaz, Vera; Fraser, Joe; Goodwin, Richard; Huxley, Caroline; Ignatowicz, Agnieszka; Karasouli, Eleni; Kim, Sung Wook; Kimani, Peter; Madan, Jason J.; Matharu, Harjit; May, Mike; Musumadi, Luhanga; Paul, Moli; Raut, Gyanu; Sankaranarayanan, Sailesh; Slowther, Anne-Marie; Sujan, Mark A.; Sutcliffe, Paul A.; Svahnstrom, Isabelle; Taggart, Frances; Uddin, Ayesha; Verran, Alice; Walker, Leigh; Sturt, Jackie
    Background Young people (aged 16–24 years) with long-term health conditions tend to disengage from health services, resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK NHS clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely. Objectives To explore how health-care engagement can be improved using digital clinical communication (DCC); understand effects, impacts, costs and necessary safeguards; and provide critical analysis of its use, monitoring and evaluation. Design Observational mixed-methods case studies; systematic scoping literature reviews; assessment of patient-reported outcome measures (PROMs); public and patient involvement; and consensus development through focus groups. Setting Twenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long-term physical or mental health conditions. Participants One hundred and sixty-five young people aged 16–24 years living with a long-term health condition; 13 parents; 173 clinical team members; and 16 information governance specialists. Interventions Clinical teams and young people variously used mobile phone calls, text messages, e-mail and voice over internet protocol. Main outcome measures Empirical work – thematic and ethical analysis of qualitative data; annual direct costs; did not attend, accident and emergency attendance and hospital admission rates plus clinic-specific clinical outcomes. Scoping reviews–patient, health professional and service delivery outcomes and technical problems. PROMs: scale validity, relevance and credibility. Data sources Observation, interview, structured survey, routinely collected data, focus groups and peer-reviewed publications. Results Digital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships, but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases and the main cost is staff time. Clinical teams had not evaluated the impact of their intervention and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures, but the Patient Activation Measure and the Physicians’ Humanistic Behaviours Questionnaire are promising. Scoping reviews suggest DCC is acceptable to young people, but with no clear evidence of benefit except for mental health. Limitations Qualitative data were mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available. Conclusions Timely DCC is perceived as making a difference to health care and health outcomes for young people with long-term conditions, but this is not supported by evidence that measures health outcomes. Such communication is challenging and costly to provide, but valued by young people.