The Development of the KSU PDS Model: 25 Years in the Making

Educational improvement demands continuous change, but change is not always productive. Reflecting on the past and vision setting for the future helps chart a course for a more productive change process. Historians urge learning from history to guide future actions

What’s the big idea? Identifying research priorities using linked data

Objectives To develop an engagement method to identify and prioritise local evidence gaps around child and maternal health, that could be addressed using linked routinely collected data from the Born and Bred in (BaBi) studies. Methods We developed a pragmatic, 2-hour online workshop method to engage local stakeholders and members of the public to identify research priorities. Stakeholder groups included parents, early years practitioners, commissioners, and service providers. The workshop involves two parts. The first part places attendees into groups with people from similar stakeholder type backgrounds to discuss areas of child and maternal health they think are important for research using linked routinely collected data. The second part places attendees into new, multidisciplinary groups to prioritise the suggestions put forward in the first part, based on criteria of urgency and importance. Results A pilot workshop identified 17 important and urgent research priorities. Key themes included maternal and infant mental health, diet and childhood obesity, Covid-19, inequalities, infant feeding and labour and delivery. This engagement method has successfully been applied in five local areas that are BaBi study sites. The outputs from these workshops have informed a pipeline of projects for the BaBi Network. Research is currently being carried out that addresses one of these research priorities. Many of the identified research priorities were not suitable for linked data research. Based on the workshop discussions, it is recommended that an understanding of the information captured in routine datasets is developed amongst stakeholders and members of the public, to allow them to better engage with linked data research. Conclusion It is possible to engage a wide range of stakeholders including practitioners, commissioners, service providers and parents in a 2-hour workshop to prioritise research questions to be answered using linked routine data. This is important if research using these data is to inform local decision-making.

Cultural adaptation of a text message library designed to support diet, activity and weight management behaviour in the postpartum period in the UK: the Supporting MumS (SMS) Study

The Supporting MumS library of text messages was developed with extensive personal and public involvement (PPI) to help with postpartum weight management and was successfully tested in a feasibility study in Northern Ireland. Before conducting an effectiveness trial, further PPI work was needed to ensure that the dietary and lifestyle advice offered within the SMS text message library was acceptable and culturally relevant for a wide range of women across the United Kingdom (UK). Recruitment was facilitated by existing community networks that helped capture a culturally diverse group of postpartum women who have struggled with their weight. Nineteen women took part in the PPI exercise: n = 4 African–Caribbean (living in London), n = 8 Asian (Bradford), n = 7 white (Scotland). The PPI work followed an iterative process with initial online group discussions, where selected text messages were reviewed and feedback was sought on their language, tone and cultural relevance. This was followed by message adaptation and re-review. Following initial group discussions to understand the main areas for adaptation, PPI work was carried out with individual mums who reviewed the entire library of text messages and provided feedback on all adaptations. Mums liked the humour and the supportive tone of the messages and approximately 15% of the messages were left unchanged. Suggested edits to ensure the messages were acceptable and relevant to women from a range of cultural backgrounds were minor in nature. Suggestions provided by PPI representatives were mainly in relation to broadening the relevance of snack ideas, recipes, food preparation advice, shopping habits (e.g., click and collect services) and workout ideas. Additional feedback included removing colloquialisms and idioms, the meaning of which may be confusing for somebody not familiar with them or a non-native English speaker (e.g., ‘run out of steam’). Personal and Public Involvement provided helpful suggestions for the cultural and regional adaptation of a lifestyle text message intervention in the postpartum period. The effectiveness and cost-effectiveness of the Supporting MumS study will be tested in a UK-wide trial

Exercise-based cardiac rehabilitation for adults with heart failure

Background Chronic heart failure (HF) is a growing global health challenge. People with HF experience substantial burden that includes low exercise tolerance, poor health-related quality of life (HRQoL), increased risk of mortality and hospital admission, and high healthcare costs. The previous (2014) Cochrane systematic review reported that exercise-based cardiac rehabilitation (CR) compared to no exercise control shows improvement in HRQoL and hospital admission among people with HF, as well as possible reduction in mortality over the longer term, and that these reductions appear to be consistent across patient and programme characteristics. Limitations noted by the authors of this previous Cochrane Review include the following: (1) most trials were undertaken in patients with HF with reduced (< 45%) ejection fraction (HFrEF), and women, older people, and those with preserved (≥ 45%) ejection fraction HF (HFpEF) were under-represented; and (2) most trials were undertaken in the hospital/centre-based setting. Objectives To determine the effects of exercise-based cardiac rehabilitation on mortality, hospital admission, and health-related quality of life of people with heart failure. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and three other databases on 29 January 2018. We also checked the bibliographies of systematic reviews and two trial registers. Selection criteria We included randomised controlled trials that compared exercise-based CR interventions with six months’ or longer follow-up versus a no exercise control that could include usual medical care. The study population comprised adults (> 18 years) with evidence of HF - either HFrEF or HFpEF. Data collection and analysis Two review authors independently screened all identified references and rejected those that were clearly ineligible for inclusion in the review. We obtained full papers of potentially relevant trials. Two review authors independently extracted data from the included trials, assessed their risk of bias, and performed GRADE analyses. Main results We included 44 trials (5783 participants with HF) with a median of six months’ follow-up. For this latest update, we identified 11 new trials (N = 1040), in addition to the previously identified 33 trials. Although the evidence base includes predominantly patients with HFrEF with New York Heart Association classes II and III receiving centre-based exercise-based CR programmes, a growing body of studies include patients with HFpEF and are undertaken in a home-based setting. All included studies included a no formal exercise training intervention comparator. However, a wide range of comparators were seen across studies that included active intervention (i.e. education, psychological intervention) or usual medical care alone. The overall risk of bias of included trials was low or unclear, and we downgraded results using the GRADE tool for all but one outcome. Cardiac rehabilitation may make little or no difference in all-cause mortality over the short term (≤ one year of follow-up) (27 trials, 28 comparisons (2596 participants): intervention 67/1302 (5.1%) vs control 75/1294 (5.8%); risk ratio (RR) 0.89, 95% confidence interval (CI) 0.66 to 1.21; low-quality GRADE evidence) but may improve all-cause mortality in the long term (> 12 months follow up) (6 trials/comparisons (2845 participants): intervention 244/1418 (17.2%) vs control 280/1427 (19.6%) events): RR 0.88, 95% CI 0.75 to 1.02; high-quality evidence). Researchers provided no data on deaths due to HF. CR probably reduces overall hospital admissions in the short term (up to one year of follow-up) (21 trials, 21 comparisons (2182 participants): (intervention 180/1093 (16.5%) vs control 258/1089 (23.7%); RR 0.70, 95% CI 0.60 to 0.83; moderate-quality evidence, number needed to treat: 14) and may reduce HF-specific hospitalisation (14 trials, 15 comparisons (1114 participants): (intervention 40/562 (7.1%) vs control 61/552 (11.1%) RR 0.59, 95% CI 0.42 to 0.84; low-quality evidence, number needed to treat: 25). After CR, a clinically important improvement in shortterm disease-specific health-related quality of life may be evident (Minnesota Living With Heart Failure questionnaire - 17 trials, 18 comparisons (1995 participants): mean difference (MD) -7.11 points, 95% CI -10.49 to -3.73; low-quality evidence). Pooling across all studies, regardless of the HRQoL measure used, shows there may be clinically important improvement with exercise (26 trials, 29 comparisons (3833 participants); standardised mean difference (SMD) -0.60, 95% CI -0.82 to -0.39; I² = 87%; Chi² = 215.03; lowquality evidence). ExCR effects appeared to be consistent different models of ExCR delivery: centre vs. home-based, exercise dose, exercise only vs. comprehensive programmes, and aerobic training alone vs aerobic plus resistance programmes. Authors’ conclusions This updated Cochrane Review provides additional randomised evidence (11 trials) to support the conclusions of the previous version (2014) of this Cochane Review. Compared to no exercise control, CR appears to have no impact on mortality in the short term (< 12 months’ follow-up). Low- to moderate-quality evidence shows that CR probably reduces the risk of all-cause hospital admissions and may reduce HF-specific hospital admissions in the short term (up to 12 months). CR may confer a clinically important improvement in health-related quality of life, although we remain uncertain about this because the evidence is of low quality. Future ExCR trials need to continue to consider the recruitment of traditionally less represented HF patient groups including older, female, and HFpEF patients, and alternative CR delivery settings including home- and using technology-based programmes

Comparison of Experiences in Two Birth Cohorts Comprising Young Families with Children under Four Years during the Initial COVID-19 Lockdown in Australia and the UK: A Qualitative Study

This study aims to understand the experience and impact of the initial COVID-19 lockdown in young families with children aged below 4 years. Free text questions were administered to participants in the ORIGINS (Australia) and Born in Bradford (UK) cohort studies to collect qualitative information on worries, concerns and enjoyable experiences during the pandemic. A total of 903 (400 for ORIGINS and 503 for BiB) participants completed the two surveys during April 2020. Despite varying in geography, levels of socio-economic disadvantage and their situational context during the pandemic, respondents from both cohorts reported similar worries and challenges during the lockdown period, including: employment/finances, health anxiety, mental health and social isolation, caring for children and child development. Families across the globe experienced both positive and negative immediate impacts of COVID-19. Population-based data can be used to inform the development of support services, public health campaigns and universal interventions to assist families in future health crises