Optimising the acceptability and feasibility of novel complex interventions: an iterative, person-based approach to developing the UK Morita therapy outpatient protocol

This is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: The aim of this paper is to showcase best practice in intervention development by illustrating a systematic, iterative, person-based approach to optimising intervention acceptability and feasibility, as applied to the cross-cultural adaptation of Morita therapy for depression and anxiety. METHODS: We developed the UK Morita therapy outpatient protocol over four stages integrating literature synthesis and qualitative research. Firstly, we conducted in-depth interviews combining qualitative and cognitive interviewing techniques, utilising vignettes of Morita therapy being delivered and analysed using Framework analysis to investigate potential patients and therapists' perceptions of Morita therapy. Secondly, we developed qualitative themes into recommendations for optimising Morita therapy and synthesised Morita therapy literature in line with these to develop a draft protocol. Thirdly, we conducted repeat interviews with therapists to investigate their views of the protocol. Finally, we responded to these qualitative themes through protocol modification and tailoring our therapist training programme. RESULTS: As a consequence of literature describing Morita therapy and participants' perceptions of the approach, we developed both a therapy protocol and therapist training programme which were fit for purpose in proceeding to a UK-based Morita therapy feasibility study. As per our key qualitative findings and resulting recommendations, we structured our protocol according to the four-phased model of Morita therapy, included detailed guidance and warning points, and supported therapists in managing patients' expectations of the approach. CONCLUSIONS: Our systematic approach towards optimising intervention acceptability and feasibility prioritises the perspectives of those who will deliver and receive the intervention. Thus, we both showcase best practice in intervention development and demonstrate the application of this process to the careful cross-cultural adaptation of an intervention in which balancing both optimisation of and adherence to the approach are key. This presentation of a generalisable process in a transparent and replicable manner will be of interest to those both developing and evaluating complex interventions in the future.The first author (HVRS) has a PhD fellowship award from the University of Exeter Medical School; DAR and JF are also funded by the University of Exeter Medical School, and DAR, as a National Institute for Health Research Senior Investigator, receives additional support from the UK National Institute for Health Research South West Peninsula Collaboration for Leadership in Applied Health Research and Care

Amalgamation of Marginal Gains (AMG) as a potential system to deliver high quality fundamental nursing care: a qualitative analysis of interviews from high performance AMG sports and healthcare practitioners

This is the final version of the article. Available from Wiley via the DOI in this recordAims and objectives To investigate the components of the Amalgamation of Marginal Gains (AMG) performance system to identify a set of principles that can be built into an innovative fundamental nursing care protocol. Background Nursing is urged to refocus on its fundamental care activities, but little evidence exists to guide practising nurses. Fundamental care is a combination of many small behaviours aimed at meeting a person's care needs. AMG is a successful system of performance management that focusses on small (or marginal) gains, and might provide a new delivery framework for fundamental nursing care. Design Qualitative interview study. Methods We undertook in depth interviews with healthcare and sports professionals experienced in AMG. We analysed data using open coding in a Framework Analysis, then interrogating the data using Normalisation Process Theory (NPT). We triangulated findings with AMG literature to develop an intervention logic model. Results We interviewed 20 AMG practitioners. AMG processes were: focusing on many details to optimise performance, identification of marginal gains using different sources, understanding current versus optimum performance, monitoring at micro and macro level, and strong leadership. Elements of normalisation were; whole team belief in AMG to improve performance, a collective desire for excellence using evidence based actions, whole team engagement to identify choose and implement changes, and individual and group responsibility for monitoring performance. Conclusions We have elicited the processes described by AMG innovators in healthcare and sport and have mapped the normalisation potential and work required to embed such a system into nursing practice.This is an independent research study funded by a UK National Institute of Health Research (NIHR) Programme Development Grant (RP-DG-1214-10001) and a NIHR Senior Investigator award to DAR. DAR and VG are also supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula

Morita therapy for depression and anxiety (Morita Trial): study protocol for a pilot randomised controlled trial.

Published onlineJournal ArticleRandomized Controlled TrialResearch Support, Non-U.S. Gov'tThis is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: Morita Therapy, a psychological therapy for common mental health problems, is in sharp contrast to established western psychotherapeutic approaches in teaching that undesired symptoms are natural features of human emotion rather than something to control or eliminate. The approach is widely practiced in Japan, but untested and little known in the UK. A clinical trial of Morita Therapy is required to establish the effectiveness of Morita Therapy for a UK population. However, a number of methodological, procedural and clinical uncertainties associated with such a trial first require addressing. METHODS/DESIGN: The Morita Trial is a mixed methods study addressing the uncertainties associated with an evaluation of Morita Therapy compared with treatment as usual for depression and anxiety. We will undertake a pilot randomised controlled trial with embedded qualitative study. Sixty participants with major depressive disorder, with or without anxiety disorders, will be recruited predominantly from General Practice record searches and randomised to receive Morita Therapy plus treatment as usual or treatment as usual alone. Morita Therapy will be delivered by accredited psychological therapists. We will collect quantitative data on depressive symptoms, general anxiety, attitudes and quality of life at baseline and four month follow-up to inform future sample size calculations; and rates of recruitment, retention and treatment adherence to assess feasibility. We will undertake qualitative interviews in parallel with the trial, to explore people's views of Morita Therapy. We will conduct separate and integrated analyses on the quantitative and qualitative data. DISCUSSION: The outcomes of this study will prepare the ground for the design and conduct of a fully-powered evaluation of Morita Therapy plus treatment as usual versus treatment as usual alone, or inform a conclusion that such a trial is not feasible and/or appropriate. We will obtain a more comprehensive understanding of these issues than would be possible from either a quantitative or qualitative approach alone. TRIAL REGISTRATION: Current Controlled Trials ISRCTN17544090 registered on 23 July 2015.The first author (HVRS) has a PhD fellowship award from the University of Exeter Medical School; DAR and JF are also funded by the University of Exeter Medical School and DAR, as a National Institute for Health Research Senior Investigator, receives additional support from the UK National Institute for Health Research South West Peninsula Collaboration for Leadership in Applied Health Research and Care. The AccEPT Clinic is funded by the National Health Service Northern, Eastern and Western Devon Clinical Commissioning Group and hosted by the University of Exeter’s Mood Disorders Centre. The Morita Trial is sponsored by the University of Exeter (contact details available on request). The sponsor and funding sources have had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, or decision to submit results

Spontaneous Octahedral Tilting in the Cubic Inorganic Caesium Halide Perovskites CsSnX3_3 and CsPbX3_3 (X = F, Cl, Br, I)

The local crystal structures of many perovskite-structured materials deviate from the average space group symmetry. We demonstrate, from lattice-dynamics calculations based on quantum chemical force constants, that all the caesium-lead and caesium-tin halide perovskites exhibit vibrational instabilities associated with octahedral titling in their high-temperature cubic phase. Anharmonic double-well potentials are found for zone-boundary phonon modes in all compounds with barriers ranging from 108 to 512 meV. The well depth is correlated with the tolerance factor and the chemistry of the composition, but is not proportional to the imaginary harmonic phonon frequency. We provide quantitative insights into the thermodynamic driving forces and distinguish between dynamic and static disorder based on the potential-energy landscape. A positive band gap deformation (spectral blueshift) accompanies the structural distortion, with implications for understanding the performance of these materials in applications areas including solar cells and light-emitting diodes

Fundamental nursing care: a systematic review of the evidence on the effect of nursing care interventions for nutrition, elimination, mobility and hygiene

This is the final version of the article. Available from Wiley via the DOI in this record.AIMS AND OBJECTIVES: To determine the effects of nursing interventions for people's nutrition, elimination, mobility and hygiene needs. BACKGROUND: Patient experience of health care is sensitive to nursing quality. A refocus on fundamental nursing care is undermined by lack of evidence of effectiveness for interventions in core areas such as elimination, nutrition, mobility and hygiene. DESIGN: SYSTEMATIC REVIEW: METHODS: We searched for and included experimental studies on interventions by professionally qualified and unregistered nurses that addressed participants' nutrition, elimination, mobility and hygiene needs. We extracted data on scope, quality and results of studies followed by descriptive narrative synthesis of included study outcomes using a novel form of harvest plots. RESULTS: We included 149 studies, 35 nutrition, 56 elimination, 16 mobility, 39 hygiene, and three addressing two or more areas simultaneously (67 randomised controlled trials (RCTs), 32 non-RCTs and 50 uncontrolled trials). Studies into interventions on participant self-management of nutrition (n=25), oral health (n=26), catheter care (n=23), and self-management of elimination (n=21) were the most prevalent. Most studies focussed their outcomes on observational or physiological measures, with very few collecting patient reported outcomes, such as quality of life, experience or self-reported symptoms. All but 13 studies were of low quality and at significant risk of bias. The majority of studies did not define primary outcomes, included multiple measures of identical concepts, used inappropriate analyses, and did not conform to standard reporting quality criteria. CONCLUSIONS: The current evidence for fundamental nursing care interventions is sparse, of poor quality and unfit to provide evidence-based guidance to practising nurses. This article is protected by copyright. All rights reserved.This study was funded by a Programme Development Grant from the UK National Institute of Health Research (NIHR). RP-DG-1214-10001. David Richards and Victoria Goodwin receive funding support from the UK National Institute for Health Research South West Peninsula Collaboration for Leadership in Applied Health Research and Care

Patients’ and nurses’ experiences of fundamental nursing care: a systematic review and qualitative synthesis

This is the final version. Available on open access from Wiley via the DOI in this recordAims and objectives To systematically identify, appraise and synthesise patients’, residents’, and nurses’ experiences of fundamental nursing care for nutrition, elimination, mobility, and hygiene. Background The evidence base for effective nursing behaviours to assist people with their fundamental care needs is sparse, hampering the development of effective interventions. Synthesising data on patients’ and nurses’ experiences of fundamentals of nursing care could contribute to the development of such an intervention. Methods Systematic review and synthesis of qualitative data from qualitative studies on patients’ and nurses’ experiences of fundamental nursing care behaviours addressing peoples’ nutrition, elimination, mobility, and hygiene needs. We appraised study quality and relevance and used a narrative approach to data synthesis, fulfilling PRISMA criteria (Supplementary file 1). Results We identified 22,374 papers, 47 met our inclusion criteria. Most papers were of low quality. Sixteen papers met our quality and relevance criteria and were included for synthesis. Papers were about nutrition (2) elimination (2), mobility (5), hygiene (5) and multiple care areas (2). We found nurses and patients report that fundamental nursing care practices involve strong leadership, collaborative 2 partnerships with patients and cohesive organisational practices aligned to nursing care objectives and actions. Conclusions. To improve fundamental care and interventions suitable for testing may require attention to leadership, patient-nurse relationships and organisational coherence plus the fundamentals of care nursing interventions themselves. Relevance to clinical practice. More rigorous mixed methods research about fundamental nursing care is needed to inform nursing practice and improve patient’s experience. Nursing interventions should include effective nurse leadership and nurse patient collaboration and a focus on fundamental care by the host organisation

Herbivore-induced shifts in carbon and nitrogen allocation in red oak seedlings

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65993/1/j.1469-8137.2008.02420.x.pd

Dynamical links between small- and large-scale mantle heterogeneity: seismological evidence

We identify PKP*PKP scattered waves (also known as P′*P′) from earthquakes recorded at small-aperture seismic arrays at distances less than 65°. P′*P′ energy travels as a PKP wave through the core, up into the mantle, then scatters back down through the core to the receiver as a second PKP. P′*P′ waves are unique in that they allow scattering heterogeneities throughout the mantle to be imaged. We use array processing methods to amplify low amplitude, coherent scattered energy signals and resolve their incoming direction. We deterministically map scattering heterogeneity locations from the core-mantle boundary to the surface. We use an extensive dataset with sensitivity to a large volume of the mantle and a location method allowing us to resolve and map more heterogeneities than have previously been possible, representing a significant increase in our understanding of small scale structure within the mantle. Our results demonstrate that the distribution of scattering heterogeneities varies both radially and laterally. Scattering is most abundant in the uppermost and lowermost mantle, and a minimum in the mid mantle, resembling the radial distribution of tomographically derived whole-mantle velocity heterogeneity. We investigate the spatial correlation of scattering heterogeneities with large-scale tomographic velocities, lateral velocity gradients, the locations of deep-seated hotspots and subducted slabs. In the lowermost 1500 km of the mantle, small-scale heterogeneities correlate with regions of low seismic velocity, high lateral seismic gradient, and proximity to hotspots. In the upper 1000 km of the mantle there is no significant correlation between scattering heterogeneity location and subducted slabs. Between 600 and 900 km depth, scattering heterogeneities are more common in the regions most remote from slabs, and close to hotspots. Scattering heterogeneities show an affinity for regions close to slabs within the upper 200 km of the mantle. The similarity between the distribution of large-scale and small-scale mantle structures suggests a dynamic connection across scales, whereby mantle heterogeneities of all sizes may be directed in similar ways by large-scale convective currents