Evaluation of a diabetes self-management program: a feasibility study

There has been a shift from paternalistic, to partnership models of care in developed healthcare systems (Cochrane 2006). Hywel Dda University Health Board is working towards increasing the provision of programs, thus meeting the criteria laid down by the Department of Health, and Diabetes UK report on structured patient education. Study aims and objectives: To assess the feasibility of conducting a RCT to evaluate the effectiveness of the DSMP in a Welsh population this trial will explore; Effectiveness of recruitment strategy and willingness of health professionals to refer participants; number of eligible participants, and willingness to take part and be randomised; follow-up rates, response rates to questionnaires, adherence rates for both groups; identify variability in outcome measures. To explore a range of factors that could inform future delivery of the DSMP the process evaluation will assess; feedback from participants and tutors about the delivery of the DSMP (venue, time, format, content, tutor participant interaction, follow up); impact of DSMP on outcomes There are positive changes in most of the DSMP outcomes. Participants said they would recommend the course to others and are applying new knowledge to everyday life. Suggested improvements were few; evening/weekend workshops and more information about die

Associations between vitamin D status and measures of glycaemia in participants with normoglycaemia, impaired fasting glucose and type 2 diabetes

Aims: To identify whether baseline vitamin D status is associated with future glycaemic control. To assess whether vitamin D status differs between two groups when classified by glucose control (above or below 6.1mmol/l: cut-off point for impaired fasting glucose; World Health Organization (WHO), 2006). Methods: Following an overnight fast 104 participants (female 53; male 51) with varying levels of glucose control attended the laboratory on three occasions, with each visit separated by 6 months. Venous blood samples were analysed for vitamin D (25(OH)D3), fasting plasma glucose (FPG), fasting plasma insulin (FPI) and HbA1c. Results: Significant negative correlations were observed between 25(OH)D3 at 0 months and HbA1c at 12 months (r = �0.241, n=75, p=0.04) and FPI at 12 months (r = �0.225, n=81, p=0.04), but not FPG at 12 months (r = �0.105, n=80, p=0.35). Participants with impaired fasting glucose or Type 2 diabetes (n=47; FPG 8.0 � 2.1mmol/l) had significantly lower 25(OH)D3 concentrations (35.1 � 20.2 vs 45.6 � 24.7nmol/l) than those with normoglycaemia (n=57; FPG 5.1 � 0.4mmol/l) (U=884.000, p=0.03). Conclusions: Participants with lower vitamin D had poor glucose control compared to those with higher vitamin D concentrations on the day of testing and at 12 months follow-up. Whilst further studies are required to determine cause and effect, these findingsmay provide additional evidence of a protective effect of vitamin D in relation to glycaemic control and the development of Type 2 diabetes

Agreement between session RPE and individual training impulse across a range of running speeds

BACKGROUND: The training impulse (TRIMP) provides a means of quantifying training dose during physical training; it is traditionally based on the heart rate response to exercise and involves establishing the heart rate – blood lactate relationship. A new approach is based on the individual’s global rating of perceived exertion (RPE) for the training session. The current study was undertaken to examine agreement between individual TRIMP and session RPE. METHODS: Nine healthy male volunteers completed three trials involving a 6 km treadmill run at speeds of 12 km×h-1, 9 km×h-1 and 7.2 km×h-1 in random order. Individual training impulse and session rating of perceived exertion were calculated for each trial. RESULTS: While both methods resulted in values increasing as the intensity of the trials increased there were no significant differences between the three trials for either method. There was a significant correlation between the two methods (N.=27) (r = 0.62, P<0.01) and the 95% limits of agreement lay between 27.34 and -107.42. Session rating of perceived exertion resulted in higher values for 24 of the 27 trials with the three giving higher individual training impulse all being during the lower training dose trials. CONCLUSIONS: The findings indicate that while the two methods are related there is a progressive increase in the disagreement as the training dose increases. Which of the two methods gives the better relationship with physiological adaptation has yet to be determined

A 15-week vitamin D supplementation and indoor cycling intervention reduces exercising heart rate, with no effect on glycaemic control in healthy adults: A pilot investigation

Significant positive correlations are often observed between vitamin D concentrations and physical activity levels. Whilst this may be due to individuals who are physically active spending time outdoors (i.e. increased opportunity for vitamin D synthesis), there is growing evidence to suggest a more complex relationship between vitamin D status, physical fitness and health outcomes. To explore this further thirty-nine healthy adults were randomly allocated to 15 weeks of exercise training (Ex), no training (NoEx), 2000 IU/day vitamin D (VitD) and/or placebo (Pla) supplementation (giving four possible allocations: NoEx+VitD; NoEx+Pla; Ex+VitD; Ex+Pla). Vitamin D status, glycaemic control and exercise responses were measured pre- and post-intervention. A series of 2 x 2 ANOVAs failed to find any effect of supplementation or exercise on any of the measures except heart rate during low intensity exercise, and vitamin D status. Heart rate was significantly reduced (6%, p < 0.05) in the Ex+VitD group. Vitamin D status was significantly raised (28%, p < 0,05) in the supplementation groups (NoEx+VitD and Ex+VitD) at a time of year (August-November) when a seasonal decline was observed in the placebo groups (33%, p < 0.05). These findings indicate that vitamin D supplementation (2000 IU/day) may have an enhancing role alongside exercise in inducing cardiorespiratory adaptations to exercise training. Further investigations are required to confirm these findings and identify the mechanisms involved

A Service Evaluation of V Heart Health

Introduction: The aim of this work was to conduct an evaluation of V Heart Health, a digital cardiac rehabilitation programme for patients with multimorbidity. Whilst the traditional (face-to-face) cardiac rehab programme is considered the ‘gold standard’ it is important that there is a menu of options available for patients and V Heart Health seems well placed to form part of this. Methods: Quantitative and qualitative methods of data collection were utilised including adherence (usability) data, routinely collected clinical data and patient satisfaction feedback. A staff focus group was conducted to explore staff perceptions with regards to the delivery of V Heart Health. Results: The collection of routine clinical data was successful where data were collected by clinicians via phone or video call. Where the onus was on patients to complete and return questionnaires and feedback forms there were some missing data. It is important that this is addressed as completeness of data and patient feedback are essential to ensure service development and improvement. The feedback from patients with regard to the programme content and the staff involved in the delivery was positive. Findings from the focus group indicated that staff felt the programme was successful and they were keen to continue developing and improving the service. They reported keeping patients at the heart of all future decisions and emphasized that V Heart Health should continue to form part of a suite of options for patients. Some of the issues described in this early rollout phase included challenges securing an appropriate venue (during COVID 19 lockdown), awareness and knowledge of wider team about V Heart Health and concerns about digital literacy within the county. Factors perceived as facilitators included staff development, IT support and teamwork. There were technology and connectivity issues described by patients that need to be explored and addressed as a priority going forward. Conclusion: it is important to offer patients choice, to include site based, home, online or blended programmes on an equitable basis with the aim to improve uptake across a range of patient groups. There are areas for development of V Heart Health described within this report which are already being explored as the programme is continuously evolving in response to feedback and staff are becoming more confident and competent in its delivery. V Heart Health has the potential to form part of the menu of programme options for patients living in Lincolnshire. This initial evaluation demonstrates preliminary proof of concept and acceptability data for V Heart Health, however further evaluation and research is warranted

Effects of non-pharmacological interventions for insomnia in children with Autistic Spectrum Condition

Autism Spectrum Condition (ASC) is the name for a range of similar conditions that affect a person's social interaction, communication, interests and behaviour. In most cases many of the features of Autism can be recognised during early childhood. It is estimated that about 1 in every 160 children has an Autism Spectrum Condition (World Health Organisation). Further to this it is thought that between 40-80% of children with Autism have difficulties relating to sleep (Polimeni et al., 2005). Such sleep problems have been linked to a range of serious implications for the child's wellbeing. This review will explore the effects of non-pharmacological interventions for insomnia in children with autistic spectrum condition

Barriers and facilitators to self-management in people living with and beyond cancer (PLWABC): a systematic review of qualitative evidence (PROTOCOL)

Review question The review objectives are: To identify, evaluate and synthesise qualitative evidence that has explored the perspectives of people living with and beyond cancer regarding self-management. To utilise this data to identify, explore and explain the potential barriers and facilitators to self-management in people living with and beyond cancer. Condition or domain being studied: Engagement (or lack of) in self-management practices/behaviours, support and resources in adults (≥18) with any diagnosis of cancer who have completed treatment for cancer. Whilst there is no universal definition of self-management, in cancer survivorship, it has been defined as “awareness and active participation by the person in their recovery, recuperation, rehabilitation, to minimise the consequences of treatment, promote survival, health and wellbeing” (DH, Macmillan Cancer Support, NHS Improvement, 2013). This definition will be used for the purposes of this review

Evaluating a tool to improve engagement and recruitment of under-served groups in trials

Acknowledgements Many thanks to all those who participated in the study and particularly the public and community involvement and engagement contributors from Greater Manchester and East Midlands. Thanks to the National Institute for Health Research Applied Research Collaboration Greater Manchester’s Public and Community Involvement and Engagement (PCIE) Forum and Panel and to The Centre for Ethnic Health Research for their support of this work. Thanks also to Francisco Beduschi Neto for creating the participant flow diagram. The Health Services Research Unit, University of Aberdeen, receives core funding from the Chief Scientist Office of the Scottish Government Health Directorates. Funding This research was supported by the National Institute for Health Research Applied Research Collaboration Greater Manchester.Peer reviewedPublisher PD