Interventions for reducing unplanned paediatric admissions: an observational study in one hospital

Objective Evidence on how best to intervene to improve paediatric acute care and therefore reduce unplanned hospital admissions is weak. We describe service evaluation work at one hospital to assess interventions at critical clinical and service decision points.Design We conducted an observational study using routine daily-collected data (April 2009–December 2015) from a medium-sized district general hospital in south-west UK, using before-and-after comparisons of admissions-related data to evaluate two interventions implemented in April and November 2014, respectively: (1) an advice and guidance (A&G) phone line, where a senior paediatrician is available for general practitioners (GPs) and emergency department (ED) and (2) a Short Stay Paediatric Assessment Unit (SSPAU). We analysed data on all admitted children (<18 years) in the catchment area (population estimate 27 740 in 2015). Outcomes were GP-referred attendances, ward admissions, less than 1 day admissions and length of stay.Results A&G phone line was associated with a reduction in the mean number of less than 1 day admissions per month (difference in means before and after intervention −16.6 (95% CI −0.2 to −32.9)) and an increase in overall monthly bed-days (difference 72.5 (95% CI 21.0 to 124.0)), but there was little evidence of a change in GP-referred attendances or ward admissions. SSPAU was associated with a reduction in the mean number of monthly ward admissions (difference −34.6 (95% CI –21.3 to −48.0)) and less than 1 day admissions (difference in means −21.7 (95% CI −8.4 to −35.1)) and a reduction in the mean number of overall bed-days per month (difference −50.2 (95% CI −12.1 to −88.3)).Conclusions Interventions for reducing time taken to senior clinician review may be effective in better managing paediatric acute care. Further work should explore results by age, condition and injury/illness status

Parametric study of EEG sensitivity to phase noise during face processing

<b>Background: </b> The present paper examines the visual processing speed of complex objects, here faces, by mapping the relationship between object physical properties and single-trial brain responses. Measuring visual processing speed is challenging because uncontrolled physical differences that co-vary with object categories might affect brain measurements, thus biasing our speed estimates. Recently, we demonstrated that early event-related potential (ERP) differences between faces and objects are preserved even when images differ only in phase information, and amplitude spectra are equated across image categories. Here, we use a parametric design to study how early ERP to faces are shaped by phase information. Subjects performed a two-alternative force choice discrimination between two faces (Experiment 1) or textures (two control experiments). All stimuli had the same amplitude spectrum and were presented at 11 phase noise levels, varying from 0% to 100% in 10% increments, using a linear phase interpolation technique. Single-trial ERP data from each subject were analysed using a multiple linear regression model. <b>Results: </b> Our results show that sensitivity to phase noise in faces emerges progressively in a short time window between the P1 and the N170 ERP visual components. The sensitivity to phase noise starts at about 120–130 ms after stimulus onset and continues for another 25–40 ms. This result was robust both within and across subjects. A control experiment using pink noise textures, which had the same second-order statistics as the faces used in Experiment 1, demonstrated that the sensitivity to phase noise observed for faces cannot be explained by the presence of global image structure alone. A second control experiment used wavelet textures that were matched to the face stimuli in terms of second- and higher-order image statistics. Results from this experiment suggest that higher-order statistics of faces are necessary but not sufficient to obtain the sensitivity to phase noise function observed in response to faces. <b>Conclusion: </b> Our results constitute the first quantitative assessment of the time course of phase information processing by the human visual brain. We interpret our results in a framework that focuses on image statistics and single-trial analyses

Physical activity and the prevention, reduction, and treatment of alcohol and other drug use across the lifespan (The PHASE review): A systematic review

The aim of this review is to systematically describe and quantify the effects of PA interventions on alcohol and other drug use outcomes, and to identify any apparent effect of PA dose and type, possible mechanisms of effect, and any other aspect of intervention delivery (e.g. key behaviour change processes), within a framework to inform the design and evaluation of future interventions. Systematic searches were designed to identify published and grey literature on the role of PA for reducing the risk of progression to alcohol and other drug use (PREVENTION), supporting individuals to reduce alcohol and other drug use for harm reduction (REDUCTION), and promote abstinence and relapse prevention during and after treatment of alcohol and other drug use (TREATMENT). Searches identified 49,518 records, with 49,342 excluded on title and abstract. We screened 176 full text articles from which we included 32 studies in 32 papers with quantitative results of relevance to this review. Meta-analysis of two studies showed a significant effect of PA on prevention of alcohol initiation (risk ratio [RR]: 0.72, 95%CI: 0.61 to 0.85). Meta-analysis of four studies showed no clear evidence for an effect of PA on alcohol consumption (Standardised Mean Difference [SMD]: 0.19, 95%, Confidence Interval −0.57 to 0.18). We were unable to quantitatively examine the effects of PA interventions on other drug use alone, or in combination with alcohol use, for prevention, reduction or treatment. Among the 19 treatment studies with an alcohol and other drug use outcome, there was a trend for promising short-term effect but with limited information about intervention fidelity and exercise dose, there was a moderate to high risk of bias. We identified no studies reporting the cost-effectiveness of interventions. More rigorous and well-designed research is needed. Our novel approach to the review provides a clearer guide to achieve this in future research questions addressed to inform policy and practice for different populations and settings.The aim of this review is to systematically describe and quantify the effects of PA interventions on alcohol and other drug use outcomes, and to identify any apparent effect of PA dose and type, possible mechanisms of effect, and any other aspect of intervention delivery (e.g. key behaviour change processes), within a framework to inform the design and evaluation of future interventions. Systematic searches were designed to identify published and grey literature on the role of PA for reducing the risk of progression to alcohol and other drug use (PREVENTION), supporting individuals to reduce alcohol and other drug use for harm reduction (REDUCTION), and promote abstinence and relapse prevention during and after treatment of alcohol and other drug use (TREATMENT). Searches identified 49,518 records, with 49,342 excluded on title and abstract. We screened 176 full text articles from which we included 32 studies in 32 papers with quantitative results of relevance to this review. Meta-analysis of two studies showed a significant effect of PA on prevention of alcohol initiation (risk ratio [RR]: 0.72, 95%CI: 0.61 to 0.85). Meta-analysis of four studies showed no clear evidence for an effect of PA on alcohol consumption (Standardised Mean Difference [SMD]: 0.19, 95%, Confidence Interval −0.57 to 0.18). We were unable to quantitatively examine the effects of PA interventions on other drug use alone, or in combination with alcohol use, for prevention, reduction or treatment. Among the 19 treatment studies with an alcohol and other drug use outcome, there was a trend for promising short-term effect but with limited information about intervention fidelity and exercise dose, there was a moderate to high risk of bias. We identified no studies reporting the cost-effectiveness of interventions. More rigorous and well-designed research is needed. Our novel approach to the review provides a clearer guide to achieve this in future research questions addressed to inform policy and practice for different populations and settings

The Glasgow 'Deep End' Links Worker Study Protocol: a quasi-experimental evaluation of a social prescribing intervention for patients with complex needs in areas of high socioeconomic deprivation

Background: ‘Social prescribing’ can be used to link patients with complex needs to local (non-medical) community resources. The ‘Deep End’ Links Worker Programme is being tested in general practices serving deprived populations in Glasgow, Scotland. Objectives: To assess the implementation and impact of the intervention at patient and practice levels. Methods: Study design: Quasi-experimental outcome evaluation with embedded theory-driven process evaluation in 15 practices randomized to receive the intervention or not. Complex intervention: Comprising a practice development fund, a practice-based community links practitioner (CLP), and management support. It aims to link patients to local community organizations and enhance practices’ social prescribing capacity. Study population: For intervention practices, staff and adult patients involved in referral to a CLP, and a sample of community organization staff. For comparison practices, all staff and a random sample of adult patients. Sample size: 286 intervention and 484 comparator patients. Outcomes: Primary patient outcome is health-related quality of life (EQ-5D-5L). Secondary patient outcomes include capacity, depression/anxiety, self-esteem, and healthcare utilization. Practice outcome measures include team climate, job satisfaction, morale, and burnout. Outcomes measured at baseline and 9 months. Processes: Barriers and facilitators to implementation of the programme and possible mechanisms through which outcomes are achieved. Analysis plan: For outcome, intention-to-treat analysis with differences between groups tested using mixed-effects regression models. For process, case-study approach with thematic analysis. Discussion: This evaluation will provide new evidence about the implementation and impact of social prescribing by general practices serving patients with complex needs living in areas of high deprivation

Qualitative systematic review of the acceptability, feasibility, barriers, facilitators and perceived utility of using physical activity in the reduction of and abstinence from alcohol and other drug use

Given the growing global increase in harm from alcohol and substance use, and the inadequacy of standard treatment to tackle the challenge, the use of physical activity (PA) interventions has received increased attention. The aim of this review is to identify common and cross cutting themes relating to how and why physical activity may impact on reduction of/abstinence from alcohol and other drug use to support future intervention design (including aspects of physical activity, barriers and facilitators, and elements of support which may have an impact). Twenty papers including qualitative data were included in the synthesis. A deductive coding framework was created and sought to identify biological, environmental and psycho-social barriers, facilitators and mechanisms of participants’ experience of engaging with physical activity interventions. Key themes supported in the evidence included how interventions influence use (e.g. reduced cravings, increases in bodily awareness and health and fitness, the development of positive focus and new identity, and increases in mood and quality of life); the impact of frequency, intensity, type, duration and timing of physical activity; perceived barriers and facilitators to engaging in physical activity (e.g. health and fitness, access and affordability, perceptions of others); and details of how much support and in what form best supports sustained changes in physical activity (e.g. social support and environment). Despite evidence being sparse, key barriers and facilitators pertinent to intervention design were identified. Recommendations for future research are indicated and the evidence promotes the need for individually tailored programmes of support for physical activity.Given the growing global increase in harm from alcohol and substance use, and the inadequacy of standard treatment to tackle the challenge, the use of physical activity (PA) interventions has received increased attention. The aim of this review is to identify common and cross cutting themes relating to how and why physical activity may impact on reduction of/abstinence from alcohol and other drug use to support future intervention design (including aspects of physical activity, barriers and facilitators, and elements of support which may have an impact). Twenty papers including qualitative data were included in the synthesis. A deductive coding framework was created and sought to identify biological, environmental and psycho-social barriers, facilitators and mechanisms of participants’ experience of engaging with physical activity interventions. Key themes supported in the evidence included how interventions influence use (e.g. reduced cravings, increases in bodily awareness and health and fitness, the development of positive focus and new identity, and increases in mood and quality of life); the impact of frequency, intensity, type, duration and timing of physical activity; perceived barriers and facilitators to engaging in physical activity (e.g. health and fitness, access and affordability, perceptions of others); and details of how much support and in what form best supports sustained changes in physical activity (e.g. social support and environment). Despite evidence being sparse, key barriers and facilitators pertinent to intervention design were identified. Recommendations for future research are indicated and the evidence promotes the need for individually tailored programmes of support for physical activity

Federally Funded Pelvic Floor Disorder Research Underreports and Inadequately Includes Women of Varied Race and Ethnicity

Objectives Inclusion of participants of color and varied ethnicity is a priority of federally sponsored research. Our objective was to describe the reporting of race and ethnicity in federally funded research published by the NICHD-funded Pelvic Floor Disorders Network (PFDN). Materials and Methods Data from PFDN publications were extracted regarding whether race or ethnicity were reported. The number of participants included in each manuscript who were identified as White, Black, Asian, Native American, and “other” and the number that were identified of Hispanic ethnicity were recorded. Data were analyzed by publication and by pelvic floor disorder (PFD) condition investigated, including urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI), pregnancy-related PFDs, or multiple PFDs. Many publications reported on overlapping patient populations. Therefore, we analyzed the data both by counting participants every time they were reported (participants reported or PRs) and by counting unique participants in original trials (primary paper published). Results One hundred thirty-two PFDN publications were published between 2003 and 2020. Of these, 21 were excluded as they were methods papers or described research without participants. Of the 111 remaining articles, 90 (81%) included descriptions of race and 55 (50%) of ethnicity. All 13 primary trials described race, and 10/13 (76.9%) described ethnicity. Of those publications describing race, 50/90 (56%) included only the descriptors White, Black, and “other”, and 14/90 (16%) only described the percentage of White patients. Of 49,218 PRs, there were 43,058 (87%) with reporting of race and 27,468 (56%) with reporting of ethnicity. Among PRs with race and ethnicity reported, 79% were reported as White, 9.9% Black, 0.4% Asian, 0.1% Native American, and 4% “other”; 13% were of Hispanic ethnicity. There were 3,906 unique patients in primary studies, all of which had race reported and 3,337 (85.4%) had ethnicity reported. Ethnic distribution was similar between the unique patients and PRs (P=0.09), but racial distribution was different (P\u3c0.01). Table 1 displays the racial and ethnic distribution by type of PFD being studied of PRs and unique participants in the original trials. The racial and ethnic diversity by analysis of PRs and by analysis of unique patients was varied based on PFD study topic (P\u3c0.01). These differences were driven by pregnancy-related and FI studies having lower proportions of White patients than studies of other PFDs. Conclusion Federally funded PFDN research does not consistently report race and ethnicity of participants, and even in those that report these characteristics, women of color and Hispanic ethnicity are underrepresented. Consistent reporting and recruitment of diverse women is needed to address this systemic inequity