The application of Evidence-Based Medicine methodologies in sports science: problems and solutions

This thesis analyses the use of 'Evidence-Based' methodologies of evidence assessment and intervention and policy design from medicine, and their use in sport and exercise science. It argues that problems exist with the application of Evidence-Based methodologies in sports science, meaning that the quality of evidence used to inform decision-making is lower than is often assumed. This thesis also offers realistic solutions to these problems, broadly arguing for the importance of taking evidence from mechanistic studies seriously, in addition to evidence from RCTs

Confident, Credible but Lonely – Outcomes Following Postgraduate Interprofessional Education in Rehabilitation

Background: Interprofessional education aims to enhance health service delivery. This study examined whether health professionals changed their clinical practice after completing a postgraduate interprofessional qualification in rehabilitation. Methods & Findings: All graduates of postgraduate qualifications in rehabilitation at University of Otago were invited to complete a questionnaire. Thirteen participants were purposively selected for further in-depth interviews. Questionnaire data were summarized using descriptive statistics. Qualitative responses from questionnaires and interview transcripts were explored using thematic analysis. The survey response rate was 24% (77/315 students). Postgraduate study was reported to have had a positive impact on professional attitudes and commitment to learning (81%), to enhance interdisciplinary collaboration (79%), and to promote change in service delivery (40%). Themes identified from questionnaire responses were: 1) increased confidence, 2) enhanced credibility, and 3) widened view of rehabilitation. Analysis of the interviews identified three contrasting themes: 1) isolation hampers momentum, 2) managers and clinical leaders do not value postgraduate qualifications, 3) implementing change required postgraduate study plus persistence. Conclusions: Educators and employers of health professionals should be aware of the benefits of postgraduate interprofessional education for health professionals and healthcare delivery. Employers should recognize and value these benefits and support health professionals to apply new skills in their clinical practice

Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study

Objectives To understand the perspectives of people with severe chronic obstructive pulmonary disease (COPD) as their illness progresses, and of their informal and professional carers, to inform provision of care for people living and dying with COPD

Traumatic brain injury rehabilitation: an overview of systematic reviews of intervention effectiveness. A pre-published protocol

INTRODUCTION. Many authors are in favour of using systematic reviews as a method for evidence synthesis in rehabilitation and the last decade has introduced several guidelines to help with their implementation in rehabilitation contexts. At present, however, there is little clear information about the quantity and quality of systematic reviews on TBI rehabilitation interventions. AIM. We aim to conduct an overview of systematic reviews published on TBI rehabilitation interventions in order to summarise the current state of evidence in this area of clinical practice. In addition to providing information on strength of evidence for intervention effectiveness, our goal is to research and summarise two additional domains: reviews’ characteristics and evidence gaps. METHODS. We will carry out a comprehensive search of the Cochrane Library database (including Database of Abstracts and Reviews of Effectiveness) MEDLINE, CINAHL, EMBASE, Epistemonikos, PDQ-evidence, and PubMed to find relevant systematic reviews. We also will make efforts to identify ongoing reviews by searching for protocols in the Cochrane Library database and in PROSPERO. We are not going to search grey literature. We will use Covidence (https://www.covidence.org/home) to manage review selection. Two review team members will independently select the reviews to be included to the overview. A third researcher will be consulted for resolving disagreements. We will use Knack software (https://www.knack.com/), to extract data on review characteristics and review findings. We will include the systematic reviews on the adult TBI population (regardless of severity, stage of recovery, or other aspects of clinical presentation), any kind of rehabilitation interventions (regardless of setting, uni- or multidisciplinarity etc) to describe review characteristics. From those systematic reviews the ones with comparisons with no treatment, placebo or sham treatment, and usual care; and with outcomes such as quality of life, activity and participation – as per International Classification of Functioning, Disability & Health –residential status, family burden, and adverse effects will provide basis for intervention effectiveness analysis. We will assess the quality of reporting with updated PRISMA (Transparent Reporting of Systematic Reviews and Meta-Analysis) by making a judgement of “yes/no/unclear” without further descriptions. We will assess the methodological quality of included reviews with AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) instrument. SYNTHESIS. We will provide a report on the characteristics of all included reviews using simple statistical analyses and narrative accounts and the main summary of results based on intervention effectiveness. Also, we aim to present conclusions specific to each intervention in terms of the current evidence base: statistical and/or narrative descriptions of effects and the evidence quality, relevant contextual factors, population, rehabilitation setting, and comparisons researched. We will not perform meta-analysis. In order to example gaps in the current evidence of TBI rehabilitation, we will separately summarise the information on ICF categorizations covered with low or very-low quality evidence or no evidence at all from existing systematic reviews. CONCLUSIONS. To support knowledge translation, we will organise the overview of reviews’ findings as comprehensive evidence maps

Exploring the experience of sleep and fatigue in male and female adults over the 2 years following traumatic brain injury: a qualitative descriptive study

To explore the experience of fatigue and sleep difficulties over the first 2 years after traumatic brain injury (TBI). Longitudinal qualitative descriptive analysis of interviews completed as part of a larger longitudinal study of recovery following TBI. Data relating to the experience of fatigue and/or sleep were extracted and coded by two independent researchers. Community-based study in the Hamilton and Auckland regions of New Zealand. 30 adult participants who had experienced mild, moderate or severe brain injury within the past 6 months (>16 years of age). 15 participants also nominated significant others to take part. Interviews were completed at 6, 12 and 24 months postinjury. Participants described feeling unprepared for the intensity, impact and persistent nature of fatigue and sleep difficulties after injury. They struggled to learn how to manage their difficulties by themselves and to adapt strategies in response to changing circumstances over time. Four themes were identified: (1) Making sense of fatigue and sleep after TBI; (2) accepting the need for rest; (3) learning how to rest and; (4) need for rest impacts on ability to engage in life. Targeted support to understand, accept and manage the sleep and fatigue difficulties experienced may be crucial to improve recovery and facilitate engagement in everyday life. Advice needs to be timely and revised for relevance over the course of recovery

Getting shot of elves: healing, witchcraft and fairies in the Scottish witchcraft trials

This paper re-examines the evidence of the Scottish witchcraft trials for beliefs associated by scholars with "elf-shot." Some supposed evidence for elf-shot is dismissed, but other material illuminates the interplay between illness, healing and fairy-lore in early modern Scotland, and the relationship of these beliefs to witchcraft itself

Factors influencing referral to and uptake and attendance of pulmonary rehabilitation for chronic obstructive pulmonary disease: a qualitative evidence synthesis of the experiences of service users, their families, and healthcare providers (Protocol)

This is a protocol for a Cochrane Review (Qualitative). The object ives are as follows: • To identify factors that influence referral to pulmonary rehab ilitation for COPD from the perspective of service users, thei r family/carers, and healthcare providers. • To identify factors that influence uptake of pulmonary rehabil itation for COPD (i.e. at least one attendance of an assessment or first programme session) from the perspective of service users , their family/carers, and healthcare providers. • To identify factors that influence attendance at pulmonary reha bilitation programmes for COPD from the perspective of servi ce users, their family/carers, and healthcare providers. • To develop an inductive explanatory framework for how these f actors may interact to contribute to better or poorer uptake or completion of pulmonary rehabilitation in order to guide acti ons of healthcare decision-makers to improve opportunities fo r people with COPD to benefit from pulmonary rehabilitation

Neptune to the Common-wealth of England (1652): the republican Britannia and the continuity of interests

In the seventeenth century, John Kerrigan reminds us, “models of empire did not always turn on monarchy”. In this essay, I trace a vision of “Neptune’s empire” shared by royalists and republicans, binding English national interest to British overseas expansion. I take as my text a poem entitled “Neptune to the Common-wealth of England”, prefixed to Marchamont Nedham’s 1652 English translation of Mare Clausum (1635), John Selden’s response to Mare Liberum (1609) by Hugo Grotius. This minor work is read alongside some equally obscure and more familiar texts in order to point up the ways in which it speaks to persistent cultural and political interests. I trace the afterlife of this verse, its critical reception and its unique status as a fragment that exemplifies the crossover between colonial republic and imperial monarchy at a crucial moment in British history, a moment that, with Brexit, remains resonant