A narrow bimalleolar width is a risk factor for ankle inversion injury in male military recruits: A prospective study

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Background: Ankle inversion injuries are one of the most common and burdensome injuries in athletic populations. Research that prospectively identifies characteristics associated with this injury is lacking. This prospective study compared baseline anthropometric and biomechanical gait characteristics of military recruits who sustained an ankle inversion injury during training, with those who remained injury-free. Methods: Bilateral plantar pressure and three-dimensional lower limb kinematics were recorded in 1065 male, injury-free military recruits, during barefoot running. Injuries that occurred during the 32-week recruit training programme were subsequently recorded. Data were compared between recruits who sustained an ankle inversion injury during training (n=27) and a sample (n=120) of those who completed training injury-free. A logistic regression analysis was used to identify risk factors for this injury. Findings: A narrower bimalleolar width and an earlier peak pressure under the fifth metatarsal were predictors of ankle inversion injury. Those who sustained an ankle inversion injury also had a lower body mass, body mass index, and a smaller calf girth than those who completed training injury-free. Interpretation: Anthropometric and dynamic gait characteristics have been identified that may predispose recruits to an ankle inversion injury during Royal Marine recruit training, allowing identification of recruits at higher risk at the start of training

School‐based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Non-pharmacological interventions for attention-deficit/hyperactivity disorder are useful treatments, but it is unclear how effective school-based interventions are for a range of outcomes and which features of interventions are most effective. This paper systematically reviews randomized controlled trial evidence of the effectiveness of interventions for children with ADHD in school settings. Three methods of synthesis were used to explore the effectiveness of interventions, whether certain types of interventions are more effective than others and which components of interventions lead to effective academic outcomes. Twenty-eight studies (n=1,807) were included in the review. Eight types of interventions were evaluated and a range of different ADHD symptoms, difficulties and school outcomes were assessed across studies. Meta-analysis demonstrated beneficial effects for interventions that combine multiple features (median effect size g=0.37, interquartile range 0.32, range 0.09 to 1.13) and suggest some promise for daily report card interventions (median g=0.0.62, IQR=0.25, range 0.13 to 1.62). Meta-regression analyses did not give a consistent message regarding which types of interventions were more effective than others. Finally, qualitative comparative analysis demonstrated that self-regulation and one-to-one intervention delivery were important components of interventions that were effective for academic outcomes. These two components were not sufficient though; when they appeared with personalisation for individual recipients and delivery in the classroom, or when interventions did not aim to improve child relationships, interventions were effective. This review provides updated information about the effectiveness of non-pharmacological interventions specific to school settings and gives tentative messages about important features of these interventions for academic outcomes

Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice

Multicomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns et al. considers the effectiveness and cost-effectiveness of all types of multicomponent interventions for older adults undergoing elective inpatient surgery. Enhanced recovery programmes (ERPs) were the most commonly evaluated intervention. An association between ERPs and decreased length of stay was observed, whilst complication rates and time to recovery were static or sometimes reduced. Important areas which lack research in the context of ERPs are patient-reported outcome measures, patients with complex needs and assessment of factors pertaining to successful ERP implementation. The next generation of ERP studies should seek to develop our understanding in these key areas

Baseline study in environmental risk assessment – Escalating need for computer models to be whole-system approach

Despite landfills having the potential to pollute the environment both during their operation and long after they have ceased to receive waste, they remain a dominant waste management option, particularly in the UK. In order to combat the environmental pollution caused by landfills, risk analysis is increasingly being employed through computer models. However, for a risk analysis process to be successful, its foundation has to be well established through a baseline study. This paper aims to identify knowledge gaps in software packages regarding environmental risk assessments in general, and especially those that have been developed specifically for landfills and landfill leachate. The research establishes that there is no holistic computer model for the baseline study of landfills, which risk assessors can use to conduct risk analyses specifically for landfill leachate. This paper also describes a number of factors and features that should be added to the baseline study system in order to render it more integrated – thereby enhancing quantitative risk analysis, and subsequently environmental risk management

Evidence for specialist treatment of people with acquired brain injury in secure psychiatric services: systematic review and narrative synthesis

This is the final version. Available from NIHR Journals Library via the DOI in this recordThe protocol for this systematic review is available in ORE at http://hdl.handle.net/10871/40286Patients with acquired brain injury (ABI) may experience various physical, cognitive or emotional sequelae and are at increased risk of mental health difficulties. They may display aggressive, sexually inappropriate or disinhibited behaviour which challenges those supporting them and poses a risk to themselves or others. Such individuals may need assessment, care and/or treatment within secure settings. There is limited availability of secure placements and referral must be based on the patient meeting certain criteria. Objectives To systematically review evidence that can inform the arrangements for the specialist care of adults with ABI who may require secure psychiatric services. Data sources Seven bibliographic databases (CINAHL, HMIC, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Social Policy & Practice, ASSIA) were searched on 27th June 2019, date-limited to 2000. Database searches were supplemented with citation searching; inspecting relevant reviews; searching ClinicalTrials.gov and WHO International Clinical Trials Registry Platform, searching relevant websites; liaising with clinical experts and affiliation searches. Review methods We sought evidence about adults with non-degenerative ABI placed in, eligible for referral to, or being assessed for eligibility for referral to secure psychiatric services in any highincome country. Eligibility for referral to secure services was based on assessment or observation of challenging behaviours. Psychometric studies of tools used in assessments were eligible for inclusion. Study selection, data extraction and quality assessment were completed independently by two reviewers. Given the heterogeneity of studies, outcomes and data, a narrative synthesis approach was used. We were interested in identifying patient, diagnostic or symptom characteristics associated with requiring care in secure settings. Findings 6297 unique titles and abstracts were screened against inclusion criteria, leading to full-text screening of 325 papers. Forty-six observational and case-control studies and one systematic review were included; however none were set in, or referred explicitly to secure settings. Thirty-eight of the primary studies evaluated patient characteristics associated with challenging behaviour. Eight primary studies and the systematic review evaluated the psychometric properties of measures used to assess challenging behaviour. Narrative synthesis indicated a highly heterogeneous set of studies providing uncertain evidence about patient characteristics which may be associated with challenging behaviours. Whilst tentative associations were found between certain patient characteristics and occurrence of challenging behaviour, the conflicting nature of this evidence reduces confidence in these findings. There was no strong evidence to recommend the use of specific patient assessment tools. Limitations We found no evidence regarding referrals to secure treatment settings and thus were not able to directly answer our research questions. Studies investigating associations between patient characteristics and challenging behaviours varied in methodological rigour and evidence was highly heterogeneous. Conclusions There is no direct evidence to support decisions about the suitable setting for the care of adults with ABI who display challenging behaviour. There is tentative evidence about patient characteristics associated with risk of challenging behaviour. Future work Primary research is needed to inform evidence-based decisions on the appropriate setting for the care of people with ABI who display challenging behaviour.National Institute for Health Research (NIHR

What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? Protocol for a systematic evidence map. Version 2

This is version 2 of the protocol. Version 1 is available in ORE at http://hdl.handle.net/10871/123482. Version 2 includes a number of small clarifying changes to version 1 of the protocol in line with the Campbell Collaboration methodological requirements for Evidence and Gap Maps. These were: - Included details of the method for identifying ongoing studies - Clarification and justification for the cut-off date for the searches for RCTs - Justification for the inclusion of studies from high income countries - Clarification of the unit of analysis for the evidence and gap map.Evaluating the potential of peer support is receiving abundant attention. This is in response to the increasing financial pressures on NHS, which has led health and social care sector to realise the importance of enabling patients and carers to support themselves more effectively. While there is strong evidence on effectiveness and cost-effectiveness of peer support intervention, it is currently not clear how future research could contribute in better understanding peer support interventions. Also, limited synthesised literature is available on which method of delivery of peer support may be the most effective in achieving positive patient outcomes and in terms of costs incurred. Thus, we aim to systematically map the volume, diversity and nature of recent, robust evidence for the use of peer support interventions in health and social care. We will conduct the systematic mapping in two stages: in stage 1 we will map systematic reviews of peer support, and in stage 2 we will map randomised controlled trials and health economic studies of peer support interventions that have not been included in recent systematic reviews. We will search several databases: MEDLINE, PsycINFO, Social Policy and Practice, HMIC, CINAHL, ASSIA and the Campbell Library. Supplementary web searches will be conducted. Results will be limited to English language studies conducted in high-income countries. Stage 1 search will be date limited from 2015 to-date. The date cut-off for the stage 2 searches will be determined following the completion of stage 1. Eligible studies will be those that involve users of adult services with a defined health and/or social care need accessing peer support delivered in any format (such as face-to-face, online, group, individual, mixed modes etc.), delivered by paid or unpaid peer supporters. Any comparator will be eligible for inclusion and all outcomes are of interest. In stage 1 of the review, high quality, recently published systematic reviews that include comparative studies (RCTs, non-randomised controlled trials, controlled and uncontrolled before-and-after trials and interrupted time series designs) evaluating the effectiveness and/or cost-effectiveness of peer support interventions will be included. The quality of all systematic reviews identified as eligible at stage 1 will be appraised using the AMSTAR2 quality appraisal tool. At stage 2. We will use the Cochrane Risk of Bias (ROB) tool and the CHEC list for assessing risk of bias of RCTs and the quality of economic evaluations, respectively. Following data extraction using EPPI Reviewer 4, studies will be entered into an interactive evidence map to visually represent the distribution of evidence across health and social care domains. The map will have multiple layers, such that studies can be identified by population group, type of peer support and outcome. We expect that by conducting this review, we will be able to direct users to existing evidence, funders to existing gaps, and reviewers to pockets of evidence that could be reviewed to help decision making. It may also be possible to use the map to identify research questions that cut across settings, populations and interventions that would help us to understand how to use peer support interventions most effectively.National Institute for Health Research (NIHR

What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? Protocol for a systematic evidence map. Version 1

This is version 1 of the protocol. Version 2 is available in ORE at http://hdl.handle.net/10871/125999. Version 2 includes a number of small clarifying changes to version 1 of the protocol in line with the Campbell Collaboration methodological requirements for Evidence and Gap Maps. These were: - Included details of the method for identifying ongoing studies - Clarification and justification for the cut-off date for the searches for RCTs - Justification for the inclusion of studies from high income countries - Clarification of the unit of analysis for the evidence and gap map.Evaluating the potential of peer support is receiving abundant attention. This is in response to the increasing financial pressures on NHS, which has led health and social care sector to realise the importance of enabling patients and carers to support themselves more effectively. While there is strong evidence on effectiveness and cost-effectiveness of peer support intervention, it is currently not clear how future research could contribute in better understanding peer support interventions. Also, limited synthesised literature is available on which method of delivery of peer support may be the most effective in achieving positive patient outcomes and in terms of costs incurred. Thus, we aim to systematically map the volume, diversity and nature of recent, robust evidence for the use of peer support interventions in health and social care. We will conduct the systematic mapping in two stages: in stage 1 we will map systematic reviews of peer support, and in stage 2 we will map randomised controlled trials and health economic studies of peer support interventions that have not been included in recent systematic reviews. We will search several databases: MEDLINE, PsycINFO, Social Policy and Practice, HMIC, CINAHL, ASSIA and the Campbell Library. Supplementary web searches will be conducted. Results will be limited to English language studies conducted in high-income countries. Stage 1 search will be date limited from 2015 to-date. The date cut-off for the stage 2 searches will be determined following the completion of stage 1. Eligible studies will be those that involve users of adult services with a defined health and/or social care need accessing peer support delivered in any format (such as face-to-face, online, group, individual, mixed modes etc.), delivered by paid or unpaid peer supporters. Any comparator will be eligible for inclusion and all outcomes are of interest. In stage 1 of the review, high quality, recently published systematic reviews that include comparative studies (RCTs, non-randomised controlled trials, controlled and uncontrolled before-and-after trials and interrupted time series designs) evaluating the effectiveness and/or cost-effectiveness of peer support interventions will be included. The quality of all systematic reviews identified as eligible at stage 1 will be appraised using the AMSTAR2 quality appraisal tool. At stage 2. We will use the Cochrane Risk of Bias (ROB) tool and the CHEC list for assessing risk of bias of RCTs and the quality of economic evaluations, respectively. Following data extraction using EPPI Reviewer 4, studies will be entered into an interactive evidence map to visually represent the distribution of evidence across health and social care domains. The map will have multiple layers, such that studies can be identified by population group, type of peer support and outcome. We expect that by conducting this review, we will be able to direct users to existing evidence, funders to existing gaps, and reviewers to pockets of evidence that could be reviewed to help decision making. It may also be possible to use the map to identify research questions that cut across settings, populations and interventions that would help us to understand how to use peer support interventions most effectively.National Institute for Health Research (NIHR

Authors’ reply re: painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey

No abstract available

Bursting out of our bubble: using creative techniques to communicate within the systematic review process and beyond

This is the final version. Available on open access from BMC via the DOI in this recordBACKGROUND: Increasing pressure to publicise research findings and generate impact, alongside an expectation from funding bodies to go beyond publication within academic journals, has generated interest in alternative methods of science communication. Our aim is to describe our experience of using a variety of creative communication tools, reflect on their use in different situations, enhance learning and generate discussion within the systematic review community. METHODS: Over the last 5 years, we have explored several creative communication tools within the systematic review process and beyond to extend dissemination beyond traditional academic mechanisms. Central to our approach is the co-production of a communication plan with potential evidence users which facilitates (i) the identification of key messages for different audiences, (ii) discussion of appropriate tools to communicate key messages and (iii) exploration of avenues to share them. We aim to involve evidence users in the production of a variety of outputs for each research project cognisant of the many ways in which individuals engage with information. RESULTS: Our experience has allowed us to develop an understanding of the benefits and challenges of a wide range of creative communication tools. For example, board games can be a fun way of learning, may flatten power hierarchies between researchers and research users and enable sharing of large amounts of complex information in a thought provoking way, but they are time and resource intensive both to produce and to engage with. Conversely, social media shareable content can be quick and easy to produce and to engage with but limited in the depth and complexity of shareable information. DISCUSSION: It is widely recognised that most stakeholders do not have time to invest in reading large, complex documents; creative communication tools can be a used to improve accessibility of key messages. Furthermore, our experience has highlighted a range of additional benefits of embedding these techniques within our project processes e.g. opening up two-way conversations with end-users of research to discuss the implications of findings.National Institute for Health Research (NIHR

Population mixing and incidence of cancers in adolescents and young adults between 1990 and 2013 in Yorkshire, UK

Purpose: Epidemiological evidence suggests a role for an infectious etiology for cancers in teenagers and young adults (TYAs). We investigated this by describing associations between infection transmission using the population mixing (PM) proxy and incidence of cancers in TYAs in Yorkshire, UK. Methods: We extracted cancer cases from the Yorkshire Specialist Register of Cancer in Children and Young People from 1990 to 2013 (n = 1929). Using multivariable Poisson regression models (adjusting for effects of deprivation and population density), we investigated whether PM was associated with cancer incidence. We included population mixing–population density interaction terms to examine for differences in effects of PM in urban and rural populations. Results: Nonsignificant IRRs were observed for leukemias (IRR 1.20, 95% CI 0.91–1.59), lymphomas (IRR 1.09, 95% CI 0.90–1.32), central nervous system tumors (IRR 1.06, 95% CI 0.80–1.40) and germ cell tumors (IRR 1.14, 95% CI 0.92–1.41). The association between PM and cancer incidence did not vary in urban and rural areas. Conclusions: Study results suggest PM is not associated with incidence of cancers among TYAs. This effect does not differ between rural and urban settings