Diabetes in athletes

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of diabetes in athletes

Improving relationship-based practice, practitioner confidence and family engagement skills through restorative approach training

Restorative Approach (RA) is an ethos and process that has been linked to a reduction of interpersonal conflict and improved relationships in various service settings but whose use is little explored in family services. This paper describes the findings of an evaluation of a training programme; The Restorative Approaches Family Engagement Project that was delivered to voluntary sector family practitioners across Wales with the intent of increasing the use of RA amongst practitioners and agencies, raising practitioner confidence when working with vulnerable families, and improving the extent to which and how practitioners engage with families. The study employed mixed methods. Quantitative measures investigated pre- and post- training practitioner perceptions of confidence, levels of family engagement, and organisational attitudes to RA. Post-training focus groups explored practitioner opinion of RAFEP and perceived changes to service delivery and receipt. Findings suggest RAFEP training promoted practitioner understanding of RA and increased perceptions of confidence when working with families in four specific aspects: developing positive relationships with service users, increasing communication, identifying service user needs/goals, and facilitating change. Qualitative data indicated that practitioners attributed the increased confidence to the service delivery framework engendered by the training and associated tools which facilitated its use and improved family engagement. Whilst host organisations were generally supportive of practitioners attending RAFEP training there was little evidence that knowledge and use of RA had been fully integrated into practitioner host agencies unless the organisation had previously used a restorative ethos

Exercise-induced asthma

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of exercise induced asthma

Optimising a co-production framework for developing public health interventions: application and testing of school-based Research Action Groups

Existing frameworks for developing public health interventions have limited guidance for researchers on how to work with stakeholders to co-produce context-specific interventions. To address this, a promising framework for the co-production of public health interventions was developed through a previous review of school-based co-production. The present study aimed to optimise this co-production framework through applying and testing it in real-world secondary school contexts. Within schools, Research Action Groups (RAGs) were established with multiple school stakeholders supported by an external facilitator to use school data to produce school-specific mental health and wellbeing interventions. A mixed method process evaluation of two contextually diverse case study secondary schools in the UK was used to optimise the co-production framework. The process evaluation sought the views of those involved (students, school staff, school Senior Management Team (SMT) members, and the external co-production facilitator/researcher) on the co-production functions they were involved in so they could be modified, if needed. Data collected for the process evaluation during co-production were a researcher diary (n = 45 entries), and observations of student photography (n = 21) and RAG meetings (n = 8). Post co-production, interviews, and surveys with RAG students (n = 18) and staff (n = 8), and two school-specific SMT focus groups (n = 10) were conducted. The study identified four recommendations to optimise and integrate co-production into real world practice. They include the need to: assess schools for their readiness to undertake co-production; more effectively communicate the necessity to have stakeholders from the whole system involved; work with SMTs throughout co-production functions; involve stakeholders outside the school to support producing solutions to change school mental health and wellbeing priorities. The framework is intended to be used by researchers to integrate stakeholders into a shared decision-making process to develop interventions that meet the needs and contexts of individual schools. It could be transferred to other settings to support the development of public health interventions for other health areas, and populations. Further evaluation to test its use in other settings is needed

Young carers, mental health and psychosocial wellbeing: A realist synthesis

Growing evidence demonstrates that the mental and psychosocial health impacts of caring vary significantly for individual children, depending on who they are, the person that they care for, their responsibilities and the wider family situation. Although individual studies have made progress in identifying the range of impacts, there is a lack of clarity around which impacts affect who and in what circumstances. This synthesis, based on RAMESES realist protocols, aims to increase clarity concerning how and why the mental and psychosocial health impacts of caring for a family member vary for different children. There were 12 391 unique search results screened at title, abstract and full-paper levels. Forty-four retained studies were analysed, resulting in the development of a model with 17 context-mechanism-outcome configurations. The model divides the configurations into three interlinking domains. The caregiving responsibilities domain considers how the impacts of caring vary with the circumstances of the individual young carer, the person they care for and their family. The identity domain details the development of a caring identity that potentially mitigates the negative effects of caring and enables positive benefits. The support domain concerns the support provided from family, community and services that, depending on quality, can mitigate or exacerbate the impacts of caring. Support also moderates the care identity by affecting self-perception of the caring role. The model has the potential to inform the development of interventions that target particular mechanisms to enable positive change for young carers. This potential can be enhanced by further research to test the model, with a focus on refining configurations where less evidence is available. There is a particular need to focus on identification which is under-represented in the model as both a mechanism and a contextual factor due to unidentified young carers being largely absent from past researc

Developing a model of the restorative approaches veteran family service

The negative impact of mental health illness on families is well known. Although the high incidence of mental health problems, especially PTSD, amongst military Veterans is recognised there is little systematic support for their families. TGP are a Welsh Charity which supports vulnerable and marginalised children, young people and families in Wales. TGP are closely associated with use of a Restorative Approach: a philosophy and practice drawn from Restorative Justice that is based on the shared set of democratic values such as honesty, trust, fairness, inclusion and collaboration. A Restorative Approach has been adopted in varied service settings including education and welfare, with encouraging signs of improved relationships and reduction in problems such as aggression and bullying. Recent research exploring use of a Restorative Approach in family support systems has found signs of better, more effective service provision and higher levels of family communication and reduced family conflict. TGP are seeking to provide a family support service for the families of Veterans with PTSD. To do so they are working with Veterans NHS Wales, a NHS service providing support for Welsh veterans with PTSD. The ‘Restorative Approach for Veteran Families Service’ seeks to work with families and Veterans alongside the VNHSW service with the intent of improving family relationships and dynamics and so benefitting the mental health of all family members including the Veteran. This research is evaluating the project over the first three years of development and implementation with the aim of identifying and addressing project facilitators and barriers and thereby producing the best model of service implementation

Exploratory trial of a school-based alcohol prevention intervention with a family component: Implications for implementation

Purpose – Involvement of parents/carers may increase effectiveness of primary school-based alcohol-misuse prevention projects through strengthening family-based protective factors, but rates of parental engagement are typically low. This paper reports findings from an exploratory trial of a school-based prevention intervention – Kids, Adults Together (KAT), based on the Social Development Model, which aimed to promote pro-social family communication in order to prevent alcohol misuse, and incorporated strategies to engage parents/carers. The purpose of this paper is to assess the feasibility and value of conducting an effectiveness trial of KAT. Design/methodology/approach – The study was a parallel-group cluster randomised exploratory trial with an embedded process evaluation. The study took place in south Wales, UK, and involved nine primary schools, 367 pupils in Years 5/6 (aged 9-11 years) and their parents/carers and teachers. Questionnaires were completed by pupils at baseline and four month follow-up, and by parents at six month follow-up. Findings – Overall KAT was delivered with good fidelity, but two of five intervention schools withdrew from the study without completing implementation. In total, 50 per cent of eligible parents participated in the intervention, and KAT had good acceptability among pupils, parents and teachers. However, a number of “progression to effectiveness trial” criteria were not met. Intermediate outcomes on family communication (hypothesised to prevent alcohol misuse) showed insufficient evidence of an intervention effect. Difficulties were encountered in identifying age appropriate outcome measures for primary school-age children, particularly in relation to family communication processes. The study was unable to find comprehensive methodological guidance on exploratory trials. Research limitations/implications – It would not be appropriate to conduct an effectiveness trial as key progression criteria relating to intervention and trial feasibility were not met. There is a need for new measures of family communication which are suitable for primary school-age children, and more guidance on the design and conduct of exploratory/feasibility trials. Originality/value – KAT achieved high rates of parental involvement, and its theoretical framework and processes could be adapted by other interventions which experience difficulties with recruitment of parents/carers

Development and Validation of ML-DQA -- a Machine Learning Data Quality Assurance Framework for Healthcare

The approaches by which the machine learning and clinical research communities utilize real world data (RWD), including data captured in the electronic health record (EHR), vary dramatically. While clinical researchers cautiously use RWD for clinical investigations, ML for healthcare teams consume public datasets with minimal scrutiny to develop new algorithms. This study bridges this gap by developing and validating ML-DQA, a data quality assurance framework grounded in RWD best practices. The ML-DQA framework is applied to five ML projects across two geographies, different medical conditions, and different cohorts. A total of 2,999 quality checks and 24 quality reports were generated on RWD gathered on 247,536 patients across the five projects. Five generalizable practices emerge: all projects used a similar method to group redundant data element representations; all projects used automated utilities to build diagnosis and medication data elements; all projects used a common library of rules-based transformations; all projects used a unified approach to assign data quality checks to data elements; and all projects used a similar approach to clinical adjudication. An average of 5.8 individuals, including clinicians, data scientists, and trainees, were involved in implementing ML-DQA for each project and an average of 23.4 data elements per project were either transformed or removed in response to ML-DQA. This study demonstrates the importance role of ML-DQA in healthcare projects and provides teams a framework to conduct these essential activities.Comment: Presented at 2022 Machine Learning in Health Care Conferenc