93 research outputs found
Amitriptyline at low-dose and titrated for irritable bowel syndrome as second-line treatment (The ATLANTIS trial):protocol for a randomised double-blind placebo-controlled trial in primary care
Development of a Supported Self-management Intervention for People With Severe Mental Illness and Type 2 Diabetes: Theory and Evidence-Based Co-design Approach
BACKGROUND: Type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the inequalities they experience within health care services. OBJECTIVE: We combined theory, empirical evidence, and co-design approaches to develop a type 2 diabetes self-management intervention for people with SMI. METHODS: The development process encompassed 4 steps: step 1 involved prioritizing the mechanisms of action (MoAs) and behavior change techniques (BCTs) for the intervention. Using findings from primary qualitative research and systematic reviews, we selected candidate MoAs to target in the intervention and candidate BCTs to use. Expert stakeholders then ranked these MoAs and BCTs using a 2-phase survey. The average scores were used to generate a prioritized list of MoAs and BCTs. During step 2, we presented the survey results to an expert consensus workshop to seek expert agreement with the definitive list of MoAs and BCTs for the intervention and identify potential modes of delivery. Step 3 involved the development of trigger films using the evidence from steps 1 and 2. We used animations to present the experiences of people with SMI managing diabetes. These films were used in step 4, where we used a stakeholder co-design approach. This involved a series of structured workshops, where the co-design activities were informed by theory and evidence. RESULTS: Upon the completion of the 4-step process, we developed the DIAMONDS (diabetes and mental illness, improving outcomes and self-management) intervention. It is a tailored self-management intervention based on the synthesis of the outputs from the co-design process. The intervention incorporates a digital app, a paper-based workbook, and one-to-one coaching designed to meet the needs of people with SMI and coexisting type 2 diabetes. CONCLUSIONS: The intervention development work was underpinned by the MoA theoretical framework and incorporated systematic reviews, primary qualitative research, expert stakeholder surveys, and evidence generated during co-design workshops. The intervention will now be tested for feasibility before undergoing a definitive evaluation in a pragmatic randomized controlled trial
Patients as qualitative data analysts: developing a method for a process evaluation of the âImproving the Safety and Continuity Of Medicines management at care Transitionsâ (ISCOMAT) randomised controlled trial
Background
How to meaningfully partner with patients as data analysts remains obscure. A process evaluation of the âImproving the Safety and Continuity Of Medicines management at care Transitionsâ (ISCOMAT) cluster randomised control trial of an intervention for improving medicines use for people living with heart failure is being conducted. The intervention includes patient held information on heart medicines and care, enhanced communication between hospital and community pharmacists, and increased engagement of community pharmacists with patient care postâhospital discharge. ISCOMAT patients living with heart failure were interviewed about experiences with the intervention. We sought to gain insights from patients on data collected to enhance our understanding of experiences with the intervention.
Objective
To develop a method for involving patients as analysts of qualitative data in a process evaluation.
Design
Patients and researchers coâanalysed qualitative data. A framework method was applied involving; familiarisation, coding, developing an analytical framework and interpretation. The process was facilitated through home working and a workshop with a training component.
Results
The coâdesigned framework enabled researchers to map all further patient interview data. Patients' specialist knowledge enhanced understanding of how the ISCOMAT intervention can be best implemented.
Conclusions
Patientsâ unique experiences can enhance validity and rigour in data analysis through sharing their interpretations of qualitative data. The involvement process is crucial in elucidating knowledge and avoiding tokenism. As analysts, patients gain an appreciation of research processes, building trust between researchers and patients. Group dynamics and involving patients throughout the whole research process are important considerations
Regional and national antimicrobial stewardship activities:a survey from the Joint Programming Initiative on Antimicrobial Resistance - Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)
Exploring severe mental illness and diabetes : protocol for a longitudinal observational and qualitative mixed methods study
Background: The average life expectancy for people with a severe mental illness (SMI) such as schizophrenia or bipolar disorder is 15-20 years less than for the population as a whole. Diabetes contributes significantly to this inequality, being 2-3 times more prevalent in people with SMI. Various risk factors have been implicated, including side effects of antipsychotic medication and unhealthy lifestyles, which often occur in the context of socio-economic disadvantage and healthcare inequality. However, little is known about how these factors interact to influence the risk of developing diabetes and poor diabetic outcomes, or how the organisation and provision of healthcare may contribute. Objective: The study aims to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with SMI. Methods: This study will employ a concurrent mixed methods design combining the interrogation of electronic primary care health records from the Clinical Practice Research Datalink (CPRD GOLD) with qualitative interviews with adults with SMI and diabetes, their relatives/friends, and healthcare staff. The study has been funded for two years, from September 2017 to September 2019 and data collection has recently ended. Results: CPRD and linked health data will be used to explore the association of socio-demographic, illness and healthcarerelated factors with both the development and outcomes of Type 2 diabetes in people with SMI. Experiences of managing the comorbidity and accessing healthcare will be explored through qualitative interviews using topic guides informed by evidence synthesis and expert consultation. Findings from both datasets will be merged to develop a more comprehensive understanding of diabetes risks, interventions and outcomes for people with SMI. Findings will be translated into recommendations for interventions and services using co-design workshops. Conclusions: Improving diabetes outcomes for people with SMI is a high priority area nationally and globally. Understanding how risk factors combine to generate high prevalence of diabetes and poor diabetic outcomes for this population is a necessary first step in developing healthcare interventions to improve outcomes for people with diabetes and SMI
Young ghosts: ethical and methodological issues of historical research in children's geographies
This paper was published in the journal, Children's Geographies [© Taylor & Francis] and the definitive version is available at: http://dx.doi.org/10.1080/14733285.2012.693838Geographers researching children and young people have often been at the forefront of disciplinary
debates in geography surrounding methodological practice and ethical considerations
(Matthews et al. 1998, Valentine 1999, Pain 2004, Hemming 2008, Hopkins and Bell 2008,
van Blerk and Barker 2008). In this short paper, I want to focus on a less-popular research
method used by childrenâs geographers â archival methods (cf. Gagen 2000, 2001) â and
reflect specifically on some of its methodological and ethical challenges. I argue that thinking
about historical research can challenge childrenâs geographers to consider other types of encounter
from that of the (embodied) encounter between a researcher and a child (Horton 2008). These
different and multiple encounters include those between the (adult) creator of âmaterialâ and a
young person, a young person (as creator) and their intended audience, and the further encounter
between a young person from the past and a present-day researcher during fieldwork. The spatial
and temporal deferral in some of these encounters suggests a re-thinking of how we approach and
conceptualise research âwithâ young people. Furthermore, these (dis)embodied encounters can
challenge ethical norms in childrenâs geographies such as consent, confidentiality and positionality
in different but overlapping ways. I contend that childrenâs geographers are well versed in
these ethical issues, some of which transfer well into the practice of historical research. For
example, issues surrounding childrenâs âvoiceâ and responsibility are quite similar (as I later
discuss), but there is a difference between contemporary and historical research in terms of the
media involved (your own tape recordings or someone elseâs recorded tapes; fresh participatory
artwork or dust-covered diaries) and a different retrieval process (direct embodied research with
young people or deferred connections in another building, time and place)
Early Release Science of the Exoplanet WASP-39b with JWST NIRSpec G395H
Measuring the abundances of carbon and oxygen in exoplanet atmospheres is
considered a crucial avenue for unlocking the formation and evolution of
exoplanetary systems. Access to an exoplanet's chemical inventory requires
high-precision observations, often inferred from individual molecular
detections with low-resolution space-based and high-resolution ground-based
facilities. Here we report the medium-resolution (R600) transmission
spectrum of an exoplanet atmosphere between 3-5 m covering multiple
absorption features for the Saturn-mass exoplanet WASP-39b, obtained with JWST
NIRSpec G395H. Our observations achieve 1.46x photon precision, providing an
average transit depth uncertainty of 221 ppm per spectroscopic bin, and present
minimal impacts from systematic effects. We detect significant absorption from
CO (28.5) and HO (21.5), and identify SO as the
source of absorption at 4.1 m (4.8). Best-fit atmospheric models
range between 3 and 10x solar metallicity, with sub-solar to solar C/O ratios.
These results, including the detection of SO, underscore the importance of
characterising the chemistry in exoplanet atmospheres, and showcase NIRSpec
G395H as an excellent mode for time series observations over this critical
wavelength range.Comment: 44 pages, 11 figures, 3 tables. Resubmitted after revision to Natur
Early Release Science of the exoplanet WASP-39b with JWST NIRCam
Measuring the metallicity and carbon-to-oxygen (C/O) ratio in exoplanet
atmospheres is a fundamental step towards constraining the dominant chemical
processes at work and, if in equilibrium, revealing planet formation histories.
Transmission spectroscopy provides the necessary means by constraining the
abundances of oxygen- and carbon-bearing species; however, this requires broad
wavelength coverage, moderate spectral resolution, and high precision that,
together, are not achievable with previous observatories. Now that JWST has
commenced science operations, we are able to observe exoplanets at previously
uncharted wavelengths and spectral resolutions. Here we report time-series
observations of the transiting exoplanet WASP-39b using JWST's Near InfraRed
Camera (NIRCam). The long-wavelength spectroscopic and short-wavelength
photometric light curves span 2.0 - 4.0 m, exhibit minimal systematics,
and reveal well-defined molecular absorption features in the planet's spectrum.
Specifically, we detect gaseous HO in the atmosphere and place an upper
limit on the abundance of CH. The otherwise prominent CO feature at 2.8
m is largely masked by HO. The best-fit chemical equilibrium models
favour an atmospheric metallicity of 1-100 solar (i.e., an enrichment
of elements heavier than helium relative to the Sun) and a sub-stellar
carbon-to-oxygen (C/O) ratio. The inferred high metallicity and low C/O ratio
may indicate significant accretion of solid materials during planet formation
or disequilibrium processes in the upper atmosphere.Comment: 35 pages, 13 figures, 3 tables, Nature, accepte
Photochemically-produced SO in the atmosphere of WASP-39b
Photochemistry is a fundamental process of planetary atmospheres that
regulates the atmospheric composition and stability. However, no unambiguous
photochemical products have been detected in exoplanet atmospheres to date.
Recent observations from the JWST Transiting Exoplanet Early Release Science
Program found a spectral absorption feature at 4.05 m arising from SO
in the atmosphere of WASP-39b. WASP-39b is a 1.27-Jupiter-radii, Saturn-mass
(0.28 M) gas giant exoplanet orbiting a Sun-like star with an equilibrium
temperature of 1100 K. The most plausible way of generating SO in
such an atmosphere is through photochemical processes. Here we show that the
SO distribution computed by a suite of photochemical models robustly
explains the 4.05 m spectral feature identified by JWST transmission
observations with NIRSpec PRISM (2.7) and G395H (4.5). SO
is produced by successive oxidation of sulphur radicals freed when hydrogen
sulphide (HS) is destroyed. The sensitivity of the SO feature to the
enrichment of the atmosphere by heavy elements (metallicity) suggests that it
can be used as a tracer of atmospheric properties, with WASP-39b exhibiting an
inferred metallicity of 10 solar. We further point out that
SO also shows observable features at ultraviolet and thermal infrared
wavelengths not available from the existing observations.Comment: 39 pages, 14 figures, accepted to be published in Natur
A core outcome set for evaluating self-management interventions in people with comorbid diabetes and severe mental illness : study protocol for a modified Delphi study and systematic review
BACKGROUND: People with diabetes and comorbid severe mental illness (SMI) form a growing population at risk of increased mortality and morbidity compared to those with diabetes or SMI alone. There is increasing interest in interventions that target diabetes in SMI in order to help to improve physical health and reduce the associated health inequalities. However, there is a lack of consensus about which outcomes are important for this comorbid population, with trials differing in their focus on physical and mental health. A core outcome set, which includes outcomes across both conditions that are relevant to patients and other key stakeholders, is needed. METHODS: This study protocol describes methods to develop a core outcome set for use in effectiveness trials of self-management interventions for adults with comorbid type-2 diabetes and SMI. We will use a modified Delphi method to identify, rank, and agree core outcomes. This will comprise a two-round online survey and multistakeholder workshops involving patients and carers, health and social care professionals, health care commissioners, and other experts (e.g. academic researchers and third sector organisations). We will also select appropriate measurement tools for each outcome in the proposed core set and identify gaps in measures, where these exist. DISCUSSION: The proposed core outcome set will provide clear guidance about what outcomes should be measured, as a minimum, in trials of interventions for people with coexisting type-2 diabetes and SMI, and improve future synthesis of trial evidence in this area. We will also explore the challenges of using online Delphi methods for this hard-to-reach population, and examine differences in opinion about which outcomes matter to diverse stakeholder groups. TRIAL REGISTRATION: COMET registration: http://www.comet-initiative.org/studies/details/911 . Registered on 1 July 2016
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