Prognostic factors for a change in eye health or vision: A rapid review

The general public are advised to have regular routine eye examinations to check their vision and ocular health; however current UK guidance on how often to have eye examinations is not evidence-based and was issued in 2002.This Rapid Review aims to provide an evidence base that stakeholders can use to form updated guidance for Wales by asking the question ‘What are the prognostic factors for a change in ocular status in the general population attending routine eye examinations?’The review included evidence available from January 2009 up until August 2023. Evidence was included from 2011 up until 2023. 19 studies were included: two systematic reviews; nine prospective cohort studies; three retrospective cohort studies; two longitudinal studies; two case-control studies; and one cross-sectional study were included.<br/

Walk with Me: a protocol for a pilot RCT of a peer-led walking programme to increase physical activity in inactive older adults

Background: Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those from lower socio-economic position, are also the most inactive. Increasing physical activity levels, particularly among those most inactive, is a public health priority. Peer-led physical activity interventions may offer a model to increase physical activity in the older adult population. This study aims to test the feasibility of a peer-led, multicomponent physical activity intervention in socio-economically disadvantaged community dwelling older adults. Methods: The Medical Research Council framework for developing and evaluating complex interventions will be used to design and test the feasibility of a randomised controlled trial (RCT) of a multicomponent peer-led physical activity intervention. Data will be collected at baseline, immediately after the intervention (12 weeks) and 6 months after baseline measures. The pilot RCT will provide information on recruitment of peer mentors and participants and attrition rates, intervention fidelity, and data on the variability of the primary outcome (minutes of moderate to vigorous physical activity measured with an accelerometer). The pilot trail will also assess the acceptability of the intervention and identify potential resources needed to undertake a definitive study. Data analyses will be descriptive and include an evaluation of eligibility, recruitment, and retention rates. The findings will be used to estimate the sample size required for a definitive trial. A detailed process evaluation using qualitative and quantitative methods will be conducted with a variety of stakeholders to identify areas of success and necessary improvements. Discussion: This paper describes the protocol for the ‘Walk with Me’ pilot RCT which will provide the information necessary to inform the design and delivery of a fully powered trial should the Walk with Me intervention prove feasible

Protocol for a feasibility study incorporating a randomised pilot trial with an embedded process evaluation and feasibility economic analysis of ThinkCancer!: a primary care intervention to expedite cancer diagnosis in Wales

Abstract Background Compared to the rest of Europe, the UK has relatively poor cancer outcomes, with late diagnosis and a slow referral process being major contributors. General practitioners (GPs) are often faced with patients presenting with a multitude of non-specific symptoms that could be cancer. Safety netting can be used to manage diagnostic uncertainty by ensuring patients with vague symptoms are appropriately monitored, which is now even more crucial due to the ongoing COVID-19 pandemic and its major impact on cancer referrals. The ThinkCancer! workshop is an educational behaviour change intervention aimed at the whole general practice team, designed to improve primary care approaches to ensure timely diagnosis of cancer. The workshop will consist of teaching and awareness sessions, the appointment of a Safety Netting Champion and the development of a bespoke Safety Netting Plan and has been adapted so it can be delivered remotely. This study aims to assess the feasibility of the ThinkCancer! intervention for a future definitive randomised controlled trial. Methods The ThinkCancer! study is a randomised, multisite feasibility trial, with an embedded process evaluation and feasibility economic analysis. Twenty-three to 30 general practices will be recruited across Wales, randomised in a ratio of 2:1 of intervention versus control who will follow usual care. The workshop will be delivered by a GP educator and will be adapted iteratively throughout the trial period. Baseline practice characteristics will be collected via questionnaire. We will also collect primary care intervals (PCI), 2-week wait (2WW) referral rates, conversion rates and detection rates at baseline and 6 months post-randomisation. Participant feedback, researcher reflections and economic costings will be collected following each workshop. A process evaluation will assess implementation using an adapted Normalisation Measure Development (NoMAD) questionnaire and qualitative interviews. An economic feasibility analysis will inform a future economic evaluation. Discussion This study will allow us to test and further develop a novel evidenced-based complex intervention aimed at general practice teams to expedite the diagnosis of cancer in primary care. The results from this study will inform the future design of a full-scale definitive phase III trial. Trial registration ClinicalTrials.gov NCT04823559. </jats:sec

Creating ‘a simple conversation’: Designing a conversational user interface to improve the experience of accessing support for study

Administrative processes are ubiquitous in modern life and have been identified as a particular burden to those with accessibility needs. Students who have accessibility needs often have to understand guidance, fill in complex forms and communicate with multiple parties to disclose disabilities and access appropriate support. Conversational user interfaces (CUIs) could allow us to reimagine such processes, yet there is currently limited understanding of how to design these to be accessible, or whether such an approach would be preferred. In the ADMINS (Assistants for the Disclosure and Management of Information about Needs and Support) project, we implemented a virtual assistant (VA) which is designed to enable students to disclose disabilities and to provide guidance and suggestions about appropriate support. ADMINS explores the potential of CUIs to reduce administrative burden and improve the experience of arranging support by replacing a static form with written or spoken dialogue. This paper reports the results of two trials conducted during the project. A beta trial using an early version of the VA provided understanding of accessibility challenges and issues in user experience. The beta trial sample included 22 students who had already disclosed disabilities and 3 disability support advisors. After improvements to the design, a larger main trial was conducted with 134 students who disclosed their disabilities to the university using both the VA and the existing form-based process. The results show that the VA was preferred by most participants to completing the form (64.2% vs 24.6%). Qualitative and quantitative feedback from the trials also identified accessibility and user experience barriers for improving CUI design, and an understanding of benefits and preferences that can inform further development of accessible CUIs for this design space

Peer-led walking programme to increase physical activity in inactive 60- to 70-year-olds: Walk with Me pilot RCT

Background Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those with a lower rather than a higher socioeconomic position, are also the most inactive. Peer-led physical activity interventions may offer a model to increase physical activity in these older adults and thus help reduce associated health inequalities. This study aims to develop and test the feasibility of a peer-led, multicomponent physical activity intervention in socioeconomically disadvantaged community-dwelling older adults. Objectives The study aimed to develop a peer-led intervention through a rapid review of previous peer-led interventions and interviews with members of the target population. A proposed protocol to evaluate its effectiveness was tested in a pilot randomised controlled trial (RCT). Design A rapid review of the literature and the pilot study informed the intervention design; a pilot RCT included a process evaluation of intervention delivery. Setting Socioeconomically disadvantaged communities in the South Eastern Health and Social Care Trust and the Northern Health and Social Care Trust in Northern Ireland. Participants Fifty adults aged 60–70 years, with low levels of physical activity, living in socioeconomically disadvantaged communities, recruited though community organisations and general practices. Interventions ‘Walk with Me’ is a 12-week peer-led walking intervention based on social cognitive theory. Participants met weekly with peer mentors. During the initial period (weeks 1–4), each intervention group participant wore a pedometer and set weekly step goals with their mentor’s support. During weeks 5–8 participants and mentors met regularly to walk and discuss step goals and barriers to increasing physical activity. In the final phase (weeks 9–12), participants and mentors continued to set step goals and planned activities to maintain their activity levels beyond the intervention period. The control group received only an information booklet on active ageing. Main outcome measures Rates of recruitment, retention of participants and completeness of the primary outcome [moderate- and vigorous-intensity physical activity measured using an ActiGraph GT3X+ accelerometer (ActiGraph, LLC, Pensacola, FL, USA) at baseline, 12 weeks (post intervention) and 6 months]; acceptability assessed through interviews with participants and mentors. Results The study planned to recruit 60 participants. In fact, 50 eligible individuals participated, of whom 66% (33/50) were female and 80% (40/50) were recruited from general practices. At 6 months, 86% (43/50) attended for review, 93% (40/43) of whom returned valid accelerometer data. Intervention fidelity was assessed by using weekly step diaries, which were completed by both mentors and participants for all 12 weeks, and checklists for the level of delivery of intervention components, which was high for the first 3 weeks (range 49–83%). However, the rate of return of checklists by both mentors and participants diminished thereafter. Outcome data indicate that a sample size of 214 is required for a definitive trial. Limitations The sample was predominantly female and somewhat active. Conclusions The ‘Walk with Me’ intervention is acceptable to a socioeconomically disadvantaged community of older adults and a definitive RCT to evaluate its effectiveness is feasible. Some modifications are required to ensure fidelity of intervention delivery is optimised. Future research needs to identify methods to recruit males and less active older adults into physical activity interventions

Protocol for a definitive randomised controlled trial and economic evaluation of a community-based rehabilitation programme following hip fracture:fracture in the elderly multidisciplinary rehabilitation-phase III (FEMuR III)

Introduction: Proximal femoral (hip) fracture is common, serious and costly. Rehabilitation may improve functional recovery but evidence of effectiveness and cost-effectiveness are lacking. An enhanced rehabilitation intervention was previously developed and a feasibility study tested the methods used for this randomised controlled trial (RCT). The objectives are to compare the effectiveness and cost-effectiveness of the enhanced rehabilitation programme following surgical repair of proximal femoral fracture in older people compared with usual care.  Methods and analysis: Protocol for phase III, parallel-group, two-armed, superiority, pragmatic RCT with 1:1 allocation ratio; allocation sequence by minimisation programme with a built-in random element; secure web-based allocation concealment. The two treatments will be usual care (control) and usual care plus an enhanced rehabilitation programme (intervention). The enhanced rehabilitation will consist of a patient-held information workbook, goal setting diary and up to six additional therapy sessions. Outcome assessment and statistical analysis will be performed blind; patient and carer participants will be unblinded. Outcomes will be measured at baseline, 17 and 52 weeks' follow-up. Primary outcome at 52 weeks will be the Nottingham Extended Activities of Daily Living scale. Secondary outcomes will measure anxiety and depression, health utility, cognitive status, hip pain intensity, falls self-efficacy, fear of falling, grip strength and physical function. Carer strain, anxiety and depression will be measured in carers. All safety events will be recorded, and serious adverse events will be assessed to determine whether they are related to the intervention and expected. Concurrent economic evaluation will be a cost-utility analysis from a health service and personal social care perspective. An embedded process evaluation will determine the mechanisms and processes that explain the implementation and impacts of the enhanced rehabilitation programme.  Ethics and dissemination: National Health Service research ethics approval reference 18/NE/0300. Results will be disseminated by peer-reviewed publication.  Trial registration number ISRCTN28376407; Pre-results registered on 23 November 2018

Agreement between pedometer and accelerometer in measuring physical activity in overweight and obese pregnant women

<p>Abstract</p> <p>Background</p> <p>Inexpensive, reliable objective methods are needed to measure physical activity (PA) in large scale trials. This study compared the number of pedometer step counts with accelerometer data in pregnant women in free-living conditions to assess agreement between these measures.</p> <p>Methods</p> <p>Pregnant women (n = 58) with body mass index ≥25 kg/m²at median 13 weeks' gestation wore a GT1M Actigraph accelerometer and a Yamax Digi-Walker CW-701 pedometer for four consecutive days. The Spearman rank correlation coefficients were determined between pedometer step counts and various accelerometer measures of PA. Total agreement between accelerometer and pedometer step counts was evaluated by determining the 95% limits of agreement estimated using a regression-based method. Agreement between the monitors in categorising participants as active or inactive was assessed by determining Kappa.</p> <p>Results</p> <p>Pedometer step counts correlated moderately (r = 0.36 to 0.54) with most accelerometer measures of PA. Overall step counts recorded by the pedometer and the accelerometer were not significantly different (medians 5961 vs. 5687 steps/day, p = 0.37). However, the 95% limits of agreement ranged from -2690 to 2656 steps/day for the mean step count value (6026 steps/day) and changed substantially over the range of values. Agreement between the monitors in categorising participants to active and inactive varied from moderate to good depending on the criteria adopted.</p> <p>Conclusions</p> <p>Despite statistically significant correlations and similar median step counts, the overall agreement between pedometer and accelerometer step counts was poor and varied with activity level. Pedometer and accelerometer steps cannot be used interchangeably in overweight and obese pregnant women.</p

What is the forecasted prevalence and incidence of long-term conditions in Wales: a rapid evidence map

It is becoming apparent that the NHS will face many issues in years to come due to the growth of ageing population in relation to the working age population alongside the increase in multimorbidity and persistent health inequalities, particularly for preventable illness. This has implications to how healthcare and health systems are delivered, and how the NHS will need to adapt to meet the increasing demand that this places on healthcare services. This rapid evidence map reports forecasted prevalence and incidence data across a range of long -term conditions in Wales to support planning about how best to organise and finance care for the increasing population with long-term conditions over the next 10 years. The findings by conditions include: atrial fibrillation, cancer, cardiovascular diseases, peripheral vascular disease, stroke, dementia, diabetes, heart failure, hypertension, mental illness, and multi-morbidities. Three risk factors for long term conditions were also included, i.e., poor diet/nutrition, obesity, and smoking. The review included evidence from 2012 to March 2023 Implications for policy and practice: Results show which long-term conditions are projected to increase over 10 years or more. Further preventive interventions through behavioural science approaches, with increased investment, should be considered to mitigate the rising prevalence of several preventable conditions. Smoking, excessive drinking and obesity are candidates for targeted preventive work, especially in areas of deprivation, to lessen health inequalities. Further research is needed for some conditions, and to provide a more comprehensive understanding of the burden of these conditions in Wales. Earlier diagnosis by genetic and genomic technologies and enabling lifestyle changes or by more cost-effective home care could reduce NHS costs of some long-term conditions

Positive Digital Practices: supporting positive learner identities and student mental wellbeing in technology-enhanced higher education

Embedding mental wellbeing in learning is a priority for the UK Higher Education sector, as increasing numbers of students disclose mental health difficulties, challenges and conditions. Technology-enhanced, distance and blended learning is uniquely positioned to make a change for good in the sector; it can provide alternatives to traditional education models, support hard-to-reach students and make positive changes to practice. However, to make positive change, it needs to address the barriers to mental health that are inherent throughout education, and embed student wellbeing throughout its practices, cultures and digital environments. The Positive Digital Practices project aims to scale up existing work on mental wellbeing in technology-enhanced learning, creating resources to support practitioners in three focus areas: Positive Learner Identities - supporting students’ emotional awareness, reflection, resilience in adversity and wellbeing literacy; Positive Digital Communities - supporting students’ sense of belonging and facilitating meaningful connections that do not rely on a campus environment; Positive Digital Pedagogies – creating and sharing pedagogical practices that support mental wellbeing. In this paper, we present baseline data from staff and students on perceptions of barriers and enablers to student mental wellbeing, and we explore examples of positive practice from the Positive Learner Identities work area. We present the participatory co-creation methodologies used, the resources created, and we discuss how these can be applied by practitioners. These resources are a call to action for post-secondary practitioners to work together to enhance student mental health and wellbeing, and make education a more inclusive, equitable experience