66 research outputs found
The views of children and young people on the use of silk garments for the treatment of eczema: a nested qualitative study within the CLOTHES randomised controlled trial
Background: Many children suffer with skin diseases, but to date, most dermatological research has been done âonâ rather than âwithâ children; in this study we actively sought the experiences of children and young people. Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects around 20% of children and can impact on health and wellbeing for children and their families. The role of specialist clothing in the management of AE is poorly understood.
Objectives: The aim of this study, which was nested in a randomised controlled trial was to qualitatively examine child participantsâ experiences of using silk garments for the treatment of AE.
Methods: Eighteen children aged 5-15, who took part in the CLOTHES trial, participated in age-appropriate individual interviews or focus groups.
Results: Thematic analysis generated 4 themes directly related to the garments: i) expectations of the garments; ii) wearing the silk garments; iii) did they help? and iv) thoughts about the garments. The conclusions from this nested qualitative study are that: there was some limited improvement in eczema for some children but that the hoped for âmiracle cureâ did not transpire. A mixed picture of knowledge, beliefs and experiences of using the silk garments emerged.
Conclusion: Engaging children in the evaluation of the garments provided first hand nuanced insights that enhanced understanding of the CLOTHES study as a whole. This nested study demonstrates that children can and indeed want to be engaged in dermatological research in meaningful ways that add to our understanding of treatment options
âWhen it goes back to my normal I supposeâ: a qualitative study using online focus groups to explore perceptions of âcontrolâ amongst people with eczema and parents of children with eczema in the UK
Objective: To inform the development of a core outcome set for eczema by engaging with people with eczema and parents of children with eczema to understand their experiences and understanding of the concept âeczema controlâ.
Design: 37 participants took part in a total of 6 semi-structured online focus groups held in a typed chatroom with 5-7 participants per group. Three groups involved adults with eczema and three groups involved parents of children with eczema. Framework analysis was used for data analysis.
Setting: A community-based sample was recruited from across the UK via social media and email.
Participants: 19 adults aged 17-61 (15/19 female, 16/19 white) and 18 parents of children with eczema aged 9 months-17 years (9/18 female, 18/19 white).
Results: Four main themes were identified. 1) âCommonalities and differences in the experiences of controlâ: a reduction in symptoms such as itch and sleep loss characterised eczema control, but what level was acceptable differed across participants. 2) âEczema control goes beyond the skinâ: psychological factors, social factors, the constant scratching and the impact on everyday activities are a variety of ways an individual can be impacted. 3) âStepping up and down of treatmentâ: participantsâ stepped-up treatment in response to loss of control, but several factors complicated this behaviour. Control needed to be maintained after stepped-up treatment ended to be acceptable. 4) âHow to measure controlâ: self-report was generally preferred to allow frequent measurements and to capture unobservable features. Although most thought their eczema needed to be measured frequently, many also felt that this was not always realistic or desirable.
Conclusions: Eczema âcontrolâ is a complex experience for people with eczema and parents of children with the condition. These experiences could have important implications on how long-term control should be measured in eczema clinical trials and clinical practice
Using practice development methodology to develop childrenâs centre teams: Ideas for the future
The Childrenâs Centre Programme is a recent development in the UK and brings together
multi-agency teams to work with disadvantaged families. Practice development methods
enable teams to work together in new ways. Although the term practice development
remains relatively poorly defined, its key properties suggest that it embraces engagement,
empowerment, evaluation and evolution. This paper introduces the Childrenâs Centre
Programme and practice development methods and aims to discuss the relevance of using
this method to develop teams in childrenâs centres through considering the findings from an
evaluation of a two-year project to develop inter-agency public health teams.
The evaluation showed that practice development methods can enable successful team
development and showed that through effective facilitation, teams can change their practice to
focus on areas of local need. The team came up with their own process to develop a strategy
for their locality
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Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings
Background
Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence.
Objectives
To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings.
Search methods
We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers.
Selection criteria
Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged â„ 60 years in hospital or residential care settings.
Data collection and analysis
We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence.
Main results
We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leaveâon body lotion; bed bath with âwash glovesâ containing numerous ingredients; and application of a hot towel after usual care bed bath.
In five studies, treatment duration ranged from five days to six months; only one study had postâtreatment followâup (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel.
Three studies each had high risk of attrition, detection, and performance bias.
Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient group (usual care plus twiceâdaily application of moisturiser) had 5.76 tears per month per 1000 occupied bedâdays compared with 10.57 tears in the usual care only group (ad hoc or no standardised skinâmoisturising regimen) (P = 0.004), but this is based on very lowâquality evidence, so we are uncertain of this result.
Only one trial (n = 133) reported measuring side effects. At 56 ± 4 days from baseline, there were three undesirable effects (itch (mild), redness (mild/moderate), and irritation (severe)) in intervention group 1 (regimen consisting of a moisturising body wash and a moisturising leaveâon lotion) and one event (mild skin dryness) in intervention group 2 (regimen consisting of body wash and a waterâinâoil emulsion containing emollients and 4% urea). In both groups, the body wash was used daily and the emollient twice daily for eight weeks. There were zero adverse events in the usual care group. This result is based on very lowâquality evidence. This same study also measured TEWL at 56 ± 4 days in the midâvolar forearm (n = 106) and the lower leg (n = 105). Compared to usual care, there may be no difference in TEWL between intervention groups, but evidence quality is low.
One study, which compared application of a hot towel for 10 seconds after a usual care bed bath versus usual care bed bath only, also measured TEWL at 15 minutes after the skin was wiped with a dry towel for one second. The mean TEWL was 8.6 g/mÂČ/h (standard deviation (SD) 3.2) in the hot towel group compared with 8.9 g/mÂČ/h (SD 4.1) in the usual care group (lowâquality evidence; n = 42), showing there may be little or no difference between groups. A lower score is more favourable.
Three studies (266 participants) measured SCH, but all evidence is of very low quality; we did not combine these studies due to differences in treatments (different skin care regimens for eight weeks; wash gloves for 12 weeks; and single application of hot towel to the skin) and differences in outcome reporting. All three studies showed no clear difference in SCH at followâup (ranging from 15 minutes after the intervention to 12 weeks from baseline), when compared with usual care. A clinical score of dryness was measured by three studies (including 245 participants); pooling was not appropriate. The treatment groups (different skin care regimens for eight weeks; a moisturising soap bar used for five days; and combinations of water soak, oil soak, and lotion for 12 days) may reduce dryness compared to standard care or no intervention (results measured at 5, 8, and 56 ± 4 days after treatment was initiated). However, the quality of evidence for this outcome is low.
Outcomes of erythema and clinical score of itch were not assessed in any included studies.
Authors' conclusions
Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate. We cannot draw conclusions regarding frequency of skin damage or side effects due to very lowâquality evidence.
Lowâquality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care.
Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patientâreported outcomes, such as comfort and acceptability
The experiences of children and young people of using silk garments for the treatment of eczema: a nested qualitative study within the CLOTHES randomised controlled trial.
Background
Many children suffer with skin diseases, but to date, most dermatological research has been done âonâ rather than âwithâ children; in this study we actively sought the experiences of children and young people. Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects around 20% of children and can impact on health and wellbeing for children and their families. The role of specialist clothing in the management of AE is poorly understood.
Objectives
The aim of this study, which was nested in a randomised controlled trial was to qualitatively examine child participantsâ experiences of using silk garments for the treatment of AE.
Methods
Eighteen children aged 5-15, who took part in the CLOTHES trial, participated in age-appropriate individual interviews or focus groups.
Results
Thematic analysis generated 4 themes directly related to the garments: i) expectations of the garments; ii) wearing the silk garments; iii) did they help? and iv) thoughts about the garments. The conclusions from this nested qualitative study are that: there was some limited improvement in eczema for some children but that the hoped for âmiracle cureâ did not transpire. A mixed picture of knowledge, beliefs and experiences of using the silk garments emerged.
Conclusion
Engaging children in the evaluation of the garments provided first hand nuanced insights that enhanced understanding of the CLOTHES study as a whole. This nested study demonstrates that children can and
indeed want to be engaged in dermatological research in meaningful ways that add to our understanding of treatment options
Embeddings in Spacetimes Sourced by Scalar Fields
The extension of the Campbell-Magaard embedding theorem to general relativity
with minimally-coupled scalar fields is formulated and proven. The result is
applied to the case of a self-interacting scalar field for which new embeddings
are found, and to Brans-Dicke theory. The relationship between Campbell-Magaard
theorem and the general relativity, Cauchy and initial value problems is
outlined.Comment: RevTEX (11 pages)/ To appear in the Journal of Mathematical Physic
Supporting families managing childhood eczema:Developing and optimising Eczema Care Online using qualitative research
Background: childhood eczema is often poorly controlled due to under-use of emollients and topical corticosteroids. Parents/carers report practical and psychosocial barriers to managing their childâs eczema, including child resistance. Online interventions could potentially support parents/carers; however, rigorous research developing such interventions has been limited. Aim: to develop an online behavioural intervention to help parents/carers manage and co-manage their childâs eczema. Design and setting: Intervention development using a theory-, evidence- and Person-Based Approach with qualitative research. Methods: a systematic review and qualitative synthesis (32 studies) and interviews with parents/carers (N=30) were used to identify barriers and facilitators to effective eczema management, and a prototype intervention was developed. Think-aloud interviews with parents/carers (N=25) were then used to optimise the intervention to increase its acceptability and feasibility. Results: qualitative research identified that parents/carers had concerns about using emollients and topical corticosteroids; incomplete knowledge and skills around managing eczema; and reluctance to transitioning to co-managing eczema with their child. Think-aloud interviews highlighted that while experienced parents/carers felt they knew how to manage eczema, some information about how to use treatments was still new. Techniques for addressing barriers included: providing a rationale explaining how emollients and topical corticosteroids work; demonstrating how to use treatments; and highlighting that the intervention provided new, up-to-date information. Conclusions: parents/carers need support in effectively managing and co-managing their childâs eczema. The key output of this research is Eczema Care Online (ECO) for Families; an online intervention for parents/carers of children with eczema, which is being evaluated in a randomised trial
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