Diversity and Scope of Senior Nurses’ Informal and Formal Experiences of Patient and Public Involvement in England

Patient and public involvement (PPI) has been recognized internationally. In England, NHS policies have increasingly emphasized the importance of patient-centered services, but limited evidence exists about the implementation of PPI policies and strategies within organizations. Few studies have explored health professionals’ perceptions of PPI and comparatively little is known about the experience of senior nurses. A national consultation utilising three focus groups aimed to explore senior nurses’ PPI experience. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Focus groups were digitally recorded and transcribed verbatim;anonymised transcripts were validated by participants and analysed with thematic analysis. Sixteen categories emerged within five sub-themes of PPI experience: provision of information and raising awareness (1 category), informal generic PPI-activities not perceived as PPI (3 categories), formal generic PPI (3 categories), involvement of specific groups (5 categories) and PPI in commissioning and strategy (4 categories). Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. Nurses performed PPI in a pragmatic sense, by virtue of the nature of nursing, but they did not recognise or label these activities as such. However, a plethora and variety of innovative activities formally recognised as patient and public involvement were undertaken, together with specific networks and groups’ involvement, and involvement linked to commissioning and strategy. Enhancing awareness of nurses through education, together with monitoring and feedback mechanisms could support the PPI implementation and effectiveness at organisations.

Emotional Support and Well-Being of Adults with Congenital Heart Disease (ACHD): Contributions of a Specialist Nursing Service

Living with a congenital heart condition can require a daunting and uncertain patient journey during which the support of a specialist nursing service is vital. A descriptive, cross-sectional evaluation completed over two years, utilised a postal questionnaire to investigate patient’s satisfaction with aspects of service. Qualitative responses to open questions on satisfaction with emotional support (n = 103) and contributions to well-being (n = 90) were analysed using a framework approach which identified eight themes. Professional knowledge and expertise, service accessibility, caring attributes, enabling patients to cope with anxiety, depression and meeting changing needs contributed positively to both patient well-being and emotional support. Family support was influential on emotional support alone, whilst mediating medical liaison exerted an impact on well-being by enhancing feelings of security. In conclusion, the specialist nursing service contributed positively to well-being and emotional support of patients and thereby to selective aspects of continuity of care.

A Prospective Survey Comparing Patients’ Experience of a Nurse-Led Clinic and Consultant-Led Clinic for Surveillance of Patients with Dilatation of the Intrathoracic Aorta

Background: Increasing workload in consultant-led clinics often means patients to wait a long time for clinic appointments. To address this, there is an increasing trend in developing nurse-led clinics across many specialities in the National Health Service. This study aims to assess whether the implementation of a nurse-led clinic in thoracic aortic surgery will optimise the utilisation of health care services and improve overall patient satisfaction. Methods: 80 follow-up patients were asked to complete a questionnaire following their appointment in an aortic clinic, which was led either by a consultant (n = 40) or an aortic specialist nurse (n = 40). All patients seen by a nurse in the clinic were assessed by a consultant surgeon prior to the clinic for suitability. No new patients were seen by a nurse. Any patient with an aortic dimension of 5 cm or greater was seen by the consultant. If there were any complicated clinical features, the patient was seen in the consultant-led clinic. Patients were asked questions about their time spent with the respective health care professionals across 12 categories (punctuality, preparedness, understanding of concerns, clarity of speech, listening, respect, explaining, letting you talk, putting you at ease, emotional support, advice and advice for next follow-up). Patients rated each category using an ordinal scale from 0 - 10. Results: Patient scores were greater in nurse-led clinics compared to consultant-led clinics across a number of categories although only punctuality reached significance (mean 9.2 vs. 6.8, p 0.05). Conclusion: Patients were highly satisfied with the nurse-led clinic across all categories, with greater satisfaction for punctuality. These findings suggest that a nurse-led clinic can be implemented for the management of carefully selected thoracic aortic surgery patient without reduction in patient satisfaction.

The Association between Vitamin D Deficiency and Developing COVID-19 Related Serious Illnesses—A Systematic Review and Meta-Analysis

Background: Coronavirus is rapidly transmitted and highly infectious, and it is also associated with high morbidity and mortality but no drugs have been recognised as being effective;therefore, it is necessary to protect against serious illnesses with an intrinsic protection mechanism. In addition, Vitamin D enhances the intrinsic protection mechanism. Purpose: This study aims to systematically review and conduct a meta-analysis to determine if vitamin D deficiency is associated with the development of severe COVID-19 illness, providing crucial insights into the potential impact of vitamin D on disease outcomes. Methods: This study is conducted through systematic reviews and meta-analysis while following well-designed research questions. Literature searches are performed according to PRISMA guidelines with inclusion and exclusion criteria through the electronic database PubMed, CINAHL and Google Scholar. All data for meta-analysis were performed using RevMan 5.4. The software program was used for blending the statistical data and deriving the cumulative result of the intervention on concluding outcomes of interest. To analyze dichotomous data, the Mantel-Haenszel method was performed, and an odds ratio was conducted for outcome evaluation with 95% confidence interval. Results: The meta-analysis showed that there is statistically significant (P Conclusion: This study indicated that Vitamin D deficiency is associated with the development of COVID-19 related serious illnesses. Also, it is highly recommended to do more randomised control trials for the establishment of this topic strongly.

Challenges and facilitators for patient and public involvement in England;focus groups with senior nurses

The concepts of patient and public involvement (PPI) have been recognized and linked with quality in health services internationally and in Europe. In England, for more than a decade, NHS policies have increasingly quoted patient-centred services. Limited evidence exists about the implementation of PPI policies and strategies within organisations;three studies only have explored health professionals’ perceptions of PPI. Although nurses’ positive support for patient and public involvement has been noted, comparatively little is known about senior nurses’ experiences of embedding PPI. A national consultation utilising three focus groups aimed to explore senior nurses’ perceptions of challenges and facilitators for PPI implementation. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Nurses’ perceptions on patient and public involvement, challenges and facilitators for its implementation were discussed. Focus groups were digitally recorded and transcribed verbatim;anonymised transcripts were validated by participants and analysed with thematic analysis. Limited resources, patient representation and recruitment, complexities of implementing PPI and national policy changes were challenging. Commissioning limitations, lack of feedback on patient experience, limited staff awareness, negative attitudes, management of patients and public expectations constituted further challenges. Nursing role characteristics and informal involvement activities, PPI policy and cultural change, commissioning PPI competencies, related service frameworks, providing feedback on patient experiences to staff and recognition of involvement benefits were recognised as facilitators. Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. However, recognition of existing nursing role characteristics and potential delivery problems created by expanded nursing roles, informal PPI practice and internal organisational sharing of patient feedback may bring an “emerging productive partnership” with nurses enabling and contributing to effective PPI.

Evaluating the Use of Vitamin D Supplementation to Improve Glycaemic Outcome in Type 2 Diabetes Mellitus Patients: A Systematic Review of Evidence

Background: The evidence indicates that vitamin D [25(OH)D] improves glycaemic outcomes in type 2 Diabetes mellitus patients. The outcome measures used to determine the accuracy of this hypothesis are: glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG) and homeostasis model assessment-insulin resistance (HOMA-IR). Methods: We performed a systematic review and meta-analysis which included all previous randomised controlled trial (RCT) studies that assessed the effects of vitamin D on glucose metabolism. We carried out an extensive electronic database search of published and unpublished RCTs, evaluating the association between vitamin D and glycaemic outcomes in type 2 diabetes mellitus patients. We searched Cochrane Library, PubMed, EMBASE, CINAHL Plus with Full Text, MEDLINE, BioMed Central, Turning Research Into Practice (TRIP), Health Technology Assessment (HTA), and Latin American and Caribbean Health Sciences (LILIACS) between the years 2005 and 2016. The full texts of relevant studies were retrieved and a snowballing technique was used to discover further studies missed from the initial database search. This was done by hand-searching for references within the retrieved articles. Results: A total of 17 studies were included in the review. The pooled effect of 15 studies that measured HbA1c showed an insignificant effect of vitamin D on HbA1c (Mean difference (MD) = -0.06 mmol/l;95% CI = -0.26 to 0.14;I2 = 76%). A pooled analysis of seven studies that measured the effect of vitamin D on blood glucose also found no significant effect of vitamin D on T2DM (MD = -0.03 mmol/l;95% CI = -0.69 to 0.63;I2 = 76%). Three studies that analysed the effect of vitamin D on insulin sensitivity also observed no significant effect (MD = -1.51 mmol/l;95% CI = -3.61 to 0.60;I2 = 67%). Conclusion: In conclusion, although vitamin D has been extensively studied in relation to some glycaemic outcomes and some indications that increased plasma vitamin D concentrations might be linked to prevention of T2DM, firm universal conclusions about its benefits cannot be drawn. Further studies with better designed trials and larger sample sizes are needed to draw firmer conclusions.

Factor Analytical Examination of the Evidence-Based Practice Beliefs Scale: Indications of a Two-Factor Structure

Background: Promotion of Evidence-Based Practice (EBP) in nursing appears to be developing slowly. Research indicates that nurses’ beliefs in EBP may play an even more significant role than knowledge and resources in making implementation feasible. To address this issue, measurement of nurses’ beliefs regarding EBP is paramount. Aims and objectives: This study explores the internal consistency reliability and the construct factor structure of the Norwegian version of the original Evidence-Based Practice Beliefs Scale (EBP-BS). Methods: The study has a Non-experimental exploratory survey design. A Norwegian translation of the EBP-BS was tested in a convenience sample of 118 healthcare professionals (95% nurses) attending a continuing education program at a University College in Norway. The response rate was 95% (n = 112). The internal consistency of the scale was measured by Cronbach’s alpha, and an explorative Principal Component Analysis (PCA) was used to explore the construct structure. Results: The overall internal consistency of the EBP-BS was acceptable. The PCA indicated a four-factor structure. The psychometric properties of two of the factors were too weak for expanding to a four-factor model. Based on our investigation of the EBP-BS, we suggest a two-factor structure model. The factors were named 1) General knowledge and confidence concerning EBP and 2) Task specific beliefs in EBP. This finding differs from previous results that indicated a unidimensional structure. Conclusion: As a starting point, reliable and valid measurement of nurses’ beliefs about EBP is required in order to identify possible obstacles and to optimize implementation in the individual clinical setting. Our results indicate that the EBP-BS has a two-factor structure. Further exploration of the factor structure is needed. Further empirical research may contribute to the resolving of controversies concerning basic understandings of the concept of EBP.

菠萝蛋白酶治疗心血管疾病的系统综述(英文)

背景:在2004年,全球估计有1710万人死于心血管疾病。根据美国心脏病协会的数据,心脏病与中风是2型糖尿病患者的首要致死及致残因素。寻找更多的安全有效的心血管疾病治疗方案对于该疾病的预防和治疗十分必要,营养补充品是可行方案之一。目的:探讨菠萝蛋白酶(一种食品补充品)对心血管疾病的预防和治疗作用。检索策略:2009年9月至2010年3月进行电子与手工检索。检索的数据库包括Ovid MEDLINE;All EBMReviews-Cochrane Database of Systematic Reviews(Cochrane DSR)、American College of Physicians(ACP)Journal Club、Database of Abstracts of Reviews of Effects(DARE)、Cochrane Central Register ofControlled Trials(CCTR)、Cochrane Methodology Register(CMR)、Health Technology Assessment(HTA)和National Health Service Economic Evaluation Database(NHSEED);Allied and ComplementaryMedicine(AMED)、British Nursing Index and Archive、EMBASE、Health Management InformationConsortium(HMIC)、ScienceDirect和Electronic Thesis Online Services(ETHOS)。检索语言限定为英文。纳入标准:有关菠萝蛋白酶用于预防或治疗心脑血管疾病的随机对照试验、人体研究、动物研究与实验性研究。资料提取与分析:3位作者分别对检索到的文章进行文献质量评估并提取文献资料。所收集的资料包括实验种类、用药剂量、治疗周期、测量指标、研究结果、菠萝蛋白酶的特征、结果的意义与研究结论。结果:在搜索到的223篇文章中,只有6篇文章符合纳入标准。包括3项动物实验和3项人体试验。菠萝蛋白酶可用来治疗急性血栓性静脉炎,因为它可减少血液中的纤维蛋白原含量,降低血小板聚集度,有保护心脏的作用,并能够改善动脉壁的结构,避免由凝血酶所诱发的血小板聚集,减少血栓的形成。结论:迄今为止,没有菠萝蛋白酶用于心血管疾病治疗的高质量的人体研究。在1948年至2010年间所发表的有关菠萝蛋白酶与心血管疾病的研究的数量极为有限。在未来的心血管疾病研究中这可能是一个值得探索的领域。

Methodological Approaches to Developing and Establishing the Body of Evidence on Post-marketing Chinese Medicine Safety

ABSTRACT Evidence based medicine demands the highest form of scientific evidence to demonstrate the efficacy and clinical effectiveness for any therapeutic intervention in order to provide best care. It is however accepted that in the absence of scientific evidence, personal experience and expert opinion together with professional judgement are critical. Obtaining evidence for drug safety, post- marketing surveillance （PMS） has focussed on follow up of observational cohorts exposed to a particular drug in order to estimate the incidence of adverse drug reactions （ADRs）. Evidence on PMS of Chinese herbal products is still limited, in particular for herbal injections. The aim of this article is to suggest a new model of ascertaining the safety of Chinese medicine using a more comprehensive approach for collecting data. To collect safety data on the Chinese herbal injection, Kudiezi, a mixed methods approach is proposed using 18 hospital information systems to detectADRs in order to prospectively observe 30,000 patients over 3 years. Evidence will also be collected using a questionnaire survey and through a sample of semi structured interviews. This information based on the expert opinion and the experience of clinicians will produce additional data on the frequency and types of side effects in clinical practice. Furthermore semi structured interviews with a random sample of patients receiving the injection will be carried out to ascertain any potential side effects missed. It is hoped that this comprehensive approach to data collection will accumulate wider evidence based on individual traditional Chinese medicine care and treatment and provide important feedback to the national data collection system to ensure completeness of ADR data recording, monitoring and any potential wider effects through developing improved ADR guidelines.

针刺作为辅助手段治疗精神分裂症的探索性病例研究(英文)

目的:探索个体针刺疗法作为常规治疗的辅助手段在精神分裂症患者中的效果;采用探索性病例研究的方法,使用定量和定性评价工具,以便能够对针刺治疗此类患者的确切疗效作出科学评价,并对未来采用针刺治疗此类患者的试验设计提供方法学建议。方法:共纳入11例精神分裂症患者,在予以10周的针刺治疗前,治疗过程中及治疗后分别采用多种有效的定量和定性评价工具对患者进行多方面的评价。这些评价手段包括对针刺治疗、全科医生及精神科医生病历的整理回顾。分析定性资料以评价受试者向研究者及其临床医生和护理人员报告的内容的可靠性。结果:11名受试者中共有8名完成了1个疗程的针刺治疗,全部11名受试者都报告了针刺治疗的积极作用,包括精神分裂症症状的改善,缓解药物的副作用,对精力、内在动机、睡眠、成瘾症状及其他身体机能的促进作用。但是,受试者向研究者和针刺医生报告的信息在不同治疗阶段有一定差别,且往往不一致;在研究结束后,受试者向研究者报告了更多的信息。结论:本研究表明,在常规疗法之外辅以针刺治疗能够给精神分裂症病人带来一定益处。对数据的三角测量表明了受试者报告内容的某些不一致性,而这些可以通过多种研究方法的混合使用得以克服。通过对数据的比较,推荐在将来的研究设计中使用阳性与阴性症状量表、针刺临床试验干预措施报告标准以及在问卷中增加对药物副作用、运动、睡眠以及日常作息的调查。在将来的研究中还应充分考虑到,恢复期患者容易复发,应该让他们可以方便地获得帮助。

The use of complementary and alternative medicine by individuals with features of metabolic syndrome

OBJECTIVE： To compare the use of complementary and alternative medicine （CAM）, including dietary supplements, by individuals with and without features of metabolic syndrome （FeMS）. METHODS： Using a cross sectional study design, information was obtained by self-administered questionnaires from 300 university individuals. FeMS was defined as any individuals self-reporting at least one of the clinical diagnoses of diabetes, hypertension, hyperlipidemia, or obesity. Finally, two categories were created for cross tabulation, and individuals with and without FeMS were compared. RESULTS： Of the 192 individuals completing the study, 39% （n=76） were currently using or had used CAM therapies in the past 12 months. Individuals with FeMS （n=54, 28%） were more likely （P〈0.05） to use different types of CAM therapies, in particular dietary and herbal supplements, aromatherapy and massage therapy compared to individuals without FeMS （n=138, 72%）. CONCLUSION： Individuals with FeMS were more likely to use CAM, particularly supplements. Doctors need to properly inquire about and understand their patients＇ supplement use, especially if CAM therapies are used in coniunction with conventional medications.

A Pragmatic Observational Feasibility Study on Integrated Treatment for Musculoskeletal Disorders：Design and Protocol

Background：Musculoskeletal disorders（MSD） comprise a wide range of conditions,associated with an enormous pain and impaired mobility,and are affecting people＇s lives and work.Management of musculoskeletal disorders typically involves a multidisciplinary team approach.Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies,though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service（NHS） setting.Objective：To determine the feasibility of all aspects of a pragmatic observational study designed：（1） to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK;（2） to determine the acceptability of the study design and research process to patients;（3） to explore patients＇ expectation and experience of receiving integrated treatments.Methods：This is an observational feasibility study,with 1-year recruitment and 1-year follow-up,conducted in Royal London Hospital for Integrated Medicine,University College London Hospital Trust,UK.All eligible patients with MSDs newly referred to the hospital were included in the study.Interventions are integrated packages of care（conventional and complementary） as currently provided in the hospital.SF-36 Health Survey,short form Brief Pain Inventory,Visual Analogue Scale,and modified Client Service Receipt Inventory will be assessed at 4/5 time points.Semi-structured interview/focus group will be carried out before treatment,and 1 year after commence of treatment.Discussion：We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital.It will inform the design of a future trial including recruitment,retention,suitability of the outcome measures and patients experiences.

定性研究方法之框架分析法

随着定性研究方法在科研领域的兴起和运用,其不同分析理论流派也逐渐发展。在其众多的流派之中,现今的框架分析法(framework analysis/approach),独树一帜,深得医学定性研究者的青睐。笔者将具体介绍该方法的来源、特点及其具体应用步骤,为中医研究者提供参考。