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AIM: To examine the characteristics of computerized decision support systems (CDSS) currently available to nurses working in the National Health Service (NHS) in England. METHOD: A questionnaire survey sent to a stratified random sample of 50% of all NHS care providers (Trusts) in England, asking respondents to provide information on CDSS currently used by nurses. RESULTS: Responses were received from 108 of the 277 Trusts included in the sample. Electronic patient record systems were the most common type of CDSS reported by Trusts (n = 61) but they were least likely to have features that have been associated with improved clinical outcomes. CONCLUSIONS: The availability of CDSS with features that have been associated with improved patient outcomes for nurses in the NHS in England is limited. There is some evidence that the nature of the Trust affects whether or not nurses have access to CDSS to assist their decision making. IMPLICATIONS FOR NURSING MANAGEMENT: The implementation of CDSS is increasing throughout the NHS. Many CDSS are introduced without adequate evidence to support its introduction and there is little evaluation of the benefits once they are implemented. Policy makers and nursing management should consider whether the introduction of CDSS aids nurse decision making and benefits patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The onset of disability in bathing is particularly important for older adults as it can be rapidly followed by disability in other daily activities; this may represent a judicious time point for intervention in order to improve health, well-being and associated quality of life. An important environmental and preventative intervention is housing adaptation, but there are often lengthy waiting times for statutory provision. In this randomised controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of bathing adaptations compared to no adaptations and to explore the factors associated with routine and expedited implementation of bathing adaptations., Methods: BATH-OUT-2 is a multicentre, two-arm, parallel-group RCT. Adults aged 60 and over who are referred to their local authority for an accessible level access shower will be randomised, using pairwise randomisation, 1:1, to receive either an expedited provision of an accessible shower via the local authority or a usual care control waiting list. Participants will be followed up for a maximum of 12 months and will receive up to four follow-ups in this duration. The primary outcome will be the participant's physical well-being, assessed by the Physical Component Summary score of the Short Form-36 (SF-36), 4 weeks after the intervention group receives the accessible shower. The secondary outcomes include the Mental Component Summary score of the SF-36, self-reported falls, health and social care resource use, health-related quality of life (EQ-5D-5L), social care-related quality of life (Adult Social Care Outcomes Toolkit (ASCOT)), fear of falling (Short Falls Efficacy Scale), independence in bathing (Barthel Index bathing question), independence in daily activities (Barthel Index) and perceived difficulty in bathing (0-100 scale). A mixed-methods process evaluation will comprise interviews with stakeholders and a survey of local authorities with social care responsibilities in England., Discussion: The BATH-OUT-2 trial is designed so that the findings will inform future decisions regarding the provision of bathing adaptations for older adults. This trial has the potential to highlight, and then reduce, health inequalities associated with waiting times for bathing adaptations and to influence policies for older adults., Trial Registration: ISRCTN Registry ISRCTN48563324. Prospectively registered on 09/04/2021., (© 2024. The Author(s).)

Objectives: To determine the feasibility of conducting a full-scale randomised controlled trial (RCT) of the effectiveness and cost-effectiveness of a self-aligning prosthetic ankle-foot compared with a standard prosthetic ankle-foot., Design: Multicentre parallel group feasibility RCT., Setting: Five prosthetics centres in England recruiting from July 2018 to August 2019., Participants: Adults aged ≥50 years with a vascular-related or non-traumatic transtibial amputation for 1 year or longer, categorised as having 'limited community mobility' and using a non-self-aligning ankle-foot., Intervention: Participants were randomised into one of two groups for 12 weeks: self-aligning prosthetic ankle-foot or existing non-self-aligning prosthetic ankle-foot., Outcomes: Feasibility measures: recruitment, consent and retention rates; and completeness of questionnaire and clinical assessment datasets across multiple time points. Feasibility of collecting daily activity data with wearable technology and health resource use data with a bespoke questionnaire., Results: Fifty-five participants were randomised (61% of the target 90 participants): n=27 self-aligning ankle-foot group, n=28 non-self-aligning ankle-foot group. Fifty-one participants were included in the final analysis (71% of the target number of participants). The consent rate and retention at final follow-up were 86% and 93%, respectively. The average recruitment rate was 1.25 participants/site/month (95% CI 0.39 to 2.1). Completeness of questionnaires ranged from 89%-94%, and clinical assessments were 92%-95%, including the activity monitor data. The average completion rates for the EQ-5D-5L and bespoke resource use questionnaire were 93% and 63%, respectively., Conclusions: This feasibility trial recruited and retained participants who were categorised as having 'limited community mobility' following a transtibial amputation. The high retention rate of 93% indicated the trial was acceptable to participants and feasible to deliver as a full-scale RCT. The findings support a future, fully powered evaluation of the effectiveness and cost-effectiveness of a self-aligning prosthetic ankle-foot compared with a standard non-self-aligning version with some adjustments to the trial design and delivery., Trial Registration Number: ISRCTN15043643., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Background: Interventions designed to support children with a diagnosis of Autism Spectrum Conditions (ASC) can be time consuming, needing involvement of outside experts. Social Stories™ are a highly personalised intervention aiming to give children with ASC social information or describing an otherwise difficult situation or skill. This can be delivered daily by staff in education settings. Studies examining Social Story™ use have yielded mostly positive results but have largely been single case studies with a lack of randomised controlled trials (RCTs). Despite this numerous schools are utilising Social Stories™, and a fully powered RCT is timely., Methods: A multi-site pragmatic cluster RCT comparing care as usual with Social Stories™ and care as usual. This study will recruit 278 participants (aged 4-11) with a clinical diagnosis of ASC, currently attending primary school in the North of England. Approximately 278 school based staff will be recruited to provide school based information about participating children with approximately 140 recruited to deliver the intervention. The study will be cluster randomised by school. Potential participants will be screened for eligibility prior to giving informed consent. Follow up data will be collected at 6 weeks and 6 months post randomisation and will assess changes in participants' social responsiveness, goal based outcomes, social and emotional health. The primary outcome measure is the Social Responsiveness Scale Second Edition (SRS-2) completed by school based staff at 6 months. Approvals have been obtained from the University of York's Research Governance Committee, Research Ethics Committee and the Health Research Authority. Study results will be submitted for publication in peer-reviewed journals and disseminated to participating families, educational staff, local authority representatives, community groups and Patient and Participant Involvement representatives. Suggestions will be made to NICE about treatment evidence dependent on findings., Discussion: This study addresses a much used but currently under researched intervention and results will inform school based support for primary school children with a diagnosis of ASC., Trial Registration: The trial is registered on the ISRCTN registry (registration number: ISRCTN11634810). The trial was retrospectively registered on 23rd April 2019.

Background: The police and others in occupations where they come into close contact with people experiencing/with mental ill health, often have to manage difficult and complex situations. Training is needed to equip them to recognise and assist when someone has a mental health issue or learning/intellectual disability. We undertook a systematic review of the effectiveness of training programmes aimed at increasing knowledge, changing behaviour and/or attitudes of the trainees with regard to mental ill health, mental vulnerability, and learning disabilities., Methods: Databases searched from 1995 onwards included: ASSIA, Cochrane Central Register of Controlled Clinical Trials (CENTRAL), Criminal Justice Abstracts, Embase, ERIC, MEDLINE, PsycINFO, Social Science Citation Index. Courses, training, or learning packages aimed at helping police officers and others who interact with the public in a similar way to deal with people with mental health problems were included. Primary outcomes were change in practice and change in outcomes for the groups of people the trainees come into contact with. Systematic reviews, randomised controlled trials (RCTs) and non- randomised controlled trials (non-RCTs) were included and quality assessed. In addition non-comparative evaluations of training for police in England were included., Results: From 8578 search results, 19 studies met the inclusion criteria: one systematic review, 12 RCTs, three prospective non-RCTs, and three non-comparative studies. The training interventions identified included broad mental health awareness training and packages addressing a variety of specific mental health issues or conditions. Trainees included police officers, teachers and other public sector workers. Some short term positive changes in behaviour were identified for trainees, but for the people the trainees came into contact with there was little or no evidence of benefit., Conclusions: A variety of training programmes exist for non-mental health professionals who come into contact with people who have mental health issues. There may be some short term change in behaviour for the trainees, but longer term follow up is needed. Research evaluating training for UK police officers is needed in which a number of methodological issues need to be addressed., Trial Registration: Protocol registration number: PROSPERO: CRD42015015981 .

Purpose of Research: To validate the Whooley questions as a screening tool for depression amongst a population of older adults in UK primary care., Objective: To assess the diagnostic performance of the Whooley questions as a screening tool for depression amongst older adults in UK primary care., Participants: A cross-sectional validation study was conducted with 766 patients aged ≥75 from UK primary care, recruited via 17 general practices based in the North of England during the pilot phase of a randomized controlled trial., Main Outcome Measures: Sensitivity, specificity and likelihood ratios comparing the index test (two Whooley questions) with a diagnosis of major depressive disorder (MDD) ascertained by the reference standard Mini International Neuropsychiatric Interview (MINI)., Results: The two screening questions had a sensitivity of 94.3% (95% confidence interval, 80.8-99.3%) and specificity of 62.7% (95% confidence interval, 59.0-66.2%). The likelihood ratio for a positive test was 2.5 (95% confidence interval, 2.2-2.9) and the likelihood ratio for a negative test was 0.09 (95% confidence interval, 0.02-0.35)., Conclusion: The two Whooley questions missed few cases of depression. However, they were responsible for a high rate of false positives. This creates additional burden on general practitioners, to conduct more detailed investigation on patients who screen positive, but many of whom turn out not to have MDD., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: There is a high prevalence of smoking among people who experience severe mental ill health (SMI). Helping people with disorders such as bipolar illness and schizophrenia to quit smoking would help improve their health, increase longevity and also reduce health inequalities. Around half of people with SMI who smoke express an interest in cutting down or quitting smoking. There is limited evidence that smoking cessation can be achieved for people with SMI. Those with SMI rarely access routine NHS smoking cessation services. This suggests the need to develop and evaluate a behavioural support and medication package tailored to the needs of people with SMI., Objective: The objective in this project was to conduct a pilot trial to establish acceptability of the intervention and to ensure the feasibility of recruitment, randomisation and follow-up. We also sought preliminary estimates of effect size in order to design a fully powered trial of clinical effectiveness and cost-effectiveness. The pilot should inform a fully powered trial to compare the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation (BSC) intervention with usual general practitioner (GP) care for people with SMI., Design: A pilot pragmatic two-arm individually randomised controlled trial (RCT). Simple randomisation was used following a computer-generated random number sequence. Participants and practitioners were not blinded to allocation., Setting: Primary care and secondary care mental health services in England., Participants: Smokers aged > 18 years with a severe mental illness who would like to cut down or quit smoking., Interventions: A BSC intervention delivered by mental health specialists trained to deliver evidence-supported smoking cessation interventions compared with usual GP care., Main Outcome Measures: The primary outcome was carbon monoxide-verified smoking cessation at 12 months. Smoking-related secondary outcomes were reduction of number of cigarettes smoked, Fagerstrom test of nicotine dependence and motivation to quit (MTQ). Other secondary outcomes were Patient Health Questionnaire-9 items and Short Form Questionnaire-12 items to assess whether there were improvements or deterioration in mental health and quality of life. We also measured body mass index to assess whether or not smoking cessation was associated with weight gain. These were measured at 1, 6 and 12 months post randomisation., Results: The trial recruited 97 people aged 19-73 years who smoked between 5 and 60 cigarettes per day (mean 25 cigarettes). Participants were recruited from four mental health trusts and 45 GP surgeries. Forty-six people were randomised to the BSC intervention and 51 people were randomised to usual GP care. The odds of quitting at 12 months was higher in the BSC intervention (36% vs. 23%) but did not reach statistical significance (odds ratio 2.9; 95% confidence interval 0.8% to 10.5%). At 3 and 6 months there was no evidence of difference in self-reported smoking cessation. There was a non-significant reduction in the number of cigarettes smoked and nicotine dependence. MTQ and number of quit attempts all increased in the BSC group compared with usual care. There was no difference in terms of quality of life at any time point, but there was evidence of an increase in depression scores at 12 months for the BSC group. There were no serious adverse events thought likely to be related to the trial interventions. The pilot economic analysis demonstrated that it was feasible to carry out a full economic analysis., Conclusions: It was possible to recruit people with SMI from primary and secondary care to a trial of a smoking cessation intervention based around behavioural support and medication. The overall direction of effect was a positive trend in relation to biochemically verified smoking cessation and it was feasible to obtain follow-up in a substantial proportion of participants. A definitive trial of a bespoke cessation intervention has been prioritised by the National Institute for Health Research (NIHR) and the SCIMITAR pilot trial forms a template for a fully powered RCT to examine clinical effectiveness and cost-effectiveness., Trial Registration: Current Controlled Trials ISRCTN79497236., Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment, Vol. 19, No. 25. See the NIHR Journals Library website for further project information.

Background: Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option., Methods/design: CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial., Discussion: Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care., Trial Registration: ISRCTN45842879 (24 July 2012).

Aim: This study explored young people's perceptions of their involvement in healthcare decisions affecting their management of care., Method: A phenomenological approach was used to allow in-depth examination of the young people's personal accounts of their experiences. Data were obtained from 10 hospitalised young people between the ages of 12-16 years from both genders and from different medical and surgical specialities using focused interviews. Transcribing, reading and listening to the data enabled data analysis through reflection and analysis., Findings: Three themes were identified: level of involvement in decision-making; psychological impact of involvement in decision making; and communication., Conclusion: Professional practice in the care of young people should include effective communication, a policy of inclusion and active assessment of competence.

Background: Receiving a patient handover from an ambulance crew occurs many times during the day across the country. Handover has major implications for subsequent patient care but there has been little investigation of the handover process between ambulance and emergency department staff., Methods: Four emergency departments and one ambulance service were included within one geographical area in the UK. The research was based on a quantitative approach using a descriptive, non-experimental cross-sectional survey. A questionnaire was distributed to a convenience sample of ambulance paramedics and emergency department nurses and doctors. The questionnaire was constructed using mainly closed questions with some qualitative date collected through open questions. Data was analysed using SPSS version 11.5., Results: Of the 101 questionnaires distributed, a total of 80 (68%) participants contributed towards the study. The results indicated emergency department staff need to appreciate that a lack of active listening skills can lead to frustration for ambulance staff. Ambulance staff must expect to repeat their handover, especially for patients in the resuscitation room. Handovers for critically ill patients should be delivered in two phases, with essential information given immediately and again thereafter to give further information when initial treatment has been undertaken., Recommendations: Suggestions are made for improving handovers by developing national guidelines and by incorporating handover in emergency department education.

Objective: To test specific standards set in the newly established cleft lip and palate service in three regions of the U.K. The standards relate to record collection and outcomes., Design: Retrospective analysis., Patients: Records of 31 children, 5 years of age, who were born in 1997 with complete unilateral clefts of lip and palate and were treated by surgeons in three regions., Main Outcome Measures: Record collection standards were measured by collecting dental study models. Outcomes were measured with the 5-Year-Old Index., Results: Of the 31 subjects, 52% had excellent and good outcomes. The 31 cases represented 62% of the total records collected., Conclusions: The three regions examined fell short of the standards set, but the outcomes were improved compared with previous national outcomes. The failings in record collection need to be rectified. This study provides baseline data for further development of cleft services within three regions.

Background: Lecturer Practitioner roles are well established in the United Kingdom. The national literature demonstrates that these staff are valuable to National Health Service trusts and universities however, their roles are busy and demanding, with conflicting expectations from the two employers. In addition, their role in addressing the theory-practice gap - a major reason for their establishment - is at best unclear. Although a number of qualitative studies have explored the topic, there have been no systematic attempts to develop the role or to quantify the effects on postholders., Aim: This paper reports a study that aimed to develop aspects of Lecturer Practitioners' work roles, examine the effects of this on individuals at one English university, and to quantify Lecturer Practitioners' occupational stress and burnout., Methods: A flexible, 'spiral' action research framework and 'collaborative group approach' were used, with mixed methods of data collection. Data were collected through focus groups, meetings and participant feedback, and participants' reflective diaries. A questionnaire using previously validated psychological attitude rating scales was also used to measure occupational stress and burnout, the extent to which the project influenced these, and the influence of Lecturer Practitioners' experience and qualifications. Six null hypotheses were constructed to measure these ideas. Findings from qualitative and quantitative perspectives were triangulated to give depth to the analysis., Findings: Five themes emerged from the focus groups: personal motivation, workload pressures, role clarity, preparation and support, and gains from the role. Specific policies and documentation were developed as a result of this initial project planning work. The findings from the questionnaire indicated that Lecturer Practitioners were no more stressed or burnt out than comparable workers. Synthesis of findings indicated, broadly speaking, that these LPs were 'thriving rather than just surviving'., Conclusion: Action research was an effective methodology for uncovering new knowledge, and bringing about organizational change in this project.