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The COVID-19 pandemic has led to the closure or reduction in support services for family carers, resulting in increased social isolation and stress for this population. The current scoping review aimed to identify the impact of COVID-19 upon carers and support provided for them during the pandemic. Four online databases (CINAHL, Medline, PsycINFO and PubMed) were systematically searched on 16th December 2020 and updated on 16th July 2021 for articles written in English and published after January 2020, focused on the carer and the impact of COVID-19. Google scholar and reference lists of relevant papers were checked, and key authors were contacted for further relevant information. The database searches identified 976 citations, which resulted in 670 unique articles following the removal of duplicates. Title and abstract screening identified 63 articles for full-text review, 11 of which were subsequently excluded, leaving 52 articles which were subject to inductive thematic analysis. Four key themes were identified. Whilst a number of issues were identified that were exacerbated by the pandemic, others directly resulting from it were revealed. Few studies discussed support measures for carers and only one trial evaluated an intervention. This review identifies the impact of COVID-19 on carers, but there is a dearth of evidence to inform appropriate tailored support. Governments need to identify carers as a priority group in social care reform and commission co-produced, evidence and experience informed pathways to reinstate support services, potentially modelled on pandemic plans following the example currently being considered for the paid healthcare workforce.

Aim To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. Methods Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. Results The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. Conclusions This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions.

Clinical academic nursing roles are rare, and clinical academic leadership positions even more scarce. Amongst the United Kingdom (UK) academia, only 3% of nurses who are employed within universities are clinically active. Furthermore, access to research fellowships and research grant funding for nurses in clinical or academic practice is also limited. The work of Florence Nightingale, the original role model for clinical academic nursing, is discussed in terms of how this has shaped and influenced that of clinical academic nurse leaders in modern UK healthcare settings. We analysed case studies with a view to providing exemplars and informing a new model by which to visualise a trajectory of clinical academic careers.A Framework analysis of seven exemplar cases was conducted for a network of Clinical Academic Nursing Professors (n = 7), using a structured template. Independent analysis highlighted shared features of the roles: (a) model of clinical academic practice, (b) infrastructure for the post, (c) capacity-building initiatives, (d) strategic influence, (e) wider influence, (f) local and national implementation initiatives, (g) research area and focus and (h) impact and contribution.All seven of the professors of nursing involved in this discourse were based in both universities and healthcare organisations in an equal split. All had national and international profiles in their specialist clinical areas and were implementing innovation in their clinical and teaching settings through boundary spanning. We outline a model for career trajectories in clinical academia, and how leadership is crucial.The model outlined emphasises the different stages of clinical academic roles in nursing. Nursing as a discipline needs to embrace the value of these roles, which have great potential to raise the standards of healthcare and the status of the profession.

BACKGROUND Globally, conducting randomised controlled trials can be a complex endeavour. The complexity increases when including participants with cognitive or intellectual disabilities. A fuller understanding of the barriers and challenges that can be expected in such trials may help researchers to make their trials more inclusive for people with disabilities. METHOD Semi-structured interviews were conducted with twelve international trial experts. RESULTS Eight themes emerged relating to challenges linked to: 1) participant co-morbidities, 2) participant ability levels, 3) ethics and consent, 4) the RCT methodology, 5) gatekeeping, 6) staff turnover, 7) lack of technical understanding and 8) attitudes and perceptions. CONCLUSION Conducting trials with cognitively disabled participants can pose unique challenges although many can be overcome with 'reasonable adjustments'. Challenges that are harder to overcome are attitudes and perceptions that people (professional staff, funding bodies, carers or fellow researchers) hold towards the utility of conducting trials with cognitively disabled populations.

Dementia is a progressive condition that leads to reduced cognition, deteriorating communication and is a risk factor for other acute and chronic health problems. The rise in the prevalence of dementia means untreated pain is becoming increasingly common with healthcare staff being challenged to provide optimal pain management. This negatively impacts the person living with dementia and their carers. There is minimal evidence that explores the pain management experience of patients as they move through acute care settings.To understand the complexities of managing the pain of older people with dementia as they progress through acute care settings, with the view of assisting staff to improve practice.A Participatory Action Research approach, guided by the Promoting Action Research in Health Services framework, was used. Three Action Cycles were completed comprising of an exploratory audit and two case studies (Action Cycle One), three focus groups with a total of 14 participants (Action Cycle Two) and the development and implementation of immediate and long-term actions (Action Cycle Three).Thematic analysis identified four themes that affected pain management practices. These were not knowing the patient; balancing competing priorities; knowledge and understanding of pain and dementia and not assimilating available information.Pain management practices for patient living with dementia, across acute care settings, was influenced by shared ways of thinking and working. Not knowing the patient, fragmentation of information and having insufficient knowledge of the subtleties of dementia led participants to deliver task-focused, target and policy-driven care that was not person-centred in its approach. Facilitated reflection enabled acute care teams to actively participate in identifying problems and finding solutions to enhance practice.

Background Escalating levels of obesity place enormous and growing demands on Health care provision in the (U.K.) United Kingdom. Resources are limited with increasing and competing demands upon them. Ethical considerations underpin clinical decision making generally, but there is limited evidence regarding the relationship between these variables particularly in terms of treating individuals with obesity. Research aim To investigate the views of National Health Service (NHS) clinicians on navigating the ethical challenges and decision making associated with obesity management in adults with chronic illness. Research design A cross-sectional, multi-site survey distributed electronically. Participants A consensus sample of nurses, doctors, dietitians and final year students in two NHS Trusts and two Universities. Ethical considerations Ethical and governance approvals obtained from a National Ethics Committee (11NIR035), two universities and two teaching hospitals. Results Of the total ( n = 395) participants, the majority were nurses (48%), female (79%) and qualified clinicians (59%). Participants strongly considered the individual to have primary responsibility for a healthy weight and an obligation to attempt to maintain that healthy weight if they wish to access NHS care. Yet two thirds would not withhold treatment for patients with obesity. Discussion While clinicians were clear about patient responsibility and obligations, the majority prioritised their duty of care and would not invoke a utilitarian approach to decision making. This may reflect awareness of obesity as a multi-faceted entity, with responsibility for support and management shared amongst society in general. Conclusions The attitudes of this sample of clinicians complemented the concept of the health service as being built on a principle of community, with each treated according to their need. However limited resources challenge the concept of needs-based decisions consequently societal engagement is necessary to agree a pragmatic way forward.

Type 2 diabetes is a chronic condition primarily self-managed by the individual. Mastery is a protective factor linked to better control of chronic conditions, effective self-management and improved medication adherence. Mastery appears increasingly important as treatment regimens and self-management demands become more complex and burdensome. Diabetes distress negatively impacts self-management, glycaemic control and treatment adherence. Understanding the relationship between diabetes distress and mastery may provide opportunities to improve condition management and adherence . This relationship may be impacted by other factors affecting the individual's perceived sense of control over their condition. This study examined the role of diabetes empowerment and depression in the relationship between diabetes distress and mastery. Data were drawn from a randomised controlled trial of 131 adults with type 2 diabetes transitioning to injection therapy. Participants completed measures of diabetes distress , mastery , depression and empowerment . Diabetes distress and depression were negatively associated with mastery, whilst diabetes empowerment was positively associated . A significant interaction effect (b = .024, t(112) = 3.79, p =

AimTo estimate and examine hospitalisation costs of Type 1 and Type 2 diabetes in an Irish public hospital.MethodsA retrospective audit of hospital inpatient admissions over a 5-year period was undertaken, and a wide range of admission-related data were collected for a sample of 7,548 admissions. Hospitalisations were costed using the diagnosis-related group methodology. A series of descriptive, univariate and multivariate regression analyses were undertaken.ResultsThe mean hospitalisation cost for Type 1 diabetes was €4,027 and for Type 2 diabetes was €5,026 per admission. Sex, admission type and length of stay were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 1 diabetes. Age, admission type, diagnosis status, complications status, discharge destination, length of stay and year were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 2 diabetes. Length of stay was associated with higher mean costs, with each additional day increasing Type 1 diabetes costs by €260 (p = 0.001) and Type 2 diabetes by €216 (p < 0.001). Unscheduled admissions were associated with significantly lower costs than elective admissions; €1,578 (p = 0.035) lower for Type 1 diabetes and €2,108 (p < 0.001) lower for Type 2 diabetes.ConclusionsThis study presents estimates of the costs of diabetes care in the Irish public hospital system and identifies the factors which influence costs for Type 1 and Type 2 diabetes. These findings may be of interest to patients, the public, researchers and those with influence over diabetes policy and practice in Ireland and internationally.

Background: People with diabetes frequently contact the ambulance service about acute problems. Overall, treating diabetes and its associated complications costs the NHS 10% of the annual budget. Reducing unnecessary hospital admissions and ambulance attendances is a high priority policy for the NHS across the UK. This study aimed to determine the characteristics of emergency calls for people with diabetes who contact the ambulance service and are subsequently conveyed to hospital by the Northern Ireland Ambulance Service (NIAS).Methods: A retrospective dataset from the NIAS was obtained from the NIAS Trust’s Command and Control system relating to calls where the final complaint group was ‘Diabetes’ for the period 1 January 2017 to 23 November 2019.Results: Of a total 11,396 calls related to diabetes, 63.2% of callers to the NIAS were conveyed to hospital. Over half of the calls related to males, with 35.5% of callers aged 60‐79. The more deprived areas had a higher frequency of calls and conveyance to hospital, with this decreasing as deprivation decreased. Calls were evenly distributed across the week, with the majority of calls originating outside of GP working hours, although callers were more likely to be conveyed to hospital during working hours. Calls from healthcare professionals were significantly more likely to be conveyed to hospital, despite accounting for the minority of calls.Conclusion: This research found that older males were more likely to contact the ambulance service but older females were more likely to be conveyed to hospital. The likelihood of conveyance increased if the call originated from an HCP or occurred during GP working hours. The availability of alternative care pathways has the potential to reduce conveyance to hospital, which has been particularly important during the COVID-19 pandemic. Integration of data is vitally important to produce high quality research and improve policy and practice in this area.

Care in the Community policies has led to people with mental illness receiving treatment and care at home; however, few studies have examined the impact on carers of providing care to a person with mental illness. This was a qualitative study of the experiences of 11 women who are informal carers of people with a long-term mental illness. The study aimed to gain an understanding of the characteristics of this particular caregiving context that contributes to the stress of the role, and to identify the ways in which services could support women in these roles to promote their wellbeing and support the recovery of those they care for. Two groups of themes emerged: the first was the sources of stress, which included how they became a carer, family obligations and relationships and engaging with services. The second was the impact on health and wellbeing, including emotional and mental health, the need for, and absence of support, and coping with stress. The study highlighted a number of unique features of mental illness that lead to additional stress for the carer and render the usual support structures and delivery mechanisms inappropriate. The results pose challenges for those tasked with supporting carers in this context and developing interventions to promote recovery in the community.

Background: Evidence indicates that poor glycemic control is associated with increased morbidity and length of stay in hospital. There are a wide range of guidelines published, which seek to ensure safe and effective inpatient glycemic control in the hospital setting. However, the implementation of these protocols is limited in practice. In particular, the feasibility of “flash” and continuous glucose monitoring (CGM) remains untested on general wards. Method: Scoping Review. Results: If used in the general ward hospital settings, CGM and flash glucose monitoring (FGM) systems could lead to improved glycemic control, decreased length of stay, and reduced risk of severe hypoglycemia or hyperglycemia. Potential problems include lack of experience with this technology and costs of sensors. Rapid analysis of glucose measurements can facilitate clinical decision making and therapy adjustment in the hospital setting. In addition, people with diabetes may be empowered to better self-manage their condition in hospital as they have direct access to their glucose data. Conclusions: More studies are required in which the feasibility, benefits and limitations of FGM and CGM in non–intensive care unit hospital settings are elucidated. We need evidence on which types of hospital wards might benefit from the introduction of this technology and the contexts in which they are less useful. We also need to identify the types of people who are most likely to find FGM and CGM useful for self-management and for which populations they have the most benefit in terms of clinical outcomes and length of stay.

Background/aims People with intellectual disability experience higher rates of multi-morbidity and health inequalities, they are frequently prescribed medications and more likely to have an avoidable or premature death. There is a recognised lack of randomised controlled trials, and subsequently a lack of evidence base, for many of the interventions and treatments provided to people with intellectual disabilities. Very few disability-specific trials are conducted, and people with intellectual, and other cognitive, disabilities are routinely excluded from mainstream trials. There is an urgent need to facilitate more disability-specific trials or to encourage mainstream trialists to include people with disabilities in their studies. Obtaining a thorough understanding of the challenges inherent in these trials, and sharing this knowledge within the research community, may contribute significantly towards addressing this need. The aim of this study was to explore the practical and methodological challenges to conducting trials with adults with intellectual disabilities and to reach a consensus regarding which are the most important challenges for researchers for inclusion in a resource toolkit. Methods A three-round modified Delphi survey was conducted with a panel of international trials researchers within the intellectual disability field. Items were assessed in terms of the consensus level and stability of responses. Results A total of 64 challenges and barriers were agreed upon, across all aspects of the trial pathway, from planning through to reporting. Some challenges and barriers had been noted in the literature previously, but many previously uncited barriers (both systemic and attitudinal) were identified. Conclusion This is the first international survey exploring the experiences of researchers conducting randomised controlled trials with adults with intellectual disabilities. Many of the barriers and challenges reported can be overcome with creativity and some additional resources. Other challenges, including attitudes towards conducting trials with disabled populations, maybe harder to overcome. These findings have implications for conducting trials with other populations with cognitive or communication difficulties. Implications for disability researchers, funding bodies and ethical review panels are discussed.

Background Psychosocial aspects of chronic diseases such as Type 2 diabetes (T2D) and cardiovascular disease (CVD) are increasingly recognised as impacting effective self-management. Until now, little was known regarding the moderating effects of empowerment and depression on the relationship between diabetes-specific distress and mastery. Purpose To evaluate the potential mediating role of diabetes empowerment and depression on the relationship between diabetes-specific distress and mastery. Methods Sample comprised 131 participants diagnosed with T2D, mean [SD] age 62.3 [8.8]; 59.5% male. Mean time since diagnosis was 10.4 years. Assessments included: emotional distress (Problem Areas in Diabetes Scale; PAID); depression and anxiety (Hospital Anxiety and Depression Scale; HADS); mastery (Pearlin Mastery Scale); and empowerment (Diabetes Empowerment Scale – Short Form; DES-SF). Data were examined using SPSS: PROCESS a logistic regression-based path analytical framework for multiple mediator models. Results Regression coefficients for the model identified distress (b=−0.249, t(5,112)=−3.71, p Conclusions These findings elucidate the impact of empowerment and depression on the association between distress and mastery in a diabetes cohort. The evidence suggests that the psychosocial interventions likely to have greatest impact on mastery are those that target key moderators such as empowerment and depression. Funding Acknowledgement Type of funding source: None

Aim To assess variables contributing to hospital conveyance for people with diabetes and the interactions between them. A secondary aim was to generate hypotheses for further research into interventions that might reduce avoidable hospital admissions. Methods A national retrospective data set including 30 999 diabetes-related callouts from the Scottish Ambulance Service was utilized covering a 5-year period between 2013 and 2017. The relationship between diabetes-related hospital conveyance and seven potential risk factors was analysed. Independent variables included: age, gender, deprivation, paramedic attendance, treatment at the scene, first blood glucose measurement and day of the week. Results In Scotland, hyperglycaemia was associated with a higher number of people being conveyed to hospital than hypoglycaemia (49.8% with high blood glucose vs. 39.3% with low glucose, P ≤ 0.0001). Treatment provided in pre-hospital care was associated with reduced conveyance rates (47.3% vs. 58.2% where treatment was not administered, P ≤ 0.0001). Paramedic attendance was also associated with reduced conveyance to hospital (51.4% vs. 59.5% where paramedic was not present, P ≤ 0.0001). Paramedic attendance in hyperglycaemic cases was associated with significantly reduced odds of conveyance (odds ratio 0.52, P ≤ 0.001). Conclusions A higher rate of conveyance associated with hyperglycaemic cases indicates a need for more resources, education and training in this area. Higher conveyance rates were also associated with no paramedic being present and no treatment being administered. This suggests that paramedic attendance may be crucial in reducing avoidable admissions. Developing and validating protocols for pre-hospital services and treatment may help to reduce hospital conveyance rates.

Structured diabetes education (SDE) is an evidence-based intervention that supports self-management in people with type 2 diabetes. In the United Kingdom, health care providers working in primary care settings are responsible for referring people with type 2 diabetes to SDE programs. However, national audits record a high percentage of nonattenders. We explored the personal experience of living with type 2 diabetes that led to individuals declining invitations to attend SDE programs. The themes suggested that emotional, cognitive, and social issues related to diagnosis and living with diabetes may be responsible for declining to attend SDE and that these factors may be masked by explanations of practical barriers. A person-centered approach to understanding the personal meaning of being diagnosed and living with type 2 diabetes may help to identify individuals’ psychosocial barriers to attending SDE.

Aim To explore the reasons young people with type 1 diabetes decline Structured Diabetes Education from the perspectives of the young people themselves, their parents and diabetes educators. Background Structured Diabetes Education programmes that are evidence based and quality assured are a key component to empowering people with diabetes to self-manage effectively. However, research reveals that uptake of structured education programmes is disappointingly low. Design Qualitative cross-sectional study involving participants from Northern Ireland and England. Methods Twenty young people with type 1 diabetes (13-22 years) who had declined Structured Diabetes Education within the past 2 years, 17 parents of a young person with type 1 diabetes and 16 diabetes educators participated in semistructured interviews and focus groups. Results Three main themes emerged from across all three groups: timing, access and communication issues. In addition, a lack of understanding by the referrer was cited by some young people and their parents. Diabetes educators were sympathetic and understood many of the reasons why Structured Diabetes Education was declined. Solutions were proposed to overcome expressed barriers. Conclusions Although the expressed reasons for declining might suggest that the young people simply did not prioritise education, this study adds a more nuanced scenario to the debate. The interviews revealed the tensions that exist between people's daily commitments and their need to self-manage their diabetes. The young people and their parents must be given a much stronger sense of the importance of Structured Diabetes Education and ways to accommodate attendance must be sought. Diabetes educators must be able to better promote the importance of Structured Diabetes Education. Relevance to clinical practice As optimal glycaemic control is so vital for long-term health, there is an urgent need to understand how to respond more fully to the needs of young people who have type 1 diabetes.

Approximately 10% of the world's population have a cognitive disability. Cognitive disabilities can have a profound impact on a person's social, cognitive or mental functioning, requiring high levels of costly health and social support. Therefore, it is imperative that interventions and services received are based upon a sound evidence-base. For many interventions for this population, this evidence-base does not yet exist and there is a need for more Randomised Controlled Trials (RCTs). The process of conducting RCTs with disabled populations is fraught with methodological challenges. We need a better understanding of these methodological barriers if the evidence-bases are to be developed. The purpose of this study was to explore the methodological and practical barriers to conducting trials with adults with cognitive disabilities. As a case example, the literature regarding RCTs for people with intellectual disabilities (ID) was used to highlight these pertinent issues. A systematic literature review was conducted of RCTs with adults with ID, published from 2000 to 2017. A total of 53 papers met the inclusion criteria and were reviewed. Some of the barriers reported were specific to the RCT methodology and others specific to people with disabilities. Notable barriers included; difficulties recruiting; obtaining consent; resistance to the use of control groups; engaging with carers, staff and stakeholders; the need to adapt interventions and resources to be disability-accessible; and staff turnover. Conducting RCTs with people with cognitive disabilities can be challenging, however with reasonable adjustments, many of these barriers can be overcome. Researchers are not maximising the sharing of their experience-base. As a result, the development of evidence-bases remains slow and the health inequities of people with disabilities will continue to grow. The importance of the MRC guidelines on process evaluations, together with implications for the dissemination of ‘evidence-base’ and ‘experience-base’ are discussed.

Aim To report on the outcomes of a pilot feasibility study of a structured self-management diabetes education programme targeting HbA1c. Methods We conducted a two-arm, individually randomized, pilot superiority trial for adults with intellectual disability and Type 2 diabetes mellitus. A total of 66 adults with disabilities across the UK met the eligibility criteria. Of these, 39 agreed to participate and were randomly assigned to either the DESMOND-ID programme (n=19) or a control group (n= 20). The programme consisted of seven weekly educational sessions. The primary outcome was HbA1c level, and secondary outcomes included BMI, diabetes illness perceptions, severity of diabetes, quality of life, and attendance rates. Results This study found that the DESMOND-ID programme was feasible to deliver. With reasonable adjustments, the participants could be recruited successfully, and could provide consent, complete the outcome measures, be randomized to the groups and attend most of the sessions, with minimal loss to follow-up. The fixed-effects model, the interaction between occasion (time) and condition, showed statistically significant results (0.05 level) for HbA1c; however, the CI was large. Conclusion This is the first published study to adapt and pilot a national structured self-management diabetes education programme for adults with intellectual disability. This study shows it is possible to identify, recruit, consent and randomize adults with intellectual disabilities to an intervention or control group. Internationally, the results of this pilot are promising, demonstrating that a multi-session education programme is acceptable and feasible to deliver. Its effectiveness should be further tested in an adequately powered trial. This article is protected by copyright. All rights reserved.

Many individuals approaching the end of life with advanced dementia will live in a care or residential home. A wide spectrum of care is required and physical and safety needs may be prioritised above all other requirements. The Namaste Care Programme is designed to provide a holistic approach to meeting the needs of those with advanced dementia. This paper will outline the process of introducing this programme into a care home and its impact upon those who were involved. With a small sample of residents (n=9) the programme ran for 4 weeks. Feedback was gathered at baseline and during the programme from family and staff. This service innovation offered useful insights and indicated that it has the potential to improve the experiences of those with dementia, their family members and staff. The learning gained will be valuable when developing this initiative at scale and for future robust evaluation.

The burden of chronic illness is increasing globally as a result of increased life expectancy, unhealthy lifestyles, and advances in medical interventions and treatments. Therefore, people living with chronic conditions, and their families, will have to assume greater responsibility in managing such conditions. However, to do so they require appropriate support from healthcare services. This article explores some of the tensions that hinder the self-management of chronic conditions. It emphasises the importance of individuals and their families having the desire, and being enabled, to assume an active and decisive role in the management of chronic conditions. Nurses have a role in enabling patients to optimise their self-management skills, but organisational constraints in healthcare services, as well as constraints in nurse training and nursing roles, may mean that nurses are unable to fulfil this role. This article considers some of the factors that may limit the development of patient and nursing roles in relation to self-management of chronic conditions.

Aim To explore the organizational context in which Type 2 diabetes structured group education is provided. Methods Four Clinical Commissioning Groups in England providing Type 2 diabetes structured self-management education participated in a qualitative study exploring the context for provision of that education. Using UK National Diabetes Audit returns, two Clinical Commissioning Groups were selected that had non-attendance rates of ≤25%, and two that had non-attendance rates of ≥50%. Between May 2016 and August 2017, 20 interviews were conducted with Clinical Commissioning Group staff including: commissioners, healthcare professionals, managers, general practitioners and diabetes educators. Data gathering was prolonged as it proved challenging to engage with healthcare staff as a result of frequent local restructuring and service disruption. Results Local audits revealed discrepancies in basic data such as referral and attendance numbers compared with national audit data. There was a commonality in the themes identified from interviews: diabetes education was rarely embedded in service structure; where education uptake was poor, a lack of central support to delivery teams was noticeable; and where education uptake was positive, delivery teams were actively engaged, sometimes relying on enthusiastic individuals. Both situations put the local sustainability of diabetes education at risk. Conclusions There appears to be a link between attendance rates and organizational issues, therefore, when considering how to increase attendance rates, the state of the diabetes education infrastructure should be reviewed. Good uptake of diabetes education can be too reliant on the enthusiastic commitment of small teams or individuals delivering the education.

ObjectivesTo assess the acceptability and use of a low-cost patient-held communication tool.DesignLongitudinal qualitative interviews at three time points over 18 months and document content analysis.SettingPrimary and community services.ParticipantsTwenty-eight dyads: People living with dementia in Northern Ireland and their informal carers.InterventionsA patient-held healthcare ‘passport’ for people living with dementia.Primary and secondary outcomesAcceptability and use of the passport—barriers and facilitators to successful engagement.ResultsThere was a qualified appreciation of the healthcare passport and a much more nuanced, individualistic or personalised approach to its desirability and use. How people perceive it and what they actually do with it are strongly determined by individual contexts, dementia stage and other health problems, social and family needs and capacities. We noted concerns about privacy and ambivalence about engaging with health professionals.ConclusionSuch tools may be of use but there is a need for demanding, thoughtful and nuanced programme delivery for future implementation in dementia care. The incentivisation and commitment of general practitioners is crucial. Altering the asymmetrical relationship between professionals and patients requires more extensive attention.

BACKGROUND Research into the use of digital technology for weight loss maintenance (intentionally losing at least 10% of initial body weight and actively maintaining it) is limited. The aim of this article was to systematically review randomized controlled trials (RCTs) reporting on the use of digital technologies for communicating on weight loss maintenance to determine its' effectiveness, and identify gaps and areas for further research. METHODS A systematic literature review was conducted by searching electronic databases to locate publications dated between 2006 and February 2018. Criteria were applied, and RCTs using digital technologies for weight loss maintenance were selected. RESULTS Seven RCTs were selected from a total of 6541 hits after de-duplication and criteria applied. Three trials used text messaging, one used e-mail, one used a web-based system and two compared such a system with face-to-face contact. From the seven RCTs, one included children (n = 141) and reported no difference in BMI Standard Deviation between groups. From the seven trials, four reported that technology is effective for significantly aiding weight loss maintenance compared with control (no contact) or face-to face-contact in the short term (between 3 and 24 months). CONCLUSIONS It was concluded that digital technologies have the potential to be effective communication tools for significantly aiding weight loss maintenance, especially in the short term (from 3 to 24 months). Further research is required into the long-term effectiveness of contemporary technologies.

The incidence of gestational diabetes mellitus (GDM)--hyperglycemia with onset or first recognition during pregnancy--is increasing and will have a significant impact on diabetes services. This study aimed to determine the feasibility and acceptability of using telemedicine in the diabetes care of women with GDM and the possibility of replacing alternate (one in every two) diabetes review appointments with telemedicine.A feasibility study for a randomized controlled trial was conducted across two sites. Fifty women with GDM were randomized to usual care (n = 26) or usual care plus telemedicine (n = 24). Telemedicine entailed weekly blood pressure and weight measurements and transmission of these data, along with blood glucose readings, for review by the healthcare team. Patients were contacted about these results as necessary. Patients completed questionnaires to measure their satisfaction with telemedicine or blood glucose monitoring. The intervention group and healthcare providers also took part in qualitative interviews. Analysis involved descriptive statistics for the satisfaction questionnaires and framework analysis for the qualitative interviews.Eighty-nine percent of patients were satisfied with telemedicine and would use it again. Both HCPs and patients found the equipment easy to use and were positive about using it to replace alternate diabetes review appointments in the future. If used in this way, healthcare providers felt that protected time in which to perform the telemedicine review would be necessary.Telemedicine may help meet the growing demand on diabetes services due to increasing numbers of women being diagnosed with GDM.

Background: Direct Payments (DP) is a service user-implemented scheme in which the individuals assessed as needing personal, social or health-related care services are given cash payments, allowing them to ‘buy in’ services they require. Previous research indicates DP offer the user greater control and flexibility over their care. However, the literature highlights problems with the system including user responsibilities, carer recruitment, provision of information and support. Aim: To examine the impact of DP on service users in a large Health and Social Care Trust, in Northern Ireland. Method: Thirty DP users from the Trust area were recruited to the study. The sample consisted of 2 respondents who were in direct receipt of DP, and 28 informal carers who implemented the budget on behalf of an eligible DP service user. Each respondent completed an interview with the study researcher, following an interview schedule devised by the research team. Results: Findings show service users are generally satisfied...

Background Type 2 diabetes is highly prevalent in patients with acute coronary syndrome and impacts negatively on health outcomes and self-management. Both conditions share similar risk factors. However, there is insufficient evidence on the effectiveness of combined interventions to promote self-management behaviour for people with diabetes and cardiac problems. Identifying critical features of successful interventions will inform future integrated self-management programmes for patients with both conditions. Objectives To assess the evidence on the effectiveness of existing interventions to promote self-management behaviour for patients presenting with acute coronary syndrome and type 2 diabetes in secondary care settings and postdischarge. Design We searched MEDLINE, PubMed, CINAHL Plus, PsycInfo, Cochrane Library and AMED for randomised controlled trials published between January 2005–December 2014. The search was performed using the following search terms of ‘acute coronary syndrome’, ‘type 2 diabetes’ and ‘self-management intervention’ and their substitutes combined. Results Of 4275 articles that were retrieved, only four trials met all the inclusion criteria (population, intervention, comparison and outcome) and were analysed. Overall, the results show that providing combined interventions for patients with both conditions including educational sessions supported by multimedia or telecommunication technologies was partially successful in promoting self-management behaviours. Implementation of these combined interventions during patient's hospitalisation and postdischarge was feasible. Intervention group subjects reported a significant improvement in self-efficacy, level of knowledge, glycated haemoglobin, blood pressure and fasting glucose test. However, there are many threats have been noticed around internal validity of included studies that could compromise the conclusions drawn. Conclusion With limited research in this area, there was no final evidence to support effectiveness of combined interventions to promote self-management behaviour for patients with type 2 diabetes and acute coronary syndrome. Sufficiently powered, good quality, well-conducted and reported randomised controlled trials are required.

Aim To increase awareness of the needs of patients with dementia in the trauma and orthopaedics unit of one acute hospital, and to collaborate with staff on the unit to identify ways of improving the care experienced by these patients and their families. Method An action research approach was used and three action research cycles were completed. Data were obtained retrospectively for 20 patients with dementia who were admitted to the unit for treatment. Deficiencies in the care of these patients were identified and related to communication, pain management and the recognition of delirium. In response, a dementia toolkit was developed by nurses and implemented on the unit to improve the care of patients with dementia. Findings Comparison of pre-implementation and post-implementation audit results indicated a significant improvement in all aspects of care for patients with dementia in the trauma and orthopaedics unit, as a result of the implementation of the dementia toolkit. Education and training were provided to staff on the ward to ensure the toolkit was implemented appropriately. Conclusion It is important to consider the specific needs of patients with dementia in acute care settings, not only the primary reason for their admission. The involvement and inclusion of staff in determining what change was needed on the unit, how change would be undertaken and the positive effects of change, demonstrates how action research can inform and improve clinical practice.

Aims and objectives This study aims to examine the effectiveness of the use of telephone empowerment-based health coaching as a cost-effective alternative to changing health behaviours of adults with Type 2 diabetes. Background Guidelines regarding lifestyle management to reduce the risk of complications in diabetes include changing patterns of eating, physical activity and smoking cessation. Traditional education/behavioural methods of support for behaviour change reveal mixed and mainly short-term effects. Design A mixed method case study approach was used (n = 10). Methods Data were collected by means of physiological measurements survey and focus group interview both before and after telephone a coaching intervention. Results Participants took greater responsibility for health and revealed high self-efficacy scores. Short-term benefits were seen in physiological variables at three months but these deteriorated with the cessation of the intervention indicating the need for continuous support. Conclusion Telephone coaching is a cost-effective approach to supporting health behaviour change for those with diabetes. It embraces the principles of empowerment and warrants further evaluation in supporting long-term behavioural changes. As such coaching emerges as a suitable proposition for this cohort. Relevance to clinical practice Health coaching has a positive impact on health behaviours for those with diabetes. Health coaching facilitates an increase in personal control of health and builds confidence in self-managing diabetes. Patients feel really supported and become motivated towards self-care.

Aim: To assess agreement between meter and diary self monitoring of blood glucose (SMBG)records, over a year, in a sample of patients with type 2 diabetes.Methods: Meter and diary records were available, for 95 individuals, who took part in theEfficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetesstudy.Pearson’s correlation coefficient was used to explore the relationships between the typesof error. Maximum likelihood estimation was used to explore changes over time through astructural equation modelling approach. Paired samples t-tests were used to determine ifthe presence of errors led to a significant difference between the mean diary and meterSMBG concentrations or coefficients of variation. Multiple regression was used to explorepossible predictors of the error indices.Results: Mean over-reporting, under-reporting, concordance and overall reliability were8.4%, 10.0%, 83.5% and 71.3%, respectively. The first week of monitoring had significantlymore under-reporting, over-reporting and less concordance and overall reliability thansubsequent weeks. The majority of concordance errors were not clinically significant. Thosethat were, tended to occur during the first three months of monitoring. Participants’ at onetrial site were significantly more likely to have recording errors than those at the largest site.Conclusions: Error levels were similar to those described previously in type 1 diabetes andthere was a suggestion of an initial learning curve for record keeping. For some individualsdiary records would not be considered acceptable if held to the same standards as bloodglucose meters.

Aim The project aims to assess current specialist practice in relation to the new and ever-changing healthcare climate and explore some of the issues that specialist nurses encounter. Background The current financial recession is driving a range of economic policy changes and consequently service provision, in particular the work and impact of nurses working in a specialist role, being examined. This has resulted in many specialist nurses feeling very vulnerable. Method A cross sectional survey was completed by nurses working in specialist roles (n = 96) in a large health and social care setting in the United Kingdom. Findings A response rate of 62% was achieved: 44% provide nurse led clinics and 42% are nurse prescribers. The mean length of time qualified as a registered nurse was 27 years. Less than a third felt that the current computer system for activity recording reflected their current workload and 65% needed administrative support. Conclusion This study demonstrates the insufficient resources available to specialist nurses resulting in inappropriate but necessary, use of time and restricted opportunities for learning and development

Caring for families of critically ill patients is part of emergency nurses' role, but there is a difference of opinion about whether families should be present during resuscitation attempts. This article reports on an opinion survey conducted at two health and social care trusts in Northern Ireland, in which 160 emergency nurses were asked for their views on holistic family-centred care during and after resuscitation. Most participants said that, although they have a duty to provide such care, they are often prevented from doing so by lack of staff and time, and by inadequate education. In light of this finding, the article suggests that staff should take part in debriefing sessions and follow-up programmes should be made available for families after resuscitations have been attempted.

Aims To identify factors that influence lack of engagement of young adults with Type 1 diabetes (aged 13–21 years) with structured diabetes education (SDE) to inform and broaden the reach of future SDE. Methods A quantitative, cross-sectional survey was undertaken of 227 young people with Type 1 diabetes drawn from 11 health trusts across Northern Ireland and England, deemed to be representative of the wider population. Participants were asked to complete a questionnaire exploring non-attendance, along with the Diabetes Care Profile, the Diabetes Empowerment Scale (Short Form), the Diabetes Knowledge Test and the 12-item General Health Questionnaire. Demographic, health and diabetes-specific variables including HbA1c were also collected. Results The five most commonly cited reasons for non-attendance were ‘Had other things to do’ (68.3%), ‘No time’ (62.2%), ‘Could not get time off school/college or work’ (60.8%), ‘Learnt about diabetes from other sources’ (55.5%) and ‘Feel able to cope on own’ (52.9%). Conclusions Greater emphasis is required on communication with young people about the benefits of SDE. In addition, efforts need to be directed to making diabetes education more accessible without losing the quality of structured programmes.

BackgroundThe importance of people with diabetes self-managing their condition effectively on a daily basis is paramount. Although the effectiveness of structured education has been demonstrated for those with type 1 diabetes a recent National (UK) Paediatric Diabetes Audit 2013/14 reported less than 40% of children and young people were recorded as having received some form of such education [1]. Despite evidence of the effectiveness of education and self-management support it is declined by a significant proportion of those invited to attend [2]. AimTo identify factors that influence lack of engagement of young people with type 1 diabetes (aged 13-21 years) with structured diabetes education to inform and broaden the reach of future SDE from a sound evidence base.MethodPhase 1: A quantitative, cross sectional survey of 227 young people with Type 1 diabetes drawn from 11 health trusts across Northern Ireland (NI) and England, (United Kingdom) deemed representative of the wider population, was undertaken. A questionnaire exploring non-attendance, health and diabetes specific variables was completed and HbA1c results collected. Phase 2: From this original cohort 72.3% of the young adults and 56% of their parents consented to be contacted again and a subset of n = 20 young people, 10 from NI and 10 from England was purposefully selected based on length of time diagnosed, gender, location and HbA1c level. We also selected n = 17 parents (10 from NI and 7 from England). The young adults and their parents participated in semi-structured interviews conducted either face to face in their own home or via telephone. Health care professionals (HCP), n = 16, from NI and England who work with young adults with diabetes took part in focus group interviews in their place of work. Each interview lasted 30-40 minutes and focus groups lasted 45-60 minutes, exploring in depth the reasons non-attendance at SDE.ResultsPhase 1: Young adultsThe five most commonly cited reasons for non-attendance were u2018Had other things to dou2019 (68.3%); u2018No timeu2019 (62.2%), u2018Could not get time off school/college or worku2019 (60.8%), u2018Learnt about diabetes from other sourcesu2019 (55.5%) and u2018Feel able to cope on ownu2019 (52.9%). The mean HbA1c of the entire sample was 76.7 (u00b1SD 20.0) mmol/mol (9.2%).Phase 2Young adults and parents The main reasons for non-attendance at diabetes education given by both the young people and parents were very similar and centred on three main themes: u2022ttiming of courses.u2022taccess issues relating to travel distance and financial implications of taking public transport and missing work.u2022tlack of communication and understanding by the referrer about the benefits of attending.Health Care Professionals The main themes arising from the HCP focus groups on their thoughts as to why adolescents chose not to attend SDE were very similar to both the parents and the young adults. The HCPs were not unsympathetic to the adolescents who they feel are already dealing with a challenging period of their life independent of the issues around diabetes, and accompanied by a high level of life-demands in which those of diabetes management often took second place. DiscussionThis study, spanning both quantitative and qualitative approaches provided the opportunity to gather data that can be genenralised (the survey) and also to probe and gain direct information from these three cohorts (the interviews). The combined findings demonstrate that greater emphasis is required on communication with young people about the benefits of structured diabetes education. In addition, efforts need to be directed to making diabetes education more accessible without losing the quality of structured programmes. Discussion with those adolescents, their parents and HCPs revealed that online modes of education should be explored alongside consideration being given to tailored approaches to individuals with specific needs. Bearing in mind that many of the young adults involved in this study had sub-optimal glycaemic control, placing themselves at risk of long term complications, solutions to non-attendance are urgently required. Further investigation is required into preferred, effective modes of delivery of diabetes education in type 1 diabetes. To date the development and provision of structured diabetes education appears to have been curriculum focussed and standardised at the expense of u2018person centerednessu2019. References1. http://www.rcpch.ac.uk/sites/default/files/page/NPDA%20Report%202014-15%20v5.2%20sent%20to%20HQIP%2025.05.2016.pdf2. http://onlinelibrary.wiley.com/doi/10.1111/dme.13120/abstract

The sudden admission to an emergency department (ED) of a patient requiring resuscitation can be a traumatic experience for families, who often require a great deal of support from ED staff. The needs of such staff must be considered too, if the care of patients and families during resuscitation attempts is to be improved. This article discusses the findings of a systematic review of the literature on family-centred care during and after resuscitation attempts, and reveals that, although families appear to favour witnessed resuscitation, the practice remains controversial among healthcare professionals. Chaotic workloads, time restraints, lack of education and poor coping abilities all appear to affect wider implementation of the practice in EDs.

Concordance of diabetes clinicians’ decision making – face-to-face versus telemedicine clinics: a feasibility trialAbstract to be presented at The World Congress on Clinical Trials in Diabetes, Berlin 2016.

AimTo evaluate the extent to which hyperglycaemia was monitored and managed among patients admitted to hospital with acute stroke and transient ischaemic attack.MethodsWe conducted a retrospective cohort study involving a review of the records of 112 patients consecutively admitted with acute stroke or TIA to all 3 district general hospitals in one Health and Social Care Trust in Northern Ireland from January 1st to April 15th, 2008. Glucose results for each of the first five days of hospital admission were ascertained. We compared interventions, clinical outcome and discharge planning between patients who experienced glucose ≥7.8mmol/l. in the first five days, and patients with lower glucose results. ResultsThe daily prevalence rate of hyperglycaemia >7.8mmol/L across the first five days ranged from 24% to 34%. A total of 41 (37%) patients experienced hyperglycaemia on at least one occasion during the first five days. A history of diabetes mellitus prompted near patient glucose testing, but among patients without diagnosed diabetes, glycaemia was under-monitored. Hyperglycaemia was a persisting trend, was under treated, and under reported to general practitioners. Elevated glucose results failed to influence higher rates of fasting plasma glucose tests and BMI assessment. ConclusionsThere is a need for greater vigilance in the detection of hyperglycaemia and undiagnosed diabetes mellitus among patients admitted to hospital with stroke or TIA.