77 results found
Thompson T, Ahmed B, Weldon SM, et al., 2021, Relative effectiveness of non-surgical interventions for pain management in knee osteoarthritis: a protocol for a component network meta-analysis of randomised controlled trials., BMJ Open, Vol: 11
INTRODUCTION: Knee osteoarthritis is a chronic degenerative disease associated with significant chronic pain, disability and impaired quality of life and is the most common form of osteoarthritis. There is no cure for knee osteoarthritis, and the main therapeutic goals are pain management and improving quality of life. The objective of this study is to evaluate the relative efficacy and acceptability of available interventions using network meta-analysis (NMA) to provide a comprehensive evidence base to inform future treatment guidelines. METHODS AND ANALYSIS: A comprehensive literature search of major electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) and clinical trial registries will identify randomised control trials (RCTs) of interventions listed in NICE guidelines for the treatment of knee osteoarthritis in adults. We will perform an NMA to estimate relative intervention effects across the whole treatment network. If any studies use multicomponent intervention packages, we will employ a component NMA model to estimate the contribution of individual components. The quality of evidence will be assessed using the Confidence in Network Meta-Analysis approach, which is based on the traditional GRADE framework adapted for NMA. Risk of bias (RoB) will be assessed using the revised Cochrane RoB 2.0 tool for RCTs. ETHICS AND DISSEMINATION: This study does not require ethical approval. Findings will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020184192.
Essex R, Weldon SM, 2021, Health Care Worker Strikes and the Covid Pandemic. Reply., N Engl J Med, Vol: 385
Creane SE, Carlile SR, Downey D, et al., 2021, The Impact of Lung Proteases on Snake-Derived Antimicrobial Peptides., Biomolecules, Vol: 11
Respiratory infections are a leading cause of global morbidity and mortality and are of significant concern for individuals with chronic inflammatory lung diseases. There is an urgent need for novel antimicrobials. Antimicrobial peptides (AMPs) are naturally occurring innate immune response peptides with therapeutic potential. However, therapeutic development has been hindered by issues with stability and cytotoxicity. Availing of direct drug delivery to the affected site, for example the lung, can reduce unwanted systemic side effects and lower the required dose. As cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) lungs typically exhibit elevated protease levels, the aim of this study was to assess their impact on snake-derived AMPs. Peptide cleavage was determined using SDS-PAGE and antimicrobial and anti-inflammatory activities of neutrophil elastase (NE)-incubated peptides were assessed using a radial diffusion assay (RDA) and an in vitro LPS-induced inflammation model, respectively. Although the snake-derived AMPs were found to be susceptible to cleavage by lung proteases including NE, several retained their function following NE-incubation. This facilitated the design of novel truncated derivatives that retained functionality following NE incubation. Snake-derived AMPs are tractable candidate treatments for use in environments that feature elevated NE levels, such as the CF airways.
McKelvey MC, Brown R, Ryan S, et al., 2021, Proteases, Mucus, and Mucosal Immunity in Chronic Lung Disease, INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, Vol: 22
Essex R, Weldon SM, 2021, Health Care Worker Strikes and the Covid Pandemic, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 384, ISSN: 0028-4793
Cleaver K, Essex R, Malamateniou C, et al., 2021, A Systematic Scoping Review and Textual Narrative Synthesis of Undergraduate Pediatric Nursing Simulations: What, Why, and How?, Clinical Simulation in Nursing, Vol: 53, Pages: 10-31, ISSN: 1876-1399
Background: Simulation is increasingly being used to train health care professionals; however, there is limited knowledge on how pediatric simulation is being used to train undergraduate nurses. This article systematically scopes the literature on the types of undergraduate pediatric nursing simulations taking place, their value, the research methods used, and areas of research focused on. Methods: A systematic scoping literature review, combined descriptive synthesis, and textual narrative synthesis were conducted. Results: A total of 139 articles were identified by the search strategy. Of these, 32 articles were included for appraisal and synthesis. Seventeen articles were quantitative, five articles were qualitative, and eight articles were mixed-methods. The research took place in six different geographical locations. The total participant sample was 2,039. Articles were categorized according to their aims and objectives and simulation types. Conclusions: This review revealed the heterogeneity of studies on this subject. Ultimately, studies were small and confined to single institutions or geographical locations. Studies that described or explored simulation as an intervention provided more interesting insights than those that evaluated or tested effectiveness. The variety of simulation types was wide, and the fidelity of the simulations being described was frequently noted; however, no reference was made as to how this was determined. Future studies would benefit from detailing the low, medium, or high technological, psychological, or environmental aspects of simulation.
Brown R, Small DM, Doherty DF, et al., 2021, Therapeutic Inhibition of Cathepsin S Reduces Inflammation and Mucus Plugging in Adult beta ENaC-Tg Mice, MEDIATORS OF INFLAMMATION, Vol: 2021, ISSN: 0962-9351
Kneebone R, Korkiakangas T, Weldon S, 2021, “Let me take care of you”: What can healthcare learn from a high-end restaurant to improve patient experience?, Journal of Communication in Healthcare, Vol: 14, Pages: 225-240, ISSN: 1753-8068
BackgroundThe patient experience is associated with patient satisfaction and health outcomes, presenting a key challenge in healthcare. The objective of the study was to explore the principles of care in and beyond healthcare, namely in a three Michelin-starred restaurant, and consider what, if any, principles of care from the diners’ experience could be transferrable to healthcare.MethodThe principles of care were first explored as part of observational fieldwork in a healthcare day surgery unit and the restaurant respectively, focusing on communication between the professionals and the patients or the diners. Care was subsequently explored in a series of public engagement events across the UK. The events used immersive simulation to recreate the healthcare and the dining experiences for the general public, and to stimulate discussion.ResultsA thematic analysis of the engagement discussions identified overarching themes in how care was experienced in and through communication; ‘informed, not bombarded’, ‘conversation, not interrogation’, ‘environment is communication’, and ‘being met as a person’. The themes suggested how the participants in simulation felt about the care they received in real time and provided recommendations for improved clinical practice.
Brown R, McKelvey MC, Ryan S, et al., 2020, The Impact of Aging in Acute Respiratory Distress Syndrome: A Clinical and Mechanistic Overview, FRONTIERS IN MEDICINE, Vol: 7
Keown K, Brown R, Doherty DF, et al., 2020, Airway Inflammation and Host Responses in the Era of CFTR Modulators, INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, Vol: 21
Markowski M, Cleaver K, Weldon SM, 2020, An integrative review of the factors influencing older nurses' timing of retirement, JOURNAL OF ADVANCED NURSING, Vol: 76, Pages: 2266-2285, ISSN: 0309-2402
Shiels J, Cwiklinski K, Alvarado R, et al., 2020, Schistosoma mansoni immunomodulatory molecule Sm16/SPO-1/SmSLP is a member of the trematode-specific helminth defence molecules (HDMs), PLOS NEGLECTED TROPICAL DISEASES, Vol: 14, ISSN: 1935-2735
Thompson T, Dias S, Poulter D, et al., 2020, Efficacy and acceptability of pharmacological and non-pharmacological interventions for non-specific chronic low back pain: a protocol for a systematic review and network meta-analysis., Syst Rev, Vol: 9
BACKGROUND: Despite the enormous financial and humanistic burden of chronic low back pain (CLBP), there is little consensus on what constitutes the best treatment options from a multitude of competing interventions. The objective of this network meta-analysis (NMA) is to determine the relative efficacy and acceptability of primary care treatments for non-specific CLBP, with the overarching aim of providing a comprehensive evidence base for informing treatment decisions. METHODS: We will perform a systematic search to identify randomised controlled trials of interventions endorsed in primary care guidelines for the treatment of non-specific CLBP in adults. Information sources searched will include major bibliographic databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO and LILACS) and clinical trial registries. Our primary outcomes will be patient-reported pain ratings and treatment acceptability (all-cause discontinuation), and secondary outcomes will be functional ability, quality of life and patient/physician ratings of overall improvement. A hierarchical Bayesian class-based NMA will be performed to determine the relative effects of different classes of pharmacological (NSAIDs, opioids, paracetamol, anti-depressants, muscle relaxants) and non-pharmacological (exercise, patient education, manual therapies, psychological therapy, multidisciplinary approaches, massage, acupuncture, mindfulness) interventions and individual treatments within a class (e.g. NSAIDs: diclofenac, ibuprofen, naproxen). We will conduct risk of bias assessments and threshold analysis to assess the robustness of the findings to potential bias. We will compute the effect of different interventions relative to placebo/no treatment for both short- and long-term efficacy and acceptability. DISCUSSION: While many factors are important in selecting an appropriate intervention for an individual patient, evidence for the analgesic effects and acceptability of a treatment are key factors in guiding t
Francesca P, Weldon SM, Lomi A, 2020, Lost in translation: Collecting and coding data on social relations from audio-visual recordings, Social Networks, ISSN: 0378-8733
Some of the constitutive features of social relations fade from view when information naturally produced by sequential social interaction is translated into network ties. Building on core concepts and ideas developed within conversation analysis, in this paper we argue that this happens because the sequential, multimodal and embodied character of social relations can be fully understood only with reference to the sequential constrains that are generated by – and at the same time shape the micro-dynamics of social interaction. We suggest that the translation of social interaction into social networks precludes analysis of the multiple interfaces that sustain social relations (multimodality), and the material resources around which social relations are organized (embodiment). We highlight audio-visual recording as a data collection technology that facilitates storage, retrieval, and analysis of complex information on social relations that is typically absent from social network data. An illustrative video-supported case study based on the observation of social and task-related interaction among members of surgical teams provides the empirical context that supports and motivates our general reflection on network data collection strategies and technologies to study social interaction. The analysis highlights the need for social networks research to return to the study of social relations.
Weldon SM, Korkiakangas T, Calzada J, et al., 2019, A surgical team simulation to improve teamwork and communication across two continents: ViSIOT Proof-of-Concept Study, Journal of Surgical Education, Vol: 76, Pages: 1413-1424, ISSN: 1931-7204
BACKGROUND: Team communication in operating rooms is problematic worldwide, and can negatively impact patient safety. Although initiatives such as the World Health Organization's Surgical Safety Checklist have been introduced to improve communication, patient safety continues to be compromised globally, warranting the development of new interventions. Video-based social science methods have contributed to the study of communication in UK ORs through actual observations of surgical teams in practice. Drawing on this, the authors have developed a surgical team simulation-training model [Video-Supported Simulation of Interactions in the Operating Theatre (ViSIOT)]. A proof-of-concept study was conducted in the UK and USA to assess if the ViSIOT simulation-training has applicability and acceptability beyond the UK. METHODS: ViSIOT training was conducted at two simulation centers in the UK and USA over a 10-month period. All surgical team participants completed a questionnaire (that assessed design, education, satisfaction, and self-confidence in relation to the training). Descriptive and inferential statistics were performed for the quantitative data and thematic analysis was conducted for the qualitative data. RESULTS: There was strong agreement from all participants in terms of their perception of the course across all sub-sections measured. Nine themes from the qualitative data were identified. The two countries shared most themes, however, some emerged that were unique to each country. CONCLUSIONS: Practical developments in the course design, technology, and recruitment were identified. Evidence of the course applicability in the USA provides further affirmation of the universal need for team communication training within ORs. Further studies are required to assess its effectiveness in improving communication in OR practice.
Ojo O, Weldon SM, Thompson T, et al., 2019, The Effect of Diabetes-Specific Enteral Nutrition Formula on Cardiometabolic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials, NUTRIENTS, Vol: 11
Ojo O, Weldon SM, Thompson T, et al., 2019, The Effect of Vitamin D Supplementation on Glycaemic Control in Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomised Controlled Trials, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol: 16
Weldon SM, Korkiakangas T, Kneebone R, 2019, How simulation techniques and approaches can be used to compare, contrast and improve care: an immersive simulation of a three-Michelin star restaurant and a day surgery unit, BMJ Simulation & Technology Enhanced Learning, Vol: 6, Pages: 65-66, ISSN: 2056-6697
Imran A, Holden B, Weldon SM, et al., 2019, 'How to help your unwell child': a sequential simulation project, BMJ Simulation and Technology Enhanced Learning, Vol: 6, Pages: 127-128, ISSN: 2056-6697
Weil A, Weldon SM, Kronfli M, et al., 2018, A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: a mixed methods study, Nurse Education Today, Vol: 71, Pages: 26-33, ISSN: 0260-6917
BACKGROUND: A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs. OBJECTIVES: The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life. SETTING/PARTICIPANTS: Based on the results of a formal Training Needs Analysis, four SqS Simulation™ specialty-based courses were designed for general medical and surgical multidisciplinary teams in an acute UK hospital. METHODS: Over three months, seven SqS Simulation™ sessions were attended by fifty-seven multidisciplinary healthcare professionals. A quasi-experimental mixed-methods study was conducted using open and closed-ended questionnaires, pre and post-intervention. Changes in course attendees' confidence levels were analysed and qualitative data from free-text answers informed potential reasons for any differences identified. RESULTS: Confidence improved for all professional cohorts (p < 0.001). The differences were found to be highly significant for 'doctors' (p < 0.001), significant for 'therapists' (p = 0.02) and not significant for the 'nurses' cohort (p = 0.238). This was explored further using a qualitative explanatory framework. Categories included: Communicating with Families; Teamwork; Goal Planning; Do Not Attempt Cardiopulmonary Resuscitation; Course Usefulness; Prior Training; and Clinical Experience. CONCLUSION: This study has shown an overall improvement in confidence across disciplines after attending a SqS Simulation™ course. The differences in quantitative results between disciplines were explored through the qualitative data
Kronfli M, Weldon SM, Kneebone R, et al., 2017, O4 Sequential simulation: a new approach to sharing challenges, opportunities and learning in maternity service delivery, Abstracts of the Association for Simulation Practice in Healthcare Annual Conference, 6th to 7th November 2017, Telford, UK, Publisher: The Association for Simulated Practice in Healthcare
Weldon SM, Kronfli M, Bello F, et al., 2017, W7 How to design a sequential simulation (SQS) for a variety of objectives, Abstracts of the Association for Simulation Practice in Healthcare Annual Conference, 6th to 7th November 2017, Telford, UK, Publisher: The Association for Simulated Practice in Healthcare
Weldon SM, Kronfli M, Weil A, et al., 2017, O53 A multi-discpilnary training programme for end-of-life care: a sequential simulation, Abstracts of the Association for Simulation Practice in Healthcare Annual Conference, 6th to 7th November 2017, Telford, UK, Publisher: The Association for Simulated Practice in Healthcare
Weldon SM, Kelay T, Ako E, et al., 2017, Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach, BMJ Simulation & Technology Enhanced Learning, Vol: 4, Pages: 13-18, ISSN: 2056-6697
Background A new challenge for healthcare managers is to improve the patient experience. Simulation is often used for clinical assessment and rarely for those operating outside of direct clinical care. Sequential simulation (SqS) is a form of simulation that re-creates care pathways, widening its potential use.Local problem Numbers, outcome measures and system profiling are used to inform healthcare decisions. However, none of these captures the personal subtleties of a patient’s experience.Intervention 56 students attended a teaching module using SqS and facilitated workshops as part of their induction week on an MSc International Health Management course. The workshop was voluntary and was offered as an opportunity for the students to gain an insight into the UK health system through the medium of simulation.Methods An evaluation survey incorporating quantitative and qualitative student feedback was conducted. Descriptive statistics were generated from the quantitative data, and thematic analysis was undertaken for the qualitative data.Results There was strong agreement for the acceptability of the workshop approach in relation to the aims and objectives. Likert scale (1–-5) mean total=4.49. Participants responded enthusiastically (revealed through the qualitative data) with ideas related to perspectives sharing, understanding healthcare management and processes and the consideration of feasibility and practicalities. They also suggested other applications that SqS could be used for.Conclusion The SqS approach has demonstrated that simulation has a wider potential than for clinical assessment alone. Further studies are required to determine its potential uses and affordances beyond its current format.
Weldon S, 2017, Changing the simulation horizon: Let there be light, Annual Physician Associate Educators' Conference
Bezemer J, Cope A, Korkiakangas T, et al., 2016, Microanalysis of video from the operating room: an underused approach to patient safety research, BMJ Quality & Safety, Vol: 26, Pages: 583-587, ISSN: 2044-5423
Huddy JR, Weldon SM, Ralhan S, et al., 2016, Sequential simulation (SqS) of clinical pathways: a tool for public and patient engagement in point-of-care diagnostics., BMJ Open, Vol: 6, Pages: e011043-e011043, ISSN: 2044-6055
OBJECTIVES: Public and patient engagement (PPE) is fundamental to healthcare research. To facilitate effective engagement in novel point-of-care tests (POCTs), the test and downstream consequences of the result need to be considered. Sequential simulation (SqS) is a tool to represent patient journeys and the effects of intervention at each and subsequent stages. This case study presents a process evaluation of SqS as a tool for PPE in the development of a volatile organic compound-based breath test POCT for the diagnosis of oesophagogastric (OG) cancer. SETTING: Three 3-hour workshops in central London. PARTICIPANTS: 38 members of public attended a workshop, 26 (68%) had no prior experience of the OG cancer diagnostic pathway. INTERVENTIONS: Clinical pathway SqS was developed from a storyboard of a patient, played by an actor, noticing symptoms of oesophageal cancer and following a typical diagnostic pathway. The proposed breath testing strategy was then introduced and incorporated into a second SqS to demonstrate pathway impact. Facilitated group discussions followed each SqS. PRIMARY AND SECONDARY OUTCOME MEASURES: Evaluation was conducted through pre-event and postevent questionnaires, field notes and analysis of audiovisual recordings. RESULTS: 38 participants attended a workshop. All participants agreed they were able to contribute to discussions and like the idea of an OG cancer breath test. Five themes emerged related to the proposed new breath test including awareness of OG cancer, barriers to testing and diagnosis, design of new test device, new clinical pathway and placement of test device. 3 themes emerged related to the use of SqS: participatory engagement, simulation and empathetic engagement, and why participants attended. CONCLUSIONS: SqS facilitated a shared immersive experience for participants and researchers that led to the coconstruction of knowledge that will guide future research activities and be of value to stakeholders concerned with the inv
Weldon S, Kneebone R, Bello F, 2016, Collaborative healthcare remodelling through Sequential Simulation (SqS): a patient and front-line staff perspective, BMJ Simulation & Technology Enhanced Learning, Vol: 2, Pages: 78-86, ISSN: 2056-6697
Background The Department of health funded an initiative to pioneer new approaches that would create a more integrated form of care.Local problem In order to receive funding, local Clinical Commissioning Groups were required to engage a range of stakeholders in a practical approach that generated the development of an integrated model of care.Intervention Two sequential simulation (SqS) workshops comprising 65 and 93 participants, respectively, were designed using real patient scenarios from the locality, covering areas of general practice, community health and adult social care. Workshops were attended by a diverse group of stakeholders. The first workshop addressed current care pathways and the second modelled ideal care pathways generated from the data obtained at the first workshop.Methods Discussions were captured through video recording, field-notes and pre and post questionnaires. Data was collated, transcribed and analysed through a combination of descriptive statistics and thematic analysis.Results The questionnaires revealed that attendees strongly agreed that they had had an opportunity to contribute to all discussions and raise questions, concerns and ideas (100%). Pre and post knowledge of current and new models of care was vastly improved. The opportunity to share information and to network was valued, with the SqS approach seen as breaking professional barriers (100%).Conclusions Simulation can be used as a tool to engage stakeholders in designing integrated models of care. The systematic data collection from the diverse ideas generated also allows for a much-needed ‘ear’ to those providing the solutions, as well as a legitimate and balanced perspective.
Objectives: To develop an intervention for educating pharmacists(community and hospital) about integrated care and their role in implementingit.Methods: We developed a sequential simulation derived from a patient’sjourney, the key scenario featuring a community pharmacist. The scenarioswere designed with input from pharmacists and patients, and emphasized theeffect operating in silos can have on the patient.Evaluation: Evaluation was by questionnaire, field notes and analysis ofvideo material. 21/37 (56.7%) participants responded to the questionnaire.19/21 expressed that they felt the event was a good or excellent educationalexperience, and had improved their confidence in their capability to improvepatient care. 19/21 said their knowledge and understanding of integrated carehad been enhanced. The sequential simulation was appreciated as a way ofvisualizing integrated care, with 19/21 describing it as good or excellent.Further themes were identified through video-analysis and field note analysis.Conclusion: Sequential Simulation is a novel and practical approach topresent current care pathways, aiming to generate a mutual focus, createparticipant empathy and bring the conventionalities of integrated care to life.We consider this approach helpful in preparing frontline staff to participate in integrated care.
Kneebone R, Weldon S-M, Bello F, 2016, Engaging patients and clinicians through simulation: rebalancing the dynamics of care, Advances in Simulation, Vol: 1, ISSN: 2059-0628
This paper proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues. This use of simulation is a radical departure from traditional transmission models of education and training. Instead, we frame simulation as co-development, through which professionals, patients and publics share their equally (though differently) expert perspectives. The paper argues that a process of participatory design can bring about new insights and that simulation offers understandings that cannot easily be expressed in words. Drawing on more than a decade of our group’s research on simulation and engagement, the paper summarises findings from studies relating to clinician-patient collaboration and proposes a novel approach to address the current need. The paper outlines a mechanism whereby pathways of care are jointly created, shaped, tested and refined by professionals, patients, carers and others who are affected and concerned by clinical care.
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