'Making every contact count' with patients with musculoskeletal conditions: a qualitative exploration of acceptability to physiotherapists

AIM

To qualitatively explore physiotherapists' experiences and acceptability of implementing 'Making Every Contact Count Healthy Conversation Skills' (MECC HCS) in routine practice with patients with musculoskeletal (MSK) conditions.

METHODS

This article reports the second phase of a mixed method, sequential explanatory study. Physiotherapists trained in and delivering MECC HCS in their practice were invited to take part in semi-structured interviews. We hoped to develop a rich, in-depth understanding of their use and perceptions of the brief intervention and to contextualise findings from the first phase of the study. Qualitative data were analysed using Reflexive Thematic Analysis.

RESULTS

Physiotherapists valued MECC HCS as being integral to their practice, promoting a person-centred approach to supporting behaviour change and enhancing self-management in patients with MSK conditions and pain. It was believed that this brief intervention could reduce workload pressure for physiotherapists and have significant wider benefits for health services. Time limitations associated with appointments did, however, pose as a challenge to MECC HCS delivery, and it was felt that more organisational-level support was needed to sustain it.

CONCLUSIONS

These findings support our quantitative data, collected in the first phase of this study. MECC HCS is a highly acceptable brief intervention that can be delivered in physiotherapy care to support behaviour change in patients with MSK conditions. Future roll-out may be optimised within organisations by providing regular refresher training and adopting a MECC champion.

'I can feel myself coming out of the rut': a brief intervention for supporting behaviour change is acceptable to patients with chronic musculoskeletal conditions

AIM

To a) understand the perceptions and experiences of patients with musculoskeletal (MSK) conditions in relation to their physiotherapy care and their acceptability of 'Making Every Contact Count Healthy Conversation Skills' (MECC HCS) as a brief intervention within this care and, b) explore the mechanisms through which MECC HCS might facilitate behaviour change and enhance self-management in patients with MSK conditions.

METHODS

This study adopted an exploratory qualitative design, in which individual, semi-structured interviews with participants were conducted. Eight participants were interviewed. Five had been engaging with physiotherapists trained in and delivering MECC HCS within their routine physiotherapy appointments and three had been engaging with physiotherapists who had not received this training and were instead delivering usual care. MECC HCS is a person-centred approach to behaviour change that aims to empower individuals to take control of their health behaviours by building self-efficacy. The MECC HCS training programme helps healthcare professionals to develop skills in i) using 'open discovery' questions to explore context and allow patients to identify barriers and generate solutions; ii) listening more than giving information/ making suggestions; iii) reflecting on practice and iv) supporting Specific, Measurable, Action-oriented, Realistic, Timed, Evaluated, Reviewed (SMARTER) goal setting.

RESULTS

Those who had engaged with MECC HCS trained physiotherapists found their physiotherapy care highly acceptable and felt that their physiotherapist listened to them, tried to understand their context and world, and helped them plan for change. These individuals experienced increases in self-efficacy and motivation for self-managing their MSK conditions. A need for continued support following physiotherapy treatment was, however, emphasised for long-term self-management.

CONCLUSIONS

MECC HCS is highly acceptable to patients with MSK conditions and pain and may successfully facilitate health-promoting behaviour change and enhance self-management. Providing opportunities to join support groups following physiotherapy treatment may promote long-term self-management and provide social and emotional benefits for individuals. The positive findings of this small qualitative study warrant further investigation on the differences in experiences and outcomes between patients engaging with MECC HCS physiotherapists and those receiving treatment as usual during routine physiotherapy care.

Making Every Contact Count with people with MSK conditions: Exploring physiotherapist acceptability

 

There are known risk factors that are associated with the onset and exacerbation of musculoskeletal (MSK) conditions and pain. Physiotherapists are uniquely placed to deliver brief interventions with their patients. Healthy Conversation Skills is the main training component of the Wessex approach to Making Every Contact Count. Despite its potential for promoting MSK health and wellbeing, there is no evidence to support its acceptability within MSK services. This is the first known study to explore the use and perceptions of the Wessex model of MECC HCS within MSK services. A mixed method design was used. Phase one employed an online questionnaire, open to all professionals trained in MECC HCS, consisting of items relating to implementation outcomes. Barriers and facilitators to delivery were explored and mapped to the Theoretical Domains Framework. Phase two invited physiotherapists for a follow-up interview and qualitatively explored their acceptability of delivering MECC HCS to patients with MSK conditions. MECC HCS was found to be highly acceptable, appropriate, and feasible. Physiotherapists reported using their skills at least daily but missed opportunities for delivering MECC HCS were evident. Barriers mapped mostly to ‘Environmental Context and Resources’ on the Theoretical Domains Framework. Qualitative themes developed during phase two were: ‘Recognising the patient as the expert supports change', ‘MECC HCS improves physiotherapy practice', ‘MECC HCS shared problem solving reduces workload', ‘time as a perceived barrier to MECC HCS’ and ‘system-level support needed to sustain MECC HCS'. MECC HCS is a promising brief intervention for supporting people with MSK conditions. Further rollout of this intervention may be beneficial for meeting the goals of the NHS and Public Health England in prevention of MSK conditions and promotion of MSK health. Barriers associated with sustainability must, however, be addressed.

Key messages

• Making Every Contact Count Healthy Conversation Skills is considered a highly acceptable brief intervention for supporting behaviour change in people with musculoskeletal conditions.

• Organisational, system-level barriers to implementation must be addressed in order to increase sustainability and enhance future roll out of the brief intervention.

How useful is the Making Every Contact Count Healthy Conversation Skills approach for supporting people with musculoskeletal conditions?

Aim

To explore the current use and perceptions of the Wessex model of Making Every Contact Count (MECC), incorporating Healthy Conversation Skills (HCS), focussing specifically on physiotherapists supporting people living with musculoskeletal conditions.

Methods

A mixed method, sequential explanatory design was employed. This article reports the first phase of the study, in which an online questionnaire was administered, consisting of items relating to perceived acceptability, appropriateness, feasibility, sustainability, and uptake of MECC HCS. Barriers and facilitators to MECC HCS delivery were additionally explored and mapped to the Theoretical Domains Framework.

Results

Seventy-one professionals responded, including 15 physiotherapists supporting people with MSK conditions. Across professional groups, MECC HCS was found to be highly acceptable, appropriate, and feasible. A significant interaction between perceived sustainability of MECC HCS and the location in which professionals worked was observed. Physiotherapists reported using their MECC HCS at least daily; however, there were discrepancies between the number of their patients they believed could benefit from behaviour change intervention, and the number to whom they reported actually delivering MECC HCS. Perceived barriers and facilitators to MECC HCS implementation mapped mostly to ‘Environmental Context and Resources’ on the Theoretical Domains Framework.

Conclusions

The Wessex model of MECC is a promising brief or very brief intervention for physiotherapists supporting individuals with musculoskeletal conditions. Barriers associated with the sustainability of the intervention within organisations must be addressed in order to enhance future implementation. Further rollout of this intervention may be beneficial for meeting the goals of the NHS and Public Health England in prevention of chronic MSK conditions and promotion of musculoskeletal health.

516 Does the Use of Adjuvant Chemotherapy Increase Incisional Hernia Rates in Colorectal Cancer Patients – A Retrospective Single Centre Cohort Study

Aim

Incisional hernias (IH) are a known complication of any major abdominal surgery. It is known that chemotherapy impairs healing processes via delayed inflammation, impaired collagen synthesis and reduced fibrin deposition and wound contraction. There are currently, to our knowledge, no trials examining the effect of adjuvant chemotherapy on incidence of IH in patients with colorectal cancer. This study aims to assess the same by comparing IH rates between chemotherapy and non-chemotherapy patient groups.

Method

All the patients who had major surgery for colorectal cancer between January 2009 and January 2014 were divided into two groups of chemotherapy (A) and non-chemotherapy (B). Records of first 160 patients from each group were retrospectively analysed.

Results

There were non-significant differences between groups for sex, tumour location, primary operation, and type of procedure (emergency or elective). Significant differences were observed for age (more elder patients in group B, p = 0.000011), method of access (more open procedures in group B and more laparoscopic procedures in group A, p = 0.0007) and Charlson co-morbidity scores (more advanced score in group B, p = 0.029). We found that 21/120 (21.21%) patients in the chemotherapy group and 12/99 (13.79%) patients in non-chemotherapy group developed Incisional hernias. Although there was a higher rate of IH in the chemotherapy group, this was not statistically significant (p = 0.27).

Conclusions

Although this study fails to demonstrate any statistically significant difference in IH incidence between two groups, but this study can act as a pilot in order to fuel further high-quality research to draw more valid conclusions.

445 Review of Restarting Elective Surgical Service in District General Hospital Post COVID 19

Aim

National Health Service (NHS) has massively reduced non-urgent elective surgical service as COVID-19 hit the UK.This study aims to evaluate the measures taken by our trust to restart elective surgical work which was suspended due to the COVID-19 pandemic.

Method

This is a single centre, retrospective, observational study. We analysed records of the first 100 patients who underwent any type of elective General Surgical operative procedure since June 2020.

Results

Our cohort included 51 female, and 49 male patients. Youngest patient was 19 years old and the eldest was of 86 years with mean age of 55.5. In our group, 16 patients were ASA grade 1, 57 were ASA 2, 26 ASA 3 and 1 patient was ASA grade 4. The median ASA grade among our patient group was 2. In this study shortest hospital stay was of 1 day and longest of 53 days with average stay of 5.2 days and SD of 7.6. In our cohort, 18 patients developed Grade 2 Clavein-Dindo(CD) Complications,6 patients developed Grade 3 and none developed complications of CD Grade 4 or beyond. Repeat COVID-19 tests for all patients staying over 7 days were negative.

Conclusions

In conclusion, through appropriate isolation and with adhering to trust guidelines, restarting of elective surgery in non-covid free hospital compound via separate pathways are feasible and should be reflected upon before stopping all elective surgical services in the future considering the threat of further waves of covid-19 or the new variant of the virus looks very real.

Meeting the UK Government's prevention agenda: primary care practitioners can be trained in skills to prevent disease and support self-management

Aims:

The NHS Long Term Plan has a prevention focus and ambition to support patients to self-manage disease through improving health behaviours. An essential requirement of self-management is behaviour change, but many practitioners have not been trained in skills to support behaviour change. ‘Healthy Conversation Skills’ (HCS) training was developed at the University of Southampton for this purpose. This article reports on a pilot study that aimed to assess the feasibility of primary care practitioners adopting HCS in their routine practice. It describes their experiences and level of competence post-training.

Methods:

Health Education England (Wessex) commissioned HCS training for 18 primary care practitioners. Fifteen of these practitioners were subsequently observed in their consultations at one or two time points; face-to-face semi-structured, reflective feedback interviews were conducted immediately following the observations. Practitioners’ HCS competence was assessed from the observations and interviews using a previously developed and published coding rubric. The interview data were analysed thematically to understand practitioners’ experiences of using the new skills.

Results:

Practitioners demonstrated competence in embedding the skills into their routine practice following HCS training. They reflected on how patients liked being asked questions, the usefulness of setting SMARTER (Specific, Measured, Action-oriented, Realistic, Timed, Evaluated and Reviewed) goals and the power of listening. They could also identify facilitators of skill use and ways to overcome challenges such as patients with competing priorities and organisational constraints. They found the skills valuable as a way of empowering patients to make changes to manage their own health.

Conclusions:

HCS are acceptable to primary care practitioners, can be readily adopted into their routine consultations and are a helpful strategy for supporting patients to make changes. HCS training has the potential to be a sustainable, scalable and effective way of contributing to the prevention agenda by supporting disease self-management, and hence of addressing today’s epidemic of lifestyle-related conditions.

Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study

Background

Almost a quarter or more than a fifth of children in the United Kingdom are overweight or obese by the time they start school. The UK Department of Health and Social Care’s national policy for combating childhood obesity has critical outcomes centered on sugar and caloric consumption reduction. Health Education England has developed two digital apps for families with children up to 15 years and for their associated health care professionals to provide a digital learning resource and tool aimed at encouraging healthy lifestyles to prevent obesity.

Objective

This feasibility study assesses the usability and acceptability of Health Education England’s NoObesity app for undertaking activities to improve families’ diet and physical activity. The purpose of the study is to evaluate the app’s influence on self-efficacy and goal setting and to determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability.

Methods

The study population will include 20 to 40 families and their linked health care professionals. Considering issues related to digital access associated with socioeconomic status and the impact on information technology use, study recruitment will be regionally focused in a low socioeconomic status area. The study will last for 9 months (3-month intervention period and 6-month follow-up). The evaluations of feasibility, acceptability, and usability will be conducted using the following scales and theoretical frameworks: (1) system usability scale; (2) Reach Effectiveness Adoption Implementation Maintenance framework; (3) Bandura model of health promotion; and (4) Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Suitability framework. App use will be captured and quantitatively analyzed for net use patterns (eg, number of screens viewed, number of logins, cumulative minutes using the app, number of plans made, and number of times goals met) and to triangulate qualitative feedback from study participants.

Results

This study was funded in March 2019 by Health Education England and received University of Oxford Medical Sciences Interdivisional Research Ethics Committee approval on January 31, 2020 (R62092/RE001). At manuscript submission, study recruitment is pending, and expected results will be published in 2021.

Conclusions

This study will provide evidence on the NoObesity app’s influence on self-efficacy and goal-setting and determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability.

International Registered Report Identifier (IRRID)

PRR1-10.2196/18068

An evaluation of a public health practitioner registration programme: lessons learned for workforce development

Aim:

This article explores the lessons learned for workforce development from an evaluation of a regional programme to support the assessment and registration of public health practitioners to the UK Public Health Register (UKPHR) in England.

Methods:

A summative and process evaluation of the public health practitioner programme in Wessex was adopted. Data collection was by an online survey of 32 public health practitioners in the Wessex area and semi-structured interviews with 53 practitioners, programme support, employers and system leaders.

Results:

All survey respondents perceived regulation of the public health workforce as very important or important. Managers and system leaders saw a register of those fit to practise and able to define themselves as a public health practitioner as a necessary assurance of quality for the public. Yet, because registration is voluntary for practitioners, less value was currently placed on this than on completing a master’s qualification. The local programme supports practitioners in the compilation of a retrospective portfolio of evidence that demonstrates fitness to practise; practitioners and managers stated that this does not support current and future learning needs or the needs of those working at a senior level.

Conclusion:

One of the main purposes of statutory regulation of professionals is to protect the public by an assurance of fitness to practise where there is a potential for harm. The widening role for public health practitioners without any regulation means that there is the risk of inappropriate interventions or erroneous advice. Regulators, policy makers and system leaders need to consider how they can support the development of the public health workforce to gain professional recognition at all levels of public health, including practitioners alongside specialists, and support a professional career framework for the public health system.

The career journeys of health trainers in two health trainer services in England

AIMS

This study follows the career journeys of health trainers and explores their reasons for becoming a health trainer, their experiences of being a health trainer and where and what they go on to.

METHODS

The study used biographical research methods to explore the experiences of seven individuals in two health trainer services. Individual maps were drawn up to preserve the uniqueness and individuality of each biographical story within its social context. Semi-structured interviews explored their journey using a narrative approach, focusing on the stages of becoming, being and moving forward as a health trainer. Thematic analysis of these interviews identified common themes and differences in the experience.

RESULTS

The start of each health trainer's journey is different but there is a remarkable similarity in the experience of being a health trainer. Being a health trainer affirmed the participants' values about 'giving back' to their community. It resulted in improved confidence as well as improved status in the community. All expressed a similar desire to progress within a health field but expressed frustration at being unable to develop a career.

CONCLUSIONS

This study explored the motivations for lay people to become health trainers using the concept of career anchors. It shows how the role strengthens desires to continue working within a health-related field thus creating a potential future public health workforce. However, the lack of progression routes for individuals creates an obstacle for them to progress. This study raises implications for how policy makers, commissioners and workforce planners can appropriately support this public health workforce.

[Analysis of dominant-recessive mutated character of nfr genes of Chlamydomonas reinhardtii and its mutual interaction with the chloroplastic psbA gene]

Phenotypic analysis of the nfr/Nfr diplontic hybrids has demonstrated the recessive mutated character of the nfr genes, and the norflurazon resistant character of the Nfr-4 And Nfr-5 mutants were resulted in by the different nuclear genes nfr-1 and nfr-2 respectively. From the tetrad analysis result of hybridizations of psbA mutant with wild strains CC-124 and nfr mutant, it have been demonstrated that the sensitivity of psbA mutated strain to norflurazon under photoautotrophic condition is due to its multiple effect whereas the chloroplast genome under the mixotrophic situation also gives some effect for resistance to norflurazon. From the titration results of cross-resistant character for antibiotics of norflurazon resistant strains, we had found that, the Nfr-3 mutant has some cross-resistance to erythromycin and streptomycin; based on this phenomenon it would be expected that this mutant having resistant character to suppressor of phytoene desaturase also give some effect for construction of chloroplastic protein.

Antibacterial activity of Vitex trifolia

The petroleum ether and ethanol extracts of Vitex trifolia leaves exhibited moderate inhibiting activity against both gram-positive and gram-negative bacteria.

Antibacterial activity of Clausena heptaphylla

The antibacterial activity of different crude extracts of Clausena heptaphylla leaves as well as three purified coumarins, obtained from the cold methanol extract, is reported.

A randomized controlled trial comparing artemether and quinine in the treatment of cerebral malaria in Bangladesh

A randomized controlled trial on 51 patients receiving artemether and 54 patients receiving quinine was undertaken to compare the effectiveness of intramuscular artemether and parenteral quinine in the treatment of cerebral malaria in adults in Bangladesh. Case fatality, fever and parasite clearance times were not significantly different in the two treatment groups. Coma resolution time was significantly delayed in artemether recipients. Results of the study suggest that treatment with artemether is as effective as parenteral quinine in the treatment of cerebral malaria in adults.

[Genetic characterization of subcbnI genes of Chlamydomonas reinhardtii]

Fourteen different revertants of Chlamydomonas reinhardtii recovered with ability of biosynthesis chlorophyll b were hybridized with wile-type strain, and tetrad analysis with random sampling was performed. It appeared that sub genes resulting in cbnI gene to reverse mutation, and localize on the first chromosome. According to its linkage that differences, 5 strains carrying various mutant alleles of suppressor genes were determined. Forward hybridological analysis demonstrated that the sub genes were absent of allelic specificity and had a single genic character in response to suppression. Phenotypic analysis of the sub/Sub diplontic hybrid have verified the dominant character of mutant sub genes. The phenomenon of present various allelic sub genes and all its characters revealed that the possibility of several ways or various regulatory means exists in biosynthesis of chlorophyll b.

Aerosol granulocyte macrophage-colony stimulating factor: a low toxicity, lung-specific biological therapy in patients with lung metastases

The objective was to study the feasibility of granulocyte macrophage-colony stimulating factor (GM-CSF) delivery to the lung using an aerosol in humans. A Phase I dose escalation study provided GM-CSF at three dose levels as a twice-a-day (BID) x 7 days schedule. Pulmonary functions were monitored using a remote spirometry device. Blood counts were checked at the beginning and end of each week of GM-CSF nebulization. If no toxicity was encountered, patients rested for 7 days and then were treated at the next dose level. Six of seven patients were successfully dose escalated from 60 microg/dose BID x 7 days, to 120 microg/dose BID x 7 days, then 240 microg/dose BID x 7 days. No toxicity was seen. Comparison of day 0 and day 7 blood leukocyte counts showed no significant increases in either leukocyte numbers or percentage of neutrophils. Pulmonary functions test changes were minor. No significant change in forced vital capacity, FEV1, peak flow, or FEF 25-75 related to either time or dose level was observed. One patient's lung metastases progressed. The other five patients received an additional 2-6 months of intermittent aerosol GM-CSF at dose level 3 without side effects. One patient with Ewing's sarcoma has a complete response, and a patient with melanoma had a partial response; the other three had stabilization of pulmonary metastases for 2-6 months. Aerosol delivery of GM-CSF is feasible, safe, and possibly effective. Aerosol cytokine delivery may achieve effective immunological activation against cancer in the lung and is worthy of further study.

Requirement of a limited segment of the sog gene for plasmid R64 conjugation

The sog gene of the IncI1 plasmid R64 was sequenced and characterized. The sog gene was shown to express two acidic proteins, SogL and SogS, with 1255 and 844 amino acid residues, respectively. The SogS protein was expressed by translational reinitiation within the SogL reading frame. Analysis of dnaG-suppression activity using the Escherichia coli dnaG strain indicated that the domain for this activity was located within the N-terminal one-third segment of the SogL protein. A Deltasog mutation was constructed by replacing most of the sog coding sequence with a DNA fragment encoding a tetracycline resistance gene. Introduction of the Deltasog mutation into an R64 derivative resulted in approximately a 50-fold reduction in transfer frequency. It was observed that only a limited portion of the SogL or SogS protein corresponding to an internal 0.94-kb EcoRV-SnaBI segment of the sog gene was required for the conjugal transfer of R64.

Repair of traumatic rupture of the aortic valve

Traumatic aortic valve rupture is a rare complication of nonpenetrating cardiac injury and can be caused by a tear or avulsion of the valve. The most common method of treatment has been valve replacement, although valve repair has been successful in a few cases of cusp tear or detachment. We report a case of aortic valve commissural avulsion in which a reparative technique was applied and the natural valve was preserved.