Epidemiology of emergency ambulance service calls related to COVID-19 in Scotland: a national record linkage study

BACKGROUND

COVID-19 has overwhelmed health services across the world; its global death toll has exceeded 5.3 million and continues to grow. There have been almost 15 million cases of COVID-19 in the UK. The need for rapid accurate identification, appropriate clinical care and decision making, remains a priority for UK ambulance service. To support identification and conveyance decisions of patients presenting with COVID-19 symptoms the Scottish Ambulance Service introduced the revised Medical Priority Dispatch System Protocol 36, enhanced physician led decision support and prehospital clinical guidelines. This study aimed to characterise the impact of these changes on the pathways and outcomes of people attended by the SAS) with potential COVID-19.

METHODS

A retrospective record linkage cohort study using National Data collected from NHS Scotland over a 5 month period (April-August 2020).

RESULTS

The SAS responded to 214,082 emergency calls during the study time period. The positive predictive value of the Protocol 36 to identify potentially COVID-19 positive patients was low (17%). Approximately 60% of those identified by Protocol 36 as potentially COVID-19 positive were conveyed. The relationship between conveyance and mortality differed between Protocol 36 Covid-19 positive calls and those that were not. In those identified by Protocol 36 as Covid-19 negative, 30 day mortality was higher in those not conveyed (not conveyed 9.2%; conveyed 6.6%) but in the Protocol 36 Covid-19 positive calls, mortality was higher in those conveyed (not conveyed 4.3% conveyed 8.8%). Thirty-day mortality rates of those with COVID-19 diagnosed through virology was between 28.8 and 30.2%.

CONCLUSION

The low positive predictive value (17%) of Protocol 36 in identifying potential COVID-19 in patients emphasises the importance of ambulance clinicians approaching each call as involving COVID-19, reinforcing the importance of adhering to existing policy and continued use of PPE at all calls. The non-conveyance rate of people that were categorised as COVID-19 negative was higher than in the preceding year in the same service. The reasons for the higher rates of non-conveyance and the relationship between non conveyance rates and death at 3 and 30 days post index call are unknown and would benefit from further study.

Goal attainment, adjustment and disengagement in the first year after stroke: A qualitative study

Understanding stroke survivor responses to attainable and unattainable goals is important so that rehabilitation staff can optimally support ongoing recovery and adaption. In this qualitative study, we aimed to investigate (i) stroke survivor's experiences of goal attainment, adjustment and disengagement in the first year after stroke and (ii) whether the Goal setting and Action Planning (G-AP) framework supported different pathways to goal attainment. In-depth interviews were conducted with eighteen stroke survivors' to explore their experiences and views. Interview data were transcribed verbatim and analysed using a Framework approach to examine themes within and between participants. Stroke survivors reported that attaining personal goals enabled them to resume important activities, reclaim a sense of self and enhance emotional wellbeing. Experiences of goal-related setbacks and failure facilitated understanding and acceptance of limitations and informed adjustment of, or disengagement from, unattainable goals. Use of the G-AP framework supported stroke survivors to (i) identify personal goals, (ii) initiate and sustain goal pursuit, (iii) gauge progress and (iv) make informed decisions about continued goal pursuit, adjustment or disengagement. Stroke survivor recovery involves attainment of original and adjusted or alternative goals. The G-AP framework can support these different pathways to goal attainment.

Facilitators and "deal breakers": a mixed methods study investigating implementation of the Goal setting and action planning (G-AP) framework in community rehabilitation teams

BACKGROUND

High quality goal setting in stroke rehabilitation is vital, but challenging to deliver. The G-AP framework (including staff training and a stroke survivor held G-AP record) guides patient centred goal setting with stroke survivors in community rehabilitation teams. We found G-AP was acceptable, feasible to deliver and clinically useful in one team. The aim of this study was to conduct a mixed methods investigation of G-AP implementation in diverse community teams prior to a large-scale evaluation.

METHODS

We approached Scottish community rehabilitation teams to take part. Following training, G-AP was delivered to stroke survivors within participating teams for 6 months. We investigated staff experiences of G-AP training and its implementation using focus groups and a training questionnaire. We investigated fidelity of G-AP delivery through case note review. Focus group data were analysed using a Framework approach; identified themes were mapped into Normalisation Process Theory constructs. Questionnaire and case note data were analysed descriptively.

RESULTS

We recruited three teams comprising 55 rehabilitation staff. Almost all staff (93%, 51/55) participated in G-AP training; of those, 80% (n = 41/51) completed the training questionnaire. Training was rated as 'good' or 'very good' by almost all staff (92%, n = 37/41). G-AP was broadly implemented as intended in two teams. Implementation facilitators included - G-AP 'made sense'; repetitive use of G-AP in practice; flexible G-AP delivery and positive staff appraisals of G-AP impact. G-AP failed to gain traction in the third team. Implementation barriers included - delays between G-AP training and implementation; limited leadership engagement; a poor 'fit' between G-AP and the team organisational structure and simultaneous delivery of other goal setting methods. Staff recommended (i) development of training to include implementation planning; (ii) ongoing local implementation review and tailoring, and (iii) development of electronic and aphasia friendly G-AP records.

CONCLUSIONS

The interaction between G-AP and the practice setting is critical to implementation success or failure. Whilst facilitators support implementation success, barriers can collectively act as implementation "deal breakers". Local G-AP implementation efforts should be planned, monitored and tailored. These insights can inform implementation of other complex interventions in community rehabilitation settings.

Evaluation of the impact of an augmented model of The Productive Ward: Releasing Time to Care on staff and patient outcomes: a naturalistic stepped-wedge trial

Background

Improving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of ‘releasing time’, which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design.

Method

The objective of this study was to assess the impact of an augmented version of The Productive Ward: Releasing Time to Care on staff and patient outcomes. The design was a naturalistic stepped-wedge trial. The setting included fifteen wards in two acute hospitals in a Scottish health board region. The intervention was the Productive Ward: Releasing Time to Care augmented with practice development transformational change methods that focused on staff caring behaviours, teamwork and patient feedback. The primary outcomes included nurses’ shared philosophy of care, nurse emotional exhaustion, and patient experience of nurse communication. Secondary outcomes covered additional key dimensions of staff and patient experience and outcomes and frequency of emergency admissions for same diagnosis within 6 months of discharge.

Results

We recruited 691 patients, 177 nurses and 14 senior charge nurses. We found statistically significant improvements in two of the study’s three primary outcomes: patients’ experiences of nurse communication (Effect size=0.15, 95% CI; 0.05 to 0.24), and nurses’ shared philosophy of care (Effect size =0.42, 95% CI; 0.14 to 0.70). There were also significant improvements in secondary outcomes: patients’ overall rating of ward quality; nurses’ positive affect; and items relating to nursing team climate. We found no change in frequency of emergency admissions within six months of discharge.

Conclusions

We found evidence that the augmented version of The Productive Ward: Releasing Time to Care Intervention was successful in improving a number of dimensions of nurse experience and ward culture, in addition to improved patient experience and evaluations of the quality of care received. Despite these positive summary findings across all wards, intervention implementation appeared to vary between wards. By addressing the contextual factors, which may influence these variations, and tailoring some elements of the intervention, it is likely that greater improvements could be achieved.

Trial registration number

UKCRN 14195.

Epidemiology of emergency ambulance service calls related to mental health problems and self harm: a national record linkage study

BACKGROUND

People experiencing a mental health crisis receive variable and poorer quality care than those experiencing a physical health crisis. Little is known about the epidemiology, subsequent care pathways of mental health and self-harm emergencies attended by ambulance services, and subsequent all-cause mortality, including deaths by suicide. This is the first national epidemiological analysis of the processes and outcomes of people attended by an ambulance due to a mental health or self-harm emergency. The study aimed to describe patient characteristics, volume, case-mix, outcomes and care pathways following ambulance attendance in this patient population.

METHODS

A linked data study of Scottish ambulance service, emergency department, acute inpatient and death records for adults aged ≥16 for one full year following index ambulance attendance in 2011.

RESULTS

The ambulance service attended 6802 mental health or self harm coded patients on 9014 occasions. This represents 11% of all calls attended that year. Various pathways resulted from these attendances. Most frequent were those that resulted in transportation to and discharge from the emergency department (n = 4566/9014; 51%). Some patients were left at home (n = 1003/9014 attendances, 11%). Others were admitted to hospital (n = 2043/9014, 23%). Within 12 months of initial attendance, 279 (4%) patients had died, 97 of these were recorded as suicide.

CONCLUSIONS

This unique study finds that ambulance service and emergency departments are missing opportunities to provide better care to this population and in potentially avoidable mortality, morbidity and service burden. Developing and testing interventions for this patient group in pre-hospital and emergency department settings could lead to reductions in suicide, patient distress, and service usage.

A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases

BACKGROUND

Decision making in health and social care requires robust syntheses of both quantitative and qualitative evidence. Meta-ethnography is a seven-phase methodology for synthesising qualitative studies. Developed in 1988 by sociologists in education Noblit and Hare, meta-ethnography has evolved since its inception; it is now widely used in healthcare research and is gaining popularity in education research. The aim of this article is to provide up-to-date, in-depth guidance on conducting the complex analytic synthesis phases 4 to 6 of meta-ethnography through analysis of the latest methodological evidence.

METHODS

We report findings from a methodological systematic review conducted from 2015 to 2016. Fourteen databases and five other online resources were searched. Expansive searches were also conducted resulting in inclusion of 57 publications on meta-ethnography conduct and reporting from a range of academic disciplines published from 1988 to 2016.

RESULTS

Current guidance on applying meta-ethnography originates from a small group of researchers using the methodology in a health context. We identified that researchers have operationalised the analysis and synthesis methods of meta-ethnography - determining how studies are related (phase 4), translating studies into one another (phase 5), synthesising translations (phase 6) and line of argument synthesis - to suit their own syntheses resulting in variation in methods and their application. Empirical research is required to compare the impact of different methods of translation and synthesis. Some methods are potentially better at preserving links with the context and meaning of primary studies, a key principle of meta-ethnography. A meta-ethnography can and should include reciprocal and refutational translation and line of argument synthesis, rather than only one of these, to maximise the impact of its outputs.

CONCLUSION

The current work is the first to articulate and differentiate the methodological variations and their application for different purposes and represents a significant advance in the understanding of the methodological application of meta-ethnography.

Improving reporting of meta-ethnography: the eMERGe reporting guidance

AIMS

The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting.

BACKGROUND

Evidence-based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta-ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta-ethnography reporting guidance is needed to improve reporting quality.

DESIGN

The eMERGe study used a rigorous mixed-methods design and evidence-based methods to develop the novel reporting guidance and explanatory notes.

METHODS

The study, conducted from 2015 to 2017, comprised of: (1) a methodological systematic review of guidance for meta-ethnography conduct and reporting; (2) a review and audit of published meta-ethnographies to identify good practice principles; (3) international, multidisciplinary consensus-building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes.

FINDINGS

Recommendations and good practice for all seven phases of meta-ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance.

CONCLUSION

The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta-ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta-ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta-ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho-oncology, Review of Education, and BMC Medical Research Methodology.

Improving the sustainability of hospital-based interventions: a study protocol for a systematic review

INTRODUCTION

Sustaining effective interventions in hospital environments is essential to improving health outcomes, and reducing research waste. Current evidence suggests many interventions are not sustained beyond their initial delivery. The reason for this failure remains unclear. Increasingly research is employing theoretical frameworks and models to identify critical factors that influence the implementation of interventions. However, little is known about the value of these frameworks on sustainability. The aim of this review is to examine the evidence regarding the use of theoretical frameworks to maximise effective intervention sustainability in hospital-based settings in order to better understand their role in supporting long-term intervention use.

METHODS AND ANALYSIS

Systematic review. We will systematically search the following databases: Medline, AMED, CINAHL, Embase and Cochrane Library (CENTRAL, CDSR, DARE, HTA). We will also hand search relevant journals and will check the bibliographies of all included studies. Language and date limitations will be applied. We will include empirical studies that have used a theoretical framework (or model) and have explicitly reported the sustainability of an intervention (or programme). One reviewer will remove obviously irrelevant titles. The remaining abstracts and full-text articles will be screened by two independent reviewers to determine their eligibility for inclusion. Disagreements will be resolved by discussion, and may involve a third reviewer if required. Key study characteristics will be extracted (study design, population demographics, setting, evidence of sustained change, use of theoretical frameworks and any barriers or facilitators data reported) by one reviewer and cross-checked by another reviewer. Descriptive data will be tabulated within evidence tables, and key findings will be brought together within a narrative synthesis.

ETHICS AND DISSEMINATION

Formal ethical approval is not required as no primary data will be collected. Dissemination of results will be through peer-reviewed journal publications, presentation at an international conference and social media.

PROSPERO REGISTRATION NUMBER

CRD42017081992.

Critcomms: a national cross-sectional questionnaire based study to investigate prehospital handover practices between ambulance clinicians and specialist prehospital teams in Scotland

BACKGROUND

Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Improving the accuracy and quality of handover may reduce associated mortality and morbidity. Although the practice of handover between Ambulance and Emergency Department clinicians has received some attention over recent years there is little evidence to support handover best practice within the prehospital domain. Further research is therefore urgently required to understand the most appropriate way to deliver clinical information exchange in the pre-hospital environment. We aimed to investigate current clinical information exchange practices, perceived challenges and the preferred handover mnemonic for use during transfer of high acuity patients between ambulance clinicians and specialist prehospital teams.

METHODS

A national, cross-sectional questionnaire study. Participants were road based ambulance clinicians (RBAC) or active members of specialist prehospital teams (SPHT) based in Scotland.

RESULTS

Over a three month study period there were 247 prehospital incidents involving specialist teams. One hundred ninety individuals completed the questionnaire; 61% [n = 116] RBAC and 39% [n = 74] SPHT. Median length of prehospital experience was 10 years (IQR 5-18). Overall current prehospital handover practices were perceived as being effective (Mdn 4.00; IQR 3-4 [1 = very ineffective - 5 = very effective]) although SPHT clinicians rated handover effectiveness slightly lower than RBAC's (Mdn 3.00 vs 4.00, U = 1842.5, p = .03). 'ATMIST' (Age, Time of onset, Medical complaint/injury, Investigation, Signs and Treatment) was deemed the mnemonic of choice. The clinical variables perceived as essential for handover are not explicitly identified within the SBAR mnemonic. The most frequently reported method of recording and transferring information during handover was via memory (n = 112 and n = 120 respectively) and 'interruptions' were perceived as the most significant barrier to effective handover.

CONCLUSION

While, overall, current prehospital handover practice is perceived as effective this study has identified a number of areas for improvement. These include the development of a shared mental model through system standardisation, innovations to support information recording and delivery, and the clear identification at incidents of a handover lead. Mnemonics must be carefully selected to ensure they explicitly contain the perceived essential clinical variables required for prehospital handover; the mnemonic ATMIST meets these requirements. New theoretically informed, evidence-based interventions, must be developed and tested within existing systems of care to minimise information loss and risk to patients.

Role and prevalence of impaired awareness of hypoglycaemia in ambulance service attendances to people who have had a severe hypoglycaemic emergency: a mixed-methods study

OBJECTIVES

(1) To compare the experiences of people who are affected by diabetes-related hypoglycaemia and either do or do not require an emergency attendance and (2) to measure the prevalence of impaired awareness of hypoglycaemia in patients who are attended by an ambulance service due to a severe hypoglycaemic event.

DESIGN

A sequential mixed-methods study.

SETTING

A qualitative interview study was undertaken with 31 people with diabetes (types 1 and 2) resident in the central belt of Scotland. A national prevalence survey of 590 Scottish Ambulance Service patients who had recently experienced a severe hypoglycaemic emergency requiring ambulance clinicians attendance. Impaired awareness of hypoglycaemia was measured using two standardised measures.

RESULTS

Considerable differences in impaired awareness of hypoglycaemia were found in the experiences of participants who did or did not require the ambulance service to treat their severe hypoglycaemic events. Those who required an ambulance reported fewer warning signs and symptoms. The prevalence of impaired awareness of hypoglycaemia in ambulance service call-outs as assessed by two standardised measures was 53% and 60%, respectively.

CONCLUSIONS

The prevalence of impaired awareness of hypoglycaemia among those who require an ambulance following a hypoglycaemic event is more than twice that found in the general population of people with diabetes. This may be because the experiences of impaired awareness in people who require an ambulance following a severe hypoglycaemic event differ to those who do not. This study provides important information to guide future prehospital clinical practice, and to develop and evaluate theoretically informed interventions. Improvements in prehospital care for this patient population could lead to global improvements in health outcomes and decreased service costs.

Subtle Realism and Occupational Therapy: An Alternative Approach to Knowledge Generation and Evaluation

Occupational therapists are increasingly engaging in research. As this occurs, important and challenging questions are being asked about the most appropriate research approaches to use. Strongly held perspectives of what best constitutes evidence often conflict with influential hierarchies of research. The British Journal of Occupational Therapy has, in recent years, published a variety of papers and letters that have presented and defended effectively the differing perspectives of research approaches. Each of these has presented challenges to occupational therapy research. This opinion piece supports a combinist approach to research. It presents and defends such an approach from a subtle realist perspective.

A Survey of Post-Registration Research Students in Occupational Therapy

In 1999, the College of Occupational Therapists' Research and Development Board was expanded. Two new members were appointed to represent post-registration research students. As little was known about this constituency of the membership of the British Association of Occupational Therapists, the Research and Development Board approved a study of post-registration students. The aims were to identify the needs of post-registration research students in occupational therapy and to develop an action plan based on the findings.

A survey was conducted. The response to the questionnaire was varied: some respondents felt very isolated within their studies whilst others felt well supported. There was general agreement that it was helpful to be in contact with other occupational therapists actively involved in research. A consultation process based on the findings of the survey was carried out to develop an action plan. This process also produced varied results, which made it difficult to make specific recommendations other than that a network was wanted.

At the Research and Development Board meeting in August 2000, the action plan recommended by the post-registration research student members, in which the main recommendation was to set up a post-registration research student network, was approved.

Research Priorities in Forensic Occupational Therapy

National research priorities have been developed and published by the College of Occupational Therapists (Ilott and White 2001). Such an exercise, however, cannot provide the specific research priorities of a particular area of practice. A questionnaire survey was undertaken to ascertain the specific research priorities of forensic occupational therapists. The survey had three parts: determining research priorities, examining outcome measures and exploring the use of protocol-driven group work.

Three specific research priorities were clearly defined by part one of the survey: the development of appropriate outcome measures, the development of rigorous and effective group-work programmes and the development of effective risk assessment tools. The nominal group technique was used in order to triangulate the data. The survey also examined the participants' use of outcome measures: a high number of the participants (62%, 44/71) stated that they used outcome measures in practice. The participants' responses to the third aspect of the survey, regarding the use of protocol-driven groups, were more varied. The majority of the groups reported by the participants were ‘home grown’, with little research base underpinning their implementation.

The methodological weaknesses of undertaking such a survey are examined. The paper concludes that having identified clinicians' priorities in forensic occupational therapy research, the challenge is how best to gather robust evidence for practice.

Complex Interventions and Complex Systems in Occupational Therapy: An Alternative Perspective

In recent years, there have been numerous discussions of complex interventions and complex systems in the health care literature. The cue for many of these discussions was the publication of an influential document on complex interventions by the Medical Research Council in 2000, and the appearance of an equally influential series of articles on complex systems in the British Medical Journal in 2001. However, it is not always clear that the work published during the intervening period recognises that complex interventions and complex systems are not, in fact, the same thing.

This paper discusses a recent contribution to the occupational therapy literature, in which the confusion between complex interventions and complex systems drives the argument. It identifies six claims made by Creek et al (2005) and suggests that only one of them is accurate. Specifically, it argues that, although occupational therapy is sometimes a complex intervention, there is no reason to suppose that it is a complex system; nor is there any good reason to believe that occupational therapy outcomes are intrinsically unpredictable. The paper concludes with an explanation of why this topic is important, and why confusing the two (very different) kinds of complexity risks compromising the idea of evidence-based practice.

In-order-to Analysis: An Alternative to Classifying Different Levels of Occupational Activity

There have been several attempts to produce an authoritative classification scheme capable of discriminating between ‘occupation’, ‘activity’, ‘task’, ‘action’ and so on, but no consensus has ever been achieved. This paper tries to diagnose the reasons for this failure to arrive at a satisfactory method of classifying different levels of occupational activity.

The paper begins with a detailed analysis of the Taxonomic Code for Occupational Performance (TCOP), the most recent attempt to produce such a scheme, and suggests that it has a number of counterintuitive implications. These are, however, rooted in a deeper problem, one which underlies not only the TCOP project but all attempts to classify occupational behaviour. Ultimately, it is argued, the classification agenda is misconceived, because it rests on the assumption that occupational terms represent real structures in the world: that they reflect (or should reflect) the way in which human doing is intrinsically divided into levels, units, sets or clusters. It is this assumption that the authors believe to be mistaken, for there is no ‘intrinsic division’ to which occupational terms can be assigned.

The paper concludes by proposing a form of analysis which, it is argued, should replace classification schemes: in-order-to analysis (IOTA). This kind of analysis, which is explained and illustrated, seeks to determine the relations between various goals that the client has and the things that he or she must be able to do in order to achieve them. It is suggested that IOTA is what various attempts at classification have been groping for, but that it captures occupational therapy's characteristic form of clinical reasoning far more effectively.

British Journal of Occupational Therapy: Revised Categories of Submission

The British Journal of Occupational Therapy provides guidance on categories for submission within its author's guide. The Editorial Board has undertaken a major revision of these categories. This paper provides an overview of the new categories, in advance of publication of the full author's guide.

A preliminary evaluation of the Visual CARE Measure for use by Allied Health Professionals with children and their parents

The Consultation and Relational Empathy (CARE) Measure (Mercer et al., 2004) is a patient-rated experience measure of practitioner empathy, developed and validated within adult health services. This study reports the feasibility, acceptability, reliability and validity of three adapted versions of the original CARE measure for the paediatric setting, namely the Visual CARE Measure 5Q, 10Q and 10Q Parent (also known as the Paediatric CARE Measure). Three hundred and sixty-nine participants (N = 149 children (40%) and N = 220 parents (60%)) completed the measure following consultation with an Allied Health Professional (AHP). AHPs felt it was feasible to use the measure in routine practice and the majority of children and parents found the measure easy to understand (98%) and complete (98%). Internal reliability (Cronbach's α) was .746 for the 5Q, .926 for the 10Q and .963 for the 10Q parent. Few participants used the 'not applicable' response (N = 28 (8%)), suggesting high content validity. AHPs found the measures relevant (95%) and useful (90%) and reported that they were likely to use them again (96%). The Visual CARE Measure shows promise as a useful tool to enable children and their parents to give their views. Further research on the tool's reliability and validity is required.

Improving self-referral for diabetes care following hypoglycaemic emergencies: a feasibility study with linked patient data analysis

Background

Hypoglycaemia is a common and potentially life threatening consequence of insulin and sulphonylurea treated Diabetes. Some severe hypoglycaemic events result in emergency ambulance attendance. Many of these patients are treated at home and do not require immediate transportation to an Emergency Department. However only 27-37 % of patients then follow up their care with a diabetes specialist. Consequently repeat severe hypoglycaemic events occur.

Methods

The intervention was implemented for 8 months, using a prospective cohort design with a historic control, in one Scottish Health Board in 2012. Data was collected using postal survey questionnaires to patients and ambulance clinicians, telephone survey follow-up questions to patients. Scottish Ambulance Service electronic records were linked with the SCI-Diabetes database of patient records to enable objective measurement of follow-up behaviour.

Results

Ambulance clinicians’ (n = 92) awareness of the intervention was high and both the prompt card and telephone call components of the intervention were delivered to most eligible patients. The intervention was perceived as highly acceptable to patients (n = 37), and very useful by both patients and ambulance clinicians. However, comparison of patient follow-up behaviours using linked-data (n = 205), suggest that the intervention was unsuccessful in improving rates of patients’ following up their care.

Conclusions

This study shows that the intervention is implementable, highly acceptable to patients, and considered very useful by both patients and ambulance clinicians. However, preliminary evidence of effectiveness is not encouraging. The study’s novel use of linking existing clinical data for outcome measurement exposed challenges in the feasibility of using this data for intervention development and evaluation. Future research should examine challenges to the successful testing and effectiveness of the intervention. Revisions are likely to be required, both to study design and the optimisation of the intervention’s content and components.

Electronic supplementary material

The online version of this article (doi:10.1186/s12873-016-0078-1) contains supplementary material, which is available to authorized users.

Consensus on items and quantities of clinical equipment required to deal with a mass casualties big bang incident: a national Delphi study

BACKGROUND

Major short-notice or sudden impact incidents, which result in a large number of casualties, are rare events. However health services must be prepared to respond to such events appropriately. In the United Kingdom (UK), a mass casualties incident is when the normal response of several National Health Service organizations to a major incident, has to be supported with extraordinary measures. Having the right type and quantity of clinical equipment is essential, but planning for such emergencies is challenging. To date, the equipment stored for such events has been selected on the basis of local clinical judgment and has evolved without an explicit evidence-base. This has resulted in considerable variations in the types and quantities of clinical equipment being stored in different locations. This study aimed to develop an expert consensus opinion of the essential items and minimum quantities of clinical equipment that is required to treat 100 people at the scene of a big bang mass casualties event.

METHODS

A three round modified Delphi study was conducted with 32 experts using a specifically developed web-based platform. Individuals were invited to participate if they had personal clinical experience of providing a pre-hospital emergency medical response to a mass casualties incident, or had responsibility in health emergency planning for mass casualties incidents and were in a position of authority within the sphere of emergency health planning. Each item's importance was measured on a 5-point Likert scale. The quantity of items required was measured numerically. Data were analyzed using nonparametric statistics.

RESULTS

Experts achieved consensus on a total of 134 items (54%) on completion of the study. Experts did not reach consensus on 114 (46%) items. Median quantities and interquartile ranges of the items, and their recommended quantities were identified and are presented.

CONCLUSIONS

This study is the first to produce an expert consensus on the items and quantities of clinical equipment that are required to treat 100 people at the scene of a big bang mass casualties event. The findings can be used, both in the UK and internationally, to support decision makers in the planning of equipment for such incidents.

Investigating the purpose of an online discussion group for health professionals: a case example from forensic occupational therapy

Background

Thousands of health-related online discussion groups are active world-wide however, very little is known about the purpose and usefulness of such groups. In 2003 an online discussion group called ‘forensic occupational therapy’ was established in the United Kingdom. This group was examined to gain an understanding of the purpose and use of online discussion groups for health professionals who may be practically and geographically isolated from others in similar areas of practice.

Methods

Following a case study design, descriptive characteristics on members’ locations and number of posts were collected from the forensic occupational therapy online discussion group. Eight years of posts (2003–2011) were examined using a theoretical thematic analysis process to identify and describe the purposes for which members were using the group.

Results

Members from 20 countries contributed to the discussion group; the vast majority of posts being from members in the United Kingdom. Activity within the group was consistently high for the first five years however, activity within the group declined in the final three years. Six purposes for which members use the online discussion group were identified: seeking and giving advice, networking, requesting and sharing material resources, service development, defining the role of occupational therapists, and student learning.

Conclusions

Findings suggest that health professionals in specialized and often isolated areas of practice are keen to connect with colleagues and learn from each other’s experiences. The main purposes for which the online discussion group was used could be summarized as communication, information sharing and networking; though activity within the group declined significantly during the last three years of the data collection period. This raises questions about the sustainability of online discussion groups within the rapidly developing social media environment.

Beliefs about responsibilities, the aims of therapy and the structure of the therapy process: a qualitative study of caseload management issues in child health occupational therapy

BACKGROUND

Individual therapists' behaviour contributes to overall caseload management in therapy services. Therapists' caseload management (i.e. actions in relation to assessment, treatment and discharging) is likely to relate to their beliefs about caseload management; it may be possible to change therapists' caseload management by changing their beliefs. This study explored children's occupational therapists' beliefs about caseload management with a view to designing a caseload management intervention.

METHODS

Twenty-five therapists from six NHS Scotland Health Boards were interviewed using a semi-structured format. Interviews were transcribed verbatim, and the interview transcripts were analysed for emerging themes. A proportion of transcripts were independently read and coded, and the themes were validated through critical discussion.

RESULTS

Key issues emerged concerning therapists' beliefs about their responsibilities, the aims of therapy and the structure of the therapy process. Therapists expressed a strong sense of professional duty/responsibility, but the interpretations of what this duty/responsibility was differed between therapists. For example, therapists expressed highly contrasting beliefs about the goals and purpose of therapy and the ways in which therapy processes should be structured. Some therapists promoted an approach structured around clients' goals, while others focused more on relationship building.

CONCLUSIONS

Therapists' beliefs about caseload management differ considerably; these differences could translate to variation in therapists' intentions and behaviours. Implications for practice, policy and future research were identified, as were implications for the way clinicians' caseload management is theorized.

Peer Review: It's Time for More Openness

The British Journal of Occupational Therapy strives to publish high quality research and scholarly papers. The journal faces a challenge in how best to meet this aim in the future. Regardless of the choices it makes, the focus on quality cannot be lost. One of the key features of quality is the peer review process, which all submitted articles must undergo. This paper reviews the policy of double-blind (anonymous) peer reviewing and suggests that an open peer review policy would provide greater transparency, accountability and credit, thereby enhancing the quality of the journal and strengthening its position for the future.

A systematic review of structured group interventions with mentally disordered offenders

BACKGROUND

Over the last 15 years, rehabilitation of offenders has been rigorously researched, resulting in new knowledge and understanding about factors decreasing recidivism amongst them. Typically, such interventions have been based on cognitive behavioural therapy. However, until recently, little research had been carried out on the rehabilitation of offenders with mental disorder. The authors present the first systematic review of the efficacy of structured group interventions with mentally disordered offenders.

AIM

To evaluate structured group interventions with mentally disordered offenders through systematic review of the evidence for their efficacy and effectiveness.

METHODS

A standardized search strategy, with complementary methods of data retrieval to ensure a high degree of recall, was employed. Meta-analysis was not undertaken due to sample heterogeneity and lack of comparable data. Instead, effect sizes were calculated on all papers with sufficient data. Pooled effect sizes were calculated for groups of interventions with a similar focus.

RESULTS

Twenty studies were retrieved that fitted the inclusion criteria. It was possible to categorize these, predominantly British, studies into four main themes: problem-solving; anger/aggression management; self-harm; and other. The mean pooled effect sizes for the first two groups were suggestive of a moderate to high effect, but methodological variation means that these findings should still be treated as preliminary.

DISCUSSION AND CONCLUSIONS

Calculated effect sizes give optimism for the efficacy of structured group interventions with mentally disordered offenders. It is important now that more rigorous and consistent research methods be applied, even in secure hospital environments. Some suggestions towards achieving this are offered, drawing from the work to date, inclusive of the need for agreement on common outcome measures and development of networks to improve sample sizes.

Scholarship of practice in the United kingdom: an occupational therapy service case study

SUMMARY Occupational therapy is required to deliver and generate evidence-based practice. This paper illustrates an approach to meeting these evidence-based expectations. Specifically, there is a description of the development of a partnership between the United Kingdom Centre for Outcomes Research and Education (UKCORE) and The State Hospital which is a forensic mental health service. This case study will illuminate (a) a rationale for partnership, (b) the process of building the partnership, and (c) outcomes of the partnership. Principles of scholarship of practice will be identified and ways of supporting services to integrate occupational therapy knowledge generation and utilisation will be outlined.