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Background: Liver disease is an increasing cause of morbidity and mortality in the United Kingdom and can be challenging to live with in the advanced stages. There has been little research exploring the healthcare experiences of UK individuals with decompensated disease when the liver cannot carry out its functions properly. A PhD research project was developed with people who have liver disease to explore care experiences in decompensated advanced liver disease. Public involvement (PI) is an essential aspect of meaningful health research, and this paper reports on the progression of our PI approach in this ongoing study. Objective: To embed PI throughout the research project to ensure that the study is meaningful to individuals with liver disease and the people who support them. Methods: The research adopts a Constructivist Grounded Theory methodology to develop a theory of care experience. Various PI approaches were considered in developing the PI strategy for this qualitative study. Initially, Embedded consultation was the preferred model, which has evolved to include aspects of collaboration and coproduction. A PI group was set up to oversee the project through the national public engagement website VOICE, and reflections on PI from three members of the group are included in this paper to illuminate the PI process. Results: Six individuals with liver disease and three carers from across the United Kingdom are part of an ongoing PI group. Their role includes commenting on the findings of the systematic literature review for this project and contributing to decisions about recruitment, data collection and data analysis. Additionally, they had a direct impact on changing the focus of the research. The PI group will continue involvement until the completion of the project. Conclusion: Successfully embedding PI into doctoral research, as demonstrated in this project, requires commitment, planning and dedication to reciprocal working for the benefit of PI contributors as well as the research. This approach could be adopted by other postgraduate researchers. Patient or Public Contribution: This project is overseen by the PI group, whose contribution is described throughout, including reflections from three PI group members. [ABSTRACT FROM AUTHOR]

Background: Treatment fidelity refers to the degree to which an intervention is implemented as intended. Promoting treatment fidelity is important to achieve a valid comparison in intervention research. However, it is often underreported: few studies detail the use and development of fidelity measures. This study aims to promote the treatment fidelity of a modified version of the Derbyshire Language Scheme (M‐DLS), a manualised intervention for children with language difficulties, by exploring participants' opinions on training and intervention delivery. Results inform development of a checklist and scoring system to monitor and promote treatment fidelity in a comparison trial. Method: Ten student speech and language therapists (SLTs) and two research assistants (RAs) participated in the study. All received training on the M‐DLS, and 10 were video‐recorded completing role‐plays of an M‐DLS session in small groups. Feedback was gathered after training and role‐plays in focus groups and interviews. Feedback was interpreted using the constructs of the Theoretical Domains Framework (TDF). A treatment fidelity checklist was then developed using the feedback. The first author and two RAs rated role‐play videos using the checklist to trial it to inform amendments and to promote interrater reliability. Interrater agreement was calculated using Spearman's test of correlation. Results: Participants discussed the importance of having clear materials and time to practise sessions. They suggested amendments to the materials and training to promote treatment fidelity. The checklist and scoring system accounted for participants' suggestions, with amendments detailed in a log. Spearman's correlation results suggested agreement between the raters was strong. Conclusions: Results emphasise the importance of training quality, practice and reflective opportunities and clear materials to promote treatment fidelity. The construction of the checklist and scoring system was described in detail, informing the development of future checklists. After further trialling, the checklist can be used to ensure the M‐DLS is delivered with high treatment fidelity in the comparison trial. What this paper adds: What is already known on this subject: Treatment fidelity is an essential component of intervention effectiveness and efficacy studies, ensuring the intervention is delivered as intended. It is also an essential component of evidence-based clinical practice. However, few research studies report the treatment fidelity process or publish the checklists used, depriving clinicians of useful information for implementation. What this study adds: This study describes in detail the iterative process of treatment fidelity checklist development, engaging those implementing the intervention in development. This ensured clarity and interrater reliability of the checklist. Furthermore, a novel scoring system was developed so that accuracy of implementation can be easily compared across users and across practice attempts. What are the clinical implications of this work?: The importance of treatment fidelity when implementing effective and efficacious interventions cannot be overstated. The treatment fidelity checklist developed for research can be easily adopted to support accurate implementation in clinical practice through an audit process. [ABSTRACT FROM AUTHOR]

Background: Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups. Aims: This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom. Methods and Procedures: In total, 43 UK families of 2–4‐year‐olds were recruited to the study, half of whom completed an 8‐week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait‐list controls. Results and Outcomes: Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait‐list controls. Conclusions and Implications: We conclude that pre‐verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population. What This Paper Adds: What is already known on the subject: Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds: This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work?: Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need. [ABSTRACT FROM AUTHOR]

Previous research has found that music brings back more vivid and emotional autobiographical memories than various other retrieval cues. However, such studies have often been low in ecological validity and constrained by relatively limited cue selection and predominantly young adult samples. Here, we compared music to food as cues for autobiographical memories in everyday life in young and older adults. In two separate four‐day periods, 39 younger (ages 18–34) and 39 older (ages 60–77) adults recorded their music‐ and food‐evoked autobiographical memories in paper diaries. Across both age groups, music triggered more frequent autobiographical memories, a greater proportion of involuntary memories, and memories rated as more personally important in comparison to food cues. Age differences impacted music‐ and food‐evoked memories similarly, with older adults consistently recalling older and less specific memories, which they rated as more positive, vivid, and rehearsed. However, young and older adults did not differ in the number or involuntary nature of their recorded memories. This work represents an important step in understanding the phenomenology of naturally occurring music‐evoked autobiographical memories across adulthood and provides new insights into how and why music may be a more effective trigger for personally valued memories than certain other everyday cues. [ABSTRACT FROM AUTHOR]

Background: Developmental language disorder (DLD) has clear functional ramifications in the areas of social competency, emotion recognition, emotional well‐being and literacy skill, which have been found to persist from childhood to adolescence. These domains are important factors during the transition from primary to secondary school in typical development (TD). Nevertheless, there is a paucity of research on the transition from primary to secondary school for adolescents with DLD and low language (LL) ability. Aims: To investigate the association between psychosocial domains, literacy skill and concerns about school during the transition to secondary school for adolescents with DLD, LL and their TD peers. The first research question examined whether levels of social competency, emotion recognition, emotional well‐being and literacy skill predicted school concern for the three groups. The second research question explored the longitudinal relationship between school concern and psychosocial and literacy indicators over the transition. Methods & Procedures: Participants (aged 10–11 years) with DLD (n = 30), LL ((n = 29) and TD (n = 42) were recruited for this longitudinal study from eight UK primary schools. Standardized language and psychosocial assessments were administered in the spring and summer terms of the final year of primary school, and the autumn and summer terms of the first year in secondary school. Outcomes & Results: Regression analyses showed pre‐transition school concern to be predicted by emotion recognition for the DLD group, by social competence and emotional well‐being for the LL group, and by social competence for the TD group. Post‐transition concern was predicted by emotional well‐being for the LL group; with no significant predictors for the DLD/TD groups. Path analyses revealed an association between literacy skill and emotion recognition for the DLD group. A developmental cascade illustrated a relationship between social competence and emotional well‐being for the TD group. Conclusions & Implications: This study concludes that transition interventions must be differentiated according to language ability; support for DLD adolescents should focus on emotion recognition skill, provision for LL adolescents should centre on emotional well‐being, and TD participants should be particularly supported in the domain of social competence in advance of the move to secondary school. Additionally, this study emphasizes the importance of the inclusion of a LL group, as their outcomes cannot be predicted using DLD/TD research. WHAT THIS PAPER ADDS: What is already known on the subject: There is limited research exploring the transition from primary school to secondary for adolescents with DLD or LL ability. Research on TD has highlighted vulnerable domains at this time. As these key areas are evidenced spheres of difficulty in DLD and LL, there was a strong impetus for this study. What this paper adds to existing knowledge: This study reveals differences between language ability groups in the predictors of school concern both pre‐ and post‐transition. Concerns of adolescents with DLD were predicted by emotion recognition, those of adolescents with LL were predicted by emotional well‐being, and a longitudinal link between social competence and emotional well‐being was evidenced for TD adolescents. What are the potential or actual clinical implications of this work?: This study has implications for researchers and clinicians, as a need has been identified for a new clinical group. It also has practical implications for transition support planning for educational practitioners, families and adolescents. [ABSTRACT FROM AUTHOR]

Background: Teenagers represent a small proportion of patients on paediatric intensive care units (PICU) in the United Kingdom. During a time when their development is rapidly changing, an admission to PICU causes additional disruption. The impact of critical illness on psychological health after discharge has not been widely reported within this population. Aim and objectives: To measure anxiety that teenagers report 48‐96 hours and 4 weeks after discharge from PICU. To explore teenagers' experiences of being admitted onto PICU. Design: Two‐phase mixed methods, explanatory sequential design. Methods: This single‐site study was conducted between February and July 2018. An NHS Ethics committee approved the study. Teenagers were screened if they were aged 13‐18 years old and had an elective or emergency admission to PICU for longer than 24 hours. Hospital Anxiety and Depression Scale, Anxiety subscale (HADS‐A) was administered on paper and completed with the researcher present. Semi‐structured interviews were conducted in‐person and over the telephone, audio‐recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Results: Nine of eighteen participants (50%) obtained scores indicating levels of anxiety which were mild (n = 3; 17%), moderate (n = 2; 11%), or severe (n = 4; 22%) 48‐96 hours after PICU discharge. Four weeks later, all participants scored below the clinically significant cut‐off level for the HADS‐A‐1 Teenagers described their experiences on PICU within three themes:Memories of treatments, side effects, and the PICU environmentLosing a sense of selfFeeling cared for Conclusions: Measured levels of anxiety had resolved in this small sample, 4 weeks after PICU discharge. This finding was not consistent with qualitative data that indicated that many experiences shared by participants were anxiety provoking. Relevance to clinical practice: Support for teenagers after PICU discharge should be available to meet individual needs; screening teenagers to identify support needs would be beneficial. [ABSTRACT FROM AUTHOR]

Learning analytics (LA) has demonstrated great potential in improving teaching quality, learning experience and administrative efficiency. However, the adoption of LA in higher education is often beset by challenges in areas such as resources, stakeholder buy‐in, ethics and privacy. Addressing these challenges in a complex system requires agile leadership that is responsive to pressures in the environment and capable of managing conflicts. This paper examines LA adoption processes among 21 UK higher education institutions using complexity leadership theory as a framework. The data were collected from 23 interviews with institutional leaders and subsequently analysed using a thematic coding scheme. The results showed a number of prominent challenges associated with LA deployment, which lie in the inherent tensions between innovation and operation. These challenges require a new form of leadership to create and nurture an adaptive space in which innovations are supported and ultimately transformed into the mainstream operation of an institution. This paper argues that a complexity leadership model enables higher education to shift towards more fluid and dynamic approaches for LA adoption, thus ensuring its scalability and sustainability. [ABSTRACT FROM AUTHOR]

Background: Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people's health expectations and potentially behaviour during the COVID‐19 pandemic. Objectives: Data were collected through an international survey (N = 6485) exploring people's thoughts and psychosocial behaviours relating to COVID‐19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself. Methods: Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5‐8 of the UK COVID‐19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile. Findings: Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID‐19‐related risks in the short term (P <.001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID‐19‐related infection or symptoms) when thinking about the next year. Discussion: This is one of the first ever studies to report compelling comparative biases in UK adults' thinking about COVID‐19. [ABSTRACT FROM AUTHOR]

Background & objectives: The comparative uses of different types of patient experience (PE) feedback as data within quality improvement (QI) are poorly understood. This paper reviews what types are currently available and categorizes them by their characteristics in order to better understand their roles in QI. Methods: A scoping review of types of feedback currently available to hospital staff in the UK was undertaken. This comprised academic database searches for "measures of PE outcomes" (2000‐2016), and grey literature and websites for all types of "PE feedback" potentially available (2005‐2016). Through an iterative consensus process, we developed a list of characteristics and used this to present categories of similar types. Main results: The scoping review returned 37 feedback types. A list of 12 characteristics was developed and applied, enabling identification of 4 categories that help understand potential use within QI—(1) Hospital‐initiated (validated) quantitative surveys: for example the NHS Adult Inpatient Survey; (2) Patient‐initiated qualitative feedback: for example complaints or twitter comments; (3) Hospital‐initiated qualitative feedback: for example Experience Based Co‐Design; (4) Other: for example Friends & Family Test. Of those routinely collected, few elicit "ready‐to‐use" data and those that do elicit data most suitable for measuring accountability, not for informing ward‐based improvement. Guidance does exist for linking collection of feedback to QI for some feedback types in Category 3 but these types  are not routinely used. Conclusion: If feedback is to be used more frequently within QI, more attention must be paid to obtaining and making available the most appropriate types. [ABSTRACT FROM AUTHOR]

When appraising research papers, how much understanding is enough? More specifically, in deciding whether research results can inform practice, do appraisers need to substantively understand how findings are derived or is it sufficient simply to grasp that suitable analytic techniques were chosen and used by researchers? The degree or depth of understanding that research appraisers need to attain before findings can legitimately/sensibly inform practice is underexplored. In this paper it is argued that, where knowledge/justified beliefs derived from research evidence prompt actions that materially affect patient care, appraisers have an epistemic duty to demand high (maximal) rather than low (minimal) levels of understanding regards finding derivation (i.e. appraisers have a duty to seek a superior epistemic situation). If this argument holds assumptions about appraiser competence/ability and the feasibility of current UK conceptions of evidence based practice are destabilized. [ABSTRACT FROM AUTHOR]

The academic study of educational technology is often characterised by critics as methodologically limited. In order to test this assumption, the present paper reports on data collected from a survey of 462 'research active' academic researchers working in the broad areas of educational technology and educational media. The paper explores their familiarity and expertise with various methods of data collection and analysis. Data from the survey highlight a preference for relatively basic forms of descriptive research, coupled with a lack of capacity in advanced quantitative data collection and analysis. The paper concludes with some directions for 'methodological capacity building' to broaden the use of methods in educational technology research. [ABSTRACT FROM AUTHOR]

This paper presents the implications and findings of a longitudinal evaluation of a UK charity's network of therapeutic projects for their effectiveness in improving child outcomes following child sexual abuse. Eight intervention projects across England and Wales participated in this one group pre- and post-test evaluation leading to a final sample of 42 children. We collected qualitative and quantitative data via the individual projects. These data included responses from the children's parents, the therapists and from the children themselves. The findings of this evaluation indicate improvements in the children's outcomes in some domains but persistence of problems in others. No deterioration was observed. We conclude the article by addressing the strengths and limitations of the evaluation and suggesting recommendations for future practitioner-researcher collaborations. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Messages This paper presents findings from a longitudinal evaluation of a UK charity's network of therapeutic projects for their effectiveness in improving child outcomes following child sexual abuse., Eight intervention projects nationally participated leading to a final sample of 42 children. Children included in this evaluation showed improvement on most measures but the strength of the findings is limited by the lack of comparison group and the number of children and young people recruited. [ABSTRACT FROM AUTHOR]

Little research so far has been devoted to understanding the diffusion of grassroots innovation for sustainability across space. This paper explores and compares the spatial diffusion of two networks of grassroots innovations, the Transition Towns Network ( TTN) and Gruppi di Acquisto Solidale ( Solidarity Purchasing Groups - GAS), in Great Britain and Italy. Spatio-temporal diffusion data were mined from available datasets, and patterns of diffusion were uncovered through an exploratory data analysis. The analysis shows that GAS and TTN diffusion in Italy and Great Britain is spatially structured, and that the spatial structure has changed over time. TTN has diffused differently in Great Britain and Italy, while GAS and TTN have diffused similarly in central Italy. The uneven diffusion of these grassroots networks on the one hand challenges current narratives on the momentum of grassroots innovations, but on the other highlights important issues in the geography of grassroots innovations for sustainability, such as cross-movement transfers and collaborations, institutional thickness, and interplay of different proximities in grassroots innovation diffusion. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this paper is to determine the influence of do not attempt cardiopulmonary resuscitation (DNACPR) orders and the Universal Form of Treatment Options (‘UFTO’: an alternative approach that contextualizes the resuscitation decision within an overall treatment plan) on nurses' decision making about a deteriorating patient. Methods: An online survey with a developing case scenario across three timeframes was used on 231 nurses from 10 National Health Service Trusts. Nurses were randomised into three groups: DNACPR, the UFTO and no‐form. Statements were pooled into four subcategories: Increasing Monitoring, Escalating Concern, Initiating Treatments and Comfort Measures. Results: Reported decisions were different across the three groups. Nurses in the DNACPR group agreed or strongly agreed to initiate fewer intense nursing interventions than the UFTO and no‐form groups (P < 0.001) overall and across subcategories of Increase Monitoring, Escalate Concern and Initiate Treatments (all P < 0.001). There was no difference between the UFTO and no‐form groups overall (P = 0.795) or in the subcategories. No difference in Comfort Measures were observed (P = 0.201) between the three groups. Conclusion: The presence of a DNACPR order appears to influence nurse decision making in a deteriorating patient vignette. Differences were not observed in the UFTO and no‐form group. The UFTO may improve the way nurses modulate their behaviours towards critically ill patients with DNACPR status. More hospitals should consider adopting an approach where the resuscitation decisions are contextualised within overall goals of care. [ABSTRACT FROM AUTHOR]

Background: Public involvement in research (PIR) can improve research design and recruitment. Less is known about how PIR enhances the experience of participation and enriches the data collection process. In a study to evaluate how UK care homes and primary health‐care services achieve integrated working to promote older people's health, PIR was integrated throughout the research processes. Objectives: This paper aims to present one way in which PIR has been integrated into the design and delivery of a multisite research study based in care homes. Design: A prospective case study design, with an embedded qualitative evaluation of PIR activity. Setting and participants: Data collection was undertaken in six care homes in three sites in England. Six PIR members participated: all had prior personal or work experience in care homes. Data collection: Qualitative data collection involved discussion groups, and site‐specific meetings to review experiences of participation, benefits and challenges, and completion of structured fieldwork notes after each care home visit. Results: PIR members supported recruitment, resident and staff interviews and participated in data interpretation. Benefits of PIR work were resident engagement that minimized distress and made best use of limited research resources. Challenges concerned communication and scheduling. Researcher support for PIR involvement was resource intensive. Discussion and conclusions: Clearly defined roles with identified training and support facilitated involvement in different aspects of the data collection process. This can also ensure that vulnerable older people who participate in research have a positive experience that reinforces the value of their views. [ABSTRACT FROM AUTHOR]

This study compared higher education dental undergraduate student performance in online assessments with performance in traditional paper-based tests and investigated students' perceptions of the fairness and acceptability of online tests, and showed performance to be comparable. The project design involved two parallel cross-over trials, one in Year 3 ( n = 132) of the dental curriculum, one in Year 5 ( n = 134). A total of 266 students undertook related tests of the same knowledge base in both online and traditional paper formats. Order of presentation of the test form was randomized. One hundred and thirty-two students in Year 3 additionally completed questions concerning their perceptions of the acceptability and fairness of the online examination process. Focus group discussions were held with groups of students ( n = 30) from both Year 3 and 5 to explore their perceptions of the online format. The online tests were created using the commercial software package MaxExam (Bristol, UK). The results were analysed using repeated measures analysis of variance (ANOVA) with the order of presentation being entered as a variable in the analysis. The results of the study showed that for both Years 3 and 5 students there was a high degree of consistency in performance between the two versions of the tests, although a minority of students performed better in the online version of the test. Over 70% of students rated the online test as acceptable, and 90% felt that the online format did not disadvantage them even in a 'high-stakes' situation. From these results, we conclude that online assessment does not confer any disadvantage to students. Students perceive such assessment to be both fair and acceptable, and to have some advantages over the traditional paper-based methods of assessment. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of effective evidence‐based treatments for depression and anxiety, many ‘harder‐to‐reach’ social and patient groups experience difficulties accessing treatment. We developed a complex intervention, the AMP (Improving Access to Mental Health in Primary Care) programme, which combined community engagement (CE), tailored (individual and group) psychosocial interventions and primary care involvement. Objectives: To develop and evaluate a model for community engagement component of the complex intervention. This paper focuses on the development of relationships between stakeholders, their engagement with the issue of access to mental health and with the programme through the CE model. Design: Our evaluation draws on process data, qualitative interviews and focus groups, brought together through framework analysis to evaluate the issues and challenges encountered. Setting & participants: A case study of the South Asian community project carried out in Longsight in Greater Manchester, United Kingdom. Key findings: Complex problems require multiple local stakeholders to work in concert. Assets based approaches implicitly make demands on scarce time and resources. Community development approaches have many benefits, but perceptions of open‐ended investment are a barrier. The time‐limited nature of a CE intervention provides an impetus to ‘do it now’, allowing stakeholders to negotiate their investment over time and accommodating their wider commitments. Both tangible outcomes and recognition of process benefits were vital in maintaining involvement. Conclusions: CE interventions can play a key role in improving accessibility and acceptability by engaging patients, the public and practitioners in research and in the local service ecology. [ABSTRACT FROM AUTHOR]

Current policy in UK health services emphasizes that, where possible, people with intellectual disabilities should access the same services as people without intellectual disabilities. One of the barriers to this is the confidence of clinicians and therapists. In this paper, we report on the development of a scale to describe the confidence of therapists in working with people with intellectual disabilities (the Therapy Confidence Scale-Intellectual Disabilities [TCS-ID]). One-hundred and eighty-one therapists who provided talking therapies but who did not work primarily with people with intellectual disabilities completed the scale; 43 people completed the scale twice for test-retest reliability purposes. One-hundred and seven people also completed a scale of general therapy self-efficacy. The TCS-ID has a single factor structure accounting for 62% of the variance, Cronbach's alpha for the scale is 0.93 and test-retest reliability is 0.83. There are significant differences in confidence based upon participants experience in working with people with intellectual disabilities and their therapeutic orientation, and there is a significant association between the TCS-ID and the General Therapy Self-efficacy Scale. Sixty clinicians working in mainstream mental health services received training on adapting their therapeutic approaches to meet the needs of people with intellectual disabilities. The TCS-ID was used pre-training and post-training and demonstrated a significant increase in confidence for all group. We suggest that the scale has good psychometric properties and can be used to develop an understanding of the impact of training for mainstream therapist in working with people with intellectual disabilities. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message There is increasing emphasis on people with intellectual disabilities receiving services from mainstream mental health services., There is no research describing the experiences and outcomes of people with intellectual disabilities receiving mainstream talking therapy services., The confidence that clinicians have in working with people with intellectual disabilities may be a barrier to them receiving mainstream services., The Therapy Confidence Scale-Intellectual Disabilities is a psychometrically sound scale for measuring the confidence of therapists in working with people with intellectual disabilities and is a useful outcome measure for training clinicians to work with people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Aims To investigate the extent of and factors associated with adherence to Type 2 diabetes medication. Methods The CINAHL, Embase, International Pharmaceutical Abstracts, Medline, PubMed and Psych INFO databases were searched for the period January 2004 to July 2013. Papers were included in the present review if they reported the prevalence of adherence (the percentage of the study population that is classified as adherent) to Type 2 diabetes medication and used validated adherence measures with a defined cut-off point to indicate adherence. Reported factors were classified as potential predictors if the studies that examined that particular variable reported consistent findings. Results Of the 27 studies included in the present review, the prevalence of adherence ranged from 38.5 to 93.1%. Only six out of 27 studies (22.2%) reported prevalence of adherence of ≥ 80% among their study population. Depression and medication cost were found to be consistent and potentially modifiable predictors for diabetes medication-taking behaviour. The associations between adherence and other factors were inconsistent among the reviewed studies. Conclusions Adherence to diabetes medication remains an ongoing problem. This review has highlighted the urgent need to develop consensus about what constitutes good adherence in diabetes. Further research is needed to clarify modifiable factors, in addition to depression and medication cost, that influence adherence and may provide a focus for targeted interventions to promote adherence, optimize diabetes control and limit the progression of diabetes. [ABSTRACT FROM AUTHOR]

Background Mindfulness-based interventions have been shown to be effective in the treatment of a range of health and psychological disorders in adults and young people without intellectual disabilities ( ID). Clinical studies are emerging reporting on the efficacy of mindfulness-based interventions as a stand-alone treatment for common clinical disorders in adults with ID. Method This paper aims to evaluate the efficacy of an innovative structured mindfulness-based cognitive therapy ( MBCT) group programme adapted for adults with ID with a diagnosis of either recurrent depression, anxiety or both clinical conditions and a history of deliberate self-harm behaviour. Two groups ran consecutively consisting of a total of fifteen participants and seven carers. All participants were recorded as having either a borderline, mild, or moderate ID. The group programme ran over a period of 9 weeks with a follow-up session at 6 weeks post group intervention. Outcome measures included the Hospital Anxiety and Depression Scale and two sub-scales from the Self- Compassion Scale administered at baseline, post therapy and at 6-week follow-up. Results The evaluation showed that participants reported an improvement in their experience of depression, anxiety, self-compassion and compassion for others. The most significant impact was in the reduced levels of anxiety reported. Improvements across all outcomes were maintained at 6-week follow-up. Conclusion The results of the evaluation suggest that people with intellectual disabilities benefit from a structured MBCT group intervention and the results are maintained at 6-week follow-up. [ABSTRACT FROM AUTHOR]

Background Statements or commitments making use of numbers have an important place in government policy. They appear at all stages of the policy process: campaigning, formulation, monitoring and evaluation. Many types of source are involved including research studies, national survey information, routine operational data collections and special systems devised to monitor particular initiatives. Method The paper presents examples of policy uses of numerical evidence, and some sources of data that have been used to support them in the field of care for people with intellectual developmental disability in England. Conclusions Different levels of precision or coverage are required at different stages of the process. Different types of numerical data are appropriate at the various stages of the policy process. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries ( United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. Methods We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to national informants. We combined various sources of information, both official years of registration and other indicators of introduction (clinical trials, guidelines, evaluation reports, sales statistics). Results and conclusions The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care. [ABSTRACT FROM AUTHOR]

The conceptual understanding that children display when predicting physical events has been shown to be inferior to the understanding they display when recognizing whether events proceed naturally. This has often been attributed to differences between the explicit engagement with conceptual knowledge required for prediction and the tacit engagement that suffices for recognition, and contrasting theories have been formulated to characterize the differences. Focusing on a theory that emphasizes omission at the explicit level of conceptual elements that are tacitly understood, the paper reports two studies that attempt clarification. The studies are concerned with 6- to 10-year-old children's understanding of, respectively, the direction (141 children) and speed (132 children) of motion in a horizontal direction. Using computer-presented billiards scenarios, the children predicted how balls would move (prediction task) and judged whether or not simulated motion was correct (recognition task). Results indicate that the conceptions underpinning prediction are sometimes interpretable as partial versions of the conceptions underpinning recognition, as the omission hypothesis would imply. However, there are also qualitative differences, which suggest partial dissociation between explicit and tacit understanding. It is suggested that a theoretical perspective that acknowledges this dissociation would provide the optimal framework for future research. [ABSTRACT FROM AUTHOR]

Background Orofacial granulomatosis ( OFG) is a rare disease of unknown cause. A cinnamon- and benzoate-free diet is successful in up to 72% of patients. Phenolic acids are among the chemical constituents restricted in this diet, which avoids some but not all of these structurally similar compounds. The present study aimed to: (i) develop a novel diet low in phenolic acids; (ii) implement this in a small clinical trial; and (iii) assess its nutritional adequacy. Methods A literature review identified 10 papers quantifying phenolic acids from which 91 10-mg phenolic acid exchanges were devised. A phenolic acid exclusion diet with precautionary micronutrient supplementation was designed and implemented in 10 patients. Phenolic acids were excluded for 6 weeks and were reintroduced at a rate of one exchange every second day for 6 weeks. Wilcoxon matched pairs tests analysed disease outcomes measured by an oral disease severity scoring tool at weeks 0, 6 and 12. Nutritional adequacy was assessed, excluding micronutrient supplementation, at weeks 0 and 6, and compared intakes with dietary reference values. Results The diet was nutritionally inadequate for a range of micronutrients. Seven of 10 patients responded. Mean [standard deviation (SD)] severity scores improved from week 0-6 [20.8 (9.39) and 10.1 (5.72); P = 0.009] and were maintained in five patients who completed the reintroduction [6.6 (3.13) and 7.2 (5.54); P = 0.713]. Conclusions A low phenolic acid diet with micronutrient supplementation holds promise of a novel dietary treatment for OFG. Further work is required in larger studies to determine long-term outcomes. [ABSTRACT FROM AUTHOR]

Aims: The aim of this paper is to present an attempt to collate the results of the client‐completed Goal Attainment Form (GAF) and to explore the usefulness of analysing the data in this way. The GAF is used primarily to add qualitative idiosyncratic data to the quantitative data collected by the CORE‐OM (Clinical Outcomes for Routine Evaluation Outcome Measure) questionnaire. Method: A sample of 477 completed GAF were used during short‐term therapy through primary care mental health services to investigate potential correlations in various different aspects between the GAF and the CORE outcome measure (CORE‐OM). The themes from these forms were qualitatively analysed to compare how clients describe their experience of therapy with clinical perspectives. Results: The results reveal several significant correlations. Themes used by clients to describe their problems and benefits of therapy were different from clinicians' perspectives. Discussion and recommendations: Several suggestions and recommendations are offered regarding evaluation, therapy and primary care short‐term therapy services. [ABSTRACT FROM AUTHOR]

This paper aims to provide developmental data on two connected naïve inheritance concepts and to explore the coherence of children's naïve biology knowledge. Two tasks examined children and adolescents' (4, 7, 10, and 14 years) conceptions of phenotypic resemblance across kin (in physical characteristics, disabilities, and personality traits). The first task required participants to predict and explain feature outcomes in both an offspring and a sibling, in a modified version of the phenotypic similarity task. In the second task, participants offered explanations for instances of parent-offspring dissimilarity and grandparent-offspring resemblance (phenotypic difference task). The inclusion of two tasks and a broad age range revealed significant age trends between 4 and 10 years in naïve inheritance concepts. However, there was little consistency in children's inheritance explanations within or across tasks. The findings are discussed with reference to debates concerning the development and structure of naïve biology concepts. [ABSTRACT FROM AUTHOR]

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people. Methods A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour. Conclusions There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid-childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach. [ABSTRACT FROM AUTHOR]

Background. There is little evidence of the integration of UK physiotherapy university education into clinical practice, and some students say that they are not adequately prepared for professional life. This was addressed by a college-based programme involving patients, carers and service users as facilitators of learning to enhance the partnership between health professionals and patients. Purpose. This programme has been running for 2 years, and this paper is an evaluation of the students' perceptions of it, appraising the outcomes of their learning in order to discover the ways in which it can be enhanced, improved or changed. Methods. A grounded theory approach utilizing focus groups and semi-structured interviews was conducted. Three focus groups representing the higher educational levels 4-6 in pre-registration physiotherapy were carried out. Following the analysis of the focus groups, seven interviews reflecting the three educational levels were conducted in order to explore in greater depth the findings from the focus groups. The analysis of the focus groups and the subsequent interviews were carried out in accordance with a grounded theory framework. Results. The students perceived the programme as a context in which to think how their learning needs could be met within a 'real' framework but on their own territory. Equally, it created feelings of anxiety at being given such an open forum that created a challenge to their communication skills. Many expressed a wish for a more explicit mentoring-learning environment. They also perceived a tension between the technical-rational demands of academia and social practice and a need to view this as a basis for critical appraisal and self-awareness. Conclusion. This programme appeared to be integral to the students' development as future physiotherapists. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Medical Education 2011:: 741-747 Good examinations have a number of characteristics, including validity, reliable scores, educational impact, practicability and acceptability. Scores from the objective structured clinical examination (OSCE) are more reliable than the single long case examination, but concerns about its validity have led to modifications and the development of other models, such as the mini-clinical evaluation exercise (mini-CEX) and the objective structured long examination record (OSLER). These retain some of the characteristics of the long case, but feature repeated encounters and more structure. Nevertheless, the practical considerations and costs associated with mounting large-scale examinations remain significant. The lack of metrics handicaps progress. This paper reports a system whereby a sequential design concentrates limited resources where they are most needed in order to maintain the reliability of scores and practicability at the pass/fail interface. We analysed data pertaining to the final examination administered in 2009. In the complete final examination, candidates see eight real patients (the OSLER) and encounter 12 OSCE stations. Candidates whose performance is judged as entirely satisfactory after the first four patients and six OSCE stations are not examined further. The others - about a third of candidates - see the remaining patients and stations and are judged on the complete examination. Reliability was calculated from the scores of all candidates on the first part of the examination using generalisability theory and practicability in terms of financial resources. The functioning of the sequential system was assessed by the ability of the first part of the examination to predict the final result for the cohort. Generalisability for the OSLER was 0.63 after four patients and 0.77 after eight patients. The OSCE was less reliable (0.38 after six stations and 0.55 after 12). There was only a weak correlation between the OSLER and the OSCE. The first stage was highly predictive of the results of the second stage. Savings facilitated by the sequential design amounted to approximately GBP30 000. The overall utility of examinations involves compromise. The system described provides good perceived validity with reasonably reliable scores; a sequential design can concentrate resources where they are most needed and still allow wide sampling of tasks. [ABSTRACT FROM AUTHOR]

Objective: This paper presents the results of a trans-cultural study looking at the possible differences in the symptomatology of Alzheimer’s disease (AD) in people from Manchester, UK and Rawalpindi, Pakistan. Methods: Two groups of people with AD (45 in each group) were recruited at the two sites. The participants and their carers were interviewed to investigate possible differences in demographics and symptomatology including cognition, depression, personality change and every day activities. The instrument used included the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Cornell Scale for Depression in Dementia (CSDD), The Brooks and McKinlay Personality Inventory and Informant Questionnaire on Cognitive Decline in the Elderly (IQ CODE). Results: The data analysis showed that compared to people from Manchester the Pakistanis had lower literacy levels but similar cognitive deficits when MMSE scores were adjusted for education. They were however more depressed; they had a different profile of personality change since the onset of illness and their reported changes in activities of daily living were more severe. Conclusion: The study has shown a number of possible cultural differences in affective symptoms, personality changes and every day activities. It highlights the need for developing mental health services for older people in Pakistan and making UK services more accessible for this growing community. Further research on service and care needs along with developing culturally sensitive instruments for assessing cognition, psychiatric symptoms, personality changes and daily activities is needed. Copyright # 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

High-grade glioma profoundly affects patients and their families. The best ongoing care for patients completing radical treatment is uncertain. To address this issue a UK-wide audit surveying the follow-up practices of multidisciplinary cancer teams was conducted. An online survey package was used with a paper version available. Of 102 clinicians approached 86 replied, a response rate of 84%. Three-monthly outpatient department appointments led by an oncologist and a specialist nurse were the norm, but more controversially, some centres conduct joint clinics with the whole neurosurgical/oncology team present or available. Nurse-led telephone follow-up in place of hospital visits is uncommon. Regular scanning is conducted despite the clinical benefits being contentious. Access to a range of allied services providing supportive care is considered, but the actual levels of need and the efficiency with which they are delivered require further investigation. The picture of UK follow-up practices revealed by this survey demonstrates that research is now needed to determine what preferences patients and families have for follow-up and their satisfaction with these. [ABSTRACT FROM AUTHOR]

Understanding the perceptions of direct care staff of their reciprocal relationships at work and levels of burnout may help us improve not only their psychological health but also the service they provide. A cross-sectional survey was undertaken with direct care staff who worked with children, older people and people with intellectual disabilities in residential settings. Staffs were asked to report their levels of burnout and perceived reciprocity in the relationship they had with service users, other staff and the organisation they worked for. Significant relationships were found between some burnout and reciprocity measures. 'Under benefit' in relationships with service users, colleagues and the organization was related to emotional exhaustion. 'Under benefit' in organizational and staff relationships was related to increased depersonalization. Reciprocity is a potentially useful concept for understanding differences in relationships across a broad range of staff and use of the reciprocity questionnaire in this study allows for comparison between diverse groups. The importance of relationships with the employing organization is highlighted in this sample and suggests that burnout is not solely linked with lack of reciprocity in the caregiving relationship per se. Copyright © 2010 John Wiley & Sons, Ltd. • Direct care staff are important intermediaries for the work of many clinical psychologists and research suggests that their well-being can influence the quality of care they provide. • There are similarities between care staff who work across different client groups. • This paper describes the development of a methodology that examines reciprocity in relationships with service users, staff and organization. • This framework is shown to be useful in exploring staff relationships and concerns that may facilitate clinical work with staff and stimulate research. [ABSTRACT FROM AUTHOR]

This paper explores conceptions of commitment and styles of money management in heterosexual couples at two points in time: Just before the wedding (T1) and about a year later (T2). It also examines the potential effects of using FOCCUS as a form of marriage preparation (MP). Forty-two couples were recruited at T1 and randomly allocated to either A MP group and a group that would not be offered any marriage preparation - the Non-Marriage Preparation group (NMP). Individual, in-depth, semi-structured interviews were carried out at T1 and T2, recorded and fully transcribed. A thematic analysis (TA) yielded three themes or levels of commitment which were used to categorize couples at T1 and T2. Their money management styles were defined based on Pahl's (1989) typology. The results showed that conceptions of commitment had developed slightly overall by T2, and had been enhanced in the MP group. At T2, a more elaborated conception of commitment was associated with a greater tendency to treat money as a collective resource. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background The limitations of reliable and accessible UK national and local quantitative data on the prevalence of childhood disability and the characteristics and circumstances of disabled children and their households have been recognized for some time. This paper reports the findings from a study that scoped and quality-assessed existing quantitative UK national and regional data sets on disabled children and their families. Methods A comprehensive search of relevant data sources with information on disabled children was undertaken. Data sources were evaluated with reference to: disability definitions and questions; potential to generate nationally representative prevalence estimates of disabled children; study design; population coverage; sampling issues; social and demographic data; appropriateness for identifying childhood as opposed to adult disability. Results Thirty-seven data sources with information on childhood disability were identified, of which 30 met the inclusion criteria: nine cross-sectional surveys, nine longitudinal and panel studies, seven administrative data sets, four specific condition databases and one was another type. Definitions and questions varied across data sources. Long-standing illness and limiting long-standing illness were the most consistently used definitions. Repeated cross-sectional surveys were found to be most appropriate for estimating overall prevalence but, with the exception of the Population Census, sample sizes were too small to study prevalence and characteristics by some population sub-groups such, including age by year, minority ethnic status and socio-economic position. Few data sources included questions appropriate for identifying childhood as opposed to adult disability or collected information from disabled children themselves. Conclusions Our findings summarize the currently available quantitative data sources on childhood disability and highlight the limitations. We make recommendations for the future development of more robust childhood disability data and issues requiring further research. To assist policy makers and service providers to make use of current data sources we have produced a brief online guide based on our findings. [ABSTRACT FROM AUTHOR]

This paper studies knowledge production in complex, collaborative research projects that brought together academics from different disciplines, research users and agricultural businesses. It takes a comparative approach, studying the interactions within interdisciplinary research teams from ten case studies, considering the process of collaboration from initial idea through to publication. The research developed a typology of participants in these projects, and identified the motivations and challenges of each. Our results analyse the process of research teams coming together and the relationships that are built up during the research. A particular challenge identified was the building of cooperation and trust. This issue is explored alongside issues of communication, methodology, data analysis and the process of drawing and publicising conclusions. [ABSTRACT FROM AUTHOR]