NIHR open research最新文献

{"title":"A person-centred consultation intervention to improve shared decision-making about, and uptake of, osteoporosis medicines (iFraP): a pragmatic, parallel-group, individual randomised controlled trial protocol.","authors":"Laurna Bullock, Elaine Nicholls, Andrea Cherrington, Stephanie Butler-Walley, Emma M Clark, Jane Fleming, Sarah Leyland, Ida Bentley, Simon Thomas, Cynthia P Iglesias-Urrutia, David Webb, Jo Smith, Sarah Bathers, Sarah Lewis, Angela Clifford, Michele Siciliano, Joanne Protheroe, Sarah Ryan, Janet Lefroy, Nicky Dale, Ashley Hawarden, Sarah Connacher, Robert Horne, Terence W O'Neill, Christian D Mallen, Clare Jinks, Zoe Paskins","doi":"10.3310/nihropenres.13571.3","DOIUrl":"10.3310/nihropenres.13571.3","url":null,"abstract":"<p><strong>Background: </strong>Good quality shared decision-making (SDM) conversations involve people with, or at risk of osteoporosis and clinicians collaborating to decide, where appropriate, which evidence-based medicines best fit the person's life, beliefs, and values. We developed the <b>i</b>mproving uptake of <b>Fra</b>cture <b>P</b>revention drug treatments (iFraP) intervention comprising a computerised Decision Support Tool (DST), clinician training package and information resources, for use in UK Fracture Liaison Service consultations. Two primary objectives to determine (1) the effect of the iFraP intervention on patient-reported ease in decision-making about osteoporosis medicines, and (2) cost-effectiveness of iFraP intervention compared to usual NHS care. Secondary objectives are to determine the iFraP intervention effect on patient reported outcome and experience measures, clinical effectiveness (osteoporosis medicine adherence), and to explore intervention acceptability, mechanisms, and processes underlying observed effects, and intervention implementation.</p><p><strong>Methods: </strong>The iFraP trial is a pragmatic, parallel-group, individual randomised controlled trial in patients referred to a Fracture Liaison Service, with nested mixed methods process evaluation and health economic analysis. Participants aged ≥50 years (n=380) are randomised (1:1 ratio) to one of two arms: (1) iFraP intervention (iFraP-i) or (2) comparator usual NHS care (iFraP-u) and are followed up at 2-weeks and 3-months. The primary outcome is ease of decision-making assessed 2 weeks after the consultation using the Decisional Conflict Scale (DCS). The primary objectives will be addressed by comparing the mean DCS score in each trial arm (using analysis of covariance) for patients given an osteoporosis medicine recommendation, alongside a within-trial cost-effectiveness and value of information (VoI) analysis. Process evaluation data collection includes consultation recordings, semi-structured interviews, and DST analytics.</p><p><strong>Discussion: </strong>The iFraP trial will answer important questions about the effectiveness of the new 'iFraP' osteoporosis DST, coupled with clinician training, on SDM and informed initiation of osteoporosis medicines.</p><p><strong>Trial registration: </strong>ISRCTN 10606407, 21/11/2022 https://doi.org/10.1186/ISRCTN10606407.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a patient centred, structured, individually tailored, multi-component intervention to promote rehabilitation and recovery after critical illness: content, theory, and construction.","authors":"Brenda O'Neill, Danny McAuley, Rachel Clarke, Sallyanne Duncan, Penelope Firshman, Ella Terblanche, Julie Bruce, Jill Costley, Bronwen Connolly, Judy Martina Bradley","doi":"10.3310/nihropenres.14023.2","DOIUrl":"10.3310/nihropenres.14023.2","url":null,"abstract":"<p><strong>Background/aims: </strong>This paper describes the development (content, theory, and construction) of a patient-centered, structured, individually tailored, multicomponent intervention (the iRehab intervention) to promote rehabilitation and recovery after critical illness.</p><p><strong>Methods: </strong>The intervention was informed by the MRC framework for complex interventions and underpinned by existing literature and psychological theories. Key stakeholders included patients who had been in intensive care and multidisciplinary staff with experience in providing healthcare and undertaking research.</p><p><strong>Results: </strong>The final intervention includes four core components: 1. weekly discussion and guidance regarding symptom management; 2. targeted exercise and physical activity; 3. support for psychological well-being; 4. peer support and information provision. These are packaged as a program to support rehabilitation and recovery after ICU discharge.Programme duration: Six weeks.Format: Weekly one-to-one remote needs assessment to identify individual participant symptoms and provide management plans, exercises, and strategies to best support recovery. Participants are encouraged to attend weekly group-based remote exercise sessions and group-based remote support sessions (iRehab Café).Mode of delivery: Remote delivery facilitated by online platforms such as Microsoft Teams or Zoom supported with video platform BEAM©, and delivery can also be supported by telephone. The preferred mode of remote delivery is agreed with the participant, and potential barriers to implementation are considered. Manuals are posted to all participants to support intervention delivery.</p><p><strong>Discussion/conclusion: </strong>This paper reports the content, theory and construction of the iRehab intervention. The iRehab intervention is currently being tested in a multicenter RCT (iRehab ISRCTN11266403), and the details reported in this paper will help with understanding of the intervention, interpretation of the findings, and replication of the intervention. Detailed intervention manuals will be available upon the completion of the trial.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"5 ","pages":"64"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adopting and embedding home sensors in social care: findings from a mixed methods, rapid evaluation.","authors":"Joseph Wherton, Stephanie Stockwell, Nikki Newhouse, Stuart Redding, Anna Louise Todsen, Caroline Potter, Stavros Petrou, Sonja Marjanovic, Sara Shaw","doi":"10.3310/nihropenres.14011.2","DOIUrl":"10.3310/nihropenres.14011.2","url":null,"abstract":"<p><strong>Background: </strong>The growing pressure faced by adult social care in England has fuelled interest in technology-enabled care (TEC). This includes the use of sensor-based technology to monitor activity patterns for 'proactive' interventions and care. However, evidence on its effectiveness and use is limited to feasibility pilots, as opposed to business-as-usual. Working with three local authorities using home sensors, we sought to define good practices and draw transferable lessons on implementing and embedding this technology in routine care practice.</p><p><strong>Methods: </strong>Across all sites, we interviewed 51 staff and system stakeholders, 19 service users and family/informal caregivers. We also used secondary data to determine the feasibility of a full economic study. The analysis was guided by the NASSS (non-adoption, abandonment, and challenges to scale-up, spread and sustainability) framework to explore factors influencing implementation and sustained adoption of the technology in use.</p><p><strong>Results: </strong>Home sensors were used across multiple care contexts (assessment, reablement, and long-term care monitoring). Perceived value and impact included an increase in service user independence and safety, family/informal caregiver reassurance, identifying healthcare needs, providing more holistic and objective assessments, and supporting dialogue regarding care needs. However, evidence of the impact across these areas was limited, and we were unable to obtain the data required to undertake an economic analysis. Key issues to consider for sustained adoption include the materiality and dependability of the technology, compatibility with service users and their care networks, workforce knowledge and confidence, inter-organizational routines and coordination work, and strategic alignment.</p><p><strong>Conclusion: </strong>Our findings indicate the need to acknowledge the labor-intensive process of embedding and adapting the use of home sensors for proactive care. Decision makers need to focus on how to support and resource incremental and system wide-changes, with particular attention paid to ensuring technology dependability, 'wrap around' support, workforce knowledge and skills, co-adaptation of inter-organization routines, cross-stakeholder collaboration, and evaluation capabilities.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"5 ","pages":"71"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forest school INterventions for Children's Health: a feasibility cluster randomised controlled trial to compare Forest School versus usual indoor classroom-based curriculum activity with KS2 children: the FINCH protocol.","authors":"Hannah A Armitt, Rachel M Bottomley-Wise, Jodi Pervin, Sarah Blower, Sara Booth-Card, Bernadka Dubicka, Michael Foers, Susan Griffin, Catherine Hewitt, Kalpita Baird, Ellen Kingsley, Angela Kingston, Charlie Peck, John Pratt, Cindy Stephenson, Marnie Palmer, Piran White, Peter A Coventry","doi":"10.3310/nihropenres.14053.1","DOIUrl":"10.3310/nihropenres.14053.1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Child and adolescent mental health is a public health priority, and prevention, early intervention, and treatment are identified as national strategic priorities. Children and young people (CYP) in the United Kingdom are experiencing poorer mental health outcomes than ever, and the demand for services is the highest on record. Understanding the effectiveness of school-based interventions for promoting and developing emotional well-being is a core research priority. A school-based intervention that is inclusive and has the potential for widespread delivery is 'Forest School'. Forest schools provide children with immersive experiences in nature that are non-classroom-based and have a core focus on child-led activities and exploration. Despite widespread implementation, evidence about optimal delivery methods for Forest Schools and their impact on mental health and emotional well-being is scarce. This study will generate new knowledge about the feasibility of running a definitive Forest School trial with Key Stage 2 (KS2) children aged between 7-11 inclusive of children with special educational needs and disabilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research questions: &lt;/strong&gt;Is Forest School an acceptable and feasible intervention to improve the mental health of KS2 children?Is it feasible to run a cluster Randomised Controlled Trial (RCT) of Forest School for children in key stage 2 (aged 7-11)?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;1. Test feasibility of trial procedures for recruitment, randomisation, and data collection2. Conduct a mixed methods process evaluation to evaluate implementation and fidelity3. Collect feasibility data to support an economic evaluation in a full trial4. Refine the current logic model and optimise the intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In Work Package (WP) 1, we will conduct a feasibility cluster RCT of a Forest School intervention with 200 children in five schools across Hull, East Yorkshire, and North Yorkshire. We will test the acceptability and feasibility of intervention delivery, assess the feasibility of the trial processes, and establish key parameters for effectiveness. In WP2, we will evaluate the quality and fidelity of intervention delivery through process evaluation, including observations and qualitative interviews. WP3 focused on the preliminary collection of health economic data. WP4 uses focus groups to refine the logic model and optimize the content of the intervention. We seek to produce a manualised toolkit informed by interconnected work packages to inform further research and implementation. The trial was registered in ISRCTN (The United Kingdom's Trial Registry). Clinical Trials Registration Number ISRCTN87263624.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient and public involvement: &lt;/strong&gt;This proposal was developed with the active involvement of parents/guardians, children, and schools alongside key stakeholders from the local authority, education, and the community sector.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Dis","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"5 ","pages":"82"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study Protocol: A retrospective observational analysis of patients treated for hospital-acquired pneumonia.","authors":"Samuel Quarton, Mohammed Baragilly, Elizabeth Sapey","doi":"10.3310/nihropenres.13853.2","DOIUrl":"10.3310/nihropenres.13853.2","url":null,"abstract":"<p><strong>Background: </strong>Hospital-acquired pneumonia (HAP) is an important complication of hospital admission, with both high incidence and consequences for patients. However, our understanding of causative organisms and prognostic factors is limited. Although ventilator-associated pneumonia (VAP,) an important subset of HAP,has been extensively investigated, less is known about non-ventilated cases, leading to calls for focused research in this group. This retrospective observational cohort study aims to define a population of patients treated as HAP by comparing ventilated and non-ventilated cases. It aims to clarify how often a microbiological diagnosis is reached, what organisms are frequently identified, and whether this has a relevant impact on the outcomes. The relative impact of positive radiographic changes among patients treated for HAP will also be assessed.</p><p><strong>Methods: </strong>Data will be obtained from the Health Data Research UK acute care hub, 'PIONEER' Cases meeting coding criteria or a clinical surveillance definition of HAP over a 5-year period will be extracted. Demographic, clinical, and microbiological variables will be analysed initially descriptively, and subsequently, with multiple logistic regression analysis to investigate factors affecting microbiological diagnosis. Key outcome variables are in-hospital, 30-day and 1 year mortality, as well as all-cause readmissions within 1 year. Secondary outcomes include nosocomial infections, such as <i>C. difficile</i>. Kaplan-Meier curves and a Cox proportional hazards regression model will be used to investigate outcomes and compare subgroups. A key comparison is between those in whom a putative pathogen is identified and those treated entirely empirically. For this purpose, we will also compare outcomes using an inverse probability of treatment weighting analysis. Additionally, we will explore identifying consolidation on chest imaging reports using natural language processing to allow consideration of the relative impact this may have on mortality and readmission rates.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"5 ","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote multicomponent rehabilitation compared to standard care for survivors of critical illness after hospital discharge (iRehab): a protocol for a randomised controlled assessor-blind clinical and cost-effectiveness trial.","authors":"Brenda O'Neill, Judy Martina Bradley, Bronwen Connolly, Julie Bruce, Martin Underwood, Ranjit Lall, Chen Ji, Jill Costley, Rachel Clarke, Paul Dark, Penelope Firshman, Nigel D Hart, Annette Henderson, Katherine Jones, Roger Kenyon, Jason Madan, Gavin D Perkins, Mariam Ratna, Kerry Raynes, Ella Terblanche, Rowena Williams, Mandana Zanganeh, Danny McAuley","doi":"10.3310/nihropenres.13910.2","DOIUrl":"10.3310/nihropenres.13910.2","url":null,"abstract":"<p><strong>Background: </strong>The consequences of critical illness can be substantial and multifactorial, encompassing physical deconditioning, mental health impairments, fatigue, and declines in health-related quality of life. We hypothesise that for people discharged after intensive care unit (ICU) for a critical illness, a six-week remote multicomponent rehabilitation intervention improves health-related quality of life, physical function, fatigue, mood, and other health-related outcomes after eight weeks, compared to standard care.</p><p><strong>Methods: </strong>This is a pragmatic, randomised controlled, open-label, assessor blind, multicentre, clinical and cost effectiveness trial with internal pilot and embedded process evaluation. Recruitment will take place in NHS hospitals across the UK. Adults (n=428: control n= 197; intervention: n=231) within 12 weeks of discharge from hospital following an ICU admission for critical illness, requiring mechanical ventilation ≥48hours will be recruited.The intervention is a six week multicomponent, structured, rehabilitation programme, delivered remotely by a trained intervention team. The intervention includes four components: weekly symptom management; targeted exercise; psychological support, and peer support and information. The control group will receive standard NHS care.The primary outcome is Health-related quality of life (HRQoL) at eight weeks post-randomisation measured using the EQ-5D-5L. Secondary outcomes are: HRQoL (six months), physical function, fatigue, illness perceptions anxiety and depression, healthcare resource use at eight weeks and six months and intervention acceptability.</p><p><strong>Conclusions: </strong>This trial will test a centrally delivered mulitcomponent rehabilitation intervention for survivors of critical illness, irrespective of geographic location or critical illness diagnosis.</p><p><strong>Trial registration: </strong>The trial is registered (04.07.2022) with the International Standard Randomised Controlled Trial Number (ISRCTN) Register ISRCTN11266403 https://doi.org/10.1186/ISRCTN11266403.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"5 ","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development of Liver Research Cymru, a new partnership to increase hepatology research activity in Wales.","authors":"A D Yeoman, H Ahmed, A Akbari, K Cullen, A Davies, D Fitzsimmons, J Gao, K Hood, C Nollett, A Vincent, W Williams, Tpi Pembroke","doi":"10.3310/nihropenres.13663.2","DOIUrl":"10.3310/nihropenres.13663.2","url":null,"abstract":"<p><strong>Background: </strong>The incidence and severity of liver disease in the United Kingdom have increased over the last 20 years. Many patients present with advanced disease with limited treatment options and subsequently high morbidity and mortality. There was also a significant correlation with deprivation. Strategies that support the earlier detection of liver disease are paramount to reverse this trend. Despite significant progress in terms of novel pathways, the optimal strategy for early detection of liver disease remains unknown. Novel ways to tackle the deprivation gradient and reduce health inequalities are urgently required.</p><p><strong>Methods: </strong>Clinical research has an enormous role to play both in terms of identifying the true scale of this challenge, where current gaps exist, and to identify the optimal early detection strategies and their implementation. We therefore established Liver Research Cymru (LRC) a multi-disciplinary collaboration that seeks to maximise the benefits from our existing data sources and clinical networks and increase the output of hepatology research in Wales.</p><p><strong>Results: </strong>LRC has developed the first Wales wide research collaborative. We have successfully collaborated with the Secure Anonymised Information Linkage (SAIL) data resource to develop a greater understanding of liver disease burdens through comprehensive analysis of primary and secondary care data. We are now using this information to evaluate the effectiveness of local early detection pathways and to identify the scale of delays in diagnosis with a view to addressing this important care gap.</p><p><strong>Conclusion: </strong>LRC has successfully brought together patients. Hepatologists and population/primary care academics to better understand current discrepancies in the early diagnosis of liver disease in Wales. In addition, it has laid a foundation for future research work based both on our preliminary findings and allowed us to collaborate with other more established liver disease research groups.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HELMET (HEaLth iMpact of E-bikes and e-scooTers) study: Data collection methods and information gathered for the evaluation of the introduction of share-hire schemes.","authors":"Miranda Eg Armstrong, James Garbutt, Tim Jones, Ben Spencer, Ian Philips, Sabina Sanghera, Lesley Welch, Rayne Roberts, Frank de Vocht, Russell Jago, Ruth Salway","doi":"10.3310/nihropenres.13857.2","DOIUrl":"10.3310/nihropenres.13857.2","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to collect and summarise information on e-bike and e-scooter use in areas with and without e-bike (EB) and e-bike plus e-scooter (EB+ES) combined share-hire schemes.</p><p><strong>Methods: </strong>This study employed a repeated cross-sectional design. An online survey asking questions about demographics, travel, and health was completed by people in August and September 2023 before the schemes were launched in Bristol (EB+ES) and Leeds (EB), with Bradford and Sheffield as control sites. A resurvey was conducted at the same sites one year later, but also in Bath (EB+ES) and Plymouth (EB). We also interviewed eight e-bike and e-scooter users and non-users in Bristol (n=4) and Leeds (n=4).</p><p><strong>Results: </strong>Following data cleaning, 3771 remained in the baseline sample and 5370 remained in the resurvey sample. The majority of participants reported having never used an e-bike (baseline: 61%; resurvey: 69%) or e-scooter (baseline: 77%; resurvey: 84%). At baseline, the most common e-bike access route was the use of their own e-bike (45%), with access via a share-hire scheme lower at 25%. In the resurvey sample, access levels were similar via a share-hire scheme (38%) and personal e-bikes (36%). The most common e-scooter access route was a share-hire scheme (baseline: 60%; resurvey: 74%). The most common weekly e-bike and e-scooter destinations were leisure/leisure venues, followed by work/education and shopping/errands.Half said they would not use an e-bike scheme and 63% indicated they would not use an e-scooter scheme. Potential users were willing to walk ~500 m to access an e-bike/e-scooter.Interviewees generally supported share-hire schemes, seeing them as a good addition to the wider transport offer, but with more support for e-bikes and reservations around e-scooters.</p><p><strong>Conclusions: </strong>These data will be important for a later evaluation of EB and EB+ES share-hire schemes on public health, social, economic, and environmental factors.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"5 ","pages":"44"},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Safe Assessment Form to Evaluate Risks ('SAFER') chart - a clinical practice evaluation study following introduction of electronic risk identification in pregnancies in Scotland.","authors":"Alex Viner, Oscar Deeks, Pamela Nayyar, Jennifer Allison, Sarah Murray, Katherine Ainslie, Neil Cockburn, Richard Lilford, Brian Magowan","doi":"10.3310/nihropenres.13791.2","DOIUrl":"10.3310/nihropenres.13791.2","url":null,"abstract":"<p><strong>Background: </strong>It is easy to overlook risk factors that require specific healthcare actions. This is particularly true in maternity care, which deals with a natural process where risk might be distinguished from normality at many points in the care pathway. In this paper, we describe the effects of clinical decision support, first in the form of paper checklists and then in the form of an electronic checklist to screen for risks of (1) venous thromboembolism (VTE), (2) intrauterine growth restriction (IUGR), (3) high body mass index (BMI), and (4) gestational diabetes mellitus (GDM). Here, we report a retrospective observational study on the effects of screening algorithms introduced first on paper and then on the computer.</p><p><strong>Methods: </strong>We screened sequential maternity records at three time points: baseline, following the introduction of a paper checklist, and following the introduction of the electronic system. First, we examined (at each time-point) the proportion of pregnancies appropriately screened at each time point. Second, we examined the proportion of correct actions taken following a positive screening result. The study was conducted at a District General Hospital in Scotland between 2011 and 2015, which covered the introduction of the above system to screen patients and suggest appropriate management for positive cases.</p><p><strong>Results: </strong>We found that the introduction of a paper checklist was associated with an increased proportion of pregnancies appropriately screened and correct actions taken contingent on positive screening. These trends continued after the introduction of the electronic system. For example, when investigating those at risk of venous thrombosis and embolism (VTE), 0/200 risk assessments were made correctly in 2011 with no formal prompts. This increased to 69/200 (0.345) in 2014 when using paper checklists, and this trend continued in 2015 when we found 192/200 (0.965) risk assessments were made correctly for antenatal and intrapartum VTE using the electronic checklists. In 2011, we observed that the number of actions contingent on positive screening for VTE completed correctly was 0/1. Increasing to 17/24 (0.708) in 2014 when using paper checklists but plateauing in 2015 when 20/33 (0.667) contingent actions were completed correctly using electronic system prompts.</p><p><strong>Conclusions: </strong>Compliance with maternity guideline recommendations for VTE, high BMI, high risk of fetal growth restriction, and GDM improved over time with the introduction of paper and electronic prompts.</p><p><strong>Tweetable abstract: </strong>Introduction of electronic maternity screening was associated with improved adherence to established guidelines compared to no screening or paper-based screening for VTE, BMI and GDM.</p><p><strong>Data sharing statement: </strong>Nil additional unpublished data from the study are available.</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"5 ","pages":"37"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12531618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the potential of cardiopulmonary exercise testing (CPET) for tailored pulmonary rehabilitation in people with interstitial lung disease (ILD): A systematic review protocol.","authors":"Ben Bowhay, Craig A Williams, Michael A Gibbons, Chris J Scotton, Owen W Tomlinson","doi":"10.3310/nihropenres.13706.2","DOIUrl":"10.3310/nihropenres.13706.2","url":null,"abstract":"<p><strong>Background: </strong>This review aims to identify which cardiopulmonary exercise test (CPET) derived variables can be used to personalise pulmonary rehabilitation (PR) for people with interstitial lung diseases. A 'one size fits all' approach does not benefit every patient due to a multitude of unique characteristics, subsets and phenotypes. No ILD-specific, tailored pulmonary rehabilitation guidelines exist in this area and exercise programme development is lacking. This leads to wide variation in the success within the literature and clinical practice.</p><p><strong>Methods: </strong>MEDLINE, Embase, CINAHL, SPORTDiscus and the Cochrane Database of Systematic Reviews will be searched to identify studies that utilise CPET variables for PR development. Quality assessment is to be performed using the Critical Appraisal Skills Program (CASP) checklists for single cohort studies and randomised controlled studies.</p><p><strong>Discussion: </strong>The primary outcomes found within the included studies for peak volume of oxygen consumption (VO _2peak), work rate (WR _peak), oxygen consumption at anaerobic threshold (VO ₂-AT), heart rate and rate of perceived exertion (RPE) would help determine which variables are optimal for prescription success. Identification of reliable methods to tailor PR for people with interstitial lung disease would enhance what is already known and potentially lead to best practice guideline development.</p><p><strong>Registration: </strong>In accordance with the guidelines, this systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 07 May 2024 (registration number CRD42024543174).</p>","PeriodicalId":74312,"journal":{"name":"NIHR open research","volume":"4 ","pages":"51"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12368488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}