Nurses' perceived barriers and facilitators to the implementation of nurse prescribing: Delphi study and focus group.

AIM: To obtain consensus on barriers and facilitators to nurse prescribing following its recent introduction in Spain. DESIGN: A three round online Delphi survey and focus group. METHODS: An exploratory method was used with three consecutive rounds of questionnaires based on anonymity and feedback, and a focus group. The study was carried out with primary care, specialized care, socio-health care and manager nurses. RESULTS: On the basis of the Delphi study that was conducted, a list of 15 barriers and 18 facilitators of nurse prescribing was obtained. However, no general consensus was found with respect to the prioritization of these barriers/facilitators. The analysis of the results of the focus group confirmed the information obtained from the Delphi study. The main barriers highlighted were dependence on the figure of the physician, insufficient training in pharmacology, a lack of institutional support and the limited list of products that could be prescribed. The key facilitators were academic knowledge and ongoing training and education, independence in the functions and responsibilities of the nursing profession, adaptation to new roles and autonomy in the case of chronic care processes. CONCLUSION: Nurses were generally positive about the introduction of nurse prescribing. The commitment of nurses to training and their accreditation as prescribers (internal forces) and health policy and nursing management (external forces) play a fundamental role in supporting the basis of nurse prescribing and ensuring that it is developed with the identified support resources, such as staff training and the provision of the materials necessary for its proper implementation, all with the aim of guaranteeing quality healthcare. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Strong models of nurse prescribing are being considered globally to address population needs. The results can help the future implementation of non-medical independent prescribing and provide guidance to the government and society on the interventions that can be used to consolidate it. IMPACT: What problem did the study address? By 2027, the world's population will receive more than 4.5 trillion doses of medicine each year. However, the WHO estimates a projected shortfall of 10 million health workers by 2030. Inadequacies with traditional physician-led care systems mean that new approaches are imperative to maintain patient access to prescription medicines, with NP being a key element in this regard. In Catalonia (Spain), the accreditation process for nurses as prescribers was implemented in 2021. It is therefore of vital importance to question and consult the nurses themselves, the main promoters of the process, to find out their perceptions and thus be able to take them into consideration in the implementation process. What were the main findings? A total of 15 barriers and 17 facilitators were identified. The main perceived barriers are dependence on the figure of the physician, insufficient training in pharmacology during undergraduate studies and a lack of institutional support. The main perceived facilitators are academic knowledge and ongoing education and training, independence in nursing functions and responsibilities, and adaptation to new roles and tasks. Where and on whom will the research have an impact? These results can contribute to improving NP implementation in Spain and serve as a reference for other countries, especially where NP education and training have only recently been instigated or are in the planning process. REPORTING METHOD: Standards for reporting qualitative research: a synthesis of recommendations. SRQR. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Costs, consequences and value for money in non-medical prescribing: a scoping review.

OBJECTIVES: Non-medical prescribing (NMP) is a key feature of the UK healthcare system that refers to the legal prescribing rights granted to nurses, pharmacists and other non-medical healthcare professionals who have completed an approved training programme. NMP is deemed to facilitate better patient care and timely access to medicine. The aim of this scoping review is to identify, synthesise and report the evidence on the costs, consequences and value for money of NMP provided by non-medical healthcare professionals. DESIGN: Scoping review DATA SOURCES: MEDLINE, Cochrane Library, Scopus, PubMed, ISI Web of Science and Google Scholar were systematically searched from 1999 to 2021. ELIGIBILITY CRITERIA: Peer-reviewed and grey literature written in English were included. The research was limited to original studies evaluating economic values only or both consequences and costs of NMP. DATA EXTRACTION AND SYNTHESIS: The identified studies were screened independently by two reviewers for final inclusion. The results were reported in tabular form and descriptively. RESULTS: A total of 420 records were identified. Of these, nine studies evaluating and comparing NMP with patient group discussions, general practitioner-led usual care or services provided by non-prescribing colleagues were included. All studies evaluated the costs and economic values of prescribing services by non-medical prescribers, and eight assessed patient, health or clinical outcomes. Three studies showed pharmacist prescribing was superior in all outcomes and cost saving at a large scale. Others reported similar results in most health and patient outcomes across other non-medical prescribers and control groups. NMP was deemed resource intensive for both providers and other groups of non-medical prescribers (eg, nurses, physiotherapists, podiatrists). CONCLUSIONS: The review demonstrated the need for quality evidence from more rigorous methodological studies examining all relevant costs and consequences to show value for money in NMP and inform the commissioning of NMP for different groups of healthcare professionals.

Co-design and prototype development of the 'Ayzot App': A mobile phone based remote monitoring system for palliative care.

BACKGROUND: Palliative care, a recognised component of care by the World Health Organization is poorly developed in low- and middle-income countries. Mobile phone technology, an effective way to increase access and sustainability of healthcare systems globally, has demonstrated benefits within palliative care service delivery, but is yet to be utilised in Ethiopia. AIM: To co-design, develop and evaluate a mobile phone based remote monitoring system for use by palliative care patients in Ethiopia. DESIGN: Two-phase co-design approach comprising multiple methods that is stakeholder interviews, focus groups, user-co-creation activities and healthcare worker prioritisation discussions 2019-2020. Phase-1 interviews (n = 40), Phase-2 focus groups (n = 3) and interviews (n = 10). SETTING/PARTICIPANTS: Hospice Ethiopia and Yekatit 12 Medical College Hospital: healthcare workers, palliative care patients, family carers & software-developers. RESULTS: Co-design activities lead to development of the prototype 'Ayzot' application, which was well received and reported to be easy to use. Patients, and family caregivers saw provision of self-care information and symptom management as a key function of the App and expressed very positive attitudes towards such information being included. Healthcare workers found the App offered service benefits, in terms of time and cost-savings. CONCLUSION: This paper provides a detailed example of the development and design of a prototype remote monitoring system using mobile phone technology for palliative care use in Ethiopia. Further development and real-world testing are required, to not only understand how it acts within usual care to deliver anticipated benefits but also to explore its effectiveness and provide cost estimates for wider implementation.

Having the conversation about vision for safe driving with older adults: an exploratory study of eyecare professional experiences in England and Australia.

CLINICAL RELEVANCE: Eyecare professionals assess older adults against the vision requirements for driving and discuss this with them on a regular basis. Improved access to resources/training would be beneficial and help eyecare professionals navigate more difficult conversations about driving, e.g., following acute vision changes. BACKGROUND: The numbers of drivers aged >65 years is increasing in many countries, in line with ageing populations. In most countries the onus is on the driver to self-monitor their vision for driving, by engaging in regular eye tests. Eyecare professionals therefore could play an important role in older driver decision-making about their fitness to drive. There is limited guidance for eyecare professionals regarding how to approach conversations with older drivers about their vision, and when these conversations should be had. METHODS: Semi-structured interviews were undertaken with eyecare professionals involved in vision assessments and decision-making about medical fitness to drive for older adults (optometrists, orthoptists, ophthalmologists). Framework analysis identified challenges and facilitators to conversations with older drivers about vision. RESULTS: Twenty-six eyecare professionals from Australia (n = 17) and England (n = 9) participated from urban and regional/rural areas. Themes were divided into facilitators (clear standards and comprehensive testing; positive approach; preparation and patient self-awareness; relationships and trust; importance of multiple options in guiding a transition to driving retirement) and challenges (acute loss of visual function; limited self-awareness of the impact of visual problems on driving; and perceived lack of resources and need for training). CONCLUSIONS: Eyecare professionals prefer to have early and regular conversations with older adults about their vision for driving. Acute visual field/acuity loss or onset of double vision, necessitating rapid changes to driving behaviour, were both identified as major challenges for eyecare professionals. Improved access to resources and training would be beneficial, to help eyecare professionals navigate these especially difficult conversations and signpost older drivers to appropriate support.

Decision support-tools for early detection of infection in older people (aged> 65 years): a scoping review.

BACKGROUND: Infection is more frequent, and serious in people aged > 65 as they experience non-specific signs and symptoms delaying diagnosis and prompt treatment. Monitoring signs and symptoms using decision support tools (DST) is one approach that could help improve early detection ensuring timely treatment and effective care. OBJECTIVE: To identify and analyse decision support tools available to support detection of infection in older people (> 65 years). METHODS: A scoping review of the literature 2010-2021 following Arksey and O'Malley (2005) framework and PRISMA-ScR guidelines. A search of MEDLINE, Cochrane, EMBASE, PubMed, CINAHL, Scopus and PsycINFO using terms to identify decision support tools for detection of infection in people > 65 years was conducted, supplemented with manual searches. RESULTS: Seventeen papers, reporting varying stages of development of different DSTs were analysed. DSTs largely focussed on specific types of infection i.e. urine, respiratory, sepsis and were frequently hospital based (n = 9) for use by physicians. Four DSTs had been developed in nursing homes and one a care home, two of which explored detection of non- specific infection. CONCLUSIONS: DSTs provide an opportunity to ensure a consistent approach to early detection of infection supporting prompt action and treatment, thus avoiding emergency hospital admissions. A lack of consideration regarding their implementation in practice means that any attempt to create an optimal validated and tested DST for infection detection will be impeded. This absence may ultimately affect the ability of the workforce to provide more effective and timely care, particularly during the current covid-19 pandemic.

Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review.

OBJECTIVES: To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders' views on IP in primary care and identify barriers and facilitators influencing implementation. SETTING: UK primary/community care. PARTICIPANTS: Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors. PRIMARY AND SECONDARY OUTCOME MEASURES: N/A. RESULTS: Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) 'Preparation', (2) 'Training', (3) 'Transition' and 4) 'Sustainment'. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care. CONCLUSIONS: In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world. PROSPERO REGISTRATION NUMBER: CRD42019124400.

'Just have some IVF!': A longitudinal ethnographic study of couples' experiences of seeking fertility treatment.

We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18-month period. Heterosexual, non-donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well-developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic-patient interactions. Our findings develop understanding of the process of 'mazing' (Image - The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals.

Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society.

BACKGROUND: Pregnant women with inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes. Comprehensive guidelines on medical management have been published; yet, there is limited guidance on service set-up and minimum standards of care for pregnant women with IBD. AIM: To develop a position statement on service set-up and minimum standards of care in the UK. METHODS: A working group consisting of 16 gastroenterologists, obstetricians, obstetric physician, IBD specialist nurses and midwives was assembled. Initial draft statements were produced and a modified Delphi process with two rounds of voting applied. Statements were modified according to voters' feedback after each round. Statements with ≥80% agreement were accepted. RESULTS: All 15 statements met criteria for inclusion. To facilitate optimal care, regular and effective communication between IBD and obstetric teams is required. There should be nominated link clinicians for IBD in obstetric units and for pregnancy in IBD units. Preconception counselling should be available for all women with IBD. All pregnant women should be advised on the safety of IBD medication during pregnancy and breast feeding, the optimal mode of delivery, the management of biologics (where applicable) and safety of childhood vaccinations. Regular audit of pregnancy outcomes and documentation of advice given is recommended. CONCLUSION: Position statements have been developed that advise on the importance of joined-up multidisciplinary care, proactive decision-making with clear documentation and communication to the woman and other healthcare practitioners.

Improving early detection of infection in nursing home residents in South Africa.

This paper sets out key challenges related to detection and management of infection in nursing home residents, and then explores the situation in South Africa, and use of decision support tools as a mechanism to improve this area of practice. In line with global trends, concerns have been raised about the rapidly increasing aging population in South Africa and the ability of the current healthcare system to keep pace with patient demand, particularly nursing home residents. Nursing home residents, who often exhibit atypical signs and symptoms, are at increased risk of infection and unplanned admissions, which account for 65% of all bed days, and cost the US healthcare economy more than a trillion dollars a year. Evidence suggests that the current workforce in South Africa receive limited training in this area and are largely unprepared to meet the demands of the aging population. Building the capacity and skills of the workforce in South Africa is one approach that could help to improve the early detection of infection and assist the nursing home workforce to provide more effective and timely care, particularly during the current COVID-19 pandemic. Decision support tools, such as the Early Detection of Infection Scale, can help ensure consistency and ensure more timely treatment, minimising unplanned admissions and healthcare expenditure. However, the potential benefits or indeed how easily this could be integrated in to nursing homes in South Africa is unknown. An important first step, as in other parts of the world, is therefore to explore views and opinions of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes.

Preconception and Diabetes Information (PADI) App for Women with Pregestational Diabetes: a Feasibility and Acceptability Study.

Diabetes mellitus increases the risk of adverse maternal and fetal outcomes. Preconception care is vital to minimise complications; however, preconception care service provision is hindered by inadequate knowledge, resources and care fragmentation. Mobile health technology, particularly smartphone apps, could improve preconception care and pregnancy outcomes for women with diabetes. The aim of this study is to co-create a preconception and diabetes information app with healthcare professionals and women with diabetes and explore the feasibility, acceptability and preliminary effects of the app. A mixed-methods study design employing questionnaires and semi-structured interviews was used to assess preliminary outcome estimates (preconception care knowledge, attitudes and behaviours), and user acceptability. Data analysis included thematic analysis, descriptive statistics and non-parametric tests. Improvements were recorded in knowledge and attitudes to preconception care and patient activation measure following the 3-month app usage. Participants found the app acceptable (satisfaction rating was 72%), useful and informative. The app's usability and usefulness facilitated usage while manual data input and competing priorities were barriers which participants felt could be overcome via personalisation, automation and use of daily reminders. This is the first study to explore the acceptability and feasibility of a preconception and diabetes information app for women with diabetes. Triangulated data suggest that the app has potential to improve preconception care knowledge, attitudes and behaviours. However, in order for women with DM to realise the full potential of the app intervention, particularly improved maternal and fetal outcomes, further development and evaluation is required.

A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists.

BACKGROUND: Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists. AIM: to compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications. DESIGN: a mixed method comparative case study. METHODS: Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). RESULTS: 489 patients were recruited: n = 243 IP sites, and n = 246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p > 0.05) and patient satisfaction (p ≤ 0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 min). CONCLUSION: This study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.

Exploratory study of clinician and patient views regarding the use of a preconception care app for women with diabetes.

Women with diabetes are at increased risk of adverse maternal and foetal outcomes. Preconception care can minimise risk of complications and improve outcomes, but current provision is inadequate. Electronic health technology, particularly apps, could improve preconception care provision but research is lacking in this area. The aim of this article is to explore the views and experiences of clinicians and women with diabetes regarding the use of a mobile app for preconception care. An exploratory study was conducted. Data were collected using focus group and interviews with 19 participants, comprising 10 clinicians and 9 women with type 1 or 2 diabetes. Data were analysed thematically. Women with diabetes and clinicians highlighted the inadequacy and challenges of current preconception care service provision and expressed a high level of enthusiasm and interest, towards a preconception care app that could support preconception care delivery for women with diabetes and overcome barriers to preconception care service provision and uptake. The acceptability of mobile health technology to both women and clinicians creates an important opportunity to overcome existing barriers to service provision, delivery and uptake, and improve both maternal and foetal outcomes for women with diabetes.

What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials.

BACKGROUND: With life expectancy continuing to rise in the United Kingdom there is an increasing public health focus on the maintenance of physical independence among all older adults. Identifying interventions that improve physical outcomes in pre-frail and frail older adults is imperative. METHODS: A systematic review of the literature 2000 to 2017 following PRISMA guidelines and registered with PROSPERO (no. CRD42016045325). RESULTS: Ten RCT trials fulfilled selection criteria and quality appraisal. The study quality was moderate to good. Interventions included physical activity; nutrition, physical activity combined with nutrition. Interventions that incorporated one or more physical activity components significantly improved physical outcomes in pre-frail and/or frail older adults. CONCLUSIONS: Physical activity interventions are key to maintaining independence in pre-frail and frail older adults. A lack of consensus regarding the definition of frailty, and an absence of core measures to assess this means any attempt to create an optimal intervention will be impeded. This absence may ultimately impact on the ability of older and frail adults to live well and for longer in the community.

Medicines management activity with physiotherapy and podiatry: A systematic mixed studies review.

OBJECTIVE: Making best use of existing skills to increase service capacity is a global challenge. The aim was to systematically review physiotherapy and podiatrist prescribing and medicines management activity, including evidence of impact on patient care, levels of knowledge and attitudes towards extended medicines role. METHODS: A search of MEDLINE, CINAHL, and Cochrane databases, using terms to identify prescribing and medicines management across a range of roles, was conducted from January 1985 to May 2016 for physiotherapy, and January 1968 to May 2016 for podiatry. Hand searching of citations and databases from professional organisations was undertaken. Data were extracted and analysed descriptively, and quality appraised by 2 reviewers using the mixed methods appraisal tool. RESULTS: 1316 papers were identified, and 21 included in the review. No studies were identified that reported prescribing and no studies specific to podiatry met the inclusion criteria. Physiotherapists were highly involved in administering medicines, providing medicines advice, and recommending new medicines. Patient satisfaction, cost and outcomes were equivalent when comparing physiotherapist-led injection therapy to traditional care. Pharmacology knowledge was variable and unmet training needs identified. CONCLUSION: Medicines management practices were identified in physiotherapy and positive outcomes of extended scope physiotherapy. There was a lack of evidence regarding podiatric practice. Review of educational preparation for medicines management is recommended along with evaluation of medicines management practice.

Efficacy and tolerability of initiating, or switching to, infliximab biosimilar CT-P13 in inflammatory bowel disease (IBD): a large single-centre experience.

OBJECTIVES: Recently, the infliximab biosimilar (CT-P13) received market authorisation for inflammatory bowel disease (IBD), allowing cost benefits when switching to CT-P13. We aim to assess the efficacy and safety of switching from originator infliximab to CT-P13 for new and existing patients. MATERIAL AND METHODS: Treatment response, remission, primary and secondary loss of response rates, and adverse events in patients who initiated infliximab originator in the 12 months pre-switch (n = 53) were compared with the patients who initiated CT-P13 in the 12 months post-switch (n = 69). Sustained responses were compared for existing infliximab originator patients who switched to CT-P13 (n = 191) and those who continued with the originator (n = 19). RESULTS: There was no difference in remission (58.1% vs. 47.4%, p = .37), response (12.6% vs. 10.5%, p = .80), secondary loss of response (24.6% vs. 42.1%, p = .10), or adverse events (4.7% vs. 0% p = 1.0) between those who switched to CT-P13 and those who continued infliximab originator. There was no difference in remission (42.0% vs. 26.4%, p = .074), response (21.7% vs. 22.6%, p = .91), primary non-response (5.8% vs. 15.1%, p = .09), secondary loss of response (21.7% vs. 22.6%, p = .91), or adverse events (8.7% vs. 11.3%, p = .63) in those who initiated CT-P13 compared with infliximab originator. CONCLUSIONS: There was no difference in the efficacy and safety of infliximab originator and CT-P13 during the first 12 months after switching.

Urgent care centre redirection: evaluation of a nurse-led intervention.

AIM: Patient redirection can help reduce service demand by providing information about more appropriate services. There is, however, no evidence about the effect of nurse-led patient redirection in urgent care centre settings. The aim of this project was to develop and evaluate a nurse-led patient 'self-care and redirection first' intervention in an urgent care centre (UCC). METHOD: Adopting a prospective observational design, the intervention was delivered to an opportunity sample of patients who attended a south London hospital UCC, between June and July 2014, and evaluated through patient interviews five to ten days after initial attendance. FINDINGS: 118 of the 1,710 people who attended the UCC participated in the intervention, of whom 81 (69%) were redirected to other services or home to self-care, and 37 were transferred to an emergency department. Of the 110 (93.2%) participants who completed the questionnaire, 97.2% were satisfied with the service. Only two accessed different services to those recommended, 72.2% ( n =85) said they would not reattend a UCC for a similar condition. CONCLUSION: Treating minor ailments in a UCC is an inefficient use of resources. A nurse-led self-care and redirection intervention can help divert patients with minor ailments to more appropriate services. Further evaluation of the effect of the intervention on service demand and costs is required.

A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life.

BACKGROUND: Self-management interventions have become increasingly popular in the management of long-term health conditions; however, little is known about their impact on psychological well-being in people with Multiple Sclerosis (MS). PURPOSE: To examine the effectiveness of self-management interventions on improving depression, anxiety and health related quality of life in people with MS. METHOD: A structured literature search was conducted for the years 2000 to 2016. The review process followed the PRISMA guidelines, and is registered with PROSPERO (no. CRD42016033925). RESULTS: The review identified 10 RCT trials that fulfilled selection criteria and quality appraisal. Self-management interventions improved health-related quality of life in 6 out of 7 studies, with some evidence of improvement in depression and anxiety symptoms. CONCLUSION: Although the results are promising more robust evaluation is required in order to determine the effectiveness of self-management interventions on depression, anxiety and quality of life in people with MS. Evaluation of the data was impeded by a number of methodological issues including incomplete content and delivery information for the intervention and the exclusion of participants representing the disease spectrum. Recommendations are made for service development and research quality improvement.

Exploring the acceptability and feasibility of a preconception and diabetes information app for women with pregestational diabetes: A mixed-methods study protocol.

BACKGROUND: Women with diabetes are at increased risk of adverse maternal and fetal outcomes. Preconception care can improve pregnancy outcomes and is paramount to minimise complications, but, current provision is sub-optimal. Mobile technology, particularly smartphones and apps have the potential to improve preconception care provision but research is lacking in this area. The need to use modern technologies to improve preconception care knowledge and awareness led to the development of a preconception and diabetes information app in Stage A of this study. OBJECTIVE: The aim of this paper, Stage B of the study, is to explore the feasibility and acceptability of the Preconception and Diabetes Information app to improve preconception care knowledge and attitudes in women with diabetes, and explore the potential for wider implementation. METHODS: A mixed-methods study design adopting a quasi-experimental approach will assess women's knowledge and attitudes related to preconception care, and level of patient activation (knowledge and confidence for self-management of health) before and after the three-month intervention period. A log of activity will be used to determine engagement with the app and semi-structured interviews will explore women's experiences. CONCLUSIONS: This is the first study to explore the acceptability and feasibility of a preconception and diabetes information app for women with diabetes. The app has potential to change the way preconception care is delivered, improve pregnancy outcomes and be widely implemented both in developed and developing countries. This is important given the considerable shortfalls in current preconception care services in the United Kingdom and around the world.

Evaluation of a formal care worker educational intervention on pressure ulceration in the community.

AIMS AND OBJECTIVES: To develop and evaluate an educational intervention for formal care workers on pressure ulceration in the community. BACKGROUND: Pressure ulcers are a major burden to health care and with an ageing population likely to increase. Formal care workers are ideally placed to identify high risk but lack standardised educational provision. DESIGN: An insider approach to action research in one provider organisation, November 2014-May 2015. METHODS: Number and categorisation of pressure ulcers, within three community nursing teams before and four months after intervention was delivered to a purposive sample (n = 250) of formal care workers, were assessed and the taught element evaluated using a questionnaire and verbal feedback. RESULTS: Total number of pressure ulcers reduced from 28-20, category II, 19-11, III unchanged at 6 and IV from 2-0 following the educational intervention. Key risk factors included impaired mobility (71%), urinary incontinence (61%) and previous pressure damage (25%), and 71% had formal care worker input. The intervention was highly rated 4·95/5 by 215 (86%) formal care workers in the evaluation questionnaire. CONCLUSIONS: Formal care workers receive little, if any, education on pressure ulceration. An educational intervention can have a positive effect within community care, with the potential to reduce direct costs of care. However, a standardised approach to education is required; an urgent review of the education provision to formal care workers, in the UK and around the world, is therefore essential if the potential that formal care workers offer is to be realised. RELEVANCE TO CLINICAL PRACTICE: Formal care workers are ideally placed to help identify and alert healthcare professionals about patients at high risk of developing pressure ulcers. If this potential is to be realised, a standardised approach to education is required.