Academic Health Science Network North East and North Cumbria

To ascertain the potential value of pelvic point-of-care ultrasound (POCUS) in the timely management of Emergency Department (ED) patients presenting with first trimester pregnancy complications. To perform a systematic review and meta-analysis with the primary outcome being the comparison of ED length of stay (ED LoS), time to ultrasound (US) diagnosis and time to operative room (OR) treatment in patients under 20 weeks gestation with complications of first trimester pregnancy when comparing POCUS to traditional specialist radiology ultrasound (RADUS). In accordance with PRISMA guidelines we performed a literature search based on specific inclusion criteria and used 2 reviewers to screen appropriate studies for inclusion. Papers were then critically appraised using RoB-2 and ROBINS-I assessment toolsbefore having data extracted for inclusion in meta-analysis where possible. We identified 13papers for inclusion in systematic review which measured a single or multiple outcome measures. 10papers addressed the ED LOS outcome, 5 studied time to ultrasound diagnosis and 4 measured time to operative treatment. Of those studies, 6contained sufficient data to be included in meta-analysis for ED LoS and 3 could be pooled for time to US diagnosis outcome. Insufficient usable studies were identified for time to OR treatment meta-analysis. The POCUS group had a reduced ED LoS of 59.6min (95% CI 23.6-95.5, P = 0.008) when compared to RADUS. The POCUS group also had a reduced time to US diagnosis of 81.8 min(95%CI 32.2-195.9, P = 0.09). Whilst all time to OR studies reported time savings in this area, no reliable conclusions could be drawn due to insufficient paper numbers and reported data. For all outcomes there was substantial heterogeneity between the studies relating to differing institutional workflows,measured timestamps, triage bias and range of disease severity.Almost all included studieswere felt to be at serious risk of bias. Whilst the use of POCUS shows promise in improving efficiency of carefor EDpatients presenting with early pregnancy complications, there are significant concerns regarding the heterogeneity and generalisability of the study data. European EDs need to explore this POCUS modality more with large scale RCTs, including clearly defined patient cohorts and POCUS protocols, to reliably confirm causality of patient benefit in this area.

Health research should reflect contexts where interventions are needed to provide evidence generalisable to practice. There is concern that socioeconomically disadvantaged populations with poorer health and care outcomes are underrepresented in research, potentially exacerbating health inequalities. Evidence on the relationship between socioeconomic deprivation and general practice research involvement is limited. To explore the relationship between socioeconomic deprivation, general practice research involvement, and recruitment. Quantitative analysis of routine data and qualitative interviews with clinical and non-clinical general practice staff in the North East and North Cumbria (NENC) area of England. Analysis of general practice and National Institute for Health and Care Research (NIHR) Clinical Research Network (now the Regional Research Delivery Network [RDN]) data to understand associations between neighbourhood deprivation and research recruitment. Semi-structured interviews with GPs and practice managers or administrators explored barriers and facilitators to research involvement and patient recruitment in disadvantaged areas. Interviews were recorded, transcribed, and thematically analysed. Research recruitment was lower among practices (n = 358) with more deprived populations (χ2(4) = 7520.8, P<0.001), and significantly lower among 'Deep End' practices in areas of blanket socioeconomic disadvantage (P<0.001). Eleven GPs and four practice managers or administrators were interviewed. Barriers included greater difficulty recruiting patients, resource pressures, limited financial benefit, and awareness. Supporting factors were research designed to meet needs of socioeconomically disadvantaged populations that was accurately costed, remunerated, and resourced, with concise, practically focused communications. To support equitable general practice research participation, research should be relevant for and designed to meet the needs of socioeconomically disadvantaged populations, and be accurately costed and remunerated. Targeting additional resource at practices in socioeconomically disadvantaged areas could incentivise equitable research participation.

Gastroschisis is a congenital anomaly of the umbilical ring with increasing prevalence, especially amongst younger mothers. There is increasing evidence that exposure to genitourinary infections (GUTI) may play an important role in the etiology of gastroschisis. This systematic review and meta-analysis aimed to identify, appraise, and summarize the literature on exposure to GUTI and gastroschisis. Six electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library electronic databases, and Prospero) were searched using a comprehensive search strategy. Citations and cited articles for all included studies were searched. Peer-reviewed, quantitative studies reporting an association of urinary tract infections (UTI) and/or sexually transmitted infections (STI) with gastroschisis were included. Prospero registration CRD42022377420. A total of 2392 papers were identified via the searches of which 15 met our inclusion criteria and were included after title and abstract and full text screening. The study period for included studies ranged from 1995 to 2016, most were from the USA. Four studies considering exposure to STIs and five to UTIs were eligible to progress to meta-analysis. Meta-analysis identified a significantly increased risk of gastroschisis in association with periconceptional exposure to UTI [OR 1.54 (95% CI 1.29, 1.8)], STI [OR 1.4 (95% CI 1.01, 1.79)]. Periconceptional exposure to GUTI is associated with an increased risk of gastroschisis. The prevention and timely treatment of GUTI amongst women of childbearing age may help to reduce the occurrence of gastroschisis.

BackgroundIndividuals with low health literacy struggle to manage long-term conditions. Addressing pain-related health competencies is important in the management of chronic pain. Virtual reality may be a useful tool for empowering sustainable health-related stratgies due to its unique ability to engage users in artificial environments. ObjectivesThe aim of this scoping review was to explore existing research on the use of virtual reality as a tool to promote health literacy in people with chronic pain. DesignScoping Review guided by framework proposed by Arksey & O'Malley. MethodArticles related to “pain”, “virtual reality” and “health literacy” were searched in four electronic databases: CINAHL, PubMed, Embase and PsycINFO using a formal search strategy. Studies were categorised based on intervention content using the Health Literacy Pathway Model which encompasses health knowledge, self-management skills, health communication and information seeking. ResultsThirteen studies met the inclusion criteria. Several elements of pain related health literacy were not addressed in the research. Interventions addressed health knowledge, self-management skills, decision making and featured content aiming to address emotional barriers to pain-related health literacy. Other components including active information seeking and use, actively communicating with health professionals and seeking and negotiating treatment options, were not explicitly addressed. ConclusionThere is heterogeneity in existing research exploring the use of VR to support people with chronic pain. Existing VR tools to address pain-related health literacy do not cover several key components of health literacy. More research is required before a robust assessment of efficacy can be undertaken.

AimsThis review aims to identify the evidence base for the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population.MethodIn this systematic review, we searched MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library for studies from January 2001 to 15th August 2022. We included a variety of study types that assessed and reported frailty including patients ≥18 years old. Studies included those that reported the prevalence of over or undertreatment of diabetes mellitus in a frail population and those examining outcomes related to glucose control in frail older people living with diabetes. Data were extracted using a bespoke extraction table using a narrative synthesis approach.ResultsA total of 4114 articles were identified with 112 meeting inclusion criteria. These included 15,130 participants across the 11 studies with sample sizes ranging from 101 to 11,140. Several areas were identified in the included studies where under or overtreatment of diabetes impacted outcomes for patients. These included hospital admissions, readmissions, length of stay, falls, mortality, cognitive impairment and cardiovascular disease outcomes.ConclusionThe results showed that there was a high heterogeneity of outcomes between the studies and that many examined small numbers of participants. In this review, both over and undertreatment were shown to increase adverse outcomes in frail older people. Further research around optimal glycaemic control for frail older people living with diabetes is required with the aim to identify ideal target ranges and produce practical clinical guidelines to promote attainment of these.

This global umbrella review aimed to synthesise evidence of socioeconomic inequalities in the uptake of routine vaccinations and identify the mechanisms that may contribute to the association. To our knowledge, no attempt has been made to synthesise the global body of systematic reviews across a variety of vaccines, geographical locations, and measures of SES. The inclusion criteria were as follows: studies assessing vaccination uptake according to education, income, occupation/employment, and/or area-level deprivation; any country or universally recommended routine vaccination (according to the WHO); qualitative or quantitative reviews, published 2011-present. The searches were performed in eight databases. The screening process followed PRISMA-E guidelines, each stage was performed by one reviewer, and a 10% sample checked by a second for consistency. Included reviews underwent data extraction, quality appraisal (AMSTAR-2), and narrative synthesis according to country-context. After deduplication, 9,163 reports underwent title and abstract screening, leaving 119 full texts to be assessed for eligibility. Overall, 26 studies were included in the umbrella review. Evidence for lower uptake amongst disadvantaged SES individuals was found in all 26 reviews. However, 17 reviews showed mixed results, as inverse associations were also identified (lower uptake for advantaged SES, and/or higher uptake for disadvantaged SES). Those that explored high-income countries had a greater prevalence of mixed findings than those focusing on low/middle-income countries. The two most frequently cited mechanisms were vaccination knowledge, and confidence in vaccination or vaccination providers. These mechanisms were often understood by review authors as varying by level of education. We find socioeconomic differences in routine vaccination uptake, but the association did not always follow a gradient. Whilst education may be associated with uptake globally, our study indicates that its role varies by country-context. A limitation is the overlap of some primary studies across the included systematic reviews.

UNderstanding Factors that explain Avoidable hospital admission Inequalities-Research study (UNFAIR) addresses how to reduce health inequalities, particularly for avoidable hospital admissions. Our Patient and Public Involvement and Engagement (PPIE) members broached that health inequalities are complex, challenging to understand and communicate. They identified a need to explore diverse views, including people who have a higher risk of health inequalities. With limited public-facing resources relating to the public's understanding or emotions around health inequalities, this project aimed to fill this gap using co-leadership and co-production. Members of the public worked with researchers to co-produce and run PPIE workshops. Thisproject was co-led by a member of the public and a researcher. One online workshop open to anyone in England accompanied by three face-to-face workshops were held. Public contributors, including people living in diverse communities, were invited. Inclusive involvement opportunities were offered including flexible ways of involvement and remuneration. To strengthen the key messages' rigour, transcriptions of the audio-recordings from each workshop, with facilitator notes, were analysed using thematic analysis. From the key messages, an animation was co-produced with public contributors with the public's voice being integral throughout. A total of 58 people took part capturing intersecting and multiple dimensions of marginalisation including people with a range of ages, genders, ethnicities, socioeconomic backgrounds, and members of communities who face exclusion (including people with learning difficulties and experiencing ill-health). The animation highlighted powerful lived experience, for example, some people are dying earlier than expected. Health inequalities conjured up powerful emotions, such as anger and hopelessness. Public views of how to address health inequalities included respecting, accepting and valuing everyone, regardless of, for example, where people live. The animation is publicly available for use by anyone, including decision makers across the health and care system. Through co-leadership and co-production, this project is an example of inclusive PPIE. This project provided a way for the public's voice to influence policy and practice to inform understanding and action to address health inequalities. The animation provides powerful insights into what health inequalities mean to people with examples of lived experience and corroborates the moral argument for action by decision makers. Members of the public, including people who were affected or at higher risk of health inequalities, co-led this project and were involved as co-creators and developers from the inception of the project to completion. Their involvement was integral and documented in full throughout the project.

BackgroundWomen are advised to take low-dose aspirin (LDA) if at increased risk of a serious pregnancy complication: pre-eclampsia. Adherence to LDA amongst pregnant women is low. This systematic review aimed to synthesise qualitative evidence related to barriers and facilitators of adherence to LDA in pregnancy.MethodsA systematic review and meta-ethnography of qualitative research was co-produced by representatives from charities, public, clinical and academic members. Electronic databases (Medline, Web of Science, CINAHL, PsycINFO, Embase, Scopus, Open Grey, Google Scholar), archives of charities and professional organisations were searched using predefined search terms. Citation searching was also undertaken. Studies containing qualitative components related to barriers and facilitators of adherence to LDA during pregnancy were included. Quality assessment was performed using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. The meta-ethnography approach was utilised, using reciprocal translation and line-of-argument synthesis. Co-production activities were facilitated by the nominal group technique followed by structured group discussions. PROSPERO registration number CRD42022359718.ResultsOut of 3094 items identified though systematic searches, six studies were included in the review. No studies were excluded based on quality assessment. Four 3rd level constructs with a total of 10 sub-themes were identified: informational gap, verbal and non-verbal signals from the health care system, personal assets, and control. In an explanatory model we demonstrate that women are advised to take prophylactic LDA in a context of lack of information and misconceptions (informational gap) with patchy and inconsistent messages from the health care system (verbal and non-verbal signals from the health care system). Women ultimately control (own) their decision about use of LDA, however arrival to a decision depends on utilisation of personal resources/assets (unique personal characteristics inherited or acquired such as beliefs and values, desire to enjoy pregnancy, perception of risk, experiences, trust, practical and cognitive skills, habits, ability to navigate/utilise social environment, as well as physical and cognitive conditions).ConclusionThere is an opportunity to support women and their support networks through improving the quality of information and its provision. This has the potential for reducing an intense need in utilisation of personal resources/assets and making use of this important preventative medicine more equitable.Priority and relevanceUse of the co-production approach is expected to streamline the intervention development process as key stakeholders were actively engaged in evidence synthesis. It will allow this group of stakeholders to translate evidence into intervention and support its implementation.