Development of an implementation science informed "Test Evidence Transition" program to improve cancer outcomes.

Introduction: Translation of cancer research into practice takes around 15 years. Programs informed by implementation science methods and frameworks offer potential to improve cancer outcomes by addressing the implementation gap. Methods: We describe the development of a Test Evidence Transition (TET) program which provides funding and support to health system delivery teams and project design and evaluation partners working together to achieve three objectives: Test innovations to support optimal cancer pathways that transform clinical practice; Evidence the process, outcome, and impact of implementation; and work with strategic partners to ensure the Transition of best practice into effective and equitable adoption across UK health systems. Results: Phase 1 launched in April 2023. Teams with the capability and motivation to implement evidence-based pathway innovations were identified and invited to submit expressions of interest. Following peer-review, teams were supported to develop full proposals with input from academics specializing in health services research, evaluation, and implementation science. Projects were selected for funding, providing an opportunity to implement and evaluate innovations with support from academic and health system partners. Conclusions: TET aims to improve cancer outcomes by identifying and addressing local-level barriers to evidence-based practice and translating findings into consistent and equitable adoption across health systems. Phase 1 projects focus on pathway innovations in diagnosis for breast and prostate cancer. We are now launching Phase 2, focusing on colorectal cancer.

New horizons in supporting older people's health and wellbeing: is social prescribing a way forward?

Older people's health and care needs are changing. Increasing numbers live with the combined effects of age-related chronic illness or disability, social isolation and/or poor mental health. Social prescribing has potential to benefit older people by helping those with social, emotional or practical needs to access relevant services and resources within the local community. However, researchers have highlighted limitations with the existing evidence-base, while clinicians express concerns about the quality of onward referral services, liability and upfront investment required. The current article provides a critical review of evidence on social prescribing, drawing on the RE-AIM Framework (Glasgow et al., 1999) to identify questions that will need to be addressed in order to inform both the design and delivery of services and the evolving research agenda around social prescribing. We emphasise the need for researchers and planners to work together to develop a more robust evidence-base, advancing understanding of the impacts of social prescribing (on individuals, services and communities), factors associated with variation in outcomes and strategies needed to implement effective and sustainable programmes. We also call on policymakers to recognise the need for investment in allied initiatives to address barriers to engagement in social prescribing programmes, provide targeted support for carers and improve access to older adult mental health services. We conclude that social prescribing has potential to support older people's health and wellbeing, but this potential will only be realised through strategic alignment of research, local level implementation and national policy and investment.

An Intervention Study: Does a Cognitive Reappraisal Technique Reduce the Perceived Stress in Fourth-Year Dental Students in New Zealand?

BACKGROUND: The fourth-year of the Bachelor of Dental Surgery (BDS) degree is considered the most stressful in the curriculum. Cognitive reappraisal is a self-applied method of stress management where an individual recognises his/her physiological responses to stress as a positive phenomenon helping him/her rise to the challenge, rather than a negative one in response to a threat situation. AIM: To investigate whether teaching fourth-year dental students to apply cognitive reappraisal reduces their perceived levels of stress. METHODS: A survey was emailed to all fourth-year dental students, inviting them to respond to a 20-item questionnaire adapted from the Dental Environmental Stress (DES) Survey. Respondents were randomly assigned to reappraisal intervention/experimental (EXP) and control intervention (CON) groups, and each group was asked to watch an educational video. The EXP group video educated respondents on how to apply cognitive reappraisal in stressful situations, and the CON group video described generic methods of stress management. A follow-up survey was conducted after 3 weeks. RESULTS: The respondent rate was 47.6%. Change scores were calculated by subtracting the follow-up DES scores from baseline DES scores. The average change score for the experimental group was +3.1, indicating a decrease in average perceived stress levels. Conversely, the average change score for the CON group was -1.06, indicating an increase in average perceived stress levels. However, this difference did not reach a statistical significance. CONCLUSION: EXP group has shown to have positive effects on stress management, and its effects on BDS students demonstrate promise.

Evaluability assessments as an approach to examining social prescribing.

We report on two evaluability assessments (EAs) of social prescribing (SP) services in South East England conducted in 2016/7. We aimed to demonstrate how EAs can be used to assess whether a programme is ready to be evaluated for outcomes, what changes would be needed to do so and whether the evaluation would contribute to improved programme performance. We also aimed to draw out the lessons learned through the EA process and consider how these can inform the design and evaluation of SP schemes. EAs followed the steps described by Wholey, New Dir Eval 33:77, (1987) and Leviton et al., Annu Rev Public Health 31:213, (2010), including collaboration with stakeholders, elaboration, testing and refinement of an agreed programme theory, understanding the programme reality, identification and review of existing data sources and assessment against key criteria. As a result, evaluation of the services was not recommended. Necessary changes to allow for future evaluation include gaining access to electronic patient records, establishing procedures for collection of baseline and outcome data and linking to data on use of other healthcare services. Lessons learned include ensuring that: (a) SP schemes are developed with involvement (and buy in) of relevant stakeholders; (b) information governance and data sharing agreements are in place from the start; (c) staffing levels are sufficient to cover the range of activities involved in service delivery, data monitoring, reporting, evaluation and communication with stakeholders; (d) SP schemes are co-located with primary care services; and (e) referral pathways and linkages to health service data systems are established as part of the programme design. We conclude that EA provides a valuable tool for informing the design and evaluation of SP schemes. EA can help commissioners to make best use of limited evaluation resources and prioritise which programmes need to be evaluated, as well as how, why and when.

Evaluation of a Sudarshan Kriya Yoga (SKY) based breath intervention for patients with mild-to-moderate depression and anxiety disorders.

AIM: Research identifies a need for expanded therapeutic options for people with mild-to-moderate depression and anxiety disorders treated within the UK National Health Service (NHS). We aimed to examine potential benefits of a Sudarshan Kriya Yoga (SKY) based breath intervention delivered in this context. BACKGROUND: SKY is a structured programme derived from yoga in which participants are taught relaxation and stress-management techniques including body postures, breathing exercises and cognitive-behavioural procedures. Previous research has demonstrated benefits for patients with clinical and non-clinical depression and anxiety. However, SKY has not yet been evaluated as a therapeutic option for patients accessing NHS primary care mental health services. METHODS: We evaluated an existing programme available to NHS patients in South East England. The intervention is community-based and delivered via four weekly 'stress buster sessions' (1-h duration), one weekend intensive workshop (2.5 days) and four weekly (90 min) follow-up sessions. Analyses were conducted on existing data [measures of depression (Patient Health Questionnaire-9) and anxiety (generalised anxiety disorder-7)] collected as part of routine care, at the start of the programme and three follow-up assessments. FINDINGS: Baseline data were available for 991 participants, of which 557 (56.2%) attended at least three weekly workshops, 216 (21.8%) attended the weekend workshop and 169 (17.1%) completed the programme. Statistically significant (P<0.05) improvements in depression and anxiety were observed in all three outcome assessments. Clinically meaningful change was observed for 74.6% of participants completing the programme. Findings indicate that SKY has the potential to benefit patient outcomes and could be offered more widely as a therapeutic option. We recommend further research to explore patients' experiences of the programme, determine the number of sessions necessary for improvement/ recovery, define the population most likely to respond and examine potential cost savings (e.g., reductions in antidepressant prescribing/referrals to secondary care).

Does a modified mindfulness-based cognitive therapy (MBCT) course have the potential to reduce stress and burnout in NHS GPs? Feasibility study.

AimTo explore, for the first time, whether a modified mindfulness-based cognitive therapy (MBCT) course has the potential to reduce stress and burnout among National Health Service (NHS) General Practitioners. BACKGROUND: There is a crisis of low morale among NHS GPs, with most describing their workload as 'unmanageable'. MBCT has been demonstrated to improve stress and burnout in other populations, but has not yet been evaluated in a cohort of NHS GPs. METHODS: NHS GPs in South East England (n=22) attended a modified version of the MBCT course approved by National Institute for Health and Care Excellence for prevention of depressive relapse. This comprised eight weekly 2-h sessions with homework (mindfulness practice) between sessions. Participants completed the Maslach Burnout Inventory (MBI) and Perceived Stress Scale (PSS) before (baseline) and then again one month (T2) and three months (T3) after attending the course. We also obtained qualitative data on participants' experiences of the course.FindingsCompliance with the intervention was very high. All GPs attended at least six sessions and all completed baseline questionnaires. At T2, data were obtained from 21 participants (95%); PSS scores were significantly lower than at baseline (P<0.001), as were MBI emotional exhaustion (P<0.001) and depersonalization scores (P=0.0421). At T3 we obtained data for 13 participants (59%); PSS scores and MBI emotional exhaustion scores were significantly lower (P<0.001; P=0.0024, respectively) and personal accomplishment scores were significantly higher (P<0.001) than at baseline. Participants reported that the course helped them to manage work pressures, feel more relaxed, enjoy their work and experience greater empathy and compassion (for self, colleagues and patients). Findings of this preliminary evaluation are promising. Further research is needed to evaluate this approach within a larger randomized-controlled trial.

The Effects of Poi on Physical and Cognitive Function in Healthy Older Adults.

This study investigated the effects of poi (a weight on the end of a cord which is swung in circular patterns around the body) compared with Tai Chi on physical and cognitive function in healthy older adults. A total of 79 participants (60-86 years) were randomly allocated to the poi or Tai Chi group. Physical and cognitive function was measured 1 month before, immediately before, immediately after, and 1 month after the intervention (two lessons a week, for 4 weeks). Immediately postintervention, both groups improved postural stability, upper limb strength, and simple attention. Tai Chi also improved systolic blood pressure. One-month postintervention, compared with immediately postintervention, both groups improved upper limb strength, upper limb range of motion, and memory. Poi also improved systolic blood pressure. Therefore, poi seems to be as effective as Tai Chi for improving physical and cognitive function in healthy older adults.

Evaluation of a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care: the role of Primary Care Mental Health Specialists.

Aim We aimed to evaluate a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care. BACKGROUND: Patients with stable long-term mental health conditions are often not discharged from secondary mental health services when no longer needed due to insufficient systems and processes to enable safe, effective, recovery-focussed treatment and support. The Primary Care Mental Health Specialist (PCMHS) Service was developed to address this gap; new PCMHS posts were introduced to act as a conduit for patients being discharged from secondary care and a single point of referral back into secondary care, should it be required. The two-year pilot, across six Clinical Commissioning Groups in South East England, began in March 2013. METHODS: Interviews were conducted with all PCMHS employed in the pilot service (n=13) and a sample of service users (n=12). The views of professionals working alongside the service, including GPs, Psychiatrists and Mental Health Nurses, were captured using a brief online questionnaire (n=50). Time and Activity Recording Sheets were used to capture data required for economic analysis. Findings Our findings indicate that the service is working well from the perspective of patients; staff employed within the service and professionals working alongside the service. Patients described the service as a 'safety net' they could fall back on in case of difficulties, whereas staff used the analogy of a 'bridge' to describe the way the service improved communication and collaboration between the various professionals and organisations involved in the patient's care. Improvements in well-being were seen to result from increased support for those transitioning from secondary to primary care, a more pro-active approach to relapse prevention and increased engagement in daily activities. Each PCMHS covered 36 patients in a one-month period, with a unit cost of £73.01 per patient.

Changes in attachment representations for young people in long-term therapeutic foster care.

This article reports on a 1-year follow-up study exploring changes in attachment security of children placed in long-term therapeutic foster care over three data collection time points. A group of eight children (age 14 to 17) were assessed over a period of 1 year using a modified version of the Separation Anxiety Test (SAT). Interviews were also conducted to explore the young people's and the carers' experiences of the placements and their personal perspectives of changes. The findings indicated some positive changes in the young people's attachment security over time, for example, a reduction in extreme reactions and a trust that adults could understand their feelings (PAE - parental accurate empathy). However, despite this PAE, the young people did not expect adults to enact this by offering them support, and this lack of expectation persisted over the 1-year period. Specific differences in relation to placement success were suggested in that young people for whom their placements broke down indicated more initial fearful and aggressive representations of adults. Overall, young people emphasised positive aspects of their placements as including being treated as adults, listened to and made to feel safe.

Pulmonary Fibrosis Secondary to FOLFOX Chemotherapy: A Case Report.

A 54-year-old female presented with a 2-week history of increasing shortness of breath and fever. She had a history of a poorly differentiated sigmoid adenocarcinoma for which she underwent an anterior resection 6 months prior to admission, followed by 12 cycles of adjuvant FOLFOX chemotherapy. The patient was treated for a severe community-acquired pneumonia; however, she remained hypoxic. A chest CT revealed extensive right-sided fibrotic changes, tractional dilatation of the airways and ground glass density, which had developed since a staging CT scan performed 2 months previously. Although her symptoms improved with steroid therapy, repeat imaging revealed that right hydropneumothorax had developed, and this required the insertion of a chest drain. Following its successful removal, the patient continues to improve clinically and radiographically. The rapid onset and nature of these changes is consistent with a drug-induced fibrotic lung disease secondary to FOLFOX chemotherapy. The phenomenon is underreported and yet, it is relatively common: it occurs in approximately 10% of patients who are treated with antineoplastic agents, although information specifically relating to FOLFOX-induced pulmonary toxicity is limited. It is associated with significant morbidity and mortality, but is often hard to differentiate from other lung conditions, making the diagnosis a challenge. Pulmonary toxicity is an important complication associated with antineoplastic agents. It should be considered in any patient on a chemotherapeutic regimen who presents with dyspnoea and hypoxia in order to try to reduce the associated morbidity and mortality.

Nonreplicating vaccines can protect african green monkeys from the memphis 37 strain of respiratory syncytial virus.

BACKGROUND: We evaluated the immunological responses of African green monkeys immunized with multiple F and G protein-based vaccines and assessed protection against the Memphis 37 strain of respiratory syncytial virus (RSV). METHODS: Monkeys were immunized with F and G proteins adjuvanted with immunostimulatory (CpG) oligodeoxyribonucleotides admixed with either Alhydrogel or ISCOMATRIX adjuvant. Delivery of F and G proteins via replication incompetent recombinant vesicular stomatitis viruses (VSVs) and human adenoviruses was also evaluated. Mucosally or parenterally administered recombinant adenoviruses were used in prime-boost regimens with adjuvanted proteins or recombinant DNA. RESULTS: Animals primed by intranasal delivery of recombinant adenoviruses, and boosted by intramuscular injection of adjuvanted F and G proteins, developed neutralizing antibodies and F/G protein-specific T cells and were protected from RSV infection. Intramuscular injections of Alhydrogel (plus CpG) adjuvanted F and G proteins reduced peak viral loads in the lungs of challenged monkeys. Granulocyte numbers were not significantly elevated, relative to controls, in postchallenge bronchoalveolar lavage samples from vaccinated animals. CONCLUSIONS: This study has validated the use of RSV (Memphis 37) in an African green monkey model of intranasal infection and identified nonreplicating vaccines capable of eliciting protection in this higher species challenge model.

The efficacy of HSV-2 vaccines based on gD and gB is enhanced by the addition of ICP27.

DNA vaccines expressing HSV-2 gD, gB, ICP27, VP22 and VP13/14 were shown to be immunogenic in mice; gD and gB elicited neutralising antibody, and all five antigens induced T cell responses measured by IFNγ ELISPOT. In murine HSV-2 challenge studies, gD and gB provided moderate to high levels of protection while ICP27 provided a lower level of protection depending on the model (intravaginal or intranasal) and the challenge dose. Combining vaccines expressing gB or gD with vaccines expressing ICP27 provided greater protection than any antigen alone. We conclude that the addition of ICP27 to enhance the anti-viral T cell response can improve the efficacy of gD- and gB-based vaccines.

Restrained eaters preserve top-down attentional control in the presence of food.

This study investigated the attentional control of restrained eaters when exposed to food. Restrained (N=55) and unrestrained eaters (N=56) completed a color word Stroop task. Top-down attentional control was assessed by adaptation effects (the Stroop effect is smaller when the previous trial is an incongruent color word than a congruent color word). Adaptation effects differed between restrained and unrestrained eaters according to the type of background image presented (high-fat food vs. non-food). Specifically, in restrained eaters adaptation effects did not differ as a function of image. In contrast, adaptation effects in unrestrained eaters were not observed with high-fat food. Motivation to either approach or avoid food may explain these differences.

Single and combination herpes simplex virus type 2 glycoprotein vaccines adjuvanted with CpG oligodeoxynucleotides or monophosphoryl lipid A exhibit differential immunity that is not correlated to protection in animal models.

Despite several attempts to develop an effective prophylactic vaccine for HSV-2, all have failed to show efficacy in the clinic. The most recent of these failures was the GlaxoSmithKline (GSK) subunit vaccine based on the glycoprotein gD with the adjuvant monophosphoryl lipid A (MPL). In a phase 3 clinical trial, this vaccine failed to protect from HSV-2 disease, even though good neutralizing antibody responses were elicited. We aimed to develop a superior, novel HSV-2 vaccine containing either gD or gB alone or in combination, together with the potent adjuvant CpG oligodeoxynucleotides (CPG). The immunogenic properties of these vaccines were compared in mice. We show that gB/CPG/alum elicited a neutralizing antibody response similar to that elicited by gD/CPG/alum vaccine but a significantly greater gamma interferon (IFN-γ) T cell response. Furthermore, the combined gB-gD/CPG/alum vaccine elicited significantly greater neutralizing antibody and T cell responses than gD/MPL/alum. The efficacies of these candidate vaccines were compared in the mouse and guinea pig disease models, including a novel male guinea pig genital disease model. These studies demonstrated that increased immune response did not correlate to improved protection. First, despite a lower IFN-γ T cell response, the gD/CPG/alum vaccine was more effective than gB/CPG/alum in mice. Furthermore, the gB-gD/CPG/alum vaccine was no more effective than gD/MPL/alum in mice or male guinea pigs. We conclude that difficulties in correlating immune responses to efficacy in animal models will act as a deterrent to researchers attempting to develop effective HSV vaccines.

Help-seeking in relation to signs of dementia: a pilot study to evaluate the utility of the common-sense model of illness representations.

Despite the importance of early diagnosis of dementia, little is known about the factors underlying help-seeking in relation to signs of the condition. In this pilot study, we aimed to examine the potential utility of the common sense model (CSM) of illness representations for understanding lay perceptions of dementia and predicting intentions to seek help in relation to possible signs and symptoms. A secondary aim was to develop a measure of (dementia-related) illness representations as a tool for future research. After reading a vignette describing a "relative" with mild or moderate dementia, participants (N = 118) completed measures of illness representations and help-seeking intentions. Analyses compared perceptions of the mild and moderate vignettes and determined the extent to which illness perceptions differentiated between alternative forms of help-seeking (e.g. seeking professional help vs. help from family members). Results indicated that cognitive deficits were more readily identified as dementia than non-cognitive symptoms; these were commonly attributed to stress or depression. Participants were more likely to indicate an intention to seek professional help if they identified the problem in the vignette as dementia, perceived symptoms as severe, as having serious consequences and as likely to be permanent, but less likely to do so if they identified the problem as stress or attributed symptoms to psychological causes. Our preliminary data suggests that help-seeking may be prevented by inaccurate illness representations or misattribution of symptoms. The CSM may provide a useful framework for understanding perceptions of dementia symptoms and for informing help-seeking pathways.

Smoking-related attitudes and perceptions among young adults in Malta and the UK.

Although youth smoking in Europe has been highlighted as a significant public health concern, there is little data available to guide development of population-specific smoking prevention measures. In this study, we examined smoking-prevalence and smoking-related attitudes and perceptions among 118 young adults in Malta (a country for which there is little existing data), with comparison data from a sample of young adults in the UK (N = 112). To ensure that samples were demographically similar (e.g. in terms of age, level of education, and social status) we obtained data from university students. Only students of Maltese nationality (in Malta), or British nationality (in the UK) were invited to participate. Participants completed measures of smoking behavior, perceived risks of smoking, subjective norms, temptation to smoke, and attitudes towards smoking cessation. Almost half (46%) of the Maltese students were current smokers, compared to 25% of the British students. British students were more aware of the risks of smoking than their Maltese counterparts, perceived greater social pressure not to smoke and held more positive attitudes towards smoking cessation; Maltese students reported greater temptation to smoke and were around others who smoke more often than the British students. Attitudes and perceptions were associated with smoking behavior in both samples although the relative importance of psychological determinants of smoking varied between the two samples. Our data indicate higher smoking prevalence and more pro-smoking attitudes/ perceptions among students in Malta, consistent with data for other Southern European countries. Findings also indicate that the influence of smoking-related attitudes and perceptions varies between populations and the influence of social norms in particular may be moderated by nationality.

Living with Ankylosing Spondylitis: the patient's perspective.

Ankylosing Spondylitis (AS) is a potentially debilitating chronic condition that necessitates a biopsychosocial approach for successful long-term management. However, the psychosocial consequences of AS are not well understood. In this study patients (N = 68) reported impacts of AS across a wide range of life domains; negative impacts included physical effects of AS, changes in mood or personality, effects on social life and relationships with friends and family, low self-esteem, stigma and worry about the future; positive impacts included increased exercise, feelings of achievement and empathy, stronger relationships, slower pace of life and a more positive perspective. Implications for treatment are discussed.

Factors influencing MMR vaccination decisions following a mumps outbreak on a university campus.

Following a number of mumps outbreaks in universities and colleges, the UK Health Protection Agency has suggested that it is appropriate to consider offering the MMR vaccine in these settings. However, little is known about the factors associated with uptake of the MMR jab or perceptions of risks/benefits of the vaccine among higher education students. The current study focused on a sample of students offered the MMR vaccine following an outbreak of mumps on a university campus. Perceptions of risks/benefits of the vaccine varied considerably and students were unlikely to have the jab when perceived risks of immunising were equivalent to perceived risks of not immunising. Results suggest that public health interventions should address students' attitudes towards the vaccine, perceptions of peer expectations, and perceptions of barriers to uptake.