Behavioural Change Techniques in Health Coaching-Based Interventions for Type 2 Diabetes: A Systematic Review and Meta-Analysis.

BACKGROUND: Given the high rates globally of Type 2 Diabetes Mellitus (T2DM), there is a clear need to target health behaviours through person-centred interventions. Health coaching is one strategy that has been widely recognised as a tool to foster positive behaviour change. However, it has been used inconsistently and has produced mixed results. This systematic review sought to explore the use of behaviour change techniques (BCTs) in health coaching interventions and identify which BCTs are linked with increased effectiveness in relation to HbA1C reductions. METHODS: In line with the PICO framework, the review focused on people with T2DM, who received health coaching and were compared with a usual care or active control group on HbA1c levels. Studies were systematically identified through different databases including Medline, Web of science, and PsycINFO searches for relevant randomised controlled trials (RCTs) in papers published between January 1950 and April 2022. The Cochrane collaboration tool was used to evaluate the quality of the studies. Included papers were screened on the reported use of BCTs based on the BCT taxonomy. The effect sizes obtained in included interventions were assessed by using Cohen's d and meta-analysis was used to estimate sample-weighted average effect sizes (Hedges' g). RESULTS: Twenty RCTs with a total sample size of 3222 were identified. Random effects meta-analysis estimated a small-sized statistically significant effect of health coaching interventions on HbA1c reduction (g+ = 0.29, 95% CI: 0.18 to 0.40). A clinically significant HbA1c decrease of ≥5 mmol/mol was seen in eight studies. Twenty-three unique BCTs were identified in the reported interventions, with a mean of 4.5 (SD = 2.4) BCTs used in each study. Of these, Goal setting (behaviour) and Problem solving were the most frequently identified BCTs. The number of BCTs used was not related to intervention effectiveness. In addition, there was little evidence to link the use of specific BCTs to larger reductions in HbA1c across the studies included in the review; instead, the use of Credible source and Social reward in interventions were associated with smaller reductions in HbA1c. CONCLUSION: A relatively small number of BCTs have been used in RCTs of health coaching interventions for T2DM. Inadequate, imprecise descriptions of interventions and the lack of theory were the main limitations of the studies included in this review. Moreover, other possible BCTs directly related to the theoretical underpinnings of health coaching were absent. It is recommended that key BCTs are identified at an early stage of intervention development, although further research is needed to examine the most effective BCTs to use in health coaching interventions. TRIAL REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228567 .

Nurses' experiences and sense making of COVID-19 redeployment and the impact on well-being, performance, and turnover intentions: A longitudinal multimethod study.

Background: During Covid-19 nurses were redeployed to new teams and specialties at a level never previously experienced. Little is known about how nurses made sense of and coped with this situation and what we can learn from this for future redeployment approaches. Objectives: We sought to understand how nurses made sense of ongoing redeployment during the COVID-19 pandemic and how this related to their psychological distress, burnout, turnover intentions, and perceived performance. Design: A longitudinal multi-method design. (ISRCTN: 18,172,749). Settings: Three acute National Health Service (NHS) Trusts in England, selected for diversity in geographical location and ethnicity, with different COVID-19 contexts. Participants: Sixty-two nurses (90 % female; 83 % white) who experienced different types of redeployment during the pandemic, with an average of 17 year's post-registration experience (mean age 41 years). Methods: We gathered both interview and survey data from 62 nurses across two or three time points in 2020-2021 and sought to find commonalities and differences in patterns of experience using Pen Portrait analysis. Results: The pandemic redeployment process was life-changing for all nurses, personally and professionally. The research uncovered an intertwined pattern of identity and sensemaking as nurses coped with COVID-19 redeployment. Three sensemaking 'journeys' were evident, involving professional identity as a nurse and identification with one's organisation. Nurses in journey one: 'Organisational Identification and Professional Identity Maintained' (n = 28) had the best outcomes for wellbeing, burnout, performance, and retention. Those experiencing the 'Devaluation of Organisational Identification But Maintenance of Professional Identity' journey (n = 24) maintained their professional identity, but their organisational identification deteriorated. Journey three nurses: 'Devaluation of both Organisational Identification and Professional Identity' (n = 10) had the worst outcomes for wellbeing, burnout, performance, and retention. A salient nurse identity triggered stoicism and resilient behaviours while external cues of control, support and contextual awareness affected organisational identification. Conclusions: Nurses made sense of their experiences of redeployment during Covid-19 differently which, in turn affected their outcomes. Given the stark differences in how nurses perceived their psychological distress, burnout, turnover intentions and performance across the journeys, the importance of understanding the cues (e.g. having autonomy) associated with each journey is apparent. Thus, our research provides clear guidance for managers to help them support nurses during redeployment.

Managing nurse redeployment during the Covid-19 pandemic, lessons for future redeployment: A qualitative study.

BACKGROUND: The mass redeployment of nurses was critical across countries necessitated by the acute health impact of Covid-19. Knowledge was limited regarding how to manage nurse redeployment or the impact that redeployment might have. Redeployment continues, particularly in response to the current staffing crisis and surges such as winter pressures. This study aims to address these gaps in evidence to inform guidance on how best to manage nurse redeployment in practice. OBJECTIVES: First, to understand the processes and underpinning decisions made by managers when managing nurse redeployment prior to and during the Covid-19 pandemic. Second, to identify the lessons that can be learned to improve the management of on-going nurse redeployment. DESIGN: Qualitative study utilising semi-structured interviews and focus groups with nurse managers (ISRCTN: 18172749). SETTING(S): Three acute National Health Service (NHS) Trusts in England with geographical and ethnic diversity, and different Covid-19 contexts. PARTICIPANTS: Thirty-two nurse managers and four Human Resource advisors responsible for redeploying nurses or receiving and supporting redeployed nurses. METHODS: Participants took part in face-to-face or virtual semi-structured interviews from February 2021 to November 2021 and virtual focus groups from July to December 2021. Qualitative data were analysed using reflexive thematic analysis. RESULTS: Four themes were evident in the data, capturing four distinctive phases of the redeployment process. There was a fundamental mismatch between how different parts of the nursing and managerial workforce conceived of their decision-making responsibilities across different phases. This led to managers taking inconsistent and sometimes contradictory approaches when redeploying nurses, and a disconnect between nursing staff at all levels of the chain of command. Furthermore, in conjunction with limited guidance in operationalising redeployment and the distressing experiences vocalised by nurses, nurse managers found nurse redeployment logistically and emotionally challenging; and felt 'caught in the middle' of meeting both their managerial and mentoring responsibilities. This became increasingly challenging during subsequent phases of redeployment and remained challenging once the pandemic waned. CONCLUSIONS: The approach to nurse redeployment in response to the Covid-19 pandemic prioritised nurse staffing numbers over personal well-being. Key principles of good practice relating to nurse redeployment during the Covid-19 pandemic can be applied to improve future redeployment of nurses and support positive outcomes. Having a planned approach for staff redeployment during normal service delivery comprising operational guidance for those tasked with implementing redeployment, that is scalable in a crisis setting, would be beneficial for the nursing workforce.

Fifty-year study of microplastics ingested by brachyuran and fish larvae in the central English North Sea.

Microplastics (MPs) are ubiquitous pollutants in marine environments. Among the many detrimental consequences of microplastic pollution, its consumption by marine biota is of particular relevance for human health, due to exposure through the food web. Long-term time-series biotic samples are overlooked sources of information for microplastics research. These collections are extremely valuable for the detection and monitoring of changes in marine environments. However, there are very few long-term studies (>10 years) of the uptake of microplastics by biota. Here, we used Dove Time Series planktonic samples (from 1971 to 2020) to assess the presence and prevalence of microplastics in the English North Sea coast over time. Fish and brachyuran larvae were selected due to their commercial importance and consequent implications for human health. A custom enzymatic digestion method was used to extract microplastics for FTIR-ATR polymer identification. An increasing cumulative trend in MP ingestion was identified. Cellophane and polyethylene terephthalate were the polymer types found most frequently in both taxa. Although a total higher microplastics uptake was observed in fish, consumption was not significantly different between taxa over time. Equally, results were not clearly related to microplastics shape or polymer type. This work did not find significant long-term evidence on the increasing uptake of microplastic particles by zooplankton over time. However, the results of this report identified additives, plasticisers, and other more complex and hazardous compounds that should not be released to the environment (e.g., bis-(2-hydroxyethyl) dimerate, propylene glycol ricinoleate) inside marine biota. The study detailed herein provides a case study for the use of long-term time-series in providing accurate assessments of microplastic pollution in marine biota.

Use of Optical Genome Mapping to Detect Structural Variants in Neuroblastoma.

BACKGROUND: Neuroblastoma is the most common extracranial solid tumour in children, accounting for 15% of paediatric cancer deaths. Multiple genetic abnormalities have been identified as prognostically significant in neuroblastoma patients. Optical genome mapping (OGM) is a novel cytogenetic technique used to detect structural variants, which has not previously been tested in neuroblastoma. We used OGM to identify copy number and structural variants (SVs) in neuroblastoma which may have been missed by standard cytogenetic techniques. METHODS: Five neuroblastoma cell lines (SH-SY5Y, NBLW, GI-ME-N, NB1691 and SK-N-BE2(C)) and two neuroblastoma tumours were analysed using OGM with the Bionano Saphyr® instrument. The results were analysed using Bionano Access software and compared to previous genetic analyses including G-band karyotyping, FISH (fluorescent in situ hybridisation), single-nucleotide polymorphism (SNP) array and RNA fusion panels for cell lines, and SNP arrays and whole genome sequencing (WGS) for tumours. RESULTS: OGM detected copy number abnormalities found using previous methods and provided estimates for absolute copy numbers of amplified genes. OGM identified novel SVs, including fusion genes in two cell lines of potential clinical significance. CONCLUSIONS: OGM can reliably detect clinically significant structural and copy number variations in a single test. OGM may prove to be more time- and cost-effective than current standard cytogenetic techniques for neuroblastoma.

Major declines in NE Atlantic plankton contrast with more stable populations in the rapidly warming North Sea.

Plankton form the base of marine food webs, making them important indicators of ecosystem status. Changes in the abundance of plankton functional groups, or lifeforms, can affect higher trophic levels and can indicate important shifts in ecosystem functioning. Here, we extend this knowledge by combining data from Continuous Plankton Recorder and fixed-point stations to provide the most comprehensive analysis of plankton time-series for the North-East Atlantic and North-West European shelf to date. We analysed 24 phytoplankton and zooplankton datasets from 15 research institutions to map 60-year abundance trends for 8 planktonic lifeforms. Most lifeforms decreased in abundance (e.g. dinoflagellates: -5 %, holoplankton: -7 % decade-1), except for meroplankton, which increased 12 % decade-1, reflecting widespread changes in large-scale and localised processes. K-means clustering of assessment units according to abundance trends revealed largely opposing trend direction between shelf and oceanic regions for most lifeforms, with North Sea areas characterised by increasing coastal abundance, while abundance decreased in North-East Atlantic areas. Individual taxa comprising each phytoplankton lifeform exhibited similar abundance trends, whereas taxa grouped within zooplankton lifeforms were more variable. These regional contrasts are counterintuitive, since the North Sea which has undergone major warming, changes in nutrients, and past fisheries perturbation has changed far less, from phytoplankton to fish larvae, as compared to the more slowly warming North-East Atlantic with lower nutrient supply and fishing pressure. This more remote oceanic region has shown a major and worrying decline in the traditional food web. Although the causal mechanisms remain unclear, declining abundance of key planktonic lifeforms in the North-East Atlantic, including diatoms and copepods, are a cause of major concern for the future of food webs and should provide a red flag to politicians and policymakers about the prioritisation of future management and adaptation measures required to ensure future sustainable use of the marine ecosystem.