Catherine R H Aicken

Much of the UK’s ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In two nursing homes, Health Care Assistants (HCAs) received training in clinical communication skills (Situation-Background-Assessment-Recommendation Education through Technology and Simulation, SETS: group training with an actor simulating scenarios); and dementia (A Walk Through Dementia, AWTD: digital simulation, delivered one-to-one). In this qualitative descriptive study, we evaluated the potential of this training to enhance HCAs’ clinical leadership skills, through thematic analysis of 24 semi-structured interviews with HCAs (before/after training) and their managers and mentors. Themes were checked by both interviewers. HCAs benefitted from watching colleagues respond to SETS scenario...

Background In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. Methods We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May–September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. Results BC women’s sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women’s atten...

We developed the eSexual Health Clinic (eSHC), an innovative, complex clinical and public health intervention, embedded within a specialist sexual health service. Patients with genital chlamydia access their results online and are offered medical management via an automated online clinical consultation, leading to antibiotic collection from community pharmacy. A telephone helpline, staffed by Sexual Health Advisers, is available to support patients and direct them to conventional services if appropriate. We sought to understand how patients used this ehealth intervention. Within exploratory studies of the eSHC (2014-2015), we conducted in-depth interviews with a purposive sample of 36 patients diagnosed with chlamydia, who had chosen to use the eSHC (age 18-35, 20 female, 16 male). Thematic analysis was conducted. Participants described choosing to use this ehealth intervention to obtain treatment rapidly, conveniently and privately, within busy lifestyles that hindered clinic acces...

Evidence on optimal methods for providing STI test results is lacking. We evaluated an online results service, developed as part of an eSexual Health Clinic (eSHC). We evaluated the online results service using a mixed-methods approach within large exploratory studies of the eSHC. Participants were chlamydia- positive and negative users of online postal self-sampling services in six National Chlamydia Screening Programme (NCSP) areas and chlamydia-positive patients from two genitourinary medicine (GUM) clinics between 21 July 2014 and 13 March 2015. Participants received a discreetly worded National Health Service 'NHS no-reply' text message (SMS) informing them that their test results were ready and providing a weblink to a secure website. Participants logged in with their date of birth and mobile telephone or clinic number. Chlamydia-positive patients were offered online management. All interactions with the eSHC system were automatically logged and their timing recorded. ...

Novel online clinical management pathways for chlamydia (eSexualHealthClinic) are being developed, enabling people to receive treatment remotely from clinical settings, with minimal contact with healthcare-professionals. Development follows Medical Research Council complex interventions guidance, and is iteratively informed by qualitative research. In a mixed-methods pilot study, the eSexualHealthClinic is being explored for acceptability and preliminary evidence of effectiveness, among people who tested positive for chlamydia through conventional services. They receive test-results by text-message, and are offered online care. After completing an automated consultation, they can collect antibiotics from community pharmacies. If they prefer, or if medically appropriate, they are managed in clinic. To describe how the pilot study's qualitative component will deepen our understanding of its quantitative findings, further informing intervention development. Ongoing semi-structured ...

The objective of this study was to examine changes in patient routes into genitourinary medicine (GUM) clinics since policy changes in England sought to improve access to sexual healthcare. Cross-sectional patient surveys at contrasting GUM clinics in England in 2004/2005 (seven clinics, 4600 patients) and 2009 (four clinics, 1504 patients). Patients completed a short pen-and-paper questionnaire that was then linked to an extract of their clinical data. Symptoms remained the most common reason patients cited for attending GUM (46% in both surveys), yet the proportion of patients having sexually transmitted infection (STI) diagnosis/es declined between 2004/2005 and 2009: 38%-29% of men and 28%-17% of women. Patients in 2009 waited less time before seeking care: median 7 days (2004/2005) versus 3 days (2009), in line with shorter GUM waiting times (median 7 vs 0 days, respectively). Fewer GUM patients in 2009 first sought care elsewhere (23% vs 39% in 2004/2005), largely from general practice, extending their time to attending GUM by a median of 2 days in 2009 (vs 5 days in 2004/2005). Patients with symptoms in 2009 were less likely than patients in 2004/2005 to report sex since recognising a need to seek care, but this was still reported by 25% of men and 38% of women (vs 44% and 58%, respectively, in 2004/2005). Patient routes to GUM shortened between 2004/2005 and 2009. While GUM patients in 2009 were less likely overall to have STIs diagnosed, perhaps reflecting lower risk behaviour, there remains a substantial proportion of high-risk individuals requiring comprehensive care. Behavioural surveillance across all STI services is therefore essential to monitor and maximise their public health impact.

Copper intrauterine devices (copper-IUDs) are relatively safer, more effective and inexpensive compared with hormonal methods and are the most widely used reversible contraception in the world, but are underused in developed countries. We systematically reviewed randomized controlled trials and controlled before-and-after studies to determine the effectiveness of interventions for improving uptake of copper-IUDs. We searched electronic databases for eligible trials. RevMan 5.1 was used to calculate Peto odd ratios with 95% confidence interval for dichotomous outcomes. Nine studies representing 7960 women met our inclusion criteria, including seven randomized controlled trials and two controlled before-and-after studies. Meta-analysis from three studies showed contraceptive provision by community workers doubled uptake of IUD, and studies on antenatal contraceptive counselling showed similar increases. One study reported major increases in IUD uptake with postnatal couple contraceptive counselling; a study on postnatal home visits and two studies on postabortion contraceptive counselling did not reach statistical significance. Community-based interventions and antenatal contraceptive counselling improved uptake of copper-IUD in studies mainly conducted in developing counties. Further research is needed on postabortion contraceptive counselling as well as longer-term effectiveness of interventions to improve use of copper-IUD.

Background Decision Analytic Models (DAMs) are established means of evidence-synthesis to differentiate between health interventions. They have mainly been used to inform clinical decisions and health technology assessment at the national level, yet could also inform local health service planning. For this, a DAM must take into account the needs of the local population, but also the needs of those planning its services. Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) re...

ABSTRACT Background In the UK, national guidelines have sought to improve access to sexual health care, in part by expanding community-based provision of sexually transmitted infection (STI) testing, diagnosis, and care. Although useful data sources exist, there is little evidence for or guidance on the effect of different combinations of sexual health services on STI control locally. With finite resources, service planners need to identify the most effective combinations of STI services for their population. We sought to develop an evidence-based webtool aimed at supporting local service planning by synthesising the key data to show the relative consequences of different service configurations for different types of population. Methods We used a decision analytic model (DAM) to identify and model the effects of the characteristics of STI service provision, demography, and sexual behaviour that are likely to have the greatest effect on the incidence of common STIs. The DAM synthesised data from a range of sources, including census, surveillance systems, and probability sample surveys. We validated the DAM using data obtained from a standardised survey of people attending health services in four geographically and sociodemographically contrasting populations across England. The results of the model were presented as a webtool, requiring users to enter routinely available demographic data for their population along with characteristics and outcomes data for existing, proposed, or both health services providing care for STIs locally. The results are processed to estimate the effect on incidence of chlamydia and gonorrhoea locally. We consulted intended users attending a national sexual health conference to gain feedback on our webtool by giving them the opportunity to try the instrument for themselves, as well as ask questions of the designer and the mathematical modeller, for example, regarding the assumptions underlying the webtool. Findings The DAM identified the following demographic and service-level characteristics as key for estimating likely STI incidence in a locality: population type (urban, suburban, or semi-rural, taking account of assumptions about the area's ethnic mix and the proportion of men who have sex with men); size of the population aged 16—44 years, stratified by sex; type or types and capacity of services offering STI testing; level of partner notification achieved by these services; and mean delay between STI test and result. Consultation and usability testing revealed that commissioners and service planners were keen to explore the relative effect on disease control of varying assumptions about the type or types and capacity of services. However, clinicians were concerned about its reductionism and absence of individual patient perspective, although interested in the potential for exploring population outcomes for their services using an interactive decision-making instrument. We addressed these concerns by revising the accompanying user guide to ensure that we clearly explained the assumptions and limitations of our webtool, as well as including a technical appendix that provided details of the mathematical model. Interpretation Our evidence-based webtool allows service planning stakeholders to exploit routine data to inform rational STI service planning for their local population, showing how a one-size-fits-all approach does not apply to STI service planning. However, a willingness of users to engage with new approaches to service planning cannot be assumed. To achieve the buy-in necessary for the deployment of such instruments, user involvement has proven vital, resulting in improved communication and clarification of its assumptions and limitations. Evidence-based service planning needs to be promoted to ensure that STI services benefit both individual and public health. Funding MRC/DH Sexual Health and HIV Research Strategy Committee (grant G0601685).

Background: While much of the world still struggles with too little to eat, in the west, obesity has emerged as a major public health issue. To date, a number of systematic reviews of the effectiveness of interventions to treat and prevent childhood obesity have been conducted (including [1-3]). In 2007, the EPPI-Centre began work on a programme of research on childhood obesity, for the English Department of Health and Department for Children, Schools and Families. The programme of work included systematic reviews of social and ...