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This is a perspective on Ridgway et al ‘Creative health a joke or valuable learning experience’. Creative health encompasses creative and arts activities that benefit health and well-being. The article evaluates a creative health placement designed to facilitate students’ learning about creative health and social prescribing, with opportunities to take part in arts activities.
Take home messages Creative health placements equip future nurses with knowledge about social prescribing initiatives to offer holistic person-centred care. The article provides valuable insights into placements that future-proof registrants’ knowledge and skills with the shift towards prevention and a neighbourhood health service. Building creative health placements into the curriculum in other institutions will improve access to this valuable learning opportunity.
A pilot creative health placement for undergraduate student nurses at a UK...
Asthma is a chronic respiratory disorder requiring ongoing medical management. This ecological study investigated the spatial and temporal patterns of notification rates for asthma from clinic visits and hospital discharges and identified demographic, meteorological and environmental factors that drive asthma in Bhutan.
Monthly numbers of asthma notifications from 2016 to 2022 were obtained from the Bhutan Ministry of Health. Climatic variables (rainfall, relative humidity, minimum and maximum temperature) were obtained from the National Centre for Hydrology and Meteorology, Bhutan. The Normalised Difference Vegetation Index (NDVI) and surface particulate matter (PM2.5) were extracted from open sources. A multivariable zero-inflated Poisson regression (ZIP) model was developed in a Bayesian framework to quantify the relationship between risk of asthma and sociodemographic and environmental correlates, while also identifying the underlying spatial structure of the data.
There were 12 696 asthma notifications, with an annual average prevalence of 244/100 000 population between 2016 and 2022. In ZIP analysis, asthma notifications were 3.4 times (relative risk (RR)=3.39; 95% credible interval (CrI) 3.047 to 3.773) more likely in individuals aged >14 years than those aged ≤14 years, and 43% (RR=1.43; 95% CrI 36.5% to 49.2%) more likely for females than males. Asthma notification increased by 0.8% (RR=1.008, 95% CrI 0.2% to 1.5%) for every 10 cm increase in rainfall, and 1.7% (RR=1.017; 95% CrI 1.2% to 2.3%) for a 1°C increase in maximum temperature. An increase in one unit of NDVI and 10 µg/m3 PM2.5 was associated with 27.3% (RR=1.273; 95% CrI 8.7% to 49.2%), and 2.0% (RR=1.02; 95% CrI 1.0% to 4.0%) increase in asthma notification, respectively. The high-risk spatial clusters were identified in the south and southeastern regions of Bhutan, after accounting for covariates.
Environmental risk factors and spatial clusters of asthma notifications were identified. Identification of spatial clusters and environmental risk factors can help develop targeted interventions that maximise impact of limited public health resources for controlling asthma in Bhutan.
Music-based training programmes, such as learning how to play an instrument or sing in a choir, have been suggested as potential interventions for promoting healthy brain ageing in older adults at risk of cognitive decline because of their ability to enhance cognitive functions and potentially promote neuroplasticity. However, there is limited empirical evidence in older adults at risk of dementia, especially that evaluates both piano and singing interventions and their effects on cognition and neuroplasticity. In this protocol, we outline a study to assess the efficacy of keyboard and singing music training programmes on reducing cognitive decline and other outcomes in older adults with Mild Cognitive Impairment (MCI).
This randomised, single-blind, controlled, parallel-group trial aims to enrol 432 individuals with MCI from the community in Sydney, Australia. Participants are randomly allocated to participate in either keyboard lessons, singing lessons or a film discussion control group once a week for 3 months. The primary objective is to assess the effectiveness of two music training programmes (keyboard and choral singing) for enhancing verbal memory after 3 months compared with control. Additionally, we will examine how these music-based interventions affect other aspects of cognition, mood, sleep, overall well-being, markers of brain plasticity and blood biomarkers of Alzheimer’s disease and neurodegeneration. Tertiary objectives are to identify factors that impact the success of the interventions, such as participation rates, engagement levels and key demographic and clinical features. Outcomes are collected at baseline and at 3 and 9 months. The primary endpoint analysis will include all randomised participants to estimate the treatment effect using intention-to-treat principles. Primary and secondary outcomes will be analysed using linear mixed models and effect size measures will be calculated.
This study will be the first robust, randomised controlled trial to assess the potential and relative value of music engagement for cognitive decline in high-risk MCI individuals, as well as broader effects on other markers of mental health, well-being and neurodegeneration. Co-designed with implementation in mind, the music interventions can potentially be delivered within memory clinic or community settings.
The Sydney University Human Research Ethics Committee (2023-026) has approved this protocol. The trial findings will be shared through conferences, publications and media.
Australian and New Zealand Clinical Trials Registry (ACTRN12623000407695), Registered 21/04/2023 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385552
2.02 29/11/2024.
To develop theories about how Nursing Associate (NA) roles are implemented and working within NHS practice: What works, for whom, in what contexts and how?
Rapid realist synthesis of: (1) empirical and grey literature; (2) realist interviews with stakeholders. Sources were analysed using a realist approach that explored the data for novel or causal insights to generate initial programme theories.
Empirical and grey sources (n = 15) and transcripts from stakeholder interviews (n = 11) were synthesised which identified three theory areas relating to NA implementation: (1) Scope of NA role: Communication and expectations; (2) Variations to the NA model of working; and (3) Career progression: Entry point, stepping stone and career in itself.
The NA holds the potential to improve nursing workforce stability by encouraging locally based, non-registered healthcare staff to transition to an NA. However, the lack of collective understanding of the NA scope of practice can cause staff friction. It is unknown whether this friction will reduce over time or if staff divisions will lead to further deterioration of the workforce.
Ongoing clear communication regarding NA scope of practice needs to be provided to aid understanding of their supplementary role and its potential contribution to nursing teams.
This work represents a first step to support both researchers and nursing workforce leaders in furthering knowledge of the impact of integrating NAs in diverse healthcare contexts and to unearth the mechanisms underpinning the success or failure of this new role.
Realist and meta-narrative evidence syntheses: Evolving standards.
Planning of the research design and interpretation of the results was completed with nurse clinicians with experience in the NA role.
Home-based physiotherapy is a current approach to manage knee osteoarthritis (OA). However, adherence to physiotherapy is poor. Non-immersive virtual reality (VR) has shown promise in improving self-efficacy and adherence in other clinical conditions. A non-immersive VR-based home physiotherapy system named Sensor-based Physiotherapy Intervention with Virtual Reality (SPIN-VR) for knee OA has been developed, integrating physiotherapy exercises into engaging games that adjust in difficulty based on real-time performance. This approach aims to enhance exercise adherence by making physiotherapy more enjoyable and personalised. To evaluate the feasibility of this intervention, a randomised controlled trial is being conducted.
This single-centre, open-label, randomised controlled feasibility trial will evaluate the SPIN-VR system over 12 weeks compared with usual care physiotherapy for knee OA. 50 participants will be randomly assigned to either the SPIN-VR or usual care group, with follow-ups at 12 and 24 weeks post randomisation. The primary outcomes will be a description of feasibility of recruitment, patient willingness to be randomised, the completeness of outcome measures and patient adherence to the intervention. Secondary outcomes include evaluations of muscle strength, endurance, aerobic capacity, exercise technique, central pain processing and self-reported pain mechanisms and moderators. Participants in the intervention arm will be interviewed after 12 weeks to capture their experience in using the VR system.
This protocol was approved by the Wales Research Ethics Committee 3. Research findings will be disseminated in open-access peer-reviewed journals, to researchers and health professionals through conference presentations, to patients and the public by organising webinars and a seminar.
Participation in physical activity (PA) is a cornerstone of the secondary prevention of stroke. Given the heterogeneous nature of stroke, PA interventions that are adaptive to individual performance capability and associated co-morbidity levels are recommended. Mobile health (mHealth) has been identified as a potential approach to supporting PA post-stroke. To this end, we used a Sequential Multiple Assignment Randomised Trial design to develop an adaptive, mHealth intervention to improve PA post-stroke – The Adaptive Physical Activity programme in Stroke (TAPAS) (Clinicaltrials.Gov NCT05606770). As the first trial in stroke recovery literature to use this design, there is an opportunity to conduct a process evaluation for this type of adaptive intervention. The aim of this process evaluation is to examine the implementation process, mechanism of change and contextual influences of TAPAS among ambulatory people with stroke in the community.
Guided by the Medical Research Council Framework for process evaluations, qualitative and quantitative methods will be used to examine the (1) implementation process and the content of TAPAS (fidelity adaptation, dose and reach); (2) mechanisms of change (participants’ response to the intervention; mediators; unexpected pathways and consequences) and (3) influence of the context of the intervention. Quantitative data will be presented descriptively, for example, adherence to exercise sessions. Qualitative data will be collected among TAPAS participants and the interventionist using semi-structured one-to-one or focus group interviews. Transcribed interviews will be analysed using reflexive thematic analysis. Key themes and sub-themes will be developed.
Ethical approval has been granted by the Health Service Executive Mid-Western Ethics Committee (REC Ref: 026/2022) (25/03/2024). The findings will be submitted for publication and presented at relevant national and international academic conferences.
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