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Creation of consensus recommendations for collaborative practice in the Malaysian psychiatric system: a modified Delphi studyThere is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. The concept of collaborative practice can include collaboration between healthcare workers of different professional backgrounds and collaboration with patients, families and communities. Most models of collaborative practice were developed in Western and high-income countries and are not easily translatable to settings which are culturally diverse and lower in resources. This project aimed to develop a set of recommendations to improve collaborative practice in Malaysia. In the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers. The Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute). This study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.
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'I felt like I was doing something wrong': A qualitative exploration of mothers' experiences of breastfeedingDespite its multiple health benefits, rates of breastfeeding to 2 years and beyond remain low in the UK. This qualitative study explored the experiences of support provided by health professionals to mothers breastfeeding beyond infancy. A key finding of the study was that health services are effective at supporting breastfeeding in the postnatal period, but that beyond the 1-year review the focus shifts to rapid weaning. A new approach to support breastfeeding continuation alongside the introduction of complementary foods is needed in line with professional guidance and recommendations. As critical reflective practitioners, health visitors are ideally placed to support and educate women about the wider social complexities of breastfeeding. However, health service commissioners need to recognise the importance of investment in the profession to enable health visitors to use their skills fully.
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Digital-based self-management interventions for people with osteoarthritis: Systematic review with meta-analysisOsteoarthritis (OA) is not curable but the symptoms can be managed through Self-management programmes. Due to the growing burden of arthritis to the health system, and the need to ensure high quality integrated services, delivering Self-management programmes through digital technologies could be an economic and effective community-based model of care. To analyze the effectiveness of digital-based self-management programs on patient outcomes in people with OA. Seven online databases and three grey literature databases were searched for randomized controlled trials (RCT) assessing digital-based structured self-management programs (D-SMP) on self-reported outcomes including pain, function, disability, and health-related quality of life in people with OA. Two reviewers independently screened the search results and reference list of identified papers and related reviews. Data about the intervention components and delivery, and behavioral change techniques were extracted. Meta-analysis, risk of bias sensitivity analysis and subgroup analysis were performed where appropriate. The GRADE approach was used to assess the quality of evidence. Eight studies were eligible including 2687 people with OA. Self-management programs were delivered via telephone plus audio/video, internet or mobile app. D-SMP compared to Treatment As Usual control group resulted in a significant, homogeneous, moderate reduction in pain (SMD -0.28, 95% CI -0.38 to -0.18) and improvement in physical function (-0.26 95% CI -0.35 to -0.16) at post-treatment. The D-SMP effect reduced slightly at 12 months follow-up but remained significant and moderate. Using the GRADE approach, the quality of evidence was rated as ‘moderate’. D-SMPs may result in a moderate improvement in pain symptoms and function in people with OA delivered. Further research is required to confirm the findings of the review and assess the effects of D-SMPs on other health-related outcomes. Clinical Trial: PROSPERO: CRD42018089322
