ObjectiveTo update a rapid review published in 2017, which evaluated the NHS Health Check programme.MethodsAn enlarged body of evidence was used to readdress six research objectives from a rapid review published in 2017, relating to the uptake, patient experiences and effectiveness of the NHS Health Check programme. Data sources included MEDLINE, PubMed, Embase, Health Management Information Consortium (HMIC), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Global Health, PsycINFO, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov and the ISRCTN registry, Web of Science, Science Citation Index, The Cochrane Library, NHS Evidence, OpenGrey and hand searching article reference lists. These searches identified records from between January 1996 and December 2019. Screening, data extraction and quality appraisal using the Critical Appraisals Skills Programme checklists were performed in duplicate. Grading of Recommendations Assessment, Development and Evaluations was implemented. Data were synthesised narratively.Results697 studies were identified, and 29 new studies included in the review update. The number of published studies on the uptake, patient experiences and effectiveness of the NHS Health Check programme has increased by 43% since the rapid review published in 2017. However, findings from the original review remain largely unchanged. NHS Health Checks led to an overall increase in the detection of raised risk factors and morbidities including diabetes mellitus, hypertension, raised blood pressure, cholesterol and chronic kidney disease. Individuals most likely to attend the NHS Health Check programme included women, persons aged ≥60 years and those from more socioeconomically advantaged backgrounds. Opportunistic invitations increased uptake among men, younger persons and those with a higher deprivation level.ConclusionsAlthough results are inconsistent between studies, the NHS Health Check programme is associated with increased detection of heightened cardiovascular disease risk factors and diagnoses. Uptake varied between population subgroups. Opportunistic invitations may increase uptake.
Library anxiety is a concept which has been recognised in academic library circles since the early 1990s. It can result in students actively avoiding the library for the duration of their studies. Madeleine Still is Trust Librarian at North Tees & Hartlepool NHS Foundation Trust and while studying for an MSc, recognised that some student nurses were exhibiting signs of library anxiety. She decided to make it the focus of her MSc dissertation, and this article discusses her research project as well as highlighting the measures she has taken to address the issues she uncovered. Madeleine graduated in July 2013 with an MSc in Information & Library Studies from Robert Gordon University.
Common mental health disorders (CMDs) represent a major public health concern and are particularly prevalent in people experiencing disadvantage or marginalisation. Primary care is the first point of contact for people with CMDs. Pharmaceutical interventions, such as antidepressants, are commonly used in the treatment of CMDs; however, there is concern that these treatments are over-prescribed and ineffective for treating mental distress related to social conditions. Non-pharmaceutical primary care interventions, such as psychological therapies and “social prescribing”, provide alternatives for CMDs. Little is known, however, about which such interventions reduce social inequalities in CMD-related outcomes, and which may, unintentionally, increase them. The aim of this protocol (PROSPERO registration number CRD42021281166) is to describe how we will undertake a systematic review to assess the effects of non-pharmaceutical primary care interventions on CMD-related outcomes and social inequalities. A systematic review of quantitative, qualitative and mixed-methods primary studies will be undertaken and reported according to the PRISMA-Equity guidance. The following databases will be searched: Assia, CINAHL, Embase, Medline, PsycInfo and Scopus. Retrieved records will be screened according to pre-defined eligibility criteria and synthesised using a narrative approach, with meta-analysis if feasible. The findings of this review will guide efforts to commission more equitable mental health services.
Background: Common mental health disorders (CMDs) are especially prevalent amongst people from socioeconomically disadvantaged backgrounds. Non-pharmaceutical primary care interventions, such as social prescribing and collaborative care, provide alternatives to pharmaceutical treatments for CMDs. Little is known about the impact of these interventions for socioeconomically disadvantaged patients. Aim: To synthesise evidence for the effects of non-pharmaceutical primary care interventions on CMDs and associated socioeconomic inequalities. Design and setting: Systematic review of quantitative primary studies published in English and undertaken in high-income countries. Method: Six bibliographic databases were searched (Medline, ASSIA, CINAHL, Embase, PsycInfo and Scopus) and additional grey literature sources screened. Data were extracted onto a standardised proforma and quality assessed using the Effective Public Healthcare Panacea Project (EPHPP) tool. Data were synthesised narratively and effect direction plots produced for each outcome. Results: Thirteen studies were included. Social prescribing interventions were evaluated in ten studies, collaborative care in two studies and a new model of care in one study. Positive results (based on effect direction) were reported for the impact of the interventions on wellbeing in socioeconomically deprived groups. Inconsistent (mainly positive) results were reported for anxiety and depression. One study reported that people from the least compared to the most deprived group benefitted most from these interventions. Overall, study quality was weak. Conclusion: Targeting non-pharmaceutical primary care interventions at socioeconomically deprived areas may help to reduce inequalities in mental health outcomes. However, only tentative conclusions can be drawn from the evidence in this review and more robust research is required.
Background Early evidence suggests that using radiofrequency ablation as an adjunct to standard care (i.e. endoscopic retrograde cholangiopancreatography with stenting) may improve outcomes in patients with malignant biliary obstruction. Objectives To assess the clinical effectiveness, cost-effectiveness and potential risks of endoscopic bipolar radiofrequency ablation for malignant biliary obstruction, and the value of future research. Data sources Seven bibliographic databases, three websites and seven trials registers were searched from 2008 until 21 January 2021. Review methods The study inclusion criteria were as follows: patients with biliary obstruction caused by any form of unresectable malignancy; the intervention was reported as an endoscopic biliary radiofrequency ablation to ablate malignant tissue that obstructs the bile or pancreatic ducts, either to fit a stent (primary radiofrequency ablation) or to clear an obstructed stent (secondary radiofrequency ablation); the primary outcomes were survival, quality of life or procedure-related adverse events; and the study design was a controlled study, an observational study or a case report. Risk of bias was assessed using Cochrane tools. The primary analysis was meta-analysis of the hazard ratio of mortality. Subgroup analyses were planned according to the type of probe, the type of stent (i.e. metal or plastic) and cancer type. A de novo Markov model was developed to model cost and quality-of-life outcomes associated with radiofrequency ablation in patients with primary advanced bile duct cancer. Insufficient data were available for pancreatic cancer and secondary bile duct cancer. An NHS and Personal Social Services perspective was adopted for the analysis. A probabilistic analysis was conducted to estimate the incremental cost-effectiveness ratio for radiofrequency ablation and the probability that radiofrequency ablation was cost-effective at different thresholds. The population expected value of perfect information was estimated in total and for the effectiveness parameters. Results Sixty-eight studies (1742 patients) were included in the systematic review. Four studies (336 participants) were combined in a meta-analysis, which showed that the pooled hazard ratio for mortality following primary radiofrequency ablation compared with a stent-only control was 0.34 (95% confidence interval 0.21 to 0.55). Little evidence relating to the impact on quality of life was found. There was no evidence to suggest an increased risk of cholangitis or pancreatitis, but radiofrequency ablation may be associated with an increase in cholecystitis. The results of the cost-effectiveness analysis were that the costs of radiofrequency ablation was £2659 and radiofrequency ablation produced 0.18 quality-adjusted life-years, which was more than no radiofrequency ablation on average. With an incremental cost-effectiveness ratio of £14,392 per quality-adjusted life-year, radiofrequency ablation was likely to be cost-effective at a threshold of £20,000 per quality-adjusted life-year across most scenario analyses, with moderate uncertainty. The source of the vast majority of decision uncertainty lay in the effect of radiofrequency ablation on stent patency. Limitations Only 6 of 18 comparative studies contributed to the survival meta-analysis, and few data were found concerning secondary radiofrequency ablation. The economic model and cost-effectiveness meta-analysis required simplification because of data limitations. Inconsistencies in standard reporting and study design were noted. Conclusions Primary radiofrequency ablation increases survival and is likely to be cost-effective. The evidence for the impact of secondary radiofrequency ablation on survival and of quality of life is limited. There was a lack of robust clinical effectiveness data and, therefore, more information is needed for this indication. Future work Future work investigating radiofrequency ablation must collect quality-of-life data. High-quality randomised controlled trials in secondary radiofrequency ablation are needed, with appropriate outcomes recorded. Study registration This study is registered as PROSPERO CRD42020170233. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 7. See the NIHR Journals Library website for further project information.
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