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10.00 am, 11 November

Facilitator: Mark Lown

Kym Snell

Developing a new reporting guideline for systematic reviews and meta-analyses of prediction model studies (TRIPOD-SR)

Introduction: Systematic reviews are essential for identifying, appraising and synthesising evidence for a particular research question and guiding future research in that field. They are also becoming increasingly necessary in prediction model research, however no specific guidance exists for reporting systematic reviews of prediction models. Therefore, existing reporting guidelines require modification to be more suitable for systematic reviews of prediction model studies. Our aim is therefore to develop a new extension to TRIPOD, specific to systematic reviews of prediction model studies.

Methods: Existing reporting guidelines were reviewed. Relevant guideline items were combined and assessed for suitability by two researchers. Item suitability and wording were discussed within the working group and a draft reporting guideline was produced. An online Delphi survey is currently being conducted involving researchers with experience in systematic review and prediction modelling to provide feedback on the proposed items.

Results: PRISMA and TRIPOD-Cluster (submitted) were identified as the most relevant reporting guidelines. They contained many overlapping items; while PRISMA contained some items specific to systematic reviews, TRIPOD-Cluster contained some items specific to prediction models. Items from both guidelines were combined and modified, and new items were added. Feedback from the Delphi survey will help to refine the reporting guideline further.

Conclusions: TRIPOD-SR is a new reporting guideline that is being developed to provide more tailored guidance for reporting systematic reviews and meta-analyses of prediction model studies.

Keywords: prediction models, systematic reviews, reporting guidelines, meta-analysis

Kiyara Fernando

Shared decision making is a national NHS priority, and has been described as an ethical imperative, yet research suggests that it is proving difficult to integrate shared decision making into routine care. The aim of this project was to understand how patients with one of two common healthcare conditions (hypertension or chronic heart failure) contribute to the consideration of healthcare choices and decision making in healthcare consultations. The research project is a systematic qualitative evidence review and synthesis describing how patients contribute to their healthcare consultations for heart failure and hypertension, with the results that could potentially influence how shared decision making in primary care is supported.

Keywords: Heart failure, Hypertension, Share Decision making

Charlotte Ford

Background: This study sought to gain an up-to-date qualitative understanding of the types of challenging experiences medical students are encountering whilst on clinical placement, the perceived impact of these experiences and the kinds of support and education that would allow them to cope more effectively with such experiences.

Methods: This study used a qualitative approach in keeping with the interpretivist research paradigm. 3rd and 4th year medical students from Newcastle University were invited by e-mail to participate in the study. Nine individual interviews were conducted using a semi-structured guide. Data were thematically analysed using the Braun and Clarke model.

Results: Students reported challenging experiences, centred around three themes: hierarchy, challenging patient situations and not feeling part of a team. Being reprimanded and humiliated were felt to reflect an ongoing underlying hierarchical structure in clinical environments. These experiences impacted on student learning, career intentions and confidence. Students made numerous suggestions for support and education, including provision of specialised student support services, better teaching organisation and improved preparation for clinical learning.

Conclusions: This study has highlighted the nature of challenging experiences that are being experienced by medical students in a modern UK medical school. Our results suggest that hierarchical structures within healthcare settings, alongside students not feeling part of the clinical team, may be having a significant impact on students. We recommend promoting active involvement of medical students in clinical settings, a zero-tolerance approach to bullying and mistreatment of medical students, and the provision of more specialised student support services.

Rebecca Dennison

Introduction: Screening to monitor glucose levels and identify those who have developed type 2 diabetes (T2D) is recommended in the postpartum period following a pregnancy affected by gestational diabetes mellitus (GDM) and at subsequent regular intervals. However, uptake of screening is historically poor. We sought to explore and develop practical approaches to support screening after GDM.

Research design and methods: We conducted semi-structured interviews, which covered whether participants had been screened and why, plans for future screening, and their views on potential interventions to facilitate attendance. Framework analysis was used to analyse the transcripts. The interview schedule, suggested interventions and thematic framework were based on a recent systematic review.

Results: Sixteen participants had undergone screening since pregnancy because the appointment had been arranged and they wanted reassurance that they did not have T2D, although only 13 planned to attend subsequent tests. The participants who had not been tested were not aware that it was recommended. The majority of the participants agreed that changes to booking tests, test location and combining appointments would facilitate attendance. Child-friendly clinics, improved understanding of GDM and postpartum testing, stopping self-testing, and GP awareness of pregnancy received a mixed response. The nature of the test used did not appear to influence attendance.

Conclusions: This population was eager for T2D screening after GDM. We have identified interventions that could be relatively easily incorporated into routine practice to make it easier to attend screening, such as flexibility in the appointment location or time and sending invitations for tests.

Keywords: Gestational diabetes, screening, qualitative

Ashley Hammond

Introduction: Respiratory tract infections (RTIs) are the most common infection in primary care. Despite this, little is known about potentially modifiable factors which could reduce our risk of RTI acquisition. Resident microbiota in the gut and respiratory tract have been shown to act as a major influencer on acquisition of hospital-acquired infections, but this has not been investigated in the community. This prospective cohort feasibility study investigated the demographic, social, behavioural and microbiota-related factors which may be associated with acquisition of acute RTIs. 

Methods: We recruited participants from two primary care practices in Bristol, aged 18-70 years old with no known condition affecting their immune system. Baseline stool and saliva samples were collected, then repeated if the participant developed respiratory symptoms (runny nose, cough, sore throat, chesty symptoms) during the six-month study period, and again at the end of the study. Risk factor questionnaires were completed by all participants. All samples were subject to 16S rRNA microbiome analysis to explore the role of the human microbiota in RTI acquisition. 

Results: Our analysis is ongoing. Preliminary data to be presented if available.  

Interpretation: Both clinicians and patients would benefit from knowing which factors increase or decrease the risk of acquiring acute respiratory infections, as this could modify behaviour. Knowledge on the influence of the human microbiota on infection acquisition could help determine whether the microbial gut community can be re-engineered in ‘at risk’ individuals to prevent the development of infection, which may involve the implementation of simple diet and lifestyle changes.