Amanda Cummings

The psychological impact of food allergy and food hypersensitivity in children, adolescents and their families

To cite this article: Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy 2010; 65: 933–945.

Management of nut allergy influences quality of life and anxiety in children and their mothers

Cummings AJ, Knibb RC, Erlewyn‐Lajeunesse M, King RM, Roberts G, Lucas JSA. Management of nut allergy influences quality of life and anxiety in children and their mothers.
Pediatr Allergy Immunol 2010: 21: 586–594.
© 2010 John Wiley & Sons A/S

The psychological impact of diagnostic food challenges to confirm the resolution of peanut or tree nut allergy

Twenty percent of children outgrow peanut allergy and 10% outgrow tree nut allergy. Resolution can be confirmed by a food challenge. Little is known about the psychosocial impact of the challenge. We aimed to investigate effects of a food challenge on anxiety, stress and quality of life (QoL) in children and their mothers on the day of a food challenge to peanuts or nuts, and in the months following the challenge.

Validation of the Paediatric Food Allergy Quality of Life Questionnaire (PFA‐QL)

The Paediatric Food Allergy Quality of Life Questionnaire (PFA‐QL) was the first tool to be developed for assessing health‐related quality of life (QoL) in children with food allergy. It has been used in a number of published studies, but has not been validated.

Implementing communication and decision-making interventions directed at goals of care: a theory-led scoping review

Objectives To identify the factors that promote and inhibit the implementation of interventions that improve communication and decision-making directed at goals of care in the event of acute clinical deterioration. Design and methods A scoping review was undertaken based on the methodological framework of Arksey and O’Malley for conducting this type of review. Searches were carried out in Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to identify peer-reviewed papers and in Google to identify grey literature. Searches were limited to those published in the English language from 2000 onwards. Inclusion and exclusion criteria were applied, and only papers that had a specific focus on implementation in practice were selected. Data extracted were treated as qualitative and subjected to directed content analysis. A theory-informed coding framework using Normalisation Process Theory (NPT) was applied to characterise and explain implementation processes. Results Searches identified 2619 citations, 43 of which met the inclusion criteria. Analysis generated six themes fundamental to successful implementation of goals of care interventions: (1) input into development; (2) key clinical proponents; (3) training and education; (4) intervention workability and functionality; (5) setting and context; and (6) perceived value and appraisal. Conclusions A broad and diverse literature focusing on implementation of goals of care interventions was identified. Our review recognised these interventions as both complex and contentious in nature, making their incorporation into routine clinical practice dependent on a number of factors. Implementing such interventions presents challenges at individual, organisational and systems levels, which make them difficult to introduce and embed. We have identified a series of factors that influence successful implementation and our analysis has distilled key learning points, conceptualised as a set of propositions, we consider relevant to implementing other complex and contentious interventions.

Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review

BackgroundNormalization Process Theory (NPT) identifies, characterises and explains key mechanisms that promote and inhibit the implementation, embedding and integration of new health techniques, technologies and other complex interventions. A large body of literature that employs NPT to inform feasibility studies and process evaluations of complex healthcare interventions has now emerged. The aims of this review were to review this literature; to identify and characterise the uses and limits of NPT in research on the implementation and integration of healthcare interventions; and to explore NPT’s contribution to understanding the dynamics of these processes.MethodsA qualitative systematic review was conducted. We searched Web of Science, Scopus and Google Scholar for articles with empirical data in peer-reviewed journals that cited either key papers presenting and developing NPT, or the NPT Online Toolkit (www.normalizationprocess.org). We included in the review only articles that used NPT as the primary approach to collection, analysis or reporting of data in studies of the implementation of healthcare techniques, technologies or other interventions. A structured data extraction instrument was used, and data were analysed qualitatively.ResultsSearches revealed 3322 citations. We show that after eliminating 2337 duplicates and broken or junk URLs, 985 were screened as titles and abstracts. Of these, 101 were excluded because they did not fit the inclusion criteria for the review. This left 884 articles for full-text screening. Of these, 754 did not fit the inclusion criteria for the review. This left 130 papers presenting results from 108 identifiable studies to be included in the review. NPT appears to provide researchers and practitioners with a conceptual vocabulary for rigorous studies of implementation processes. It identifies, characterises and explains empirically identifiable mechanisms that motivate and shape implementation processes. Taken together, these mean that analyses using NPT can effectively assist in the explanation of the success or failure of specific implementation projects. Ten percent of papers included critiques of some aspect of NPT, with those that did mainly focusing on its terminology. However, two studies critiqued NPT emphasis on agency, and one study critiqued NPT for its normative focus.ConclusionsThis review demonstrates that researchers found NPT useful and applied it across a wide range of interventions. It has been effectively used to aid intervention development and implementation planning as well as evaluating and understanding implementation processes themselves. In particular, NPT appears to have offered a valuable set of conceptual tools to aid understanding of implementation as a dynamic process.

Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: Results from the ColoREctal Well-being (CREW) cohort study

More people are living with the consequences of cancer and comorbidity. We describe frequencies of comorbidities in a colorectal cancer cohort and associations with health and well‐being outcomes up to 5 years following surgery.

Escalation-related decision making in acute deterioration: a retrospective case note review

Aim To describe how decision making inter-relates with the sequence of events in individuals who die during admission and identify situations where formal treatment escalation plans (TEPs) may have utility. Design and methods A retrospective case note review using stratified sampling. Two data analysis methods were applied concurrently: directed content analysis and care management process mapping via annotated timelines for each case. Analysis was followed by expert clinician review (n=7), contributing to data interpretation. Sample 45 cases, age range 38–96 years, 23 females and 22 males. Length of admission ranged from <24 hours to 97 days. Results Process mapping led to a typology of care management, encompassing four trajectories: early de-escalation due to catastrophic event; treatment with curative intent throughout; treatment with curative intent until significant point; and early treatment limits set. Directed content analysis revealed a number of contextual issues influencing decision making. Three categories were identified: multiple clinician involvement, family involvement and lack of planning clarity; all framed by clinical complexity and uncertainty. Conclusions The review highlighted the complex care management and related decision-making processes for individuals who face acute deterioration. These processes involved multiple clinicians, from numerous specialities, often within hierarchical teams. The review identified the need for visible and clear management plans, in spite of the frame of clinical uncertainty. Formal TEPs can be used to convey such a set of plans. Opportunities need to be created for patients and their families to request TEPs, in consultation with the clinicians who know them best, outside of the traumatic circumstances of acute deterioration.

48 Findings from a scoping exercise of adult acute hospital trusts in england recording decisions about treatment escalation for those at risk of deterioration at the end of life

Introduction Planning and communicating treatment decisions in a context of clinical uncertainty presents a key challenge. Increasing evidence supports the desirability of documenting a care-plan that addresses options about treatment escalation (Treatment Escalation Plan (TEP)) ensuring quality of healthcare for patients, in line with their wishes, prevention from distressing treatments and unnecessary harm as end of life approaches (Dalgaard et al., 2010, Carey et al., 2015, Obolensky et al., 2010, Gott et al., 2011, National Confidential Enquiry into Patient Outcome and Death, 2012, Fritz et al., 2013). Aims To ascertain current procedures for recording treatment decisions in situations of clinical uncertainty. To identify and characterise key components of TEPs and understand the implications of these when incorporated into clinical practice. Method A scoping exercise of all UK NHS adult acute Trusts. Telephone interviews were conducted to gain more indepth knowledge of processes and analysed using directed content analysis. Where a TEP was in use, content analysis was conducted to understand the structure and information required to complete them. Results 55/150 Trusts provided details of systems used. Of these 43 had experience of using a TEP, 29 of which had been formally evaluated. A further 6 were sourced through online searches. There was wide variation in the processes used. Forms consistently attended to seven key components: Resuscitation; Communication; ceilings of care; supportive care; capacity; transferability; colour/format. Conclusion TEPs are valuable in ensuring patients’ dignity and comfort when faced with acute pathophysiological deterioration at end of life and have potential to minimise harm from unnecessary and/or unwanted investigations and treatment. However, inconsistency in availability and incorporation into practice has implications for quality and consistency of patient care. References . CAREY, I., SHOULS, S., BRISTOWE, K., MORRIS, M., BRIANT, L., ROBINSON, C., CAULKIN, R., GRIFFITHS, M., CLARK, K., KOFFMAN, J. & HOPPER, A. 2015. Improving care for patients whose recovery is uncertain. The AMBER care bundle: design and implementation. BMJ Supportive & Palliative Care, 5, 405–411. . DALGAARD, K. M., THORSELL, G. & DELMAR, C. 2010. Identifying transitions in terminal illness trajectories: a critical factor in hospital-based palliative care. International Journal Of Palliative Nursing, 16, 87–92. . FRITZ, Z., MALYON, A., FRANKAU, J. M., PARKER, R. A., COHN, S., LAROCHE, C. M., PALMER, C. R. & FULD, J. P. 2013. The Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: a mixed methods evaluation of the effects on clinical practice and patient care. Plos One, 8, e70977–e70977. . GOTT, M., INGLETON, C., BENNETT, M. I. & GARDINER, C. 2011. Transitions to palliative care in acute hospitals in England: qualitative study. BMJ Supportive & Palliative Care, 1, 42–48. . NATIONAL CONFIDENTIAL ENQUIRY INTO PATIENT OUTCOME AND DEATH2012. Time to interevene? : NCEPOD. . OBOLENSKY, L., CLARK, T., MATTHEW, G. & MERCER, M. 2010. A patient and relative centred evaluation of treatment escalation plans: a replacement for the do-not-resuscitate process. J Med Ethics, 36, 518–20.