Vivien Coates

Aims: To identify, appraise and synthesise the current evidence relating to symptoms, experiences, management and impact of menopause on QoL among women with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) and to identify evidence gaps. Methods: We conducted a scoping review guided by Arksey and O'Mally's framework by searching CINAHL, MEDLINE, EMBASE, PsychINFO and PubMed using an iterative approach to pre‐specified eligibility criteria which were reviewed with increasing familiarity with the literature. Studies focusing on peri‐menopausal and menopausal people assigned female at birth with a diagnosis of T1DM or T2DM were included. Results: In total, 16,681 records were identified from which 77 papers were subjected to full review, with 22 eligible. Research focus and methodology varied: 16 observational studies, 2 expert consensus reviews, 2 interventional studies, 1 patient and public involvement paper and 1 qualitative grounded theory paper. PRISMA‐ScR guidelines were followed for transparency of reporting. Findings indicate women with diabetes experience menopausal symptoms similar to those of women without diabetes; however, they may be at risk of increased severity of symptoms, HRT use was linked to lower HbA1c levels but is largely overlooked, limited research has been undertaken exploring women's experiences and awareness of support during the menopause; existing research evidence suggests they are ill‐informed and lacking effective evidence based support. There is a particular dearth of evidence relating to women with T1DM. Conclusions: This review provides evidence that menopause has a negative influence upon quality of life for many women with diabetes. The impacts span managing diabetes and menopausal symptoms and seeking and receiving support. A hypothesised bidirectional relationship between diabetes and menopause may exist: whereby progression of one may be influenced by the other also resulting in a lower quality of life. While high‐level evidence on this complex inter‐relationship remains limited, particularly in T1DM populations, it suggests significant unmet need for those experiencing diabetes and menopause together.

Aim: To establish a comprehensive pre‐implementation baseline of pain management for people living with dementia (PLWD) in acute hospitals by exploring behavioural, contextual, organisational and clinical practice factors to inform the implementation of the DOTS approach. Background: Pain is common yet frequently under‐recognised and inconsistently managed in PLWD in acute care. Behaviour change frameworks, such as COM‐B, may help identify determinants of practice and inform implementation strategies. Design: Multiple‐methods study, underpinned by the COM‐B framework and guided by the Medical Research Council framework for developing and evaluating complex interventions. Methods: The study was conducted across five wards in two acute hospitals in the United Kingdom. Healthcare staff ( n = 148) completed an adapted 6‐item COM‐B self‐evaluation scale (0–10). Semi‐structured interviews with ward managers and a pain management specialist nurse ( n = 6) were analysed using deductive thematic analysis. A retrospective review of patient documentation ( n = 50) assessed compliance with the National Institute for Health and Care Excellence dementia guidelines. Results: Staff reported high perceived capability, opportunity and motivation, suggesting strong self‐reported readiness to deliver effective pain management. However, qualitative findings highlighted barriers across the COM‐B domains, including knowledge gaps and inconsistent use of pain assessment tools. Documentation review highlighted deficits in recording acute pain, chronic pain history and usual pain management strategies. Only five patients received analgesia within 60 min of admission, despite many presenting with fractures or serious infections. Conclusion: A discrepancy exists between self‐reported behavioural determinants and documented clinical practice, indicating inconsistent pain management for PLWD in acute care. Implications for Clinical Practice: Interventions should prioritise strengthening healthcare staff's capability and embedding structured, system‐level processes to support timely person‐centred pain management. Reporting Methods: STROBE guidelines were followed. Patient or Public Contribution: A multidisciplinary steering group, including clinical leaders and dementia representatives, contributed to the study.

Aim: To determine which pain management approaches have been implemented in an acute hospital setting and gauge the extent to which they effectively assess and manage pain among patients with dementia. Design: The review followed the Joanna Briggs Institute framework, guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis extension for scoping reviews (PRISMA‐ScR). Method: The search strategy was designed to locate published and unpublished studies through online databases such as MEDLINE (Ovid) and CINAHL, as well as relevant grey literature sources, such as the WHO database. The review included primary and secondary research publications from 2005 to 2023 relating to patients with dementia in an acute hospital setting. The study focused on overall pain management approaches, including pain assessment, processes, and interventions to manage pain. Tables were used to extract and synthesise results using descriptive statistics. Results: Fourteen studies met the inclusion criteria. They included a range of designs: five cross‐sectional and two cohort studies; five interventional studies; one action research project; and one quality improvement programme. The interventions identified in the review mainly involved validating pre‐existing pain assessment tools, such as the Pain Assessment in Advanced Dementia Scale (PAINAD). Overall, the authors' primary strategy for implementing their respective interventions was organising participant awareness‐raising and training sessions. Conclusions: There is a lack of standardised, person‐centred protocols for managing pain in patients with dementia and a dearth of evidence relating to pain reduction among this client group. While valid pain assessment tools exist, their use alone does not guarantee timely or effective pain relief. Although studies reported the development of interventions to promote effective pain management, they did not consistently demonstrate a systematic reduction in pain among the patient groups. Whilst education on pain management is vital, it has been shown that education alone is insufficient to improve care. Implications for Practice: The review identified several validated instruments for assessing pain in people living with dementia; however, the availability of tools alone is not enough to change practice. A broader shift in pain management is required. Nurses need organisational support not only to incorporate observational pain assessment tools into routine workflows but also to connect assessments to clear clinical actions and adopt a proactive, holistic approach. This includes preventing diagnostic overshadowing by recognising pain as a potential cause of behavioural change and ensuring that pain management strategies go beyond assessment to deliver timely, person‐centred interventions. Health care providers need to support nursing staff beyond providing training and updates to encourage evidence‐based practice and to engender a culture in which pain management is a priority. Patient or Public Contribution: No patient or public contribution was made towards this review.

Objectives: Understanding the factors that influence avoidable and unavoidable hospital conveyance, including rurality and distance from hospital for diabetes-related metabolic problems is important and will help to inform guidelines and develop policy for emergency services including paramedic and ambulance staff. This study compared the impact of degree of rurality, and other factors on conveyance rates across rural and urban areas in Scotland. Methods: Using a national retrospective five-year dataset from the Scottish Ambulance Service we conducted a univariate, bivariate and multivariable analysis of factors influencing conveyance to hospital for people with diabetes-related metabolic complications. The analysis focused on rurality using a national standardised classification, initial blood glucose level, type and complexity of treatment at the scene, day of the week or time of day, paramedic attendance, time spent at the scene and the distance to the nearest hospital as potentially significant factors. Results: Conveyance rates were highest for those experiencing hyperglycaemia (82%), for those under 20yr (69%) or over 80yr (64%), and for females (58%). Rates were lower for longer time spent at the scene and the longer the distance to hospital from the scene. Probability of conveyance was more likely with increasing age, with glucose levels in the normal or higher range and less likely for males, and if there was a paramedic in attendance. There was no association of degree of rurality with probability of conveyance. Conclusions: Conveyance to hospital following ambulance callouts for diabetes metabolic complications is related to predictable factors. The presence of a paramedic is associated with lower probability of conveyance. Rurality does not appear to be associated with increased probability of higher conveyance rates.

Background International guidelines recommend structured diabetes education to empower individuals with type 2 diabetes (T2D). While DESMOND is an effective programme for T2D management, it is often inaccessible to people with intellectual disabilities (ID) due to their unique needs. There is limited evidence on the effectiveness of adapted T2D education for this group, despite the importance of tailored support in preventing complications and early mortality. We previously adapted the DESMOND programme for adults with ID, creating DESMOND-ID. A feasibility study showed it is possible to recruit and deliver the programme to adults with ID and their carers, who found it valuable. Initial findings suggest DESMOND-ID may improve blood glucose control, warranting further investigation through a large-scale randomised controlled trial (RCT). Methods The "My Diabetes & Me" study will be conducted in two stages: an internal pilot and a main RCT. The pilot will recruit 108 participants over 10 months to assess recruitment and retention, using glycated haemoglobin (HbA1c, mmol/mol) at six months as the primary outcome. This will inform the design of the main study. Across both stages, 450 participants will be randomly assigned to receive either the DESMOND-ID intervention or treatment as usual (TAU). The intervention group, with their carers, will attend weekly sessions for seven weeks, plus two booster sessions at one and three months post-programme. Primary outcome is HbA1c at six months. Secondary outcomes include HbA1c at 12 and 18 months (pilot only), anthropometric data, self-reported outcomes, and other risk factors. A process evaluation will explore barriers and facilitators to implementation using qualitative and quantitative methods. Conclusion DESMOND-ID is the first structured T2D education programme tailored for adults with ID, and this RCT is the first to evaluate its clinical and cost-effectiveness. Trial Registration 09/11/2022 ISRCTN83150600 ( https://doi.org/10.1186/ISRCTN83150600 )

Care in the Community policies has led to people with mental illness receiving treatment and care at home; however, few studies have examined the impact on carers of providing care to a person with mental illness. This was a qualitative study of the experiences of 11 women who are informal carers of people with a long-term mental illness. The study aimed to gain an understanding of the characteristics of this particular caregiving context that contributes to the stress of the role, and to identify the ways in which services could support women in these roles to promote their wellbeing and support the recovery of those they care for. Two groups of themes emerged: the first was the sources of stress, which included how they became a carer, family obligations and relationships and engaging with services. The second was the impact on health and wellbeing, including emotional and mental health, the need for, and absence of support, and coping with stress. The study highlighted a number of unique features of mental illness that lead to additional stress for the carer and render the usual support structures and delivery mechanisms inappropriate. The results pose challenges for those tasked with supporting carers in this context and developing interventions to promote recovery in the community.

The COVID-19 pandemic has led to the closure or reduction in support services for family carers, resulting in increased social isolation and stress for this population. The current scoping review aimed to identify the impact of COVID-19 upon carers and support provided for them during the pandemic. Four online databases (CINAHL, Medline, PsycINFO and PubMed) were systematically searched on 16th December 2020 and updated on 16th July 2021 for articles written in English and published after January 2020, focused on the carer and the impact of COVID-19. Google scholar and reference lists of relevant papers were checked, and key authors were contacted for further relevant information. The database searches identified 976 citations, which resulted in 670 unique articles following the removal of duplicates. Title and abstract screening identified 63 articles for full-text review, 11 of which were subsequently excluded, leaving 52 articles which were subject to inductive thematic analysis. Four key themes were identified. Whilst a number of issues were identified that were exacerbated by the pandemic, others directly resulting from it were revealed. Few studies discussed support measures for carers and only one trial evaluated an intervention. This review identifies the impact of COVID-19 on carers, but there is a dearth of evidence to inform appropriate tailored support. Governments need to identify carers as a priority group in social care reform and commission co-produced, evidence and experience informed pathways to reinstate support services, potentially modelled on pandemic plans following the example currently being considered for the paid healthcare workforce.

Background: Clinical academic nursing roles are rare, and clinical academic leadership positions even more scarce. Amongst the United Kingdom (UK) academia, only 3% of nurses who are employed within universities are clinically active. Furthermore, access to research fellowships and research grant funding for nurses in clinical or academic practice is also limited. The work of Florence Nightingale, the original role model for clinical academic nursing, is discussed in terms of how this has shaped and influenced that of clinical academic nurse leaders in modern UK healthcare settings. We analysed case studies with a view to providing exemplars and informing a new model by which to visualise a trajectory of clinical academic careers.Methods: A Framework analysis of seven exemplar cases was conducted for a network of Clinical Academic Nursing Professors (n = 7), using a structured template. Independent analysis highlighted shared features of the roles: (a) model of clinical academic practice, (b) infrastructure for the post, (c) capacity‐building initiatives, (d) strategic influence, (e) wider influence, (f) local and national implementation initiatives, (g) research area and focus and (h) impact and contribution.Findings: All seven of the professors of nursing involved in this discourse were based in both universities and healthcare organisations in an equal split. All had national and international profiles in their specialist clinical areas and were implementing innovation in their clinical and teaching settings through boundary spanning. We outline a model for career trajectories in clinical academia, and how leadership is crucial.Conclusion: The model outlined emphasises the different stages of clinical academic roles in nursing. Nursing as a discipline needs to embrace the value of these roles, which have great potential to raise the standards of healthcare and the status of the profession.