A Meta-Ethnographic Review of Factors Relating to Vaccine Hesitancy in the European Parental Population
Lidia Cilcic | University of Warwick
One in ten European children are at risk of contracting a vaccine-preventable disease due to low immunisation coverage. As parents play an important role in the vaccination decision, understanding their perception about inoculations is essential to address the low uptake. The aim of this study was to gain better insight into the factors that influence parental vaccine hesitancy in Europe and to produce a better framework to explain this phenomenon.
This meta-ethnographical review was carried out in April-May 2020 by following Noblit and Hare’s approach. The articles retrieved from relevant medical databases were primary papers written in English, published after 2000 and presenting qualitative data. The appraisal process involved the use of CASP qualitative checklist. ‘Line of argument’ synthesis was used to develop a higher order interpretation.
Thirteen studies were included in the analysis from which five themes were identified: 1) Trust in professionals, institutions, and government, 2) Relationship and communication with healthcare professionals, 3) Perceived minimal threat of the disease, 4) Personal experience, 5) Too young to vaccinate. The meta-ethnographic synthesis revealed how the different themes interact with one another to influence parental choice. Moreover, the duty to protect was showed to play an important role in how these factors are perceived by parents.
This review presents an updated framework explaining vaccine hesitancy in the European parental population. Uptake of childhood immunisations could be encouraged by fostering trustworthy relationships between parents and medical professionals and through clearer messages on the risks of vaccine-preventable diseases.
Identification of GP Referral Patterns in which Malignant Melanomas were Referred as Non-Urgent
Yasmeen Hassan Al Sadek | Cardiff University
Cutaneous malignant melanoma is the deadliest form of skin cancer, thus early detection and prompt referral is pivotal to improve prognosis. A recent audit has revealed that ~50% of GPs refer melanomas as “Routine” as opposed to “Urgent Suspected Cancers” (USC), potentially resulting in late management. We aimed to identify reasons why GPs are discouraged from using the USC referral route for clinically obvious melanomas.
Analysis of all “routine” referrals sent by GPs through Teledermatology between August 2017 and July 2018 was carried out using the Welsh Clinical Portal. Questionnaires were sent to these GPs for enquiry.
42% of melanomas (n=120) were referred routinely by GPs. From the 15 GP responses received, the consensus was that because referrals are reviewed, and if needed, re-prioritised within two days by a Consultant Dermatologist, the referral priority (Routine, Urgent or USC) chosen is given minimal consideration. Additionally, some GPs lacked the confidence to suspect malignancy in difficult-to-identify lesions. Overall, using the routine channel has no effect on the outcome of the referral as both referral routes are given equal priority. Malfunctions in the referral system, however, have resulted in a referral backlog thus forcing USC referrals to be reviewed as priority. Consequently, routine referrals were reviewed twenty days later than usual, potentially delaying urgent management.
Encouraging GPs to refer skin lesions accurately and educating them about melanoma subtypes is necessary to guarantee undelayed management in secondary care. Subsequently, an education tool was produced to install confidence in GPs to enthuse their index of suspicion.
Experiences with the Enhanced Return to Play Guidelines in Rugby Union - are they being Successfully Implemented Across Levels of the Game and are they Protecting Players?
Imogen McMurray | University of Warwick
Rugby union has now seen 61 players retire due to ongoing concussion issues. In 2014 the Rugby football union (RFU) bought in the enhanced return to play guidelines (ERTP) to protect players from the cumulative effects of concussion and to ensure the correct recovery period for players was followed. However, previous studies have found that player education and the implementation of the guidelines is lacking, in particular at the amateur level.
An interview study of 16 participants, including coaches, players and medical staff at both professional and amateur level either face to face or over Skype, with set consistent stem questions that guided the interviewer.
This study found that the guidelines, in most cases, are being implemented across all levels of the game but the effectiveness is dependent on player education, which appears to be variable at the amateur level.
This study has shown that while implementation of the guidelines has improved, further education about the long-term effects of concussion is needed at all levels. Headcase, the RFU initiative brought in for the amateur level, is failing to penetrate with many amateurs having never heard of it.
One novel finding of this study, was the idea that the ERTP guidelines are not aligned with the professional player’s working week, requiring contact training on the last day before a match. Further work needs to be done by the RFU to encourage player education and more research is needed on the longer-term impact of concussion.
Does Exposure to Environmental Tobacco Smoke lead to Increased Severity of Illness in Infants Hospitalised with Bronchiolitis?
Kayleigh Nicholson | University of Warwick
Bronchiolitis is the most common disease in infants under 1 year old. Although most cases are mild, hospitalisation for severe disease can occur. As hospital admissions are rising each year, understanding risk factors for severe bronchiolitis is becoming increasingly important. To date, there have been no reviews investigating the effects of smoke exposure on severity of bronchiolitis.
In this review, systematic searches of databases were performed, in addition to reference lists and grey literature searches. Comprehensive exclusion criteria were used to identify suitable papers. Outcomes used to define severity included severity scores, clinical criteria, respiratory support, admission to ICU, and readmission following discharge. Following extraction of data, a narrative synthesis of results was performed
Of the 12 studies included, three studies found second hand smoke exposure was significantly associated with severe bronchiolitis. Another three studies found exposure significantly increased the risk of readmission. Although two studies suggested there is no effect on ICU admission, one study found postnatal smoke exposure further increases the risk of ICU admission in patients with prenatal smoke exposure. One study found smoke exposure results in a significant risk of requiring oxygen supplementation, however this was not reflected by the percentage of infants with smoke exposure in the most intensive treatment groups.
Postnatal smoke exposure increases the risk of severe bronchiolitis, whether this translates to an increase in the intensity of care required is unclear. Further research into effective smoking cessation methods is warranted to decrease the number of severe bronchiolitis cases.
A Systematic Review of Physical Activity and its Effect on Burnout and/or Quality of Life in Medical Students
Charlotte Taylor | University of Warwick
Medical students are at high risk of burnout and reduced quality of life (QoL). The prevalence of these increases throughout medical school and raises the risk of dropping out. It is important to investigate strategies which could be used to reduce the incidence of burnout and increase QoL, thus mitigating their negative effects. Physical activity has been shown to reduce burnout and increase QoL in different populations. This systematic review aimed to examine whether physical activity/exercise changes the likelihood of burnout and/or influences QoL in medical students.
Articles were identified through the databases Embase, Medline, PsycINFO, Scopus and Web of Science. Studies were included if both physical activity/exercise and burnout or QoL were measured. A comparison between the two was required. Only studies with medical students were included. A narrative synthesis was conducted due to heterogeneity in the dataset.
Fifteen studies were included, comprising 10,500 medical students. Of these, eight measured burnout, six measured QoL and one measured both burnout and QoL. Physical activity was negatively associated with burnout with a weak-moderate effect size. There was also a positive relationship between physical activity and QoL scores. Furthermore, the findings were suggestive of a dose-response effect of physical activity on both burnout and QoL; higher intensities and frequencies precipitated greater improvements in outcomes.
This review demonstrates that physical activity has an important role in reducing burnout and enhancing QoL. These findings have significant implications for practices aiming to promote wellbeing in medical education.