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      Pioglitazone and barriers to effective post-stroke comorbidity management in stroke survivors with diabetes

      research-article
      , MD, MSc, PhD , , MD, PhD, , MD, PhD, , MD, PhD, , MD, PhD, , MD, PhD
      Neurosciences
      Riyadh : Armed Forces Hospital

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          Abstract

          Objectives:

          To explore the barriers preventing pioglitazone use in stroke survivors and primary and secondary stroke care services.

          Methods:

          A qualitative grounded theory approached design was used to assess post-stroke diabetes treatments and to assess clinical applicability of pioglitazone as a preventive treatment to minimize its side effects (SEs) associated. Three focus groups were established with 48 participants from Scotland and Wales health board centers during January 2019 to July 2022.

          Results:

          A qualitative grounded theory approached design was used to assess post-stroke diabetes treatments and to assess clinical applicability of pioglitazone as a preventive treatment to minimize its SEs associated. Three focus groups were established with 48 participants from Scotland and Wales health board centers during January 2019 to July 2022.

          Conclusion:

          These strategies might allow greater treatment adherence by stroke survivors and increased confidence of the health care professionals in their practice. The findings suggest that further research will be needed to facilitate wider usage of pioglitazone in treating people with stroke and health education is necessitate when using diabetes drugs post-stroke.

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          Most cited references39

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Developing and evaluating complex interventions: the new Medical Research Council guidance

            Evaluating complex interventions is complicated. The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance
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              Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework

              Background It is increasingly acknowledged that ‘acceptability’ should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients. Methods Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators. Results From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Conclusion Despite frequent claims that healthcare interventions have assessed acceptability, it is evident that acceptability research could be more robust. The proposed definition of acceptability and the TFA can inform assessment tools and evaluations of the acceptability of new or existing interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2031-8) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Neurosciences (Riyadh)
                nsj
                Neurosciences
                Neurosciences
                Riyadh : Armed Forces Hospital
                1319-6138
                1319-6138
                January 2024
                : 29
                : 1
                : 44-50
                Affiliations
                From the College of Medicine and Pharmacy (Azhari), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the School of Cardiovascular and Metabolic Health (Azhari, Quinn, Dawson), University of Glasgow, Glasgow, from the School of Geriatric Medicine Centre (Hewitt, O’Neill), Cardiff University, and from the Clinical Research and Innovation Centre (Smith), Aneurin Bevan University Health Board, Newport, United Kingdom
                Author notes
                Address correspondence and reprint request to: Dr. Hala F. Azhari, Clinical Cardiovascular and Stroke Medicine, Clinical Pharmacology, College of Medicine and Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia. E-mail: hfazhari@ 123456uqu.edu.sa
                Author information
                https://orcid.org/0000-0002-3010-3057
                Article
                Neurosciences-29-1-44
                10.17712/nsj.2024.1.20230043
                10827012
                38195138
                ffc66877-e4b2-4190-a999-47338df6fb20
                Copyright: © Neurosciences

                Neurosciences is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work.

                History
                : 31 May 2023
                : 20 November 2023
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