Evaluation of mindfulness-based cognitive therapy for life and a cognitive behavioural therapy stress-management workshop to improve healthcare staff stress: study protocol two randomized controlled trials

Background: Healthcare workers experience higher levels of work-related stress and higher rates of sickness absence than workers in other sectors. Psychological approaches have potential in providing healthcare workers with the knowledge and skills to recognise stress and to manage stress effectively. The strongest evidence for effectiveness in reducing stress in the workplace is for stress-management courses based on cognitive behaviour therapy (CBT) principles and mindfulness-based interventions (MBIs). However, research examining effects of these interventions on sickness absence (an objective indicator of stress) and compassion for others (an indicator of patient care) is limited, as is research on brief CBT stress-management courses (which may be more widely accessible) and on MBIs adapted for workplace settings. Methods/Design: This protocol is for two randomised controlled trials with participant preference between the two trials and 1:1 allocation to intervention or waitlist within the preferred choice. The first trial is examining a one-day CBT stress-management workshop and the second trial an 8-session Mindfulness-Based Cognitive Therapy for Life (MBCT-L) course, with both trials comparing intervention to waitlist. The primary outcome for both trials is stress at post-intervention with secondary outcomes being sickness absence, compassion for others, depression symptoms, anxiety symptoms, wellbeing, work-related burnout, self-compassion, presenteeism, and mindfulness (MBCT-L only). Both trials aim to recruit 234 staff working in the National Health Service in the UK. Discussion: This trial will examine whether a one-day CBT stress-management workshop and an 8-session MBCT-L course are effective at reducing healthcare staff stress and other mental health outcomes compared to waitlist, and, whether these interventions are effective at reducing sickness absence and presenteeism and at enhancing wellbeing, self-compassion, mindfulness and compassion for others. Findings will help inform approaches offered to reduce healthcare staff stress and other key variables. A note of caution is that individual-level approaches should only be part of the solution to reducing healthcare staff stress within a broader focus on organisational-level interventions and support

Evaluation of mindfulness-based cognitive therapy for life and a cognitive behavioural therapy stress-management workshop to improve healthcare staff stress: study protocol two randomized controlled trials

Background: Healthcare workers experience higher levels of work-related stress and higher rates of sickness absence than workers in other sectors. Psychological approaches have potential in providing healthcare workers with the knowledge and skills to recognise stress and to manage stress effectively. The strongest evidence for effectiveness in reducing stress in the workplace is for stress-management courses based on cognitive behaviour therapy (CBT) principles and mindfulness-based interventions (MBIs). However, research examining effects of these interventions on sickness absence (an objective indicator of stress) and compassion for others (an indicator of patient care) is limited, as is research on brief CBT stress-management courses (which may be more widely accessible) and on MBIs adapted for workplace settings. Methods/Design: This protocol is for two randomised controlled trials with participant preference between the two trials and 1:1 allocation to intervention or waitlist within the preferred choice. The first trial is examining a one-day CBT stress-management workshop and the second trial an 8-session Mindfulness-Based Cognitive Therapy for Life (MBCT-L) course, with both trials comparing intervention to waitlist. The primary outcome for both trials is stress at post-intervention with secondary outcomes being sickness absence, compassion for others, depression symptoms, anxiety symptoms, wellbeing, work-related burnout, self-compassion, presenteeism, and mindfulness (MBCT-L only). Both trials aim to recruit 234 staff working in the National Health Service in the UK. Discussion: This trial will examine whether a one-day CBT stress-management workshop and an 8-session MBCT-L course are effective at reducing healthcare staff stress and other mental health outcomes compared to waitlist, and, whether these interventions are effective at reducing sickness absence and presenteeism and at enhancing wellbeing, self-compassion, mindfulness and compassion for others. Findings will help inform approaches offered to reduce healthcare staff stress and other key variables. A note of caution is that individual-level approaches should only be part of the solution to reducing healthcare staff stress within a broader focus on organisational-level interventions and support

Specialist palliative care in care homes: Integrating care could improve quality of life and reduce costs (Pilot study)

The Scottish Government’s Strategic Framework for Action on Palliative and End of Life Care sets out a vision of universal access to palliative care by 2021. This includes individuals, families and carers having timely and focused conversations with appropriately skilled professionals to plan end of life care, in accordance with their needs and preferences. The vision will be achieved by widening the range of health and care staff providing palliative care, delivering appropriate training, and supporting clinical and health economic evaluations of palliative and end of life care models. Despite care homes being a key location where older people die, access to specialist palliative care is limited. Staff often feel inadequately trained or prepared to look after people who are dying. Consequently, care home residents are more likely to die in hospital, with uncontrolled symptoms, or without adequate care planning in place

Happier during lockdown: a descriptive analysis of self-reported wellbeing in 17,000 UK school students during Covid-19 lockdown.

Funder: The Westminster FoundationRelatively little research has focused on children and young people (CYP) whose mental health and wellbeing improved during Covid-19 lockdown measures. We aimed to (1) determine the proportion of CYP who self-reported improvement in their mental wellbeing during the first Covid-19 lockdown and (2) describe the characteristics of this group in relation to their peers. We conducted a descriptive analysis of data from the 2020 OxWell Student Survey, a self-report, cross-sectional survey of English CYP. A total of 16,940 CYP primarily aged 8-18 years reported on change in mental wellbeing during lockdown. We characterised these CYP in terms of school, home, relational, and lifestyle factors as well as feelings about returning to school. One-third (33%) of CYP reported improved mental wellbeing during the first UK national lockdown. Compared with peers who reported no change or deterioration, a higher proportion of CYP with improved mental wellbeing reported improved relationships with friends and family, less loneliness and exclusion, reduced bullying, better management of school tasks, and more sleep and exercise during lockdown. In conclusion, a sizeable minority of CYP reported improved mental wellbeing during lockdown. Determining the reasons why these CYP felt they fared better during lockdown and considering how these beneficial experiences can be maintained beyond the pandemic might provide insights into how to promote the future mental health and wellbeing of school-aged CYP. All those working with CYP now have an opportunity to consider whether a systemic shift is needed in order to understand and realise any learnings from experiences during the pandemic.Funding ES is funded by a Gates Cambridge Scholarship (Grant Number: OPP1144). SP is funded by a National Institute for Health Research (NIHR) Post-Doctoral Fellowship award (Grant Number PDF-2017-10-029) and The Westminster Foundation. NC is supported by funding from the UK Research and Innovation (UKRI) Emerging Minds Network. KLM is funded by the NIHR Oxford Health Biomedical Research Centre (BRC-1215-20005). PBJ is supported by the NIHR Applied Research Collaboration East of England. MF was supported by funding from the NIHR Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust. The OxWell Student Survey is supported by the NIHR Oxford Health Biomedical Research Centre, an MRC Pathfinder Award to the University of Oxford, and the Westminster Foundation. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care

Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes

Background: Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. Aim: To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. Design: Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. Setting/participants: 1700 residents in 12 Australian care homes for older people. Results: Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: −0.44, −0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). Conclusion: The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes

Integrating specialist palliative care into residential care for older people: a stepped wedge trial (INSPIRED trial)

Residential facilities for older persons (hereafter “facilities”) are increasingly involved in supporting older people at end of life; consequently, the provision of palliative care is required to improve outcomes for residents. The national palliative care strategy sets a vision which aims to (i) improve awareness and understanding, (ii) be appropriate and effective, (iii) has high quality leadership and governance and (iv) builds capacity and capability. The national palliative care standards re-assert the need for palliative care to be available to all people living with progressive or advanced disease. In 2014-2015, we developed and tested a new approach to integrating specialist palliative care into residential care to meet the objectives of the national strategy and improve the delivery of high quality appropriate care to older Australians. The study was funded by ACT Health

Integrating specialist palliative care into residential care for older people: a stepped wedge trial (INSPIRED trial)

Residential facilities for older persons (hereafter “facilities”) are increasingly involved in supporting older people at end of life; consequently, the provision of palliative care is required to improve outcomes for residents. The national palliative care strategy sets a vision which aims to (i) improve awareness and understanding, (ii) be appropriate and effective, (iii) has high quality leadership and governance and (iv) builds capacity and capability. The national palliative care standards re-assert the need for palliative care to be available to all people living with progressive or advanced disease. In 2014-2015, we developed and tested a new approach to integrating specialist palliative care into residential care to meet the objectives of the national strategy and improve the delivery of high quality appropriate care to older Australians. The study was funded by ACT Health

Improved quality of death and dying in care homes: a palliative care stepped wedge randomized control trial in Australia

OBJECTIVES: Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying. DESIGN: Using a stepped wedge randomized control trial, care homes were randomly assigned to crossover from control to intervention using a random number generator. Analysis used a generalized linear and latent mixed model. The trial was registered with ANZCTR: ACTRN12617000080325. SETTING: Twelve Australian care homes in Canberra, Australia. PARTICIPANTS: A total of 1700 non-respite residents were reviewed from the 12 participating care homes. Of these residents, 537 died and 471 had complete data for analysis. The trial ran between February 2017 and June 2018. INTERVENTION: Palliative Care Needs Rounds (hereafter Needs Rounds) are monthly hour-long staff-only triage meetings to discuss residents at risk of dying without a plan in place. They are chaired by a specialist palliative care clinician and attended by care home staff. A checklist is followed to guide discussions and outcomes, focused on anticipatory planning. MEASUREMENTS: This article reports secondary outcomes of staff perceptions of residents' quality of death and dying, care home staff confidence, and completion of advance care planning documentation. We assessed (1) quality of death and dying, and (2) staff capability of adopting a palliative approach, completion of advance care plans, and medical power of attorney. RESULTS: Needs Rounds are associated with staff perceptions that residents had a better quality of death and dying (P < .01; 95% confidence interval [CI] = 1.83-12.21), particularly in the 10 facilities that complied with the intervention protocol (P < .01; 95% CI = 6.37-13.32). Staff self-reported perceptions of capability increased (P < .01; 95% CI = 2.73-6.72). CONCLUSION: The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes

2018: Art & Mobilities Network Inaugural Symposium Instant Journal (Peter Scott Gallery)

"Mobilities has been gaining momentum through networks, conferences, books, special issues, exhibitions and in the practices of artists, writers and curators. In recognition of this activity we are forming an Art & Mobilities network through which to consolidate, celebrate and develop this work.Inspired by the recent foregrounding of Mobility and the Humanities (Pearce & Merriman, 2018) and drawing on last November's successful Mobile Utopia Exhibition amongst others, the Centre for Mobilities Research (CEMORE) at Lancaster University are pleased to hold a UK Art & Mobilities Network Inaugural Symposium 2018 on the 3rd of July 2018. The aim of the symposium is to bring together people in the UK who are active in the field of mobilities and art in order to discuss the distinctive contribution that art makes to mobilities research and vice versa. We would be delighted if you can join us for this one-day event to help shape the network, particularly in the context of a fast-changing world, not just socio-politically but in terms of the place of art in the academy and vice versa. There are nearly 30 key international artists and researchers gathered on this day both locally and via Skype. We invite all participants in the symposium to bring with them an artwork, artefact, written statement or quote that can be displayed as a ‘pop up’ exhibition. These artefacts will be used during the day to focus discussion around different facets of mobilities and art." (Jen Southern, Kai Syng Tan, Emma Rose, Linda O'Keeffe Editors

α5β1 integrin recycling promotes Arp2/3-independent cancer cell invasion via the formin FHOD3

Invasive migration in 3D extracellular matrix (ECM) is crucial to cancer metastasis, yet little is known of the molecular mechanisms that drive reorganization of the cytoskeleton as cancer cells disseminate in vivo. 2D Rac-driven lamellipodial migration is well understood, but how these features apply to 3D migration is not clear. We find that lamellipodia-like protrusions and retrograde actin flow are indeed observed in cells moving in 3D ECM. However, Rab-coupling protein (RCP)-driven endocytic recycling of α5β1 integrin enhances invasive migration of cancer cells into fibronectin-rich 3D ECM, driven by RhoA and filopodial spike-based protrusions, not lamellipodia. Furthermore, we show that actin spike protrusions are Arp2/3-independent. Dynamic actin spike assembly in cells invading in vitro and in vivo is regulated by Formin homology-2 domain containing 3 (FHOD3), which is activated by RhoA/ROCK, establishing a novel mechanism through which the RCP–α5β1 pathway reprograms the actin cytoskeleton to promote invasive migration and local invasion in vivo