The development, feasibility, and acceptability of a breakfast group intervention for stroke rehabilitation

Background: There are 1.2 million stroke survivors in the UK and the number is projected to increase significantly over the next decade. Research suggests that between 50% and 80% of hospitalised stroke survivors experience difficulties with eating and drinking. Presently, rehabilitation approaches to address these difficulties involve individual rehabilitation sessions led by uni-professionals. Recent national stroke guidance recommends that stroke survivors receive three hours of daily rehabilitation and emphasises the importance of addressing the psychosocial aspects of recovery. Implementing these recommendations presents a challenge to healthcare professionals, who must explore innovative methods to provide the necessary rehabilitation intensity. This study aimed to address these challenges by codesigning a multi-disciplinary breakfast group intervention and implementation toolkit to improve psychosocial outcomes. Methods: The Hawkins 3-step framework for intervention design was used to develop a multidisciplinary breakfast group intervention and to understand if it was acceptable and feasible for patients and healthcare professionals in an acute stroke ward. The Hawkins 3- steps were 1) evidence review and consultations 2) coproduction 3) prototyping. In collaboration with fifteen stakeholders, a prototype breakfast group intervention and implementation toolkit were codesigned over four months. Experience-based Codesign was used to engage stakeholders. Results: The literature review is the first to investigate the psychosocial impact of eating and drinking difficulties post stroke. The key finding was the presence of psychological and social impacts which included, the experience of loss, fear, embarrassment shame and humiliation as well as social isolation. Stroke survivors were striving to get back to normality and this included the desire to socially dine with others. Two prototype iterations of the intervention were tested with 16 stroke survivors across three hospital sites. The multidisciplinary breakfast group intervention was designed to offer intensive rehabilitation in a social group context. The codesigned implementation toolkit guided a personalised and tailored approach. A perceived benefit of the intervention was the opportunity to address the psychosocial aspects of eating and drinking rehabilitation as well as providing physical rehabilitation. Stroke survivors highly value the opportunity to socialise and receive support from their peers. The intervention was acceptable to both patients and healthcare professionals, and the workforce model proved practical and feasible to deliver using a collaborative approach in the context of resource-limited healthcare. Conclusions: The breakfast group interventions, developed through codesign, were positively received by patients and staff and feasible to deliver. They introduce an innovative and novel approach to stroke rehabilitation, personalised to each individual's needs, and offer a comprehensive intervention which addresses both physical and psychosocial aspects which target challenges related to eating and drinking. Unique contributions of this study include a theoretical model for breakfast group interventions, a programme theory and practical tool kit for clinicians to support the translation of research findings and implement breakfast groups in clinical practice

2020-2021 Graduate Catalog

https://digitalcommons.sacredheart.edu/g_cat/1066/thumbnail.jp

Quantifying, Understanding and Predicting Differences Between Planned and Delivered Dose to Organs at Risk in Head & Neck Cancer Patients Undergoing Radical Radiotherapy to Promote Intelligently Targeted Adaptive Radiotherapy

Introduction: Radical radiotherapy (RT) is an effective but toxic treatment for head and neck cancer (HNC). Contemporary radiotherapy techniques sculpt dose to target disease and avoid organs at risk (OARs), but anatomical change during treatment mean that the radiation dose delivered to the patient – delivered dose (DA), is different to that anticipated at planning – planned dose (DP). Modifying the RT plan during treatment – Adaptive Radiotherapy (ART) – could mitigate these risks by reducing dose to OARs. However, clinical data to guide patient selection for, and timing of ART, are for lacking. Methods: 337 patients with HNC were recruited to the Cancer Research UK VoxTox study. Demographic, disease and treatment data were collated, and both DP and DA to organs at risk (OARs) were computed from daily megavoltage CT image guidance scans, using an open-source deformable image registration package (Elastix). Toxicity data were prospectively collected. Relationships between DP, DA and late toxicities were investigated with univariate, and logistic regression normal tissue complication probability (NTCP) modelling approaches. A sub-study of VoxTox recruited 18 patients who had MRI scans before RT fractions 1, 6, 16, and 26. Changes in salivary gland volumes and relative apparent diffusion coefficient (ADC) values were measured and related to toxicity events. Results: Spinal cord dose differences were small, and not predicted by weight loss or shape change. Mean DA to all other OARs was higher than DP; factors predicting higher DA included primary disease site, concomitant therapy, shape change and advanced neck disease. Nine patients (3.7%) saw DA>DP by 2Gy to more than half of the OARs assessed. These patients all had received bilateral neck RT for N-stage 2b oropharyngeal cancer. Strong uni- and multivariate relationships between OAR dose and toxicity were seen. Differences between DA and DP-based dose-toxicity models were minimal, and not statistically significant. On MRI, both parotid and submandibular glands shrank during treatment, whilst relative ADC rose. Relationships with toxicity were inconclusive. Conclusions: Small differences between OAR DP and DA mean that DA-based toxicity prediction models confer negligible additional benefit at the population level. Factors such as primary disease sub-site, concomitant systemic therapy, staging and shape change may help to select the patients that do develop clinically significant dose differences, and would benefit most from ART for toxicity reduction

2019-2020 Graduate Catalog

https://digitalcommons.sacredheart.edu/g_cat/1063/thumbnail.jp

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Health and Wellbeing in Late Life

This open access book takes a multidisciplinary approach to provide a holistic understanding of late old age, and situates the aged person within the context of family, caregivers, clinical and other institutions. All through the book, the author discusses preparedness for an aging individual as well as the society in the Indian context. The book highlights inevitable but mostly neglected health issues like depression, dementia, fall, and frailty and provides detailed analyses of solutions that are practicable in low resource settings. It also brings up intergenerational differences and harmony in the context of holistic care of older Indians. Alongside clinical perspectives, the book uses narratives of elderly patients to dwell on the myriad of problems and issues that constitute old age healthcare. Demonstrating cases that range from the most influential to the most underprivileged elderly in India, the book enlightens multiple caregivers—doctors, nurses, and professional caregivers as well as family members—about the dynamic approach required in dealing with complex issues related to late old age. The narratives make the book relatable and interesting to non-academic readers, with important lessons for gerontological and geriatric caregiving. It is also of use to older adults in preparing for active aging

Health and Wellbeing in Late Life

This open access book takes a multidisciplinary approach to provide a holistic understanding of late old age, and situates the aged person within the context of family, caregivers, clinical and other institutions. All through the book, the author discusses preparedness for an aging individual as well as the society in the Indian context. The book highlights inevitable but mostly neglected health issues like depression, dementia, fall, and frailty and provides detailed analyses of solutions that are practicable in low resource settings. It also brings up intergenerational differences and harmony in the context of holistic care of older Indians. Alongside clinical perspectives, the book uses narratives of elderly patients to dwell on the myriad of problems and issues that constitute old age healthcare. Demonstrating cases that range from the most influential to the most underprivileged elderly in India, the book enlightens multiple caregivers—doctors, nurses, and professional caregivers as well as family members—about the dynamic approach required in dealing with complex issues related to late old age. The narratives make the book relatable and interesting to non-academic readers, with important lessons for gerontological and geriatric caregiving. It is also of use to older adults in preparing for active aging