Enhancing Social Interaction between Preschoolers and Older Adults with Dementia - Report Series # 6

This qualitative intergenerational study, conducted in the spring and summer of 2005, was structured within the parameters of the High/Scope educational approach. High/Scope is guided by active learning which allows children the choice to develop their own learning priorities based on their interests and abilities. Within this model, 5 older adult clients from the Victorian Order of Nurses (VON) Seniors Day Program (Halton Branch) interacted with 5 pre-school children from the Sheridan Child Care Centre. Twelve sessions were conducted over a 6-week time period, and data was collected through both remote (web-casting) and participant observation. Although quantitative data that tracked physical interaction between children and older adults did not show a significant increase in intergenerational interaction, qualitative data indicated greater interaction with frequency of sessions. This study points to a need for further research into specific intergenerational activities and their impact on children, older adults with cognitive impairments and their families

Standards and Principles to Enable Interoperability and Integration of 5P Medicine Ecosystems

Health and social care ecosystems are currently a matter of foundational organizational, methodological and technological paradigm changes towards personalized, preventive, predictive, participative precision (5P) medicine. For designing and implementing such advanced ecosystems, an understanding and correct representation of structure, function and relations of their components is inevitable. To guarantee consistent and conformant processes and outcomes, the specifications and principles must be internationally standardized. Summarizing the first author's Keynotes over the last 15 years of pHealth conferences, the paper discusses concepts, standards and principles of 5P medicine ecosystems including their design and implementation. Furthermore, a guidance to find and to deploy corresponding international standards in practical projects is provided.publishedVersionPeer reviewe

Effects of Music Training on Cortical Plasticity: : Cognitive Rehabilitation of Patients with Traumatic Brain Injury

The aim of this thesis was to explore the neuroplastic effects of playing the piano on patients with cognitive impairment following a mild traumatic brain injury (mTBI). It was hypothesised that playing the piano would stimulate neural networks to re-route neural connections and link up cortical circuits that had been functionally inhibited due to minor disruption of brain tissue. The objective of the intervention was to restore the patients’ cognitive processing to pre-injury levels. The study was designed as a pilot study with three experimental groups: (1) 7 patients with cognitive deficits following mTBI two years post-injury (Group 1), (2) 11 healthy subjects (Group 2), and (3) 12 further healthy subjects (Group 3). A between-group design and a longitudinal (pre-post-intervention) within-subject design were applied. Groups 1 and 2 were given eight weeks of piano training. A combination of cognitive and functional neuroimaging (task-based and resting-state fMRI) in addition to neuropsychological tests were performed pre- and post-intervention for all three groups. The results concurrently demonstrated in two independent analyses and fMRI datasets that longitudinal changes in functional connectivity took place within the orbitofrontal cortex (OFC) in the mTBI patient group only, showing increased connectivity between the OFC regions post-intervention involved in executive functions (EF), social cognition and emotional regulation. This finding provides support for the contribution of the OFC as a key mechanism that potentially drives the cognitive benefit of piano training in TBI, and further suggests a network of other connected frontal regions that may be linked to this. The key findings of this study could suggest a causal relationship between musical training and a functional reorganisation of neural networks that promotes enhanced cognitive performance. These results might hold promise as regards adding a novel music-based intervention to the cognitive rehabilitation of mTBI patients.Doktorgradsavhandlin

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

Background Flexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme. Aim To conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation. Objectives (1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes? Data sources Searches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search. Design Mapping review and rapid, systematic evidence syntheses. Setting Care homes with and without nursing in high-income countries. Review methods Published literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses. Results Seven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising. Limitations This review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded. Conclusions This review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation. Future work Future work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context. Study registration This study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938. Funding The National Institute for Health Research Health Services and Delivery Research programme

Designing Environments for People with Dementia

The ebook edition of this title is Open Access and is freely available to read online. This review systematically explores and assesses the quality of the evidence base for effective and supportive design of living environments for people living with Dementia. Dementia is a major challenge for all countries, as the population with the condition is growing rapidly. Societies desperately need to identify measures which mean that they can continue to thrive with a large population of people who are cognitively impaired. Medical treatments are poor, and there is little indication of better medications appearing in the coming decades. There is urgent need for non-medical advances which can address the challenge including ensuring environments are conducive to living better with Dementia. Whilst there is a lot of activity in this area of Dementia friendly design, the evidence base remains poorly synthesized and weak. This book pulls evidence together to provide a solid reference point from which further research and further developments in the field of Dementia care and support can proceed

Development of an evidence-based intervention to improve agitation for people with dementia in care homes

Background Agitation is common, persistent and distressing and can lead to care home admission. There is a paucity of evidence for the sustained effects of interventions to manage agitation and little is known about how care home staff understand and respond to residents’ agitation. Aim To co-produce and initially test the feasibility and acceptability of the MARQUE (Managing Agitation and Raising Quality of Life) intervention, an evidence-based, manualised training intervention to reduce agitation. Methods I conducted a systematic review of effective components of psychosocial interventions delivered by care home staff to people with dementia and a qualitative study of care home staff experiences of caring for agitated residents. I integrated these findings with additional stakeholder involvement, co-producing the intervention. I conducted a mixed methods feasibility and process evaluation in one home. Results Care home staff experienced agitation as diverse, unpredictable and persistent and tried to prevent agitation from emerging and manage episodes once they occurred. Responding to agitation was not a linear process and staff faced dilemmas when attempts to respond to residents’ needs were inhibited by structural and procedural constraints. I co-produced a manualised training intervention with a system of on-going support to reduce agitation in people living with dementia in care homes. I successfully recruited and retained staff and residents with dementia and delivered the intervention to eligible staff in the care home. Conclusions To ensure sustainability and maximise implementation, I developed an intervention to support staff to identify and respond to resident unmet needs, to look after themselves and to minimise the impact of agitation, building upon the approaches and strategies already being used by care home staff. In initial testing, I found that the co-produced MARQUE intervention was feasible to deliver, acceptable to staff and ready for testing in a randomised controlled trial (RCT)

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

New Metropolitan Perspectives

​This open access book presents the outcomes of the symposium “NEW METROPOLITAN PERSPECTIVES,” held at Mediterranea University, Reggio Calabria, Italy on May 26–28, 2020. Addressing the challenge of Knowledge Dynamics and Innovation-driven Policies Towards Urban and Regional Transition, the book presents a multi-disciplinary debate on the new frontiers of strategic and spatial planning, economic programs and decision support tools in connection with urban–rural area networks and metropolitan centers. The respective papers focus on six major tracks: Innovation dynamics, smart cities and ICT; Urban regeneration, community-led practices and PPP; Local development, inland and urban areas in territorial cohesion strategies; Mobility, accessibility and infrastructures; Heritage, landscape and identity;and Risk management,environment and energy. The book also includes a Special Section on Rhegion United Nations 2020-2030. Given its scope, the book will benefit all researchers, practitioners and policymakers interested in issues concerning metropolitan and marginal areas