Development of a Dysphagia Management Protocol for Older Residents in a Care Home Setting. (abstract only)

Purpose: The aim of this study is to develop a co-designed dysphagia management protocol for older residents living in a care home setting. Method: A qualitative study is being conducted within four care homes in a region in the North of England; these were purposively selected to ensure representation of a range of care models across the care home sector. A literature search was conducted to establish good practice in the management of dysphagia in care homes. The findings from the literature review informed the development of semi-structured interview/focus group guides. Eight focus groups have been conducted with 40 members of the nursing and care assistant team and semi-structured interviews conducted with four nursing home managers. These have explored the assessment and management of dysphagia and the barriers and opportunities for improvement in dysphagia management. Interviews will also be conducted with residents (n=16) and nominated relatives, and quality managers (n=4). The interview and focus group data are being analyzed using the Framework Approach. Results: The literature review and preliminary data analysis suggest the following emerging themes: Lack of integrated approaches to education and training; Enablers and barriers to effective dysphagia management; Impact of relationship with other health care professionals on dysphagia management. Conclusion: These findings will lead to the co-design of a protocol for optimizing nutrition and hydration which is based on evidence and best practice principles and which can be adopted in the care home setting. This protocol will be produced by January 2018. The study has been funded by the Abbeyfield Foundation

Incorporating social determinants of health into the clinical management of type 2 diabetes

Type 2 diabetes (T2DM) is increasing in global and national prevalence. It is more common among people with poor social determinants of health (SDoH). Furthermore, SDoH are known to influence health related choice, and therefore the glycaemic management of people with T2DM. There is a growing body of evidence affirming an irrefutable relationship between SDoH and T2DM. Currently SDoH are considered at a population level, whereas T2DM is usually managed individually. Assessing and addressing SDoH related barriers, at an individual, clinical level may contribute to improved glycaemic management for people with T2DM. Developing an approach to assess SDoH related management barriers, and incorporating it into usual clinical care will allow insight into ‘nonclinical’ obstacles to self-management. Additionally, investigation into strategies to address the identified barriers will extend and contextualise this approach, and could broaden and augment current efforts to improve glycaemic management for people with T2DM. An exploratory, descriptive research design will facilitate the exploration of the most appropriate methods and strategies for incorporating SDoH into clinical practice. These approaches can then be trialled and evaluated to inform an evidence-based approach for this addition to the usual clinical care of people with T2DM. This presentation will describe a current research project that is investigating how SDoH can be incorporated into the clinical management of T2DM, and discuss the findings so far

Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes - a review of the literature

Type 2 diabetes (T2DM) is increasing in global prevalence. It is more common among people with poor social determinants of health (SDoH). Social determinants of health are typically considered at a population and community level; however, identifying and addressing the barriers related to SDoH at an individual and clinical level, could improve the self-management of T2DM. This literature review aimed to explore the methods and strategies used in clinical settings to identify and address the SDoH in individuals with T2DM. A systematic search of peer-reviewed literature using the electronic databases MEDLINE, CINAHL, Scopus and Informit was conducted between April and May 2017. Literature published between 2002 and 2017 was considered. Search results (n = 1,119) were screened by title and abstract against the inclusion and exclusion criteria and n = 56 were retained for full text screening. Nine studies met the inclusion criteria. Review and synthesis of the literature revealed written and phone surveys were the most commonly used strategy to identify social determinant-related barriers to self-management. Commonly known SDoH such as; income, employment, education, housing and social support were incorporated into the SDoH assessments. Limited strategies to address the identified social needs were revealed, however community health workers within the clinical team were the primary providers of social support. The review highlights the importance of identifying current and individually relevant social determinant-related issues, and whether they are perceived as barriers to T2DM self-management. Identifying self-management barriers related to SDoH, and addressing these issues in clinical settings, could enable a more targeted intervention based on individually identified social need. Future research should investigate more specific ways to incorporate SDoH into the clinical management of T2DM

The feasibility of using sonoelastography to identify the effect of joint hypermobility syndrome on elasticity of gastrocnemius muscle

Background: Joint hypermobility syndrome (JHS) is a heritable connective tissue disorder in which multiple synovial joints demonstrate a painful and extraordinary range of motion. Genetically there are abnormal changes in the connective tissue matrix in people with JHS, and that may alter the viscoelasticity of their muscular tissue. Sonoelastography (SEG) is a new technology in musculoskeletal practice for assessing tissue elasticity. This study aimed to determine the feasibility of using SEG to distinguish between those with and without a diagnosis of JHS. Gastrocnemius muscle (GM) elasticity was examined, as it is essential for balance and walking.Methods: Twenty participants were examined in a cross-sectional feasibility study: 10 participants diagnosed with JHS and 10 age- and gender-matched healthy controls. The dominant GM was scanned three times using SEG. The colours of the SEG images indicate soft (red), intermediate (green) and hard (blue) tissues. ImageJ software was used to analyse the images by identifying the mean percentage of pixels of each colour.Results: For the JHS group, nine females and one male were examined, with a mean age of 38.9 years (S.D. 15.53). Similarly, for the non-JHS group, nine females and one male were examined, with a mean age of 38.9 years (S.D. 12.37). The groups were comparable in terms of age, gender and BMI (P = 1.00, 1.00, and 0.77, respectively).The JHS group had a significantly higher percentage of blue (hard tissue) pixels when compared with the control group (P = 0.035). No significant differences were found in the mean percentage of green (intermediate) and red (soft) pixels (P = 0.55 and P = 0.051, respectively).SEG required a reasonable amount of training for clinicians with sufficient background in musculoskeletal anatomy, 4 h of observation and practical training. The examination was completed in < 5 min, so it may be reasonable for use in clinical practice, and it was well tolerated by patients. The SEG image was analysed in < 5 minutes.Conclusion: The results indicate that the GM in people with JHS had more areas of hard tissue when compared with the control group, contradicting the expected results. However, GM hyperactivity has been identified during walking in people with JHS, and increased muscle tone might therefore explain the findings. The findings need to be verified in a much larger future study. The SEG seems a feasible tool for quantifying muscular tissue elasticity in JHS

Improving type 2 diabetes care and self-management at the individual level by incorporating social determinants of health

Objective: Suboptimal social determinants of health impede type 2 diabetes self-management. They are usually considered at population and community levels, not individually. The study objective was to draw on perspectives of people who have type 2 diabetes to identify and explore the impact of social determinants on self-management and ways to incorporate them into individual care. Methods: Purposively selected participants chose to partake in focus groups or interviews. Data were analysed and themes identified through deductive and inductive thematic analysis. Results: Social issues hinder type 2 diabetes self-management. Additionally, an individual’s feelings and poor mental health, competing priorities and understanding about diabetes are important considerations. Support was provided via health professionals, community supports, financial support, personal support and informal self-management support. Conclusions: Social determinants of health could be formally incorporated into individual care for people with type 2 diabetes if a socio-ecological view of health is taken as it considers the broader social and environmental circumstances in peoples lives. Implications for public health: Care for people with type 2 diabetes could be transformed if social determinants of health are formally assessed and responded to at an individual level. A socio-ecological view of health in individual care and clinical settings would enable social determinants of health to be formally incorporated into type 2 diabetes care

Global practices in teaching young learners: ten years on

This report compares the data collected in 2010 in the Global Practices in Teaching English to Young Learners project (Garton et al. 2011) with similar data collected in2020. The 2020 project replicates and extends the 2010 research to examines six key questions: 1. Who is teaching young learners? 2. What are the main learning and teaching activities that teachers use in their day-to-day practices and have they changed over the last ten years? 3. What are the challenges faced by YL teachers? Have these changed over the last ten years? 4. How do teachers teach speaking, manage large classes, practise differentiation, enhance motivation and maintain effective discipline? 5. Which local solutions to pedagogical issues have potential for global relevance? 6. Are recent research findings reflected in how EELL is practised? We first review the most recent literature in the field, particularly the growing body of research in Latin America, and the emerging research from the Middle East as well as the more well-established field in Asia. We then describe the methodology used in the 2020 study before presenting the key findings. The findings focus on the main similarities and differences between the two studies, drawing on both questionnaire and classroom-based case study data. In the conclusion, we suggest ways forward for research in this field to ensure teaching and learning in the primary sector is both effective and enjoyable

A consensus based approach to the development of a digital dysphagia management guide for care homes (abstract only)

Background Dysphagia (difficulty swallowing) is common in older people. Up to 75% of residents in nursing homes have swallowing difficulties. Effective management of dysphagia is complex and multi-dimensional. Without proper understanding of what is needed residents’ health and well-being are compromised. An integrated whole systems approach across both catering and clinical services is required. Aim To develop and evaluate an evidence based digital guide to effectively manage dysphagia in care homes. Study Design A consensus based, co-design approach was used to: Examine the evidence-base, views of residents, staff and company representatives to better understand management and shared decision-making in dysphagia care. Co-design a digital guide that promotes adoption of best practice. Conduct a validation process of the guide. Findings A purposive sample of four homes were recruited. Eight focus groups were conducted with 37 members of the workforce and individual semi-structured interviews were carried out with 4 care home managers, 4 quality managers and 6 residents. Analysis determined four key themes around good practice: Training, Food, Quality and Safety, and Workforce. Themes were used to design a digital guide incorporating text, photographs and videos, to enable staff to use the evidence to support their residents to eat and drink safely. The Guide was piloted by 57 staff over 12 weeks. Remote monitoring of activity showed that pages were displayed a total of 1913 times, with Food as the most viewed section (33%). 73% of people reported the Guide helped them do their job more effectively and 88% would recommend the Guide to others. 90% reported the Guide was easy to use. Discussion Using a co-design approach to the development of a digital guide to support dysphagia management in care homes resulted in a resource which was evaluated positively for content, design and usability. Funding is now being sought for a large scale evaluation

A consensus based approach to the development of a digital dysphagia management guide for care homes (abstract only)

Background Dysphagia (difficulty swallowing) is common in older people. Up to 75% of residents in nursing homes have swallowing difficulties. Effective management of dysphagia is complex and multi-dimensional. Without proper understanding of what is needed residents’ health and well-being are compromised. An integrated whole systems approach across both catering and clinical services is required. Aim To develop and evaluate an evidence based digital guide to effectively manage dysphagia in care homes. Study Design A consensus based, co-design approach was used to: Examine the evidence-base, views of residents, staff and company representatives to better understand management and shared decision-making in dysphagia care. Co-design a digital guide that promotes adoption of best practice. Conduct a validation process of the guide. Findings A purposive sample of four homes were recruited. Eight focus groups were conducted with 37 members of the workforce and individual semi-structured interviews were carried out with 4 care home managers, 4 quality managers and 6 residents. Analysis determined four key themes around good practice: Training, Food, Quality and Safety, and Workforce. Themes were used to design a digital guide incorporating text, photographs and videos, to enable staff to use the evidence to support their residents to eat and drink safely. The Guide was piloted by 57 staff over 12 weeks. Remote monitoring of activity showed that pages were displayed a total of 1913 times, with Food as the most viewed section (33%). 73% of people reported the Guide helped them do their job more effectively and 88% would recommend the Guide to others. 90% reported the Guide was easy to use. Discussion Using a co-design approach to the development of a digital guide to support dysphagia management in care homes resulted in a resource which was evaluated positively for content, design and usability. Funding is now being sought for a large scale evaluation

Improvement and decline of cognitive function in schizophrenia over one year: a longitudinal investigation using latent growth modelling.

BACKGROUND: Long-term follow-up studies of people with schizophrenia report stability of cognitive performance; less is known about any shorter-term changes in cognitive function. METHODS: This longitudinal study aimed to establish whether there was stability, improvement or decline in memory and executive functions over four assessments undertaken prospectively in one year. Cognitive performance was assessed during randomized controlled trials of first- and second-generation antipsychotic medication. Analyses used a latent growth modeling approach, so that individuals who missed some testing occasions could be included and trajectories of cognitive change explored despite missing data. RESULTS: Over the year there was significant decline in spatial recognition but no change in pattern recognition or motor speed. Improvement was seen in planning and spatial working memory tasks; this may reflect improved strategy use with practice. There were significant individual differences in the initial level of performance on all tasks but not in rate of change; the latter may have been due to sample size limitations. Age, sex, premorbid IQ and drug class allocation explained significant variation in level of performance but could not predict change. Patients randomized to first-generation drugs improved more quickly than other groups on the planning task. CONCLUSION: We conclude that cognitive change is present in schizophrenia but the magnitude of change is small when compared with the large differences in cognitive function that exist between patients. Analyses that retain patients who drop out of longitudinal studies, as well as those who complete testing protocols, are important to our understanding of cognition in schizophrenia.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are