Assessing the built environment in care homes for people with dementia

This article draws on our evaluation of environmental improvements to a care home for people with dementia, some results of which were recently published in this journal (Abbott et al, 2016). Here, we discuss different ways of assessing the built environment of care homes, and suggest how staff teams can approach such a task themselves, or in collaboration with other teams. Such assessments could be used to track changes over time, or to compare different homes. The methods could also be used in staff training to help sensitise or re-sensitise staff to environmental factors in the care that they provide. We compare the three methods that we used in the evaluation: • routinely collected data about incidents and behaviours that might reflect the physical environment; • already existing environmental assessment tools; and • interviews with staff, residents and visitors about the quality of the environment as a place to live, work or visit. We consider four key questions in relation to each method: • Can data be collected quickly and cheaply? • Does the method intrude on the privacy of residents? • Does it show how the environment affects residents, visitors and staff? • Does it also illustrate the context and culture of the home? The rationales for these questions are self-explanatory except perhaps the last. As we showed in our earlier article (Abbott et al, 2016), those we interviewed highlighted the importance of the overall context and culture of the home: the building can support but cannot determine the overall quality of care. It is therefore useful to know which methods may help to capture some of that context

A systematic review of the published literature on interventions to improve personal self-care for people with severe mental health problems

Introduction: People with severe mental health problems often struggle to manage everyday tasks such as personal hygiene, housework, shopping, cooking and budgeting. These functional problems result in self-neglect and are associated with specific cognitive impairments and poor outcomes. Despite their importance, little guidance is available for practitioners in how to address these problems. / Method: We conducted a systematic review of the research literature published since 1990 on the effectiveness of interventions that aim to assist people with severe mental health problems to manage their personal self-care. We searched six major electronic databases and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance in the conduct of the review and reporting of results. / Results: Our search identified 2808 papers of which only eight met our inclusion criteria. The included papers comprised six randomised controlled trials and two ‘pre-post’ studies reporting on evaluations of five different interventions. We used narrative synthesis to summarise our findings. The strongest evidence was for cognitive adaptation training, comprising environmental supports provided in the home that address the functional problems arising from specific cognitive impairments. / Conclusion: The paucity of research into interventions to assist personal self-care for people with severe mental health problems is surprising. More research in this area is urgently needed

The experience of loneliness among people with a “personality disorder” diagnosis or traits: a qualitative meta-synthesis

BACKGROUND: Loneliness is prevalent among people with a "personality disorder" diagnosis or who have related personality traits, but the experience of loneliness among people with "personality disorder" diagnoses/traits has not been well described. A qualitative approach has potential to help understand the experience of loneliness among people with "personality disorder" diagnoses/traits, and to develop interventions that promote recovery. We therefore aimed to synthesise the qualitative literature relevant to this topic. METHOD: We conducted a meta-synthesis of qualitative studies exploring the subjective experience of loneliness as reported by people with "personality disorder" diagnoses/traits. We searched four databases using pre-formulated search terms, selected eligible articles, appraised the quality of each, and analyzed data from eligible studies using thematic synthesis. RESULT: We identified 39 articles that described the experience of loneliness in people with "personality disorder" diagnoses/traits. From extracted data, we identified seven themes: (1) disconnection and emptiness: a "haunting alienation", (2) alienation arising from childhood experiences, (3) thwarted desire for closeness and connection, (4) paradox: for both closeness and distance, (5) experiences of existential loneliness, (6) recovery, embedded in a social world, and (7) group therapy: a setback. Our results suggest that for our sample early alienating and traumatic experiences may pave the way for experiences of loneliness, which further exacerbate "personality disorder" symptoms and distress. CONCLUSION: Despite describing a need to belong and efforts to cope with unmet social needs, people with "personality disorder" diagnoses/traits (particularly "emotionally unstable personality disorder") report experiencing an intense disconnection from other people. This seems rooted in early adversities, reinforced by later traumatic experiences. Given the apparent salience of loneliness to people with "personality disorder" diagnoses/traits, interventions focused on helping people connect with others, which may include both psychological and social components, have potential to be beneficial in reducing loneliness and promoting recovery

Physical modeling of small shallow conductive 3-D targets with high-frequency electromagnetics

The goal of this study is to show that physical modeling can provide important support for three-dimensional (3D) interpretation of electromagnetic geophysical data for environmental problems. This is specially true when high-frequency electromagnetic methods are used, which are difficult to model with existing 3D forward modeling programs. Existing electromagnetic geophysical systems usually operate in the frequency range of a few hertz to several hundred hertz. For environmental problems, such as characterization of waste sites, systems with higher frequencies are desirable. This is because at lower frequencies, the depth of investigation is too deep for environmental characterizations. This leads to subsurface images, which don`t have enough resolution to map small shallow objects. Electromagnetic 3D modeling programs which solve the full wave equation are still not widely available, even though 3D modeling has improved remarkably during the last few years (Oristaglio and Spies, 1995). Since such a program was not available for this study, we used a specialized 3D program EM1DSH (Zhou, 1989). With this program, we can model layered-earth cases, taking dielectric effects into account over the whole frequency range of interest. Stewart et al. (1994) published ellipticity curves for similar system configurations and frequency ranges that indicate that dielectric effects can not be neglected for model calculations using frequencies above several 100 kHz. EM1DSH can also model thin conductive sheets in a two-layer earth but neglecting dielectric effects. Therefore we are only able to model and compare our field data with 3D forward modeling results for the lower frequencies. One way of bridging the gap between the interpretation needs and limitations of existing 3D forward modeling programs is to conduct physical modeling experiments. 6 refs., 2 figs

DO IT Trial: vitamin D Outcomes and Interventions in Toddlers - a TARGet Kids! randomized controlled trial.

BackgroundVitamin D levels are alarmingly low (<75 nmol/L) in 65-70% of North American children older than 1 year. An increased risk of viral upper respiratory tract infections (URTI), asthma-related hospitalizations and use of anti-inflammatory medication have all been linked with low vitamin D. No study has determined whether wintertime vitamin D supplementation can reduce the risk of URTI and asthma exacerbations, two of the most common and costly illnesses of early childhood. The objectives of this study are: 1) to compare the effect of 'high dose' (2000 IU/day) vs. 'standard dose' (400 IU/day) vitamin D supplementation in achieving reductions in laboratory confirmed URTI and asthma exacerbations during the winter in preschool-aged Canadian children; and 2) to assess the effect of 'high dose' vitamin D supplementation on vitamin D serum levels and specific viruses that cause URTI.Methods/designThis study is a pragmatic randomized controlled trial. Over 4 successive winters we will recruit 750 healthy children 1-5 years of age. Participating physicians are part of a primary healthcare research network called TARGet Kids!. Children will be randomized to the 'standard dose' or 'high dose' oral supplemental vitamin D for a minimum of 4 months (200 children per group). Parents will obtain a nasal swab from their child with each URTI, report the number of asthma exacerbations and complete symptom checklists. Unscheduled physician visits for URTIs and asthma exacerbations will be recorded. By May, a blood sample will be drawn to determine vitamin D serum levels. The primary analysis will be a comparison of URTI rate between study groups using a Poisson regression model. Secondary analyses will compare vitamin D serum levels, asthma exacerbations and the frequency of specific viral agents between groups.DiscussionIdentifying whether vitamin D supplementation of preschoolers can reduce wintertime viral URTIs and asthma exacerbations and what dose is optimal may reduce population wide morbidity and associated health care and societal costs. This information will assist in determining practice and health policy recommendations related to vitamin D supplementation in healthy Canadian preschoolers

The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey

Background: Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. Methods: We enquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. Results: The same three information sources – professional meetings & conferences, peerreviewed journals and medical colleagues – were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. Conclusion: No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be identified and such analysis could provide valuable additional input into the evaluation of clinical research outputs

Effectiveness of interventions to improve employment for people released from prison: systematic review and meta-analysis

BACKGROUND: People released from prison experience complex health challenges in addition to challenges resettling into the community. Consequently, employment rates are low. Participating in good quality employment can support good health and is protective against future reoffending. Multiple interventions are provided to support people into employment on release. The effectiveness of interventions for improving employment outcomes has not previously been evaluated in a meta-analysis. AIM: Our objective was to examine the effectiveness of interventions to improve employment following release from prison. METHOD: We searched seven databases and three trial registries for peer reviewed randomised controlled trials (RCTs), published since 2010, that included adults and measured an employment outcome(s). We conducted meta-analysis using random effects models with sub-group and sensitivity analyses. We appraised bias risk per outcome, and incorporated this into an assessment of the certainty estimates for each outcome. A group of people with experience of imprisonment met with us throughout the project to inform our search strategy and interpretation of results. RESULTS: We included 12 RCTs (2,875 participants) which were all conducted in the USA. Few outcomes were of low risk of bias. Intervention participants were 2.5 times more likely to work at least one day (95% CI:1.82-3.43) and worked more days over 12 months (MD = 59.07, 95% CI:15.83-102.32) compared to controls. There was no effect on average employment status or employment at study end. There is moderate certainty in these estimates. CONCLUSION: Interventions can improve some employment outcomes for people released from prison. More evidence is required to establish effective interventions for sustaining quality employment, particularly outside the USA, and which consider outcomes for different groups of people released, such as women or those with health or substance use needs

Following Through: The Consistency of Survivorship Care Plan Use in United States Cancer Programs

The Institute of Medicine suggests that consistent survivorship care plan (SCP) use involves developing and delivering SCPs to all cancer survivors and their primary care providers (PCPs). We describe the consistency of SCP use in US cancer programs and assess its relationship with cancer program-level determinants