The effectiveness of local authority social services for older people in Great Britain: a critical literature review

Introduction: Older people are the main users of adult social care services in Great Britain. Evidence suggests that occupational therapists employed by local authorities are providing interventions that promote and maintain older people’s independence, and decrease dependency on other services. However, such evidence is disparate in nature and lacks synthesis. Method: This literature review systematically selected, critically appraised, and thematically synthesized the post 2000 published and unpublished evidence on the effectiveness and cost effectiveness of occupational therapy interventions for older people in social care services. Findings: Identified themes established: the localized nature of social care services for older people; organizational and policy impacts on services, and factors influencing effectiveness and cost effectiveness. Although occupational therapists are increasingly involved in rehabilitation and reablement, there is a continuing focus on equipment and adaptations provision. A high level of service user satisfaction was identified, once timely occupational therapy services were received. Conclusion: Overall, occupational therapy in social care is perceived as effective in improving quality of life for older people and their carers, and cost effective in making savings for other social and healthcare services. However, the complex nature of social care services makes it difficult to disaggregate the effectiveness of occupational therapy from other services

Using joint interviews in a narrative-based study on illness experiences

Researchers increasingly recognize the usefulness of using joint interviews in research on illness experiences. However, there is limited discussion of joint interviews as a data collection method and of the factors that influence the choice to conduct individual or joint interviews. Although there are several advantages and disadvantages of both methods, the reasons that underpin the choice to use joint interviews are often not discussed in detail in the literature. Drawing from a narrative-based study on the experiences of living with motor neuron disease, we present joint interviews as a method sensitive both to the shared experience of illness and to the multiple perspectives around illness. Using interview excerpts, we discuss how through the use of joint interviews researchers can explore the intersubjective and heteroglossic nature of illness experiences. We argue that using joint interviews can offer valuable information about how couples co-construct meaning and share experiences

A review of independent living adaptations

This study will explore and test potential changes to the structural and delivery mechanisms for independent living adaptations. This is in order to move towards the Welsh Government goal of ensuring that adaptations can be delivered more speedily to those who need them. In doing so, it will help reduce inherent inequalities in the current system by ensuring joined up solutions, prevention and early intervention activity. This Review was commissioned in the light of some £35 million being spent annually by local authorities in Wales on Disabled Facilities Grants (DFGs) and the Welsh Government’s own spending of approximately £8 million on Physical Adaptations Grants (PAG) for social tenants. The Review was carried out between May and November 2014 and addressed three aims: mapping the current system performance Indicators testing the feasibility of options for change

Scoping our future research priorities

Motability has excellent customer relationships and a robust mechanism to obtain and respond to feedback from its customers. However the Tenth Anniversary Trust has a wider remit pertaining to research into the broader topic of mobility and therefore wished to extend its understanding of this concept with both customers and other key stakeholders. The key challenge was to understand the lived experience of individuals with mobility needs and to identify priority areas for future research investment. The challenge was addressed by scoping the views of those who manage their own disability and those who support them personally or professionally. This report describes how this key challenge has been met and the related outcomes identified

A review of independent living adaptations

This study will explore and test potential changes to the structural and delivery mechanisms for independent living adaptations. This is in order to move towards the Welsh Government goal of ensuring that adaptations can be delivered more speedily to those who need them. In doing so, it will help reduce inherent inequalities in the current system by ensuring joined up solutions, prevention and early intervention activity. This Review was commissioned in the light of some £35 million being spent annually by local authorities in Wales on Disabled Facilities Grants (DFGs) and the Welsh Government’s own spending of approximately £8 million on Physical Adaptations Grants (PAG) for social tenants. The Review was carried out between May and November 2014 and addressed three aims: mapping the current system performance Indicators testing the feasibility of options for change

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Understanding reflective practice in occupational therapy

This study aims to identify occupational therapists’ understanding of reflective practice in three separate settings: mental health, stroke rehabilitation and general medicine. The factors that encourage or hinder reflection are investigated and analysed to inform future practice