Palliative care for people with dementia living at home: a systematic review of interventions

Background: The European Association for Palliative Care White Paper defined optimal palliative care in dementia based on evidence and expert consensus. Yet, we know little on how to achieve this for people with dementia living and dying at home. Aims: To examine evidence on home palliative care interventions in dementia, in terms of their effectiveness on end-of-life care outcomes, factors influencing implementation, the extent to which they address the European Association for Palliative Care palliative care domains and evidence gaps. Design: A systematic review of home palliative care interventions in dementia. Data sources: The review adhered to the PRISMA guidelines and the protocol was registered with PROSPERO (CRD42018093607). We searched four electronic databases up to April 2018 (PubMed, Scopus, Cochrane library and CINAHL) and conducted lateral searches. Results: We retrieved eight relevant studies, none of which was of high quality. The evidence, albeit of generally weak quality, showed the potential benefits of the interventions in improving end-of-life care outcomes, for example, behavioural disturbances. The interventions most commonly focused on optimal symptom management, continuity of care and psychosocial support. Other European Association for Palliative Care domains identified as important in palliative care for people with dementia, for example, prognostication of dying or avoidance of burdensome interventions were under-reported. No direct evidence on facilitators and barriers to implementation was found. Conclusions: The review highlights the paucity of high-quality dementia-specific research in this area and recommends key areas for future work, for example, the need for process evaluation to identify facilitators and barriers to implementing interventions.Peer reviewedFinal Published versio

Improving living and dying for people with advanced dementia living in care homes: a realist review of Namaste Care and other multisensory interventions

© The Author(s). 2018Background: Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances. Methods: This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops. Results: We included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia. Conclusions: This realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.Peer reviewe

State-Trait Anxiety and the Relationship with Patient Outcomes Following TKA

Purpose: To analyze the relationships between state (S) and trait (T) anxiety and functional outcome measure performance in patients following total knee arthroplasty (TKA) receiving physical therapy (PT). Methods: Nineteen patients (62.7±9.9 years) who recently underwent TKA completed testing post-TKA and at discharge that included the modified Lower Extremity Functional Scale (mLEFS), Numeric Pain Rating Scale (NPRS), State-Trait Anxiety Inventory (STAI), Pain Catastrophizing Questionnaire (PCQ), knee range of motion (ROM), thirty-second chair stand test (30s-CST), and the timed up and go (TUG) test. Additionally, NPRS, ROM, 30s-CST, and TUG measures were taken at three and five weeks following TKA. Results: Baseline S- and T-anxiety correlated highly with baseline PCQ (ρ= .546-.676, p= .001-.016) and the 30s-CST (S-Anxiety ρ= -0.531, p= .019). Baseline S- and T-anxiety revealed strong correlations with discharge PCQ scores (S-anxiety ρ= .462-.536, p= .018-.046). The discharge S- and T-anxiety surveys also correlated with discharge measures of mLEFS (ρ= .606-.675, p= .002-.006) and NPRS (ρ= .588-.707, p= .001-.008). Conclusions and Recommendations: This study of S- and T-anxiety and its effects on outcomes following TKA procedures revealed patients’ pain, ROM, and functional outcome measures improved, while S-anxiety, T-anxiety, and PCQ scores had no significant changes from baseline to discharge. Knowing this, clinicians could be proactive and incorporate relaxation techniques, stretching, and massage as a standard means of care

Relationships Between Physical Training and Marksmanship Performance in Law Enforcement Officers

Law enforcement is a dangerous occupation that necessitates excellent physical fitness levels as well as exceptional shooting skills to ensure officer safety and survival. PURPOSE: The purpose of this study is to assess relationships between dynamic shooting accuracy and physical training behaviors in law enforcement officers. METHODS: Subjects consisted of 70 tactical (SWAT) law enforcement officers from various local, state and national agencies. Each subject completed a survey including information on general experience in law enforcement, as well as previous and current weapons and physical training. Subjects completed several dynamic shooting drills with both a pistol and a rifle. Performance in the drills were used to create an overall shooting score. RESULTS: An operator’s overall shooting performance was associated with their years of experience in special operations with more accurate shooters having 6-10 years of experience (p = 0.027). Operators in the lowest shooting category logged fewer hours training (\u3c 250 rounds) with their primary weapon with their team (p = 0.047). Operators in the highest shooting category had a greater tendency to participate in shooting competitions (64.7%, p = 0.016). Operators at the 50% ranking or above were more likely to train at the department or agency gym (61.1% for 51-75%, 47.1% for \u3e75%, p = 0.040). CONCLUSION: Law enforcement officers must consistently perform in high stress and high risk environments that require substantial physical demands as well as firearm proficiency. Years of experience have an overall pragmatic effect on shooting performance and likely increases operational success. Increased experience in law enforcement may be an indicator of improved performance and proficiency. Participants who performed in the highest percentiles were more like to partake in competition shooting. This does not conclusively predict that performance relies on completion shooting alone, however it does suggest that the training used to prepare for such competitions positively affects shooting performance

Salivary C-Reactive Protein and Cortisol Analysis in Collegiate Female Lacrosse Athletes during a 2-Game Week

Cortisol (CORT) and C-reactive protein (CRP) are two indicators of stress and are linked to tissue inflammation and illness. Increased stress and inflammation have been shown to decrease cognitive functioning, leading to diminished performance for athletes. Subjectively, athletes indicate fluctuations in stress, but few studies have assessed the physiological response of training and competition in elite female athletes. PURPOSE: The primary aim was to assess the acute response of CORT and CRP in Division I female lacrosse athletes during a high-stress week, including two games and three practices during the competitive season. The secondary aim was to assess the relationships between the evening measures of CORT and CRP with objective workload measures. METHODS: Saliva samples were collected from the 14 Division I female lacrosse players each morning and evening over the course of a week during competition season. Days 2, 4, and 5 consisted of afternoon/evening (PM) practices lasting approximately two hours, with days 3 and 6 consisting of PM games. Day 1 was a resistance training day and day 7 was a rest day. Workload was measured using wearable global positioning system (GPS) units. Variables included were total distance (m), high-intensity distance (m, \u3e60% max sprint speed), sprints (count, \u3e90% max sprint speed), accelerations (count, \u3e3 m/s2), decelerations (count, \u3e3 m/s2), and sprint distance (m. \u3e 90% max sprint speed) RESULTS: CORT levels increased after the first game (0.36 ± 0.54 µg/dl) and peaked on the morning of Day 5 (1.03 ±0.08 µg/dl). The two significantly low CORT readings were observed in the morning on Day 3 (0.051±0.068 µg/dl) and on Day 4 PM (0.36 ± 0.48 µg/dl) (approximately 24 hours post-game collection, low workload day). Significantly higher salivary CORT concentrations were measured in the morning on Days 1 (0.61 ± 0.46 µg/dl), 5 (1.03 ±0.08 µg/dl), and 6 (0.76 ± 0.60 µg/dl). CRP levels fluctuated during the sampling period without a clear relationship to the game days. Significantly lower CRP salivary concentrations were seen in the morning on Day 5 (5.15 ± 4.03 pg/ml), and significantly higher CRP salivary concentrations on Days 2 (9.88 ± 2.83 pg/ml) and 3 PM (9.37 ± 3.72 pg/ml) (post-game, high workload). Repeated measures Pearson correlation analyses indicated trivial to low correlations between CORT and workload (r = 0.028 to 0.201, p = 0.167 to 0.847) and low correlations between CRP and workload (r = 0.182 to 0.274, p = .051 to 0.102). CONCLUSION: CRP and cortisol levels fluctuated greatly on a day-to-day basis. CRP tended to have a more direct response to load, with higher values directly after games. CORT values were less predictable in relation to workload and may therefore be affected by other factors such as academic load or the athlete’s personal life. Future research should consider the role of travel and academic load and their effects on CORT and CRP in a student athlete

Using non-participant observation to uncover mechanisms: insights from a realist evaluation

This article outlines how a realist evaluation of dementia care in hospitals used non-participant observation to support the refinement and testing of mechanisms likely to lead to the use of person-centred care. We found that comments and explanations of their actions from hospital staff during observation periods provided insights into the reasoning that generated their actions for care in real time. This informed subsequent data collection and analysis. Two worked examples of mechanisms first identified during non-participant observation demonstrate (1) how they were uncovered, and (2) how this informed research activities for theory refinement. Early, iterative engagement with the analytic process, primarily involving reflection and debate with the research team, maximised the potential of observation data to support surfacing underlying mechanisms, linking them to specific contexts and outcomes.Peer reviewedFinal Accepted Versio

Using video consultation technology between care homes and health and social care professionals: a scoping review and interview study during COVID-19 pandemic

© 2022 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. This is the accepted manuscript version of an article which has been published in final form athttps://doi.org/10.1093/ageing/afab279Background the COVID-19 pandemic disproportionately affected care home residents’ and staffs’ access to health care and advice. Health and social care professionals adapted rapidly to using video consultation (videoconferencing) technology without guidance. We sought to identify enablers and barriers to their use in supporting care home residents and staff. Methods a scoping review of the evidence on remote consultations between healthcare services and care homes. Interviews with English health and social care professionals about their experiences during the pandemic. Findings were synthesised using the non-adoption, abandonment, scale-up, spread, sustainability framework. Results 18 papers were included in the review. Twelve interviews were completed. Documented enablers and barriers affecting the uptake and use of technology (e.g. reliable internet; reduced travelling) resonated with participants. Interviews demonstrated rapid, widespread technology adoption overcame barriers anticipated from the literature, often strengthening working relationships with care homes. Novel implementation issues included using multiple platforms and how resident data were managed. Healthcare professionals had access to more bespoke digital platforms than their social care counterparts. Participants alternated between platforms depending on individual context or what their organisation supported. All participants supported ongoing use of technologies to supplement in-person consultations. Conclusions the evidence on what needs to be in place for video consultations to work with care homes was partly confirmed. The pandemic context demolished many documented barriers to engagement and provided reassurance that residents’ assessments were possible. It exposed the need to study further differing resident requirements and investment in digital infrastructure for adequate information management between organisations.Peer reviewe

Current State of Commercial Wearable Technology in Physical Activity Monitoring 2015-2017

International Journal of Exercise Science 11(7): 503-515, 2018. Wearable physical activity trackers are a popular and useful method to collect biometric information at rest and during exercise. The purpose of this systematic review was to summarize recent findings of wearable devices for biometric information related to steps, heart rate, and caloric expenditure for several devices that hold a large portion of the market share. Searches were conducted in both PubMed and SPORTdiscus. Filters included: humans, within the last 5 years, English, full-text, and adult 19+ years. Manuscripts were retained if they included an exercise component of 5-min or greater and had 20 or more participants. A total of 10 articles were retained for this review. Overall, wearable devices tend to underestimate energy expenditure compared to criterion laboratory measures, however at higher intensities of activity energy expenditure is underestimated. All wrist and forearm devices had a tendency to underestimate heart rate, and this error was generally greater at higher exercise intensities and those that included greater arm movement. Heart rate measurement was also typically better at rest and while exercising on a cycle ergometer compared to exercise on a treadmill or elliptical machine. Step count was underestimated at slower walking speeds and in free-living conditions, but improved accuracy at faster speeds. The majority of the studies reviewed in the present manuscript employed different methods to assess validity and reliability of wearable technology, making it difficult to compare devices. Standardized protocols would provide guidance for researchers to evaluate research-grade devices as well as commercial devices used by the lay public

Assessment of Relationships Between External Load Metrics and Game Performance in Women’s Lacrosse

International Journal of Exercise Science 15(6): 488-497, 2022. The purpose of this study was to analyse the relationship between external load metrics with game performance for Division I collegiate female lacrosse. Data were collected using microtechnology during 26 games with 13 athletes (attackers n = 5, midfielders n = 8). External load variables included: total distance (TD), distance rate (DR), high-intensity (HI) distance, speed, HI sprints, accelerations, decelerations, metabolic equivalent distance (MED), and sprints. For attackers, goals, points, shots, and shots on goal (SOG) had low, positive associations with TD (r = 0.32 to 0.42) and MED (r = 0.39 to 0.45). For midfielders, goals, shots, and draw controls had low, positive relationships with TD (r = 0.34 to 0.41), DR (r = 0.33 to 0.45), and decelerations (r = 0.30 to 0.35). Points and SOG had low associations with TD (r = 0.35), DR (r = 0.33), accelerations (r = 0.31), and decelerations (r = 0.32 to 0.35). Turnovers demonstrated low, positive relationships with HI distance (r = 0.31) and HI sprints (r = 0.41). Though the correlations were low, they still revealed insights into workload metrics and offensive game statistics in the sport of lacrosse. Training for attackers should focus on agility and a training base for TD. Training for midfielders should focus on HI endurance and sprinting