Incidence rates and multidisciplinary response to delirium in acute stroke: a mixed methods investigation

Delirium is a serious medical condition affecting up to 30% of hospital in-patients and associated with significant negative consequences such as increased mortality, morbidity as well as an increased long term risk of cognitive impairment. Delirium is difficult to identify due to its fluctuating course and the various subtypes, which are not well recognised by hospital staff. Stroke patients display a number of the precipitating and predisposing factors for delirium, yet the incidence of delirium in this population is not well documented. It is not known how best to identify delirium in this population and the ways in which multidisciplinary healthcare staff understand the condition. This thesis outlines the mixed methods of investigation which set out to answer these questions, utilising a systematic review and meta-analysis, an online survey, and online focus groups. The thesis makes a novel contribution to the field of stroke research in identifying the incidence of delirium as 28.1% (95% CI: 22.9 to 33.2), as well as synthesising research on the specific risk factors and outcomes associated with delirium in this population. The thesis also highlights the inconsistent practice of delirium identification in acute stroke, in both research and clinical practice. A further contribution is in the response of various healthcare professionals when it comes to identifying delirium in stroke patients: more doctors than nurses identify delirium, nurses have a recognised role in highlighting physiological changes associated with the condition and allied health professionals may lack confidence in their knowledge of the condition, as seen in their use of tentative language to discuss delirium. Despite this, the data suggest that the appropriate management of the condition takes place. The thesis argues that more education and organisational recognition of delirium as a diagnostic priority needs to take place in order to potentially improve outcomes for this population

Identifying and responding to delirium in acute stroke: Clinical team members’ understandings

Gail Carin-Levy - ORCID 0000-0001-6487-3343 https://orcid.org/0000-0001-6487-3343Chris McVittie - ORCID 0000-0003-0657-7524 https://orcid.org/0000-0003-0657-7524Delirium is associated with increased mortality, morbidity and length of hospital stay. In the acute stroke setting, delirium identification is challenging due to the complexity of cognitive screening in this patient group. The aim of this study was to explore how members of interprofessional stroke unit teams identified and responded to a potential delirium in a patient. Online focus groups and interviews utilizing case vignettes were conducted with 15 participants: nurses, occupational therapists, speech and language therapists, and physiotherapists working in acute stroke services. Participants’ understandings of delirium varied, most participants did not identify the symptoms of a possible hypoactive delirium, and nearly all participants discussed delirium symptoms in tentative terms. Aspects of interprofessional working were discussed through the expression of distinct roles around delirium identification. Although participants demonstrated an ethos of person-focused care, there are ongoing challenges involved in early identification and management of delirium in stroke survivors.https://doi.org/10.1177/104973232095929531pubpub

Questioning loneliness: an exploration of the research discourses related to stroke survival in a remote rural community in Scotland

Gail Carin-Levy - ORCID: 0000-0001-6487-3343 https://orcid.org/0000-0001-6487-3343Michelle Elliot - ORCID: 0000-0002-0181-5581 https://orcid.org/0000-0002-0181-5581This paper reflects on a pilot study exploring the loneliness experiences of stroke survivors living in remote rural communities in Scotland. Empirical evidence gathered at the time of establishing this study demonstrated that there were no studies published around the subjective experiences of stroke survivors living alone in remote rural Scottish communities. Yet, stroke survivors in rural settings in other parts of the world report a longing for social contact as well as the experience of a reduction in participation in shared activities, suggestive of potential loneliness and isolation. This paper focuses on our experience interviewing one participant recruited in the early stages of the COVID-19 pandemic. Due to the pandemic, the study had to be terminated, but we were left with data gathered from this one conversation which revealed a rich narrative centred around past and present occupations. At no point was there any sense of loneliness expressed, despite the context within which this participant lived: alone, in a remote community, experiencing a degree of communication difficulties and unable to leave the house independently. All commonly hallmark ‘warning signs’ of a person at risk of loneliness. In this reflection we offer perspectives on assumptions and expectations of loneliness that are problematically constructed by the dominant narratives and theories at the time.Funding for project expenses received by CASS, QMUhttps://bristoluniversitypressdigital.com/view/journals/jps/aop/article-10.1332-14786737Y2024D000000013/article-10.1332-14786737Y2024D000000013.xml?tab_body=pdfhttps://doi.org/10.1332/14786737Y2024D000000013aheadofprintaheadofprin

Delirium in Acute Stroke: A Survey of Screening and Diagnostic Practice in Scotland

Aims to survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland, and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods An invitation to participate in a web-based survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data and content analysis was used to interpret free text responses. Results Sixty five responses were logged (30% return rate). 48% of respondents reported they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium and 32% stated they combined clinical judgment with a standardised tool. 28% of clinicians reported they used The Confusion Assessment Method however, only 13.5% felt it was suitable for stroke patients. Conclusions Screening for delirium is inconsistent in Scottish stroke services and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended.sch_occsch_phypub3207pu

The effect of different body positions on anthropometric measurements and derived estimates of body composition

Ms Gail Carin-Levy was funded by the Stroke Association, UK (TSA 03/02). We are grateful to the staff of the Clinical Research Facility, Royal Infirmary Edinburgh, where this work was performed.Purpose: Measurement of cross-sectional lean limb area using physical anthropometry is usually performed in the standing position, but sometimes this may be impractical. Our aim was to determine the effect of different positions on cross-sectional lean area of the upper arm, calf and thigh derived from girth and skin-fold measurements. Methods: Twenty healthy volunteers participated. Girth and skin-fold thickness of the upper arm, calf and thigh were measured in the standing, sitting and supine positions. We derived lean cross-sectional area (cm2), and calculated the mean difference, its 95% confidence intervals (CI), and the 95% limits of agreement (LOA) between standing and the other two positions. Results: For the upper arm, mean differences in lean cross-sectional area for the supine-standing and sitting-standing positions were 0.7cm2, (95% CI -0.6 to 2.0) and -0.6cm2, (95% CI -1.4 to 0.3) respectively. Mean differences for thigh were 3.9cm2 (95% CI -2.3 to 10.1) and -4.3cm2 (95% CI -8.6 to 0.0) for supine-standing and sitting-standing respectively. For the calf, mean difference for supine-standing was -3.1cm2 (95% CI -5.3 to -0.9), while for sitting-standing it was 0.3cm2 (95% CI -1.8 to 2.4). The range of values expected to cover agreement for 95% of subjects (LOA) was widest for the thigh and narrowest for the upper arm. Conclusion: In young healthy subjects, lean cross-sectional area differs according to measurement position, particularly for the lower limb. The same measurement method should be used in any one individual when monitoring change.sch_occ1. Matiega J, The testing of physical efficiency. Am J Phys Anthropol 1921; 4: 223-230. 2. Behnke AR, Feen GB, Welham WC. The specific gravity of healthy men. JAMA 1942; 118: 495-501. 3. Durnin JVGA, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974; 32: 77-97. 4. Jackson AS, Pollock ML. Generalized equations for predicting body density of men. Br J Nutr 1978; 40: 497-504. 5. Lohman TG, Roche AF, Martorell R (Eds). Anthropometric standardization reference manual. Champaign IL: Human Kinetics, 1988: 1-90. 6. ISAK International Standards for Anthropometric Assessment. The International Society for the Advancement of Kinanthropometry, Potchefstroom, South Africa, 2001: 57-72, 73-88. 7. Brynningsen PK, Damsgaard EMS, Husted SE Improved nutritional status in elderly patients 6 months after stroke The Journal of Nutrition, Health and Aging 2007;11:75-79 8. Bland MJ, Altman DG. Statistical Methods for Assessing Agreement Between Two Methods of Clinical Measurement. Lancet I; 1986: 307-10. 9. Martin AD, Spenst LF, Drinkwater DT, Clarys JP. Anthropometric estimation of muscle mass in men. Med Sci Sports Exerc; 1990: 22, 729-733. 10. Tothill P, Stewart AD. Estimation of Thigh Muscle and Adipose Tissue Volume using Magnetic Resonance Imaging and Anthropometry. J Sports Sci 2002; 20: 563-576. 11. Altman DG. Practical Statistics for Medical Research. London: Chapman and Hall, London, 1995: 396-400. 12. Carin-Levy G, Greig C, Lewis S, Hannan J, Young A, Mead G. Longitudinal changes in muscle strength and mass after stroke. Cerebrovasc Dis 2006; 21:201-207.6pub605pub

Psychosocial aspects of scuba diving for people with physical disabilities: an occupational science perspective.

PURPOSE: This project investigated the psychosocial benefits of scuba diving for individuals with acquired physical impairments. METHOD: In-depth, semi-structured interviews were conducted with 3 volunteers recruited from a diving club specializing in training people with disabilities to dive. Qualitative methods were used to analyze the data in order to identify the themes recurring in the interviews. RESULTS: The respondents indicated that diving is a challenging, enjoyable activity that enhances their quality of life through enriched social experiences and improved self-concept. Furthermore, subjects stressed that carrying out the activity in a buoyant environment allowed them to feel weightless, thus free from their impairments and equal to non-disabled divers. IMPLICATIONS: The study highlighted the need to carry out further research in this field in order to gain better insight into the impact of scuba diving on the quality of life of people with physical impairments. French But. Ce projet avait pour but d'examiner les avantages psychosociaux de la plonge sous-marine pour les personnes ayant des dficiences physiques acquises. Mthodologie. Des entrevues semi-structures en profondeur ont t ralises auprs de trois participants volontaires recruts dans un club de plonge spcialis dans l'enseignement de la plonge des personnes ayant des dficiences physiques. Des mthodes qualitatives ont t utilises afin d'analyser les donnes, en vue de dterminer les thmes rcurrents dans les entrevues. Rsultats. Les rpondants ont indiqu que la plonge tait une activit agrable, pleine de dfis qui rehaussait leur qualit de vie grce aux riches expriences sociales vcues et l'amlioration de leur concept de soi. Par ailleurs, les sujets ont affirm que le fait de faire une activit en milieu flottant leur permettait d'avoir une impression d'apesanteur, et qu'ils se sentaient librs de leur handicap et gaux face des plongeurs sans handicap. Consquences. L'tude a permis de mettre en relief le besoin de poursuivre des recherches dans ce domaine afin de mieux comprendre les effets de la plonge sous-marine sur la qualit de vie des personnes ayant des dficiences physiques.sch_occBlinde, E. M., & McClung, L. R. (1997). Enhancing the physical and social self through recreational activity: Accounts of individuals with physical disabilities. Adapted Physical Activity Quarterly, 14, 327-344. Brabant, J. (1983). Scuba diving for the disabled. Sports 'n' Spokes, Nov-Dec, 9-11. Buning, M. A. (1999). Physical activity and fitness for disabled people, a call for action. Occupational Therapy Practice, October, 27-31. Compton, D. M., Eisenman, P. A., & Henderson, H. L. (1989). Exercise and fitness for disabled people. Sports Medicine, 7, 150-162. Coyle, C. P., & Santiago, M. C. (1995). Aerobic exercise training and depressive symptoms in adults with physical disabilities. Archives of Physical Medicine and Rehabilitation, 76, 647-652. Csikszentmihalyi, M. (1975). Beyond boredom and anxiety. San Francisco: Jossey-Bass Publishers. Csikszentmihalyi, M., & Csikszentmihalyi, I.S. (1988). Optimal experience: Psychological studies in flow and consciousness. Cambridge: Cambridge University Press. Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: Harper Perennial. Dey, I. (1993). Qualitative data analysis: A user friendly guide for social scientists. London: Routledge. Emerson, H. (1998). Flow and occupation, a review of the literature. Canadian Journal of Occupational Therapy, 65, 37-44. Finlay, L. (2000). Multiple voices, multiple paths choosing between qualitative traditions. British Journal of Occupational Therapy, 63, 580-582. Fleming, N. C., & Melamed, Y. (1977). Report of a scuba diving training course for paraplegic and double leg amputees with an assessment of physiological and rehabilitation factors. South Pacific Underwater Medicine Society Journal, 7, 19-35. Guttmann, L. (1976). Text of sport for the disabled. Aylesbury: HM+M Publishers. Heimer, S., & Relac, M. (1998). The importance of recreational sport and sports programmes during rehabilitation and post rehabilitation of the physically disabled. Kinesiology, 30, 57-62. Hinojosa, J., Sabari, J., & Pedretti, L. (1993). Position paper: Purposeful activity. American Journal of Occupational Therapy, 47, 1081-1082. Krefting, L. (1991). Rigor in qualitative research, the assessment of trustworthiness. American Journal of Occupational Therapy, 45, 214-222. Law, M., Steinwender, S., & Leclair, L. (1998). Occupation, health and well-being. Canadian Journal of Occupational Therapy, 65, 81-91. Lynch, P. R. (1996).Historical and basic perspectives of scuba diving. Medicine and Science in Sports and Exercise, 28, 570-2. Madorsky, J. G. B., & Madorsky, A.G. (1988). Scuba diving: Taking the wheelchair out of wheelchair sports. Archives of Physical Medicine and Rehabilitation, 69, 215-218. Meyers, C. A. (1995). Defining and assessing quality of life. British Journal of Occupational Therapy, 58, 146-150. Microsoft Word (1998). Software for operating system Windows 98. [Computer software]. Noreau, L., & Shephard, R.J. (1995). Spinal cord injury exercise and quality of life. Sports Medicine, 20, 226-250. Oliver, M. (1990). The politics of disablement. Basingstoke, UK: Macmillan. Pasek, P. B., & Schkade, J. K. (1996). Effects of a skiing experience on adolescents with limb deficiencies: An occupational adaptation perspective. American Journal of Occupational Therapy, 50, 24-31. Pentland,W., Harvey, A.S., & Walker, J. (1998). The relationship between time-use and health and well being in men with spinal cord injury. Journal of Occupational Science Australia, 5, 14-25. Radomski, M.V. (1995). There is more to life than putting on your pants. American Journal of Occupational Therapy, 49, 487-490. Rebeiro, K. L., & Cook, J.V. (1999). Opportunity not prescription. An exploratory study of the experience of occupational engagement. Canadian Journal of Occupational Therapy, 66, 176-187. Rebeiro, K. L., & Polgar, J. M. (1998). Enabling occupational performance: Optimal experience in therapy. Canadian Journal of Occupational Therapy, 65, 14-22. Shank, J.W., Coyle, C. P., Boyd, R., & Kinney,W.B. (1996). A classification scheme for therapeutic recreation research grounded in the rehabilitative sciences. Therapeutic Recreation Journal, 30, 179-196. Sturgess, C .E. N., & Clatworthy, M.C. (1981). A scuba diving acquaintance course for the severely disabled. South Pacific Underwater Medicine Society Journal, 11, 27-31. Taub, D. E., Blinde, E. M., & Greer, K. R. (1999). Stigma management through participation in sport and physical activity, experience of male college students with physical disabilities. Human Relations, 52, 1469-1483. Taylor, L. P. S., & McGruder, J. E. (1996). The meaning of sea kayaking for persons with spinal cord injuries. American Journal of Occupational Therapy, 50, 39-46. Townsend, E. (1997). Occupation, potential for personal and social transformation. Journal of Occupational Science Australia, 4, 18-26. Wilcock, A. A. (1991). Occupational science. British Journal of Occupational Therapy, 54, 297-300. Williamson, J. A., McDonald, F. W., Galligan, E. A., Baker, P. G., & Hammond, C. T. (1984). Selection and training of disabled persons for scuba diving. Medical Journal of Australia, 141, 414-418. Wright, R. (1998). Research pathways for occupational therapists, taking our own road. British Journal of Occupational Therapy, 61, 418-422. Yerxa, E. J., Clark F., Frank, G., Jackson, J., Parham, D., Pierce, D. (1990). An introduction to occupational science, a foundation for occupational therapy in the 21st century. Occupational Therapy in Health Care, 6, 1-17. Zhan, L. (1992). Quality of life conceptual and measurement issues. Journal of Advanced Nursing, 17, 795-800.74pub119pub

Tyldesley and Grieve's Muscle, Nerves and Movement in Human Occupation 4th ed.

OxfordNow in its fourth edition 'Tyldesley and Grieve's Muscles, Nerves and Movement' has established itself as the leading textbook for the study of movement by occupational therapists. The book provides students with a sound understanding of the way in which bones, joints, muscles and nerves allow the body to perform movement during daily activities. Early chapters provide a foundation for the study of movement, with the complexity of detail increasing as the book progresses. Functional anatomy is related to the movements of daily living and is supported by activities for experiencing and observing the way we perform everyday tasks. Later chapters consider the integration of sensory and motor processes for the planning and execution of movement. This fourth edition has been extensively updated and revised. Highly illustrated and now in full colour throughout the book also includes: - Case histories with self assessment exercises - Summary boxes - Key terms - Practice notepadssch_occpub2512pu

Examining the Person-Environment-Occupation Model (PEO Model) in a physical acute health care setting

Examining the Person-Environment-Occupation Model (PEO Model) in a physical acute health care setting. With radical changes in practice environments, demand for new skill sets (Baptiste 2005), and the global changing economic landscape, Wilding and Whiteford (2008) highlight the need and value for occupational therapists working within physical acute health care settings to feel empowered through their use of language and representation of occupational therapy. Therefore, the diversity of the PEO Model as a potential underpinning occupation-focussed model of practice for this setting is examined. A convenience sample of occupational therapists (n=7), utilising a generic qualitative design, examined some of the strengths and limitations of the use of language within this model, and the extent to which the model 'mirrors' their practice. Findings suggest the PEO Model diversifies effectively with the practice realities of this setting, and aspects of the model connect occupational therapists' values and beliefs to an acute health care setting.sch_occpub2598pu

Letter by Carin-Levy et al regarding article, delirium in acute stroke: A systematic review and meta-analysis

sch_occ43pub2904pub

Should Scottish OTs engage in the end of life debate?

sch_occpub2597pu