The feasibility and acceptability of an intervention to improve career adaptability skills in Olympic and Paralympic athletes

The Olympic and Paralympic Games are a pinnacle experience for athletes, coaches, support staff and their families. Conceptualized as a series of meta-career transitions, each Games is unique in its own way and present intense, emotional, physical and psychological demands on competitors. Research has shown that individuals’ ability to adapt to career transitions has implications for their well-being, mental health, motivation and productivity. Consequently, the aim of this research was to develop and test an athlete transition support programme that would enhance career adaptability skills in Irish Olympic and Paralympic athletes, coaches and athlete support providers. Best practice in intervention development is to approach the design systematically utilizing prior evidence and theory, and to subsequently pilot the intervention to assess key barriers and facilitators to successful implementation. Following this, exploratory trials should be conducted, which ultimately lead to the implementation of a definitive evaluation. Following the six steps of quality intervention development model, this research presents four studies which inform the development and testing of a psychoeducation intervention delivered to Olympic and Paralympic athletes, coaches and athlete support providers prior to their participation in the Rio 2016 Summer Games. There is a gap in the career transition in sport literature pertaining to preventive interventions which this thesis addresses. Additionally, career adaptability skills have yet to be explored in any elite sport context. This thesis also draws the field of implementation science into sport psychology. The first study is a systematic review of the characteristics of the implementation of well-being related interventions in Olympic and Paralympic athletes. The purpose of this study is to review literature which has attempted to enhance the well-being of Olympic and Paralympic athletes and extract data pertaining to the implementation characteristics of the intervention. The findings suggest that to date little consideration has been given to the impact of implementation factors on intervention effectiveness. The second study is a qualitative exploration of the factors Irish Olympic and Paralympic athletes, coaches, and athlete support providers believe affect an athlete’s engagement in a psychoeducation intervention. The key findings suggest for such an intervention to be feasible and acceptable, it should be delivered in group format, at the training location of the athletes, and be packaged as a workshop to assist athletes in adapting to all stages of the Games and should emphasize the benefits to performance. The third study explores the initial efficacy of video as a delivery method for career adaptability psychoeducation with this population. Participants included 168 athletes with a mean age of 26.46 years (N = 116). Additionally, 10 coaches with a mean age of 40.20 years and 47 athlete support providers with a mean age of 39.77 years participated. Informed by entertainment-education theory, a video 155 seconds in length was found to be effective for communicating up to three learning points immediately following viewing.The fourth study explored the transfer of learning from a group-based psychoeducation intervention delivered over the course of a 90-minute workshop. 140 individuals comprised of Olympic and Paralympic athletes, coaches and sport science and medicine support personnel attended the workshop. Of the 140 attendees, ninety-eight attendees consented to participate in the research. Sports represented included Cerebral Palsy football, mixed Paralympic events, hockey, boxing, rugby 7's, athletics, rowing, triathlon, pentathlon, badminton. Overall participants rated the workshops as satisfactory, useful and relevant to their career. Recommendations for the refinement of the intervention and future research were made. A pre-post evaluation of participants’ ability to accurately generalize the content of the intervention found significant improvement in thoughts and behaviours following the intervention, with small-large effect sizes calculated. Additionally, less than 20% of all participant’s successfully transferred their learning to the real-world context at two time points following intervention. Overall, participants rated their adaptation to the post-Games career meta-transition positively, and listed skills learned at the workshop as helpful during this adaptation. This thesis contributes to the literature on career adaptability, implementation science, and the practical delivery of career transitions interventions to Olympic and Paralympic populations. Strengths of this thesis lie in the systematic development and testing of a psychoeducation intervention, and in the practical application of career transition theory. Practical recommendations for the development of psychoeducation interventions including both digital video and group format delivery are made

Examining the presence and nature of delusions in Alzheimer's disease and frontotemporal dementia syndromes

Objectives Abnormal beliefs and delusions have been reported in some people with dementia, however, the prevalence of delusions, and their neurocognitive basis has been underexplored. This study aimed to examine the presence, severity, content and neural correlates of delusions in a large, well-characterised cohort of dementia patients using a transdiagnostic, cross-sectional approach. Methods Four-hundred and eighty-seven people with dementia were recruited: 102 Alzheimer's disease, 136 behavioural-variant frontotemporal dementia, 154 primary progressive aphasia, 29 motor neurone disease, 46 corticobasal syndrome, 20 progressive supranuclear palsy. All patients underwent neuropsychological assessment and brain magnetic resonance imaging, and the Neuropsychiatric Inventory was conducted with an informant, by an experienced clinician. Results In our cohort, 48/487 patients (10.8%) had delusions. A diagnosis of behavioural-variant frontotemporal dementia (18.4%) and Alzheimer's disease (11.8%) were associated with increased risk of delusions. A positive gene mutation was observed in 11/27 people with delusions. Individuals with frequent delusions performed worse on the Addenbrooke's Cognitive Examination (p = 0.035), particularly on the orientation/attention (p = 0.022) and memory (p = 0.013) subtests. Voxel-based morphometry analyses found that increased delusional psychopathology was associated with reduced integrity of the right middle frontal gyrus, right planum temporale and left anterior temporal pole. Conclusion Our results demonstrate that delusions are relatively common in dementia and uncover a unique cognitive and neural profile associated with the manifestation of delusions. Clinically, delusions may lead to delayed or misdiagnosis. Our results shed light on how to identify individuals at risk of neuropsychiatric features of dementia, a crucial first step to enable targeted symptom management

The feasibility and acceptability of an intervention to improve career adaptability skills in Olympic and Paralympic athletes

The Olympic and Paralympic Games are a pinnacle experience for athletes, coaches, support staff and their families. Conceptualized as a series of meta-career transitions, each Games is unique in its own way and present intense, emotional, physical and psychological demands on competitors. Research has shown that individuals’ ability to adapt to career transitions has implications for their well-being, mental health, motivation and productivity. Consequently, the aim of this research was to develop and test an athlete transition support programme that would enhance career adaptability skills in Irish Olympic and Paralympic athletes, coaches and athlete support providers. Best practice in intervention development is to approach the design systematically utilizing prior evidence and theory, and to subsequently pilot the intervention to assess key barriers and facilitators to successful implementation. Following this, exploratory trials should be conducted, which ultimately lead to the implementation of a definitive evaluation. Following the six steps of quality intervention development model, this research presents four studies which inform the development and testing of a psychoeducation intervention delivered to Olympic and Paralympic athletes, coaches and athlete support providers prior to their participation in the Rio 2016 Summer Games. There is a gap in the career transition in sport literature pertaining to preventive interventions which this thesis addresses. Additionally, career adaptability skills have yet to be explored in any elite sport context. This thesis also draws the field of implementation science into sport psychology. The first study is a systematic review of the characteristics of the implementation of well-being related interventions in Olympic and Paralympic athletes. The purpose of this study is to review literature which has attempted to enhance the well-being of Olympic and Paralympic athletes and extract data pertaining to the implementation characteristics of the intervention. The findings suggest that to date little consideration has been given to the impact of implementation factors on intervention effectiveness. The second study is a qualitative exploration of the factors Irish Olympic and Paralympic athletes, coaches, and athlete support providers believe affect an athlete’s engagement in a psychoeducation intervention. The key findings suggest for such an intervention to be feasible and acceptable, it should be delivered in group format, at the training location of the athletes, and be packaged as a workshop to assist athletes in adapting to all stages of the Games and should emphasize the benefits to performance. The third study explores the initial efficacy of video as a delivery method for career adaptability psychoeducation with this population. Participants included 168 athletes with a mean age of 26.46 years (N = 116). Additionally, 10 coaches with a mean age of 40.20 years and 47 athlete support providers with a mean age of 39.77 years participated. Informed by entertainment-education theory, a video 155 seconds in length was found to be effective for communicating up to three learning points immediately following viewing.The fourth study explored the transfer of learning from a group-based psychoeducation intervention delivered over the course of a 90-minute workshop. 140 individuals comprised of Olympic and Paralympic athletes, coaches and sport science and medicine support personnel attended the workshop. Of the 140 attendees, ninety-eight attendees consented to participate in the research. Sports represented included Cerebral Palsy football, mixed Paralympic events, hockey, boxing, rugby 7\u27s, athletics, rowing, triathlon, pentathlon, badminton. Overall participants rated the workshops as satisfactory, useful and relevant to their career. Recommendations for the refinement of the intervention and future research were made. A pre-post evaluation of participants’ ability to accurately generalize the content of the intervention found significant improvement in thoughts and behaviours following the intervention, with small-large effect sizes calculated. Additionally, less than 20% of all participant’s successfully transferred their learning to the real-world context at two time points following intervention. Overall, participants rated their adaptation to the post-Games career meta-transition positively, and listed skills learned at the workshop as helpful during this adaptation. This thesis contributes to the literature on career adaptability, implementation science, and the practical delivery of career transitions interventions to Olympic and Paralympic populations. Strengths of this thesis lie in the systematic development and testing of a psychoeducation intervention, and in the practical application of career transition theory. Practical recommendations for the development of psychoeducation interventions including both digital video and group format delivery are made

Compression bandages or stockings versus no compression for treating venous leg ulcers:Intervention review

BACKGROUND: Leg ulcers are open skin wounds on the lower leg that can last weeks, months or even years. Most leg ulcers are the result of venous diseases. First‐line treatment options often include the use of compression bandages or stockings. OBJECTIVES: To assess the effects of using compression bandages or stockings, compared with no compression, on the healing of venous leg ulcers in any setting and population. SEARCH METHODS: In June 2020 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In‐Process & Other Non‐Indexed Citations), Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta‐analyses and health technology reports to identify additional studies. There were no restrictions by language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials that compared any types of compression bandages or stockings with no compression in participants with venous leg ulcers in any setting. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, and risk‐of‐bias assessment using the Cochrane risk‐of‐bias tool. We assessed the certainty of the evidence according to GRADE methodology. MAIN RESULTS: We included 14 studies (1391 participants) in the review. Most studies were small (median study sample size: 51 participants). Participants were recruited from acute‐care settings, outpatient settings and community settings, and a large proportion (65.9%; 917/1391) of participants had a confirmed history or clinical evidence of chronic venous disease, a confirmed cause of chronic venous insufficiency, or an ankle pressure/brachial pressure ratio of greater than 0.8 or 0.9. The average age of participants ranged from 58.0 to 76.5 years (median: 70.1 years). The average duration of their leg ulcers ranged from 9.0 weeks to 31.6 months (median: 22.0 months), and a large proportion of participants (64.8%; 901/1391) had ulcers with an area between 5 and 20 cm(2). Studies had a median follow‐up of 12 weeks. Compression bandages or stockings applied included short‐stretch bandage, four‐layer compression bandage, and Unna's boot (a type of inelastic gauze bandage impregnated with zinc oxide), and comparator groups used included 'usual care', pharmacological treatment, a variety of dressings, and a variety of treatments where some participants received compression (but it was not the norm). Of the 14 included studies, 10 (71.4%) presented findings which we consider to be at high overall risk of bias. Primary outcomes There is moderate‐certainty evidence (downgraded once for risk of bias) (1) that there is probably a shorter time to complete healing of venous leg ulcers in people wearing compression bandages or stockings compared with those not wearing compression (pooled hazard ratio for time‐to‐complete healing 2.17, 95% confidence interval (CI) 1.52 to 3.10; I(2) = 59%; 5 studies, 733 participants); and (2) that people treated using compression bandages or stockings are more likely to experience complete ulcer healing within 12 months compared with people with no compression (10 studies, 1215 participants): risk ratio for complete healing 1.77, 95% CI 1.41 to 2.21; I(2) = 65% (8 studies with analysable data, 1120 participants); synthesis without meta‐analysis suggests more completely‐healed ulcers in compression bandages or stockings than in no compression (2 studies without analysable data, 95 participants). It is uncertain whether there is any difference in rates of adverse events between using compression bandages or stockings and no compression (very low‐certainty evidence; 3 studies, 585 participants). Secondary outcomes Moderate‐certainty evidence suggests that people using compression bandages or stockings probably have a lower mean pain score than those not using compression (four studies with 859 participants and another study with 69 ulcers): pooled mean difference −1.39, 95% CI −1.79 to −0.98; I(2) = 65% (two studies with 426 participants and another study with 69 ulcers having analysable data); synthesis without meta‐analysis suggests a reduction in leg ulcer pain in compression bandages or stockings, compared with no compression (two studies without analysable data, 433 participants). Compression bandages or stockings versus no compression may improve disease‐specific quality of life, but not all aspects of general health status during the follow‐up of 12 weeks to 12 months (four studies with 859 participants; low‐certainty evidence). It is uncertain if the use of compression bandages or stockings is more cost‐effective than not using them (three studies with 486 participants; very low‐certainty evidence). AUTHORS' CONCLUSIONS: If using compression bandages or stockings, people with venous leg ulcers probably experience complete wound healing more quickly, and more people have wounds completely healed. The use of compression bandages or stockings probably reduces pain and may improve disease‐specific quality of life. There is uncertainty about adverse effects, and cost effectiveness. Future research should focus on comparing alternative bandages and stockings with the primary endpoint of time to complete wound healing alongside adverse events including pain score, and health‐related quality of life, and should incorporate cost‐effectiveness analysis where possible. Future studies should adhere to international standards of trial conduct and reporting

Effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal vs standard care ventilation on 90-day mortality in patients with acute hypoxemic respiratory failure

Importance In patients who require mechanical ventilation for acute hypoxemic respiratory failure, further reduction in tidal volumes, compared with conventional low tidal volume ventilation, may improve outcomes. Objective To determine whether lower tidal volume mechanical ventilation using extracorporeal carbon dioxide removal improves outcomes in patients with acute hypoxemic respiratory failure. Design, Setting, and Participants This multicenter, randomized, allocation-concealed, open-label, pragmatic clinical trial enrolled 412 adult patients receiving mechanical ventilation for acute hypoxemic respiratory failure, of a planned sample size of 1120, between May 2016 and December 2019 from 51 intensive care units in the UK. Follow-up ended on March 11, 2020. Interventions Participants were randomized to receive lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal for at least 48 hours (n = 202) or standard care with conventional low tidal volume ventilation (n = 210). Main Outcomes and Measures The primary outcome was all-cause mortality 90 days after randomization. Prespecified secondary outcomes included ventilator-free days at day 28 and adverse event rates. Results Among 412 patients who were randomized (mean age, 59 years; 143 [35%] women), 405 (98%) completed the trial. The trial was stopped early because of futility and feasibility following recommendations from the data monitoring and ethics committee. The 90-day mortality rate was 41.5% in the lower tidal volume ventilation with extracorporeal carbon dioxide removal group vs 39.5% in the standard care group (risk ratio, 1.05 [95% CI, 0.83-1.33]; difference, 2.0% [95% CI, −7.6% to 11.5%]; P = .68). There were significantly fewer mean ventilator-free days in the extracorporeal carbon dioxide removal group compared with the standard care group (7.1 [95% CI, 5.9-8.3] vs 9.2 [95% CI, 7.9-10.4] days; mean difference, −2.1 [95% CI, −3.8 to −0.3]; P = .02). Serious adverse events were reported for 62 patients (31%) in the extracorporeal carbon dioxide removal group and 18 (9%) in the standard care group, including intracranial hemorrhage in 9 patients (4.5%) vs 0 (0%) and bleeding at other sites in 6 (3.0%) vs 1 (0.5%) in the extracorporeal carbon dioxide removal group vs the control group. Overall, 21 patients experienced 22 serious adverse events related to the study device. Conclusions and Relevance Among patients with acute hypoxemic respiratory failure, the use of extracorporeal carbon dioxide removal to facilitate lower tidal volume mechanical ventilation, compared with conventional low tidal volume mechanical ventilation, did not significantly reduce 90-day mortality. However, due to early termination, the study may have been underpowered to detect a clinically important difference