Knowledge needs and use in long‐term care homes for older people: A qualitative interview study of managers’ views

This is the final version. Available on open access from Wiley via the DOI in this record. We explore the views of managers' knowledge needs and use to optimise care practices and enhance the life experience for older people living, and staff working, in long‐term care homes (with and without nursing). This paper contributes to previous research by offering insights into the knowledge types drawn upon and used by managers to inform efforts to better support gaining and mobilising knowledge. Using a pragmatic qualitative approach, we undertook 19 semi‐structured interviews with managers and leaders in 15 care homes in the South West of England, varying in geographical location, size and type of ownership. We did a thematic analysis of the data using Framework Analysis. Our interpretations were informed by the existing literature on knowledge types. We identified three themes from our analysis as to managers’ knowledge needs and use when implementing changes. First, views about training and formal reports or “explicit knowledge” consisting of the two sub‐themes “gaining explicit knowledge” and “research knowledge”. Second, perspectives relating to practical experience or “tacit knowledge” and judging the use of knowledge in particular cases or “phronesis”. Third, the role of emotion in managers’ knowledge needs and use. We found that having knowledge was positively valued by managers and leaders for improving care practices and enhancing the lives of people residing in care homes. Tacit knowledge and phronesis were particularly highly valued and we note challenges with the perceived applicability, relevance and use of research evidence. We identify that emotions are an important component within knowledge use and a need to further understand how to support the emotional wellbeing of managers so they can support care staff and residents. Greater consideration is needed as to how to optimise gaining and mobilising all knowledge types ‐ “know‐what,” “know‐how,” “know‐when” and “know‐feel” ‐ to benefit people living, and staff working, in care homes.National Institute for Health Research Applied Research Collaboration South West Peninsul

Indoor Nature Interventions for Health and Wellbeing of Older Adults in Residential Settings: A Systematic Review.

This is the author accepted manuscript. The final version is available from Oxford University Press via the DOI in this record.BACKGROUND AND OBJECTIVES: Having contact with nature can be beneficial for health and wellbeing, but many older adults face barriers with getting outdoors. We conducted a systematic review of quantitative studies on health and wellbeing impacts of indoor forms of nature (both real and simulated/artificial), for older adults in residential settings. RESEARCH DESIGN AND METHODS: Search terms relating to older adults and indoor nature were run in 13 scientific databases (MEDLINE, CINAHL, AgeLine, Environment Complete, AMED, PsychINFO, EMBASE, HMIC, PsychARTICLES, Global Health, Web of Knowledge, Dissertations and Theses Global, and ASSIA). We also pursued grey literature, global clinical trials registries, and a range of supplementary methods. RESULTS: Of 6,131 articles screened against eligibility criteria, 26 studies were accepted into the review, and were quality-appraised using the Effective Public Health Practice Project (EPHPP) tool. The participants were 930 adults aged over 60. Nature interventions and health/wellbeing outcomes were heterogeneous, which necessitated a narrative synthesis. The evidence base was generally weak, with 18 of 26 studies having a high risk of bias. However, several higher-quality studies found indoor gardening and horticulture programs were effective for cognition, psychological wellbeing, social outcomes, and life satisfaction. DISCUSSION AND IMPLICATIONS: There is inconsistent evidence that indoor nature exposures are beneficial for older care residents. We expect that successful interventions were, at least partly, facilitating social interaction, supporting feelings of autonomy/control, and promoting skill development, that is, factors not necessarily associated with nature per se. Higher-quality studies with improved reporting standards are needed to further elucidate these mechanisms.European CommissionNational Institute for Health Research (NIHR

Goal setting and strategies to enhance goal pursuit in adult rehabilitation: summary of a Cochrane systematic review and meta-analysis

This is the author proof version of an article accepted for publication in European Journal of Physical and Rehabilitation Medicine 2016.Final version available from the publisher.This paper is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 7, Art. No.: CD009727, DOI: 10.1002/14651858 (see www.thecochranelibrary.com for information?Article first published online: January 15, 2016.INTRODUCTION: Goal setting is considered an essential part of rehabilitation, but approaches to goal setting vary with no consensus regarding the best approach. The aim of this systematic review and meta-analysis was to assess the effects of goal setting and strategies to enhance the pursuit of goals on improving outcomes in adult rehabilitation. EVIDENCE ACQUISITION: We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trial registries for randomized control trials (RCTs), cluster RCTs, or quasi-RCTs published before December 2013. Two reviewers independently screened all search results, then critically appraised and extracted data on all included studies. We identified 39 trials, which differed in clinical context, participant populations, research question related to goal use, and outcomes measured. Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. EVIDENCE SYNTHESIS: These 18 studies provided very low-quality evidence for a moderate effect size that any type of goal setting is better than no goal setting for improving health-related quality of life or self-reported emotional status (N.=446, standard mean difference [SMD]=0.53, 95% confidence interval [CI]: 0.17 to 0.88), and very low-quality evidence of a large effect size for self-efficacy (N.=108, SMD=1.07, 95% CI: 0.64 to 1.49). Fourteen studies compared a structured approach to goal setting to “usual care” goal setting, where some goals may have been set but no structured approach was followed. These studies provided very low-quality evidence for a small effect size that more structured goal setting results in higher patient self-efficacy (N.=134, SMD=0.37, 95% CI: 0.02 to 0.71). No conclusive evidence was found to support the notion that goal setting, or structured goal setting in comparison to “usual care” goal setting, changes outcomes for patients for measures of participation, activity, or engagement in rehabilitation programs. CONCLUSIONS: This review found a large and increasing amount of research being conducted on goal setting in rehabilitation. However, problems with study design and diversity in methods used means the quality of evidence to support estimated effect sizes is poor. Further research is highly likely to change reported estimates of effect size arising from goal setting in rehabilitation.SD’s position at the University of Exeter Medical School is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health

3D Visibility Representations of 1-planar Graphs

We prove that every 1-planar graph G has a z-parallel visibility representation, i.e., a 3D visibility representation in which the vertices are isothetic disjoint rectangles parallel to the xy-plane, and the edges are unobstructed z-parallel visibilities between pairs of rectangles. In addition, the constructed representation is such that there is a plane that intersects all the rectangles, and this intersection defines a bar 1-visibility representation of G.Comment: Appears in the Proceedings of the 25th International Symposium on Graph Drawing and Network Visualization (GD 2017

What is the best way of delivering virtual nature for improving mood?: An experimental comparison of high definition TV, 360º video, and computer generated virtual reality

This is the final version. Available on open access from Elsevier via the DOI in this record. Exposure to ‘real’ nature can increase positive affect and decrease negative affect, but direct access is not always possible, e.g. for people in health/care settings who often experience chronic boredom. In these settings ‘virtual’ forms of nature may also have mood-related benefits (e.g. reducing boredom) but it has been difficult to separate effects of nature content from those of delivery mode. The present laboratory-based study explored whether exposure to three different delivery modes of virtual nature could reduce negative affect (including boredom) and/or increase positive affect. Adult volunteer participants (n = 96) took part in a boredom induction task (to simulate the emotional state of many people in health/care settings) before being randomly assigned to view/ interact with a virtual underwater coral reef in one of three experimental conditions: (a) 2D video viewed on a high-definition TV screen; (b) 3600 video VR (360-VR) viewed via a head mounted display (HMD); or (c) interactive computer-generated VR (CG-VR), also viewed via a HMD and interacted with using a hand-held controller. Visual and auditory content was closely matched across conditions with help from the BBC’s Blue Planet II series team. Supporting predictions, virtual exposure to a coral reef reduced boredom and negative affect and increased positive affect and nature connectedness. Although reductions in boredom and negative affect were similar across all three conditions, CG-VR was associated with significantly greater improvements in positive affect than TV, which were mediated by greater experienced presence and increases in nature connectedness. Results improve our understanding of the importance of virtual nature delivery mode and will inform studies in real care settings.EU Horizon 202

Quitting patient care and career break intentions among general practitioners in South West England: findings of a census survey of general practitioners

Objective: Given recent concerns regarding general practitioner (GP) workforce capacity, we aimed to describe GPs’ career intentions, especially those which might impact on GP workforce availability over the next 5 years. Design: Census survey, conducted between April and June 2016 using postal and online responses , of all GPs on the National Health Service performers list and eligible to practise in primary care. Two reminders were used as necessary. Setting: South West England (population 3.5  million), a region with low overall socioeconomic deprivation. Participants: Eligible GPs were 2248 out of 3370 (67 % response rate). Main outcome measures: Reported likelihood of permanently leaving or reducing hours spent in direct patient care or of taking a career break within the next 5 years and present morale weighted for non-response. Results: Responders included 217 7 GPs engaged in patient care. Of these, 863 (37% weighted, 95%  CI 35 % to 39 %) reported a high likelihood of quitting direct patient care within the next 5 years. Overall, 1535 (70% weighted, 95%  CI 68 % to 72 %) respondents reported a career intention that would negatively impact GP workforce capacity over the next 5 years, through permanently leaving or reducing hours spent in direct patient care, or through taking a career break. GP age was an important predictor of career intentions; sharp increases in the proportion of GPs intending to quit patient care were evident from 52 years. Only 305 (14% weighted, 95%  CI 13 % to 16 %) reported high morale, while 1195 ( 54 % weighted, 95%  CI 52 % to 56 %) reported low morale. Low morale was particularly common among GP partners. Current morale strongly predicted GPs’ career intentions; those with very low morale were particularly likely to report intentions to quit patient care or to take a career break. Conclusions: A substantial majority of GPs in South West England report low morale. Many are considering career intentions which, if implemented, would adversely impact GP workforce capacity within a short time period. Study registration: NIHR HS&DR - 14/196/02, UKCRN ID 20700

Using interpretative phenomenological analysis to inform physiotherapy practice: An introduction with reference to the lived experience of cerebellar ataxia

The attached file is a pre-published version of the full and final paper which can be found at the link below.This article has been made available through the Brunel Open Access Publishing Fund.Qualitative research methods that focus on the lived experience of people with health conditions are relatively underutilised in physiotherapy research. This article aims to introduce interpretative phenomenological analysis (IPA), a research methodology oriented toward exploring and understanding the experience of a particular phenomenon (e.g., living with spinal cord injury or chronic pain, or being the carer of someone with a particular health condition). Researchers using IPA try to find out how people make sense of their experiences and the meanings they attach to them. The findings from IPA research are highly nuanced and offer a fine grained understanding that can be used to contextualise existing quantitative research, to inform understanding of novel or underresearched topics or, in their own right, to provoke a reappraisal of what is considered known about a specified phenomenon. We advocate IPA as a useful and accessible approach to qualitative research that can be used in the clinical setting to inform physiotherapy practice and the development of services from the perspective of individuals with particular health conditions.This article is available through the Brunel Open Access Publishing Fund

Understanding why primary care doctors leave direct patient care: a systematic review of qualitative research

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordData availability statement: All data relevant to the study are included in the article or uploaded as supplementary information. No additional data available.Background UK general practitioners (GPs) are leaving direct patient care in significant numbers. We undertook a systematic review of qualitative research to identify factors affecting GPs’ leaving behaviour in the workforce as part of a wider mixed methods study (ReGROUP). Objective To identify factors that affect GPs’ decisions to leave direct patient care. Methods Qualitative interview-based studies were identified and their quality was assessed. A thematic analysis was performed and an explanatory model was constructed providing an overview of factors affecting UK GPs. Non-UK studies were considered separately. Results Six UK interview-based studies and one Australian interview-based study were identified. Three central dynamics that are key to understanding UK GP leaving behaviour were identified: factors associated with low job satisfaction, high job satisfaction and those linked to the doctor–patient relationship. The importance of contextual influence on job satisfaction emerged. GPs with high job satisfaction described feeling supported by good practice relationships, while GPs with poor job satisfaction described feeling overworked and unsupported with negatively impacted doctor–patient relationships. Conclusions Many GPs report that job satisfaction directly relates to the quality of the doctor–patient relationship. Combined with changing relationships with patients and interfaces with secondary care, and the gradual sense of loss of autonomy within the workplace, many GPs report a reduction in job satisfaction. Once job satisfaction has become negatively impacted, the combined pressure of increased patient demand and workload, together with other stress factors, has left many feeling unsupported and vulnerable to burn-out and ill health, and ultimately to the decision to leave general practice

Adherence to physical rehabilitation delivered via tele-rehabilitation for people with multiple sclerosis: a scoping review protocol

IntroductionUsing tele-rehabilitation methods to deliver exercise, physical activity (PA) and behaviour change interventions for people with multiple sclerosis (pwMS) has increased in recent years, especially since the SARS-CoV-2 pandemic. This scoping review aims to provide an overview of the literature regarding adherence to therapeutic exercise and PA delivered via tele-rehabilitation for pwMS.Methods and analysisFrameworks described by Arksey and O’Malley and Levacet alunderpin the methods. The following databases will be searched from 1998 to the present: Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Health Management Information Consortium Database, ProQuest Dissertations and Theses Global, Pedro, Cochrane Central Register of Controlled Trials, US National Library of Medicine Registry of Clinical Trials, WHO International Clinical Trials Registry Platform portal and The Cochrane Database of Systematic Reviews. To identify papers not included in databases, relevant websites will be searched. Searches are planned for 2023. With the exception of study protocols, papers on any study design will be included. Papers reporting information regarding adherence in the context of prescribed therapeutic exercise and PA delivered via tele-rehabilitation for pwMS will be included. Information relating to adherence may comprise; methods of reporting adherence, adherence levels (eg, exercise diaries, pedometers), investigation of pwMS’ and therapists’ experiences of adherence or a discussion of adherence. Eligibility criteria and a custom data extraction form will be piloted on a sample of papers. Quality assessment of included studies will use Critical Appraisal Skills Programme checklists. Data analysis will involve categorisation, enabling findings relating to study characteristics and research questions to be presented in narrative and tabular format.Ethics and disseminationEthical approval was not required for this protocol. Findings will be submitted to a peer-reviewed journal and presented at conferences. Consultation with pwMS and clinicians will help to identify other dissemination methods.</jats:sec