Is the Morriston Occupational Therapy Outcome Measure (MOTOM) an appropriate tool for reablement services?

© The Author(s) 2024. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1177/03080226241269255Introduction: The Care Act (2014) requires local authorities to provide reablement services but does not standardise how to do this, leading to different services utilising different outcome measures. This article investigates the Morriston Occupational Therapy Outcome Measure, which has been under researched in community reablement settings. Method: A questionnaire was distributed to the staff working within one local authority to seek their experience of using the Morriston Occupational Therapy Outcome Measure. The questionnaire consisted of closed and open-ended questions to gain insights into their understanding and experience of the Morriston Occupational Therapy Outcome Measure. Findings: Quantitative findings showed that staff felt they understood the Morriston Occupational Therapy Outcome Measure, and most respondents agreed that the Morriston Occupational Therapy Outcome Measure was an effective tool for reablement services. However, staff provided contradictory responses as to whether the Morriston Occupational Therapy Outcome Measure was applied consistently or that service users understand the assessment. Qualitative: Findings showed the Morriston Occupational Therapy Outcome Measure is a service user tool, service provider tool, and it provides quality assurance. However, the Morriston Occupational Therapy Outcome Measure can have restricted applicability and within this local authority, more training was needed to improve the consistency of goal-scoring. Conclusion: The Morriston Occupational Therapy Outcome Measure does have strengths within reablement services; however, to ensure it is an effective tool, this research highlights the need for a high level of training.Peer reviewe

Exploring the usefulness of real-time digitally supported fatigue monitoring in fatigue management : Perspectives from occupational therapists and brain injury survivors

Introduction: Persistent fatigue after acquired brain injury (ABI) needs long-term self-management. Self-monitoring supports self-management and informs the use of fatigue management strategies. Using ecological momentary assessment to monitor fatigue offers a data-driven approach to managing fatigue. Aims: To explore the usefulness of self-monitoring fatigue in real-time, using ecological momentary assessment to support self-management, from the perspective of people with ABI and occupational therapists. Methods: People with ABI monitoried their fatigue by wearing a Fitbit and completing six surveys a day on their phone for 6 days. Think aloud and semi-structured interviews elicited views on self-monitoring and the data generated. Transcripts were analysed using reflexive thematic analysis. Results: Four themes were developed from people with ABI (n = 9): (1) Attending to experience, (2) making sense of data, (3) the relationship between fatigue and activity, (4) implications for daily life. Three themes from occupational therapists (n = 5): (1) Challenges of using of data, (2) perceived benefits of self-monitoring, (3) viewing data in relation to their understanding of fatigue. Conclusion: Data generated in real-time challenged perspectives on fatigue and fatigue management. These insights may help people with ABI and their clinicians to plan personalised strategies for fatigue management and evaluate its impact on daily living

Intersectionality of inequalities in revascularization and outcomes for acute coronary syndrome in England:nationwide linked cohort study

BackgroundInequalities in access to care for women, people of non-white ethnicity, who live in areas of social deprivation, and with multiple long-term conditions lead to inequity of outcomes. We investigated the intersectionality of these causes of health inequality on coronary revascularization and clinical outcomes for admissions with acute coronary syndrome (ACS).Methods and resultsWe included hospital admissions in England for types of ACS from April 2015 to April 2018 and linked Hospital Episode Statistics to the Office for National Statistics mortality data. The primary outcome was time to all-cause mortality. Time-to-event analyses examined the associations of sex, ethnicity, and socioeconomic deprivation with revascularization. Of 428 700 admissions with ACS, 212 015 (48.8%) received revascularization within 30 days. Women, black ethnicity, multimorbid, and frail patients were less likely to undergo revascularization. South Asian ethnicities had higher [hazard ratio (HR) = 1.15, 95% confidence interval (CI) 1.14–1.17] revascularization rates and comparable risk-adjusted survival but higher re-admission rates when compared to other ethnic groups. Women had higher 1-year all-cause [25.5% vs. 14.7%—ST-elevation myocardial infarction (STEMI); 24.9% vs. 18.7%—non-ST-elevation myocardial infarction (NSTEMI)] and cardiovascular (22.6% vs. 13.2%—STEMI; 20.3% vs. 15.6%—NSTEMI) mortality than men. After adjusting for confounders, women had a lower all-cause mortality when compared to men.DiscussionOutcomes attributed to women and people of South Asian ethnicity may be attributable to age, comorbidity and frailty at presentation. Black ethnicity, geography, and social deprivation may be sources of inequality. These findings highlight the unmet need and may provide potential targets for interventions that address inequalities

Imaging tumour hypoxia with positron emission tomography.

Hypoxia, a hallmark of most solid tumours, is a negative prognostic factor due to its association with an aggressive tumour phenotype and therapeutic resistance. Given its prominent role in oncology, accurate detection of hypoxia is important, as it impacts on prognosis and could influence treatment planning. A variety of approaches have been explored over the years for detecting and monitoring changes in hypoxia in tumours, including biological markers and noninvasive imaging techniques. Positron emission tomography (PET) is the preferred method for imaging tumour hypoxia due to its high specificity and sensitivity to probe physiological processes in vivo, as well as the ability to provide information about intracellular oxygenation levels. This review provides an overview of imaging hypoxia with PET, with an emphasis on the advantages and limitations of the currently available hypoxia radiotracers.Cancer Research UK (CRUK) funded the National Cancer Research Institute (NCRI) PET Research Working party to organise a meeting to discuss imaging cancer with hypoxia tracers and Positron Emission Tomography. IF was funded by CRUK and is also supported by the Chief Scientific Office. ALH is supported by CRUK and the Breast Cancer Research Foundation. RM is funded by NIHR Cambridge Biomedical Research Centre.This is the accepted manuscript. The final version is available from Nature Publishing at http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2014610a.html

Behaviour change interventions to promote physical activity in people with intermittent claudication:the OPTIMA systematic review

Background: People with intermittent claudication (IC) are significantly less active compared to their peers without IC, worsening future health outcomes. Supervised exercise training (SET) is not commonly available, but behaviour change techniques (BCTs) in unsupervised interventions can improve physical activity (PA). Specific BCTs, theoretical mechanisms, and contextual features linked to effectiveness remain unclear. Objectives: To conduct an integrative synthesis of: effectiveness of BCT-based interventions (BBI) on daily PA and clinical/patient reported outcomes; BCTs and theoretical mechanisms within effective BBI; feasibility and acceptability. Primary outcomes: short-term (<6mths) and maintenance (>6mths) of daily PA. Secondary outcomes: clinical/patient reported outcomes. Data sources: Seven primary studies databases; Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, Health Technology Assessment Database and Trial Registers to 31 August 2023. Review methods: Systematic review 1: interventions incorporating ≥1 BCT (coded using BCT taxonomy v1, and Theoretical Domains Framework). Systematic review 2: quantitative, qualitative, mixed-methods research on patient/provider experiences. Study quality assessed using Cochrane-RoB-2; ROBINS-I and MMAT. Results: 53 articles (41 studies) were included in systematic review 1, and 28 articles (28 studies) in systematic review 2. Eleven randomised controlled trials (RCTs) demonstrated that BBI increased daily PA in the short term [increase of 0.20 SMD (95%CI: 0.07 to 0.33), ~473 steps/day] with high certainty. Evidence of maintenance of daily PA is unclear [increase of 0.12 SMD; ~288 steps/day]. BCTs aimed at improving patients' intentions to engage in PA were most effective. Network analysis suggests that BBI improved daily PA and may be better than SET in maintaining daily PA. BBIs were acceptable and had short/medium-term benefits to initial/absolute claudication distance/time, walking impairment scores, and disease-specific quality of life. Conclusions: BBIs are effective, targeting intention to engage in PA, in improving daily PA and functional outcomes in the short term although evidence is limited for maintenance. There is a need for more RCTs examining daily PA and clinical outcomes, including longer-term follow-up, with detailed descriptions of BCTs, costs, and provider views. Study registration: The is registered as PROSPERO CRD42020159869 Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in XXX Journal: Vol. XX, No. XX. See the NIHR Journals Library website for further project informatio

Imaging oxygenation of human tumours

Tumour hypoxia represents a significant challenge to the curability of human tumours leading to treatment resistance and enhanced tumour progression. Tumour hypoxia can be detected by non-invasive and invasive techniques but the inter-relationships between these remains largely undefined. (18)F-MISO and Cu-ATSM-PET, and BOLD-MRI are the lead contenders for human application based on their non-invasive nature, ease of use and robustness, measurement of hypoxia status, validity, ability to demonstrate heterogeneity and general availability, these techniques are the primary focus of this review. We discuss where developments are required for hypoxia imaging to become clinically useful and explore potential new uses for hypoxia imaging techniques including biological conformal radiotherapy

Standardising management of consent withdrawal and other clinical trial participation changes: The UKCRC Registered Clinical Trials Unit Network’s PeRSEVERE project

Background/Aims: Existing regulatory and ethical guidance does not address real-life complexities in how clinical trial participants’ level of participation may change. If these complexities are inappropriately managed, there may be negative consequences for trial participants and the integrity of trials they participate in. These concerns have been highlighted over many years, but there remains no single, comprehensive guidance for managing participation changes in ways that address real-life complexities while maximally promoting participant interests and trial integrity. Motivated by the lack of agreed standards, and observed variability in practice, representatives from academic clinical trials units and linked organisations in the United Kingdom initiated the PeRSEVERE project (PRincipleS for handling end-of-participation EVEnts in clinical trials REsearch) to agree on guiding principles and explore how these principles should be implemented. / / Methods: We developed the PeRSEVERE principles through discussion and debate within a large, multidisciplinary collaboration, including research professionals and public contributors. We took an inclusive approach to drafting the principles, incorporating new ideas if they were within project scope. Our draft principles were scrutinised through an international consultation survey which focussed on the principles’ clarity, feasibility, novelty and acceptability. Survey responses were analysed descriptively (for category questions) and using a combination of deductive and inductive analysis (for open questions). We used predefined rules to guide feedback handling. After finalising the principles, we developed accompanying implementation guidance from several sources. / / Results: In total, 280 people from 9 countries took part in the consultation survey. Feedback showed strong support for the principles with 96% of respondents agreeing with the principles’ key messages. Based on our predefined rules, it was not necessary to amend our draft principles, but comments were nonetheless used to enhance the final project outputs. Our 17 finalised principles comprise 7 fundamental, ‘overarching’ principles, 6 about trial design and setup, 2 covering data collection and monitoring, and 2 on trial analysis and reporting. / / Conclusion: We devised a comprehensive set of guiding principles, with detailed practical recommendations, to aid the management of clinical trial participation changes, building on existing ethical and regulatory texts. Our outputs reflect the contributions of a substantial number of individuals, including public contributors and research professionals with various specialisms. This lends weight to our recommendations, which have implications for everyone who designs, funds, conducts, oversees or participates in trials. We suggest our principles could lead to improved standards in clinical trials and better experiences for participants. We encourage others to build on our work to explore the application of these ideas in other settings and to generate empirical evidence to support best practice in this area

Intersectionality of inequalities in revascularization and outcomes for acute coronary syndrome in England: nationwide linked cohort study

\ua9 The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. Background: Inequalities in access to care for women, people of non-white ethnicity, who live in areas of social deprivation, and with multiple long-term conditions lead to inequity of outcomes. We investigated the intersectionality of these causes of health inequality on coronary revascularization and clinical outcomes for admissions with acute coronary syndrome (ACS). Methods and results: We included hospital admissions in England for types of ACS from April 2015 to April 2018 and linked Hospital Episode Statistics to the Office for National Statistics mortality data. The primary outcome was time to all-cause mortality. Time-to-event analyses examined the associations of sex, ethnicity, and socioeconomic deprivation with revascularization. Of 428 700 admissions with ACS, 212 015 (48.8%) received revascularization within 30 days. Women, black ethnicity, multimorbid, and frail patients were less likely to undergo revascularization. South Asian ethnicities had higher [hazard ratio (HR) = 1.15, 95% confidence interval (CI) 1.14–1.17] revascularization rates and comparable risk-adjusted survival but higher re-admission rates when compared to other ethnic groups. Women had higher 1-year all-cause [25.5% vs. 14.7%—ST-elevation myocardial infarction (STEMI); 24.9% vs. 18.7%—non-ST-elevation myocardial infarction (NSTEMI)] and cardiovascular (22.6% vs. 13.2%—STEMI; 20.3% vs. 15.6%—NSTEMI) mortality than men. After adjusting for confounders, women had a lower all-cause mortality when compared to men. Discussion: Outcomes attributed to women and people of South Asian ethnicity may be attributable to age, comorbidity and frailty at presentation. Black ethnicity, geography, and social deprivation may be sources of inequality. These findings highlight the unmet need and may provide potential targets for interventions that address inequalities