The role of adult social care in the prevention of intensive health and care needs: a scoping review

Context: Despite the strong emphasis on prevention in social care policy, there is a lack of evidence on the effectiveness of preventive social care interventions to delay escalation of intensive care needs. Objective(s): We reviewed the literature relating to the role of Adult Social Care to prevent escalation of care needs. We aimed to identify mechanisms in service delivery that prevent development of long-term care needs. Method(s): We used the PRISMA-ScR framework to review papers reporting the (cost)effectiveness of preventative services. Findings were qualitatively synthesised using elements of realist synthesis. Findings: Thirty-one papers were included covering: integrated care, intermediate care, rehabilitation, post-discharge services, community-based care, and domiciliary care. Overall, we found few studies with conclusive results to inform policy and practice. Moreover, the evidence was mostly concerned with the impact of social care on health care utilisation, with relatively few studies addressing the impact on social care utilisation. There was some preliminary evidence for the effectiveness of multi-faceted support set within the community, and improvements were observed for patients’ Quality of Life. Limitations: The variety of papers we included reflects the complexity of the social care landscape but prevents robust assessment of the impact of services to delay advancing care needs. Implications: Greater investment in research in this field will help policy makers and families target scarce resources and invest in the most effective prevention services. We emphasise the impact of prevention services can take several years to realise, which must be reflected in research design and social care funding

Identifying Regional Stakeholder-Informed Priorities for Adult Social Care Research: A Mixed-Method Study in Kent, Surrey, and Sussex

Context: There is an urgent need for sustainable change in the social care sector, and research plays an essential role in the identification of priority areas. Thus far, there have been few priority setting exercises within adult social care research. The current study explores regional priorities for adult social care research in Kent, Surrey, and Sussex. Stakeholders were consulted from the starting point of the project, ensuring that the identified research priorities were fully informed by the people that the subsequent research will have an impact on. Objectives: Our main aim was to identify research priorities for adult social care within the region, and more specifically, relevant activities within these priority areas that could benefit from evaluation. Methods: We employed a mixed-method design using online focus groups with social care professionals (N = 37) and members of the public (N = 7), and an online survey following the focus groups (N = 28). Focus group discussions were informed by themes based on The Care Act 2014. Findings: Content analysis was used to analyse discussions, which yielded a list of 46 actionable research questions. Rankings of discussion themes were produced to establish order of importance. Limitations: We approached the ranking of priorities only at a higher-order theme level, and not at the level of the specific questions. Implications: The extensive list of research questions produced in this study supports social care researchers to conduct studies that address pressing issues for care systems and the public

Reflections on the Use of Synchronous Online Focus Groups in Social Care Research

Focus groups are an extensively employed research method for the collection of qualitative data. Recent developments in teleconferencing platforms have produced a substantial increase in online research, including online focus groups. The current study is the first to discuss methodological reflections on the conduct of online focus groups in adult social care research. Previously reported research on the use of online focus groups in healthcare research cannot readily be applied to the significantly distinct social care sector. Unique characteristics of the social care sector, such as the dispersion of social care services, the significant funding gap, ongoing recruitment and retention issues, and an ageing population becoming increasingly reliant on social care have consequences for the design, conduct and appropriateness of the online focus group method. In this article, we review the use of synchronous online focus groups in social care research. We conducted six online focus groups with social care professionals (total N = 37). The online focus group method is evaluated by analysing and reporting data from a participant experience survey and researcher reflection logs. Additionally, this article reviews Microsoft Teams as a platform for online focus groups. It is concluded that the benefits of increased accessibility and representation significantly outweigh the limitations related to online social communication. We suggest that the use of the online focus groups method could enhance the relatively scarce research capacity in social care, and we provide practical recommendations for the design and conduct of online focus groups in social care research

Pelvic floor functional outcomes after total abdominal versus total laparoscopic hysterectomy for endometrial cancer

Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer.To evaluate pelvic floor function in women who have had surgical treatment for early stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium (LACE) trial and to compare patients' outcomes who had total abdominal total versus total laparoscopic hysterectomy.Multinational, phase 3, randomized non-inferiority trial comparing disease-free survival of patients who had total abdominal hysterectomy versus total laparoscopic hysterectomy. This substudy analyses the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory (PFDI)) administered pre-operatively, and at follow-up visits 6, 18, 30, 42, and 54 months post-operatively.Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy n=195; total laparoscopic hysterectomy n=186). At 6-months post-surgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor wellbeing (total abdominal hysterectomy: mean change -11.17, 95% CI: -17.11 to -5.24; total laparoscopic hysterectomy mean change -10.25, 95% CI: -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months post-surgery.These findings suggest that pelvic floor function in terms of urinary, bowel and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early stage endometrial cancer

The Role of Adult Social Care in the Prevention of Intensive Health and Care Needs: A Scoping Review

Context: Despite the strong emphasis on prevention in social care policy, there is a lack of evidence on the effectiveness of preventive social care interventions to delay escalation of intensive care needs. Objective(s): We reviewed the literature relating to the role of Adult Social Care to prevent escalation of care needs. We aimed to identify mechanisms in service delivery that prevent development of long-term care needs. Method(s): We used the PRISMA-ScR framework to review papers reporting the (cost)effectiveness of preventative services. Findings were qualitatively synthesised using elements of realist synthesis. Findings: Thirty-one papers were included covering: integrated care, intermediate care, rehabilitation, post-discharge services, community-based care, and domiciliary care. Overall, we found few studies with conclusive results to inform policy and practice. Moreover, the evidence was mostly concerned with the impact of social care on health care utilisation, with relatively few studies addressing the impact on social care utilisation. There was some preliminary evidence for the effectiveness of multi-faceted support set within the community, and improvements were observed for patients’ Quality of Life. Limitations: The variety of papers we included reflects the complexity of the social care landscape but prevents robust assessment of the impact of services to delay advancing care needs

Vitamin A and marbling attributes: Intramuscular fat hyperplasia effects in cattle

© 2017 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Twenty Angus steers were fed a diet low in β-carotene and vitamin A for 10 months. Ten steers were supplemented with vitamin A weekly, while the other ten steers did not receive any additional vitamin A. The results demonstrated that the restriction of vitamin A intake increased intramuscular fat (IMF) by 46%. This was a function of the total number of marbling flecks increasing by 22% and the average marbling fleck size increasing by 14%. Vitamin A restriction resulted in marbling flecks that were less branched (22%) and slightly more round (4%) with an increased minor axis length (7%). However, restricting vitamin A did not affect the size of the intramuscular or subcutaneous adipocyte cells or the subcutaneous fat depth. The results suggest that vitamin A affects the amount of marbling and other attributes of the marbling flecks due to hyperplasia rather than hypertrophy. This may explain why vitamin A restriction specifically affects IMF rather than subcutaneous fat deposition

Effects of delayed feeding, sodium butyrate and glutamine on intestinal permeability in newly-hatched broiler chickens

The aim of the current study was to investigate the effects of delayed feeding, and supplementation with sodium butyrate or glutamine in drinking water, on intestinal permeability (IP) in young broiler chickens. Newly-hatched male chickens (Ross 308) were allocated to four groups comprising Control, 24 h delayed fed (DF), DF supplemented with sodium butyrate (0.1%) in the drinking water and DF supplemented with glutamine (1%) in the drinking water. On days 2, 4 and 7, twelve birds per group were randomly selected, weighed and orally gavaged with fluorescein isothiocyanate dextran (FITC-d) at 2.2 mg / ml / chicken. Serum FITC-d concentration was analysed by spectrophotometry while serum diamine oxidase and D-lactic acid concentrations were analysed by microplate reader. FITC-d concentrations in the Control and DF groups were not statistically different on any day, suggesting that delayed feeding did not affect IP. Additionally, sodium butyrate increased IP compared to DF and Control on day 2 only (p

Care Workers and Managers’ Experiences of Implementing Infection Control Guidance in an Epidemic Context: A Qualitative Study in the South East of England, during the COVID-19 Prevaccination Era

The national response to COVID-19 has had a severe impact on adult social care settings, with high mortality amongst people receiving and providing care in England. Care workers had to rapidly adapt to new infection control measures to protect themselves, their colleagues, and the people receiving care. Infection control in residential and domiciliary care is always complex, but COVID-19 infection control measures impacted exceptionally on care workers’ working and everyday lives. We undertook qualitative interviews with care workers and managers (n = 10) in residential and domiciliary care for older people in the Southeast England during the first wave of the pandemic to understand their experiences, solutions, and concerns to implement guidance in practice. Data were analysed using framework analysis, and the following eight themes were identified: (1) Increasing visibility and support for the sector; (2) the impact of negative messaging about the sector; (3) feelings of isolation; (4) accessibility and usability of guidance; (5) social care staff as agents in producing and sharing good practice; (6) managing expectations and the impact of conflicting messages in the media; (7) improving communication with hospitals; and (8) problems in the early pandemic. The findings reveal widespread concerns for the marginalisation of the sector in the policy response and the inadequacy of infection control guidance. Guidance would benefit from a better understanding of domiciliary and residential care settings. This might involve the following steps: (a) coproduction of guidance with adult social care stakeholders, including those in direct-care roles and (b) a shift away from a clinical model of infection control towards a more flexible approach that attends to the inherent variability of care settings

How can risk of COVID-19 transmission be minimised in domiciliary care for older people: development, parameterisation and initial results of a simple mathematical model

This paper proposes and analyses a stochastic model for the spread of an infectious disease transmitted between clients and care workers in the UK domiciliary (home) care setting. Interactions between clients and care workers are modelled using specially generated networks, with network parameters reflecting realistic patterns of care needs and visit allocation. These networks are then used to simulate and SEIR-type epidemic dynamics with different numbers of infectious and recovery stages. The results indicate that with the same overall capacity provided by care workers, the minimum peak proportion of infection, and the smallest overall size of infection are achieved for the highest proportion of overlap between visit allocation, i.e. when care workers have the highest chances of being allocated a visit to the same client they have visited before. An intuitive explanation of this is that while providing the required care coverage, maximising overlap in visit allocation reduces the possibility of an infectious care worker inadvertently spreading the infection to other clients. The model is generic and can be adapted to any directly transmitted infectious disease, such as, more recently, COVID-19, provided accurate estimates of disease parameters can be obtained from real data