Using an assessment tool to support capacity assessments undertaken remotely in the context of a global health crisis:A feasibility study

This thesis comprises a systematic literature review, an empirical paper and a critical appraisal. A systematic review of quantitative studies examining the efficacy of cognitive interventions to improve decision-making in people with Mild Cognitive Impairment (MIC) was conducted. Twenty-six papers were identified. Results indicate that interventions to improve decision-making in people with MCI can be effective. Most studies tested interventions designed to improve higher-order thinking skills, or executive functions, that are thought to underpin decision-making. Of these, interventions targeting logical reasoning, cognitive control and inhibition demonstrated the best results. Risk of bias arising from poor quality research design or reporting affected most studies. Consequently, it was not possible to draw clear conclusions about the efficacy of particular interventions at this time. Implications and recommendations for research are discussed. The empirical paper explores the feasibility of using a capacity assessment tool designed to support remote working during the COVID-19 health crisis. Views were gathered from eight participants either through online focus groups or online individual interviews. Data from transcribed discussions, notes taken by a focus group assistant and notes from focus group debrief sessions between the researcher and focus group assistant were analysed using thematic analysis. Findings indicate that the tool is perceived to be feasible for use in practice and merits additional research. The assessment tool was praised for its structure and for prompts, questions and examples that enabled participants to obtain useful data in a pressurised context. Clinical implications are discussed and recommendations for research are outlined. The critical appraisal section offers reflections on the process of undertaking research into mental capacity and decision making. Ethical, philosophical and practical benefits and challenges are explored. The experience of undertaking research during a significant health crisis is examined and recommendations made for future applied research in these areas

I Get By with a Little Help from My Friends

A qualitative study was completed to find if transition related skills of the young adults with intellectual disabilities improved while living for five years at the Friendship House. The Friendship House is a special dorm where individuals with intellectual disabilities live side by side with graduate students. Each of these young adults with intellectual disabilities were interviewed with an instrument that aligned with the Individuals with Disabilities Education Act (IDEA) entitled the Transition Planning Inventory (TPI). Findings from the TPI show that living at the Friendship House has helped these individuals improve their IDEA transition related skills of employment, home living, recreation/leisure and community participation. Areas of continual improvement include self-determination skills and social skills. Overall, the individuals with intellectual disabilities have grown in their IDEA transition related skills while living in this unique dorm

Supporting someone with an eating disorder: a systematic review of caregiver experiences of eating disorder treatment and a qualitative exploration of burnout management within eating disorder services

Aims: Eating disorder recovery is often supported by caregivers and mental health professionals. This research portfolio focuses on the experiences of supporting someone with an eating disorder from the perspective of the caregivers and also mental health professionals. The aims of this research portfolio are: Firstly, to systematically review the published qualitative literature relating to the experiences of caregivers supporting someone during eating disorder treatment; and secondly, to investigate the factors which may contribute to burnout, the factors which may protect against burnout and ways of managing work related stress for healthcare professionals who work in an eating disorder service. Method: A systematic review and meta-synthesis of caregiver experiences with eating disorder treatment was conducted. Searches identified 1927 studies of which 12 met the inclusion criteria for the study. Quality assessment revealed a number of strengths and also some limitations of the studies. For the research study ten healthcare professionals were interviewed on their experiences of supporting people with an eating disorder and ways of managing work related stress/burnout in this role. Interpretative Phenomenological Analysis was used to analyse the data. Results: Five major themes were identified from the systematic review: “access to treatment”, “key features of treatment”, “support for the caregiver”, “encounters with health care professionals” and “the future – hopes and fears”. The research study identified seven super-ordinate themes: “Dealing with Client Physical Health Risks”, “Working to Different Goals from the Client”, “Awareness of own Eating Patterns”, “Personal Accomplishment”, “Working Together as a Team”, “Working with Caregivers” and “Ways of Managing Work Related Stress”. Conclusions: The systematic review highlighted a number of clinical implications including the importance to caregivers of early intervention, the provision of practical, tailored information, support for the caregiver, the need for caregivers and professionals to work collaboratively and the importance of instilling hope in caregivers. The research study highlights potential contributors to burnout in eating disorder services as well as positive or protective factors to burnout. It also highlights ways of managing burnout through ensuring a work-life balance, utilising self-care strategies, self-reflection and realising recovery is not ‘all or nothin

GoPrime: development of an in silico framework to predict the performance of real-time PCR primers and probes using foot-and-mouth disease virus as a model

Real-time PCR (rPCR) is a widely accepted diagnostic tool for the detection and quantification of nucleic acid targets. In order for these assays to achieve high sensitivity and specificity, primer and probe-template complementarity is essential; however, mismatches are often unavoidable and can result in false-negative results and errors in quantifying target sequences. Primer and probe sequences therefore require continual evaluation to ensure they remain fit for purpose. This paper describes the development of a linear model and associated computational tool (GoPrime) designed to predict the performance of rPCR primers and probes across multiple sequence data. Empirical data were generated using DNA oligonucleotides (n = 90) that systematically introduced variation in the primer and probe target regions of a diagnostic assay routinely used to detect foot-and-mouth disease virus (FMDV); an animal virus that exhibits a high degree of sequence variability. These assays revealed consistent impacts of patterns of substitutions in primer and probe-sites on rPCR cycle threshold (CT) and limit of detection (LOD). These data were used to populate GoPrime, which was subsequently used to predict rPCR results for DNA templates (n = 7) representing the natural sequence variability within FMDV. GoPrime was also applicable to other areas of the FMDV genome, with predictions for the likely targets of a FMDV-typing assay consistent with published experimental data. Although further work is required to improve these tools, including assessing the impact of primer-template mismatches in the reverse transcription step and the broader impact of mismatches for other assays, these data support the use of mathematical models for rapidly predicting the performance of rPCR primers and probes in silico

Impact and experiences of vestibular disorders and psychological distress: Qualitative findings from patients, family members and healthcare professionals

Introduction: People with vestibular disorders frequently experience reduced quality of life and challenges with activities of daily living. Anxiety, depression and cognitive problems often co‐present with vestibular disorders and can aggravate symptoms and prolong clinical recovery. We aimed to gain in‐depth insights into the impact of vestibular disorders and the contribution of psychological factors by exploring multistakeholder perspectives. Methods: Semistructured interviews were conducted between October 2021 and March 2022 with 47 participants in the United Kingdom including: 20 patients (age M = 50.45 ± 13.75; 15 females), nine family members (age M = 61.0 ± 14.10; four females), and 18 healthcare professionals. Data were analysed using framework analysis. Results: Vestibular disorders impact diverse aspects of patients' lives including work, household chores, socialising, and relationships with family and friends. Being unable to engage in valued activities or fulfil social roles contributes to feelings of grief and frustration, affecting identity, confidence, and autonomy. Anxiety and low mood contribute to negative thought processes, avoidance, and social withdrawal, which can impede clinical recovery through reduced activity levels, and end engagement with treatment. Coping strategies were thought to help empower patients to self‐manage their symptoms and regain a sense of control, but these require oversight from healthcare providers. Conclusions: Daily activity limitations, social participation restrictions, and psychological distress can interact to impact quality of life, sense of self, and clinical recovery amongst people with vestibular disorders. Information and resources could aid societal awareness of the impact of vestibular disorders and help patients and families feel understood. An individualised and comprehensive approach that concurrently addresses mental, physical, social, and occupational needs is likely to be beneficial. Patient or Public Contribution: Two group meetings were held at the beginning and end of the study with a patient and public involvement network formed of people with vestibular disorders and family members. These individuals commented on the study aims, interview schedule, participant recruitment practices, and interpretation of the themes identified. Two core patient members were involved at all stages of the research. These individuals contributed to the formulation of the interview schedule, development and application of the coding scheme, development and interpretation of themes, and preparation of the final manuscript

Participant perspectives on cognitive remediation and social recovery in early psychosis (CReSt-R): an acceptability study

Aim: Psychosis spectrum disorders continue to rank highly among causes of disability. This has resulted in efforts to expand the range of treatment targets beyond symptom remission to include other recovery markers, including social and occupational function and quality of life. Although the efficacy of psychosocial interventions in early psychosis has been widely reported, the acceptability of these interventions is less well-known. This study explores the participant perspective on a novel, psychosocial intervention combining cognitive remediation and social recovery therapy. Methods: We employed a qualitative research design, based on semi-structured interviews and reflexive thematic analysis. Six participants with early psychosis were recruited from the intervention arm of a randomized pilot study, three women and three men, aged between 22 and 27 years. Results: Four themes were developed through the analytical process, namely, (1) a solid therapeutic foundation, (2) multi-directional flow of knowledge, (3) a tailored toolset, and (4) an individual pathway to recovery. Participants also provided pragmatic feedback about how to improve the delivery of the therapy assessments and intervention. Both the themes and pragmatic feedback are described. Conclusions: People with early psychosis described the intervention as acceptable, engaging, helpful and person-centred, suggesting its potential role in a multicomponent therapy model of early intervention in psychosis services. Participants in this study also highlight the importance of an individualized approach to therapy, the vital role of the therapeutic relationship and the ecological validity and value of adopting an assertive outreach delivery, providing therapy outside a conventional clinic setting

Children's Services Reform Research Study : Rapid Evidence Review

This is a Scotland-based research study being undertaken by CELCIS, the Centre for Excellence for Children’s Care and Protection. CELCIS was asked by the Scottish Government to carry out this research study with the aim of gathering evidence to inform decision-making about how best to deliver children's services in Scotland in light of the proposed introduction of the National Care Service, and its commitment to keep The Promise of the Independent Care Review. The purpose of the research is to answer the question: What is needed to ensure that children, young people and families get the help they need, when they need it? The research study has four separate strands of work, which together aim to provide a comprehensive and holistic approach to answering this question. The findings of each strand of work will be published separately, in a full research report and a shorter summary report. We hope that this overview acts as a guide to help you to navigate through each strand of the research, and the different evidence that these will present. A final report will be published at the end of the study which will draw together and synthesise all four strands of the findings to address the research question