Training needs and development of online AT training for healthcare professionals in UK and France

Background: Assistive Technologies (AT) in healthcare can increase independence and quality of life for users. Concurrently, new AT devices offer opportunities for individualised care solutions. Nonetheless, AT remains under-utilised and is poorly integrated in practice by healthcare professionals (HCPs). Although occupational therapists (OTs), physiotherapists and speech and language therapists (SLTs) consider that AT solutions can offer problem-solving approaches to personalised care, they have a lesser understanding of application of AT in their practice. In this paper, we report findings of a survey on AT knowledge and experiences of HCPs in UK and France. Training needs also explored in the survey are presented in a separate paper on development of online training for the ADAPT project. Method: A survey of 37 closed/open questions was developed in English and French by a team of healthcare researchers. Content was informed by published surveys and studies. Email invitations were circulated to contacts in Health Trusts in UK and France ADAPT regions and the survey was hosted on an online platform. Knowledge questions addressed AT understanding and views of impact on user’s lives. Experience questions focussed on current practices, prescription, follow-up, abandonment and practice standards. 429 HCPs completed the survey (UK=167; FR=262) between June and November 2018. Key results: Participants were mainly female (UK 89.2%; FR 82.8%) and qualified 10+ years (UK 66.5%; FR 62.2%). A key group in both countries were OTs (UK 34.1%; FR 46.6%), with more physiotherapists and SLTs in UK (16.8%, 16.8%; Vs. FR 6.5%, 2.3%), and more nurses in France (22.1% Vs. UK 10.8%). More HCPs were qualified to degree level in France (75.2%; UK 48.5%, p<0.001). In terms of knowledge, all HCPs agreed that AT helps people complete otherwise difficult or impossible tasks (UK 86.2%; FR 94.3%) and that successful AT adoption always depends on support from carers, family and professionals (UK 52.7%; FR 66.2%). There were some notable differences between countries that require further exploration. For example, more French HCPs thought that AT is provided by trial and error (84.7%, UK 45.5%, p<0.001), while more UK HCPs believed that AT promotes autonomous living (93.4%; FR 42.8%, p<0.001). Also, more French HCPs considered that AT refers exclusively to technologically-advanced electronic devices (71.8%, UK 28.8%, p<0.001). In both countries, top AT prescribers were OTs, physiotherapists and SLTs. Respondents had little/no knowledge in comparing/choosing AT (UK 86.8%; FR 76.7%) and stated they would benefit from interdisciplinary clinical standards (UK 80.8%; FR 77.1%). A third of HCPs did not know if AT users had access to adequate resources/support (UK 34.1%; FR 27.5%) and rated themselves as capable to monitor continued effective use of AT (UK 38.9%; FR 34.8%). Conclusion: Knowledge and application of AT was varied between the two countries due to differences in health care provision and support mechanisms. Survey findings suggest that HCPs recognised the value of AT for users’ improved care, but had low confidence in their ability to choose appropriate AT solutions and monitor continued use, and would welcome AT interdisciplinary clinical standards

A literature review of the challenges encountered in the adoption of assistive technology (AT) and training of healthcare professionals

Background: Long-term disabilities often result in loss of autonomy and social interaction. Accordingly, there is a demand for Assistive Technology (AT) devices to enable individuals to live independently for as long as possible. However, many people experience difficulties in obtaining and using AT. This paper presents findings from a narrative literature review undertaken as part of the development of AT training for healthcare professionals, one of the work areas of the ADAPT project (Assistive Devices for Empowering Disabled People through Robotic Technologies), funded by EU INTERREG France (Channel) England. The results of the review informed the design of a survey of healthcare professionals regarding their views and experiences of AT and the development of AT training. Method: The review sought to understand challenges encountered in the adoption and use of AT as well as how training of healthcare professionals in AT takes place. A narrative approach was adopted as the most appropriate way to synthesise published literature on this topic and describe its current state-of-art. Narrative reviews are considered an important educational tool in continuing professional development. An initial search was conducted via databases in the UK and France, including CINAHL, Academic Search Index, Social Sciences Citation Index, BDSP (Base de données en Santé Publique), Documentation EHESP/MSSH (Ecole des Hautes Etudes en Santé Publique/Maison des Sciences Sociales et Handicap), Cairn, Google Scholar and Pubmed. Inclusion criteria for the review included: covering issues relating to AT provision and training, English or French language, and published from 1990 onwards. Application of these criteria elicited 79 sources, including journal papers (48), reports (11), online sources (11), books (6) and conference papers (3). Sources were thematically analysed to draw out key themes. Key results: The majority of papers were from USA and Canada (27), then UK (20) and France (19). Others were from Europe (7), Australia (3), country unknown (2), and one joint UK/France publication. The main source of literature was journal papers (48), of which the most common types were practice reports (18), evaluation surveys (10) and qualitative studies (9). The review uncovered a number of key challenges related to the adoption of devices, including: difficulty defining AT across disciplines, lack of knowledge of healthcare professionals and users, obtrusiveness and stigmatisation AT users can experience when using devices, and shortfalls in communication amongst professional groups and between professionals and users. These issues can lead to abandonment of AT devices. Furthermore, substantial barriers to healthcare professionals exist, including inconsistent provision and quality of training, lack of evaluation of training, lack of resources and funding, shortage of qualified professionals to teach, and the increasingly rapid development of the technologies. Conclusion: Support, training and education for prescribers, distributors, users, and their carers is vital in the adoption and use of AT. Evidence indicates a need for comprehensive education in the AT field, as well as ongoing assessment, updates and evaluation which is embedded in programmes

Novel robotic assistive technologies: choosing appropriate training for healthcare professionals

One of the key challenges for the training of healthcare professionals (HCPs) is to maintain a good understanding and knowledge of new assistive technologies (ATs) that are currently on the market [1]. Indeed, at present, available training on ATs is limited and does not meet the practice-related needs of HCPs. It is in this context that the ADAPT European project aims to develop a new AT training programme for healthcare professionals, which will also introduce them to the project’s new AT developments - a smart powered wheelchair and a virtual reality wheelchair-driving simulator. The program consists of six multimodal units; five delivered via e-learning and one through a blended method of e-learning and face-to-face sessions. The development of the content is guided by findings from an earlier literature review and an online survey of AT training needs for HCP’s, both undertaken by the ADAPT cross-national research team, comprised of UK and French experts. The level of technical difficulty increases with successive units in order to train all HCPs to use innovative ATs more widely in their practice. A Learning Management System enables the dissemination of the e-learning AT program. Preliminary results from participant unit-specific evaluations available at this stage are overall positive and encouraging

Small urban centres as launching sites for plant invasions in natural areas : insights from South Africa

CITATION: McLean, P. et al. 2017. Small urban centres as launching sites for plant invasions in natural areas: insights from South Africa. Biological Invasions, 19(12):3541-3555. doi:10.1007/s10530-017-1600-4The original publication is available at https://www.springer.com/journal/10530Alien species are often first introduced to urban areas, so it is unsurprising that towns and cities are often hotspots for invasions. However, while large cities are usually the first sites of introduction, small towns are more numerous and have a greater chance of launching invasions into natural areas as they have proportionally larger interfaces with their surroundings. In this paper we develop a set of scenarios as hypotheses to explore the role of small towns in facilitating within-country dispersal of alien plants. In particular, we developed ten scenarios for how introductions to small towns, agricultural and natural areas can lead to landscape-scale invasions. We tested a part of these scenarios using a case study of a highly invaded region in South Africa (the Berg River catchment in the Western Cape). We specifically investigated the main plant invasion routes between 12 small towns and their surrounding agricultural and natural areas. This was accomplished by conducting urban-specific alien plant surveys in towns, then comparing these results to regional databases of naturalized and/or invasive plants. Many of the alien plants found in urban areas were listed as invasive or naturalized in the catchment (over 30% of the total alien species pool). Despite marked environmental gradients across the study area, we found no relationships between the alien plant species richness in towns and climatic variables or with levels of anthropogenic disturbances. All towns hosted large numbers of invasive plant species and nearly half of the alien species found in towns were naturalized or invasive in surrounding areas. The likelihood of alien plants being naturalized or invasive outside urban areas increased in proportion to their local abundance in towns and if they were tall and woody. Ornamental horticulture was the main reason for introduction of these alien species (69%). Small towns can and do harbour significant populations of plant taxa that are able to spread to surrounding natural areas to launch invasions. Comparing lists of species from urban alien plant surveys with those from naturalisation records for the region is a useful protocol for identifying species which may be moving along the introduction– naturalization–invasion continuum.https://link.springer.com/article/10.1007/s10530-017-1600-4Publisher’s versio

Extreme oceanographic forcing and coastal response due to the 2015-2016 El Nino

The El Niño-Southern Oscillation is the dominant mode of interannual climate variability across the Pacific Ocean basin, with influence on the global climate. The two end members of the cycle, El Niño and La Niña, force anomalous oceanographic conditions and coastal response along the Pacific margin, exposing many heavily populated regions to increased coastal flooding and erosion hazards. However, a quantitative record of coastal impacts is spatially limited and temporally restricted to only the most recent events. Here we report on the oceanographic forcing and coastal response of the 2015–2016 El Niño, one of the strongest of the last 145 years. We show that winter wave energy equalled or exceeded measured historical maxima across the US West Coast, corresponding to anomalously large beach erosion across the region. Shorelines in many areas retreated beyond previously measured landward extremes, particularly along the sediment-starved California coast

Clinical use of HIV integrase inhibitors : a systematic review and meta-analysis

Background: Optimal regimen choice of antiretroviral therapy is essential to achieve long-term clinical success. Integrase inhibitors have swiftly been adopted as part of current antiretroviral regimens. The purpose of this study was to review the evidence for integrase inhibitor use in clinical settings. Methods: MEDLINE and Web-of-Science were screened from April 2006 until November 2012, as were hand-searched scientific meeting proceedings. Multiple reviewers independently screened 1323 citations in duplicate to identify randomized controlled trials, nonrandomized controlled trials and cohort studies on integrase inhibitor use in clinical practice. Independent, duplicate data extraction and quality assessment were conducted. Results: 48 unique studies were included on the use of integrase inhibitors in antiretroviral therapy-naive patients and treatment-experienced patients with either virological failure or switching to integrase inhibitors while virologically suppressed. On the selected studies with comparable outcome measures and indication (n = 16), a meta-analysis was performed based on modified intention-to-treat (mITT), on-treatment (OT) and as-treated (AT) virological outcome data. In therapy-naive patients, favorable odds ratios (OR) for integrase inhibitor-based regimens were observed, (mITT OR 0.71, 95% CI 0.59-0.86). However, integrase inhibitors combined with protease inhibitors only did not result in a significant better virological outcome. Evidence further supported integrase inhibitor use following virological failure (mITT OR 0.27; 95% CI 0.11-0.66), but switching to integrase inhibitors from a high genetic barrier drug during successful treatment was not supported (mITT OR 1.43; 95% CI 0.89-2.31). Integrase inhibitor-based regimens result in similar immunological responses compared to other regimens. A low genetic barrier to drug-resistance development was observed for raltegravir and elvitegravir, but not for dolutegravir. Conclusion: In first-line therapy, integrase inhibitors are superior to other regimens. Integrase inhibitor use after virological failure is supported as well by the meta-analysis. Careful use is however warranted when replacing a high genetic barrier drug in treatment-experienced patients switching successful treatment