A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions. (PRISMS Practical systematic RevIew of Self-Management Support for long-term conditions)

Background: Despite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked. Aim: To undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts. Methods: Self-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support. Results: We included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need. Conclusions: Supporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations. Study registration: This study is registered as PROSPERO CRD42012002898. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Prolonged play with the ColorFlares : how does open-ended play behavior change over time?

This paper describes an explorative user study with interactive objects for open-ended play, i.e. play with flexible game goals and rules. Children were asked to play with interactive objects, called the ColorFlares, in three free play sessions over a period of three weeks. We measured social interaction in terms of social play and social communication. We found that group play over all three sessions remained high. We also found that communication in the first session was mainly about the possibilities of the ColorFlares. Later on, communication was related more to the games that were played, giving each other feedback. We also discuss the personal and situational factors that have influence on the test results

Prolonged play with the ColorFlares : how does open-ended play behavior change over time?

This paper describes an explorative user study with interactive objects for open-ended play, i.e. play with flexible game goals and rules. Children were asked to play with interactive objects, called the ColorFlares, in three free play sessions over a period of three weeks. We measured social interaction in terms of social play and social communication. We found that group play over all three sessions remained high. We also found that communication in the first session was mainly about the possibilities of the ColorFlares. Later on, communication was related more to the games that were played, giving each other feedback. We also discuss the personal and situational factors that have influence on the test results

Risk indicators for the Charles Bonnet Syndrome

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Fast model-based approximation of the closed-loop performance limits of gas/liquid inline separators for accellerated design

A current trend in the oil and gas industry is to use compact so called inline separators (ILS). Unlike their large conventional counterparts, the operation of these separators is very sensitive towards variations in the multiphase flow to be separated. This sensitivity easily results in operational problems and economic loss and may prohibit the application of ILS, in particular as many current production operations are facing large slug flow type of variations. One way to reduce the ILS sensitivity towards flow variations is via improved control. Here, motivated by the industrial need for cost-effective compact separators with sufficient flow variation handling capabilities, a model based approach is pursued to obtain this improvement. More specific, as a first main contribution, a new approach to control oriented modeling of gas/liquid (G/L) ILS is proposed which, in contrast to currently available such modeling approaches, allows for a comprehensive evaluation and design of G/L ILS control strategies. As an example application of the models resulting from this approach and as a second main contribution of this paper, a new model and feedforward control based method for fastly approximating the closed-loop performance limits of a G/L ILS is proposed. The motivation for pursuing this method is an acceleration in overall G/L ILS design speed. The merits of the method are demonstrated through a simulation based application on a commercially available G/L ILS. © 2011 IFAC

Transinguinal preperitoneal (TIPP) vs endoscopic total extraperitoneal (TEP) procedure in unilateral inguinal hernia repair: a randomized controlled trial

Purpose: The Lichtenstein hernioplasty has long been seen as the gold standard for inguinal hernia repair. Unfortunately, this repair is often associated with chronic pain, up to 10–35%. Therefore, several new techniques have been developed, such as the transinguinal preperitoneal patch (TIPP) and the endoscopic total extraperitoneal (TEP) technique. Several studies showed beneficial results of the TIPP and TEP compared to the Lichtenstein hernioplasty; however, little is published on the outcome when comparing the TIPP and TEP procedures. This study aimed to evaluate outcomes after the TIPP vs the TEP technique for inguinal hernia repair. Methods: A single-center randomized controlled trial was carried out between 2015 and 2020. A total of 300 patients with unilateral inguinal hernia were enrolled and randomized to the TIPP- or TEP technique. Primary outcome was chronic pain (defined as any pain following the last 3 months) and quality of life, assessed with Carolinas comfort scale (CCS) at 12 months. Secondary outcomes were: wound infection, wound hypoesthesia, recurrence, readmission within 30 days, and reoperation. Results: A total of 300 patients were randomized (150 per group). After a follow-up of 12 months, we observed significantly less postoperative chronic groin pain, chronic pain at exertion, wound hypoesthesia, and wound infections after the TEP when compared to the TIPP procedure. No significant differences in quality of life, reoperations, recurrence rate, and readmission within 30 days were observed. Conclusion: We showed that the TEP has a favorable outcome compared to the TIPP procedure, leading to less postoperative pain and wound complications, whereas recurrence rates and reoperations were equal in both the groups