Treatment outcomes in schizophrenia: qualitative study of the views of family carers

Abstract Background Schizophrenia is a complex, heterogeneous disorder, with highly variable treatment outcomes, and relatively little is known about what is important to patients. The aim of the study was to understand treatment outcomes informal carers perceive to be important to people with schizophrenia. Method Qualitative interview study with 34 individuals and 8 couples who care for a person with schizophrenia/schizoaffective disorder. Interviews were transcribed verbatim and analysed by a thematic framework based approach. Results Carers described well-recognised outcomes of importance, alongside more novel outcomes relating to: Safety (of the patient/others); insight (e.g. into non-reality of psychotic phenomena); respite from fear, distress or pain; socially acceptable behaviour; getting out of the house; attainment of life milestones; changes in personality and/or temperament; reduction of vulnerability to stress; and several aspects of physical health. Conclusions These findings have the potential to inform the development of patient- or carer- focused outcome measures that take into account the full range of domains that carers feel are important for patients. Keywords Schizophrenia Treatment Patient Carer Outcom

Use of Large Data Sets in Evaluating Program Outcome in Pediatric Hearing Loss

Introduction Permanent hearing loss (PHL) in childhood can profoundly impact development, with high economic costs to children and society. Hearing technology and service delivery advances, including universal newborn hearing screening implemented in Ontario in 2002 as part of the Infant Hearing Program (IHP), aim to improve outcomes of children with PHL. Objectives and Approach We examined the impact of IHP screening on age of identification of PHL, and compared healthcare utilization in children with and without PHL, in the Census Metropolitan Area of Ottawa. Children with PHL, identified from a database at the Children’s Hospital of Eastern Ontario, were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences. Five residents of Ottawa acted as non-PHL controls for each PHL case. A regression discontinuity design (RDD) was used to investigate differences in age of identification pre- and post-IHP implementation. Poisson regression will compare healthcare utilization among children with and without PHL. Results Receipt of the HBPB was associated with reductions in low birth weight births (adjusted Relative Risk (aRR): 0.77; 95% CI: 0.63, 0.93) and preterm births (aRR: 0.78 (0.68, 0.90)), and increases in breastfeeding initiation (aRR: 1.05 (1.00, 1.09)) and large-for-gestational age births (aRR: 1.11 (1.01, 1.23)). HBPB receipt during pregnancy was also associated with increases in 1- and 2-year immunizations for FN children (aRR: 1.14 (1.09, 1.19), and aRR: 1.28 (1.19, 1.36), respectively). Reductions in the risk of being developmentally vulnerable in the language and cognitive domain of the EDI were also found for FN children whose mothers had received the HBPB during pregnancy (aRR: 0.85 (0.74, 0.97). Conclusion/Implications IHP implementation resulted in earlier identificationof PHL in children, allowing earlier access to audiologic and habilitative services. However, children with PHL used the health system more often and in different ways from those without PHL. These results can support improvements in service delivery for children with PHL

Protecting older people living in care homes from COVID-19 : a protocol for a mixed-methods study to understand the challenges and solutions to implementing social distancing and isolation.

Older people living in residential and nursing care homes often have complex needs and are at high risk of poor health outcomes and mortality, especially if they contract COVID-19. Care homes use infection prevention and control measures such as social distancing and isolating residents to protect them from COVID-19. The care home sector has stated that implementing social distancing and isolation when caring for residents is a significant challenge. This paper presents the protocol of a mixed-methods study to explore and understand the real-life experiences of implementing social distancing and isolation of residents in care homes for older people from the perspective of residents, families/friends and staff working in and with care homes. The study aims to develop a toolkit of resources for health and care delivery now and for future outbreaks of infectious diseases. The study will be conducted in three phases. Phase 1 is a rapid review of evidence to collate knowledge on the mechanisms and measures used by care homes and long-term facilities to socially distance and isolate older people or control the spread of other infectious and contagious diseases. The review results will contribute to participant interviews in phase 2 and toolkit development in phase 3. Phase 2 will involve case studies with six care homes in England, involving the conduct of individual interviews with residents, families and friends, and staff, collection of care home policies and protocols related to social distancing and isolation for residents, and routinely collected care home data. A focus group with a purposive sample of external key informants will also be conducted. Phase 3, synthesising findings from phases 1 and 2, will inform the codesign of a toolkit of resources for residents, families/friends and care homes. The study has been approved by Coventry and Warwick Research Ethics Committee (20/WM/0318). To maximise impact, we will work closely with the Study Committees and the Patient and Public Involvement group to ensure the findings reach key stakeholders, including residents, families/friends, care homes, commissioners and organisations representing care home providers. We will disseminate the study outputs in peer-reviewed and professional journals, at professional conferences and via other knowledge transfer activities with the care home sector, and resident and carer organisations. The toolkit comprising evidence-informed guidance and resources and a mosaic film will be hosted on a project webpage. This project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (Project reference NIHR132541). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. CRD42021226734. [Abstract copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Social Distancing and Isolation Strategies to Prevent and Control the Transmission of COVID-19 and Other Infectious Diseases in Care Homes for Older People: An International Review.

Older people living in care homes are at high risk of poor health outcomes and mortality if they contract COVID-19 or other infectious diseases. Measures used to protect residents include social distancing and isolation, although implementation is challenging. This review aimed to assess the social distancing and isolation strategies used by care homes to prevent and control the transmission of COVID-19 and other infectious diseases. Seven electronic databases were searched: Medline, CINAHL, Embase, PsycINFO, HMIC, Social Care Online, and Web of Science Core Collection. Grey literature was searched using MedRxiv, PDQ-Evidence, NICE Evidence Search, LTCCovid19.org and TRIP. Extracted data were synthesised using narrative synthesis and tabulation. 103 papers were included (10 empirical studies, seven literature reviews, and 86 policy documents). Strategies used to prevent and control the transmission of COVID-19 and other infectious diseases included social distancing and isolation of residents and staff, zoning and cohorting of residents, restriction of resident movement/activities, restriction of visitors and restriction of staff working patterns. This review demonstrates a lack of empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. Evaluative research on these interventions is needed urgently, focusing on the well-being of all residents, particularly those with hearing, vision or cognitive impairments

Internationalisation in learning and teaching : Thematic Peer Group report

Publisher PD

Neoadjuvant Chemotherapy Modulates the Immune Microenvironment in Metastases of Tubo-Ovarian High-Grade Serous Carcinoma

This research was funded by Swiss Cancer League (BIL KLS-2883-02-2012), the European Research Council (ERC322566), Cancer Research UK (A16354), and Barts and The London Charity (467/1307)

Implicit and explicit pedagogical practices related to sociocultural issues and social justice in physical education teacher education programs

Background: For many years, scholars in PETE have argued for the importance of educating pre-service teachers (PSTs) about equality (e.g., Evans 1990), sociocultural perspectives and issues (e.g., Cliff, Wright and Clarke, 2009; Author 2014) and critical pedagogy (e.g., Fernandez-Balboa 1997; Philpot 2015). Despite this advocacy, we would argue that there are significant differences in how faculty teach about sociocultural issues, and for, social justice. The pedagogical actions through which Physical Education Teacher Educators (PETEs) do this work is the focus of this paper. Purpose: We investigated the pedagogical approaches and strategies used by PETE faculty to address and educate PSTs about social justice and sociocultural issues related to gender, race, sexuality, (dis)ability, socioeconomic status and religion in their individual PETE programs. In this study, we draw on transformational pedagogy (Ukpokodu 2009; Ovens 2017) as a framework for theorizing the data. Through this study, we highlight the pedagogical practices espoused as those that engender transformative learning. Data collection and analysis: Data for this interpretive qualitative research study was collected primarily through in-depth semi-structured interviews with over 70 PETEs who work in 48 PETE programs across Australia, Canada, England, Ireland New Zealand, Sweden, and the United States. Furthermore, an informational survey was used to gather demographic data of the participants. The participants, all current PETEs, had a wide range of professional experiences, which included the length of time in the profession, the type of institution employed, educational backgrounds and courses taught. Data analysis was completed using the processes of content analysis and the constant comparative method (Corbin and Strauss 2008). Findings: Three major themes represent the findings. In the first theme, ‘Intentional and Explicit Pedagogies’ we provide descriptions of the approaches and strategies used by PETEs in this study that were planned in advance of the learning experiences. In the second theme, ‘Teachable Moments’ we provide examples of how PETEs utilized ‘teachable moments’ in implicit and explicit ways to educate PSTs about sociocultural issues. The third theme, ‘Resistance and Constraints’ captures the individual challenges PETE faculty faced within their courses if, and when, they teach for equity and social justice. The findings suggest that social justice struggles to find an explicit presence within many PETE programs and that educating PSTs about sociocultural issues and social justice is lacking in many PETE programs

Evidence-based Toxicology for the 21st Century: Opportunities and Challenges

The Evidence-based Toxicology Collaboration (EBTC) was established recently to translate evidence-based approaches from medicine and health care to toxicology in an organized and sustained effort. The EBTC held a workshop on “Evidence-based Toxicology for the 21st Century: Opportunities and Challenges” in Research Triangle Park, North Carolina, USA on January 24-25, 2012. The presentations largely reflected two EBTC priorities: to apply evidence-based methods to assessing the performance of emerging pathwaybased testing methods consistent with the 2007 National Research Council report on “Toxicity Testing in the 21st Century” as well as to adopt a governance structure and work processes to move that effort forward. The workshop served to clarify evidence-based approaches and to provide food for thought on substantive and administrative activities for the EBTC. Priority activities include conducting pilot studies to demonstrate the value of evidence-based approaches to toxicology, as well as conducting educational outreach on these approaches

Evidence-based Toxicology for the 21st Century: Opportunities and Challenges

The Evidence-based Toxicology Collaboration (EBTC) was established recently to translate evidence-based approaches from medicine and health care to toxicology in an organized and sustained effort. The EBTC held a workshop on “Evidence-based Toxicology for the 21st Century: Opportunities and Challenges” in Research Triangle Park, North Carolina, USA on January 24-25, 2012. The presentations largely reflected two EBTC priorities: to apply evidence-based methods to assessing the performance of emerging pathwaybased testing methods consistent with the 2007 National Research Council report on “Toxicity Testing in the 21st Century” as well as to adopt a governance structure and work processes to move that effort forward. The workshop served to clarify evidence-based approaches and to provide food for thought on substantive and administrative activities for the EBTC. Priority activities include conducting pilot studies to demonstrate the value of evidence-based approaches to toxicology, as well as conducting educational outreach on these approaches