Latent profile analysis in frontotemporal lobar degeneration and related disorders: clinical presentation and SPECT functional correlates

<p>Abstract</p> <p>Background</p> <p>Frontotemporal Lobar Degeneration (FTLD) thus recently renamed, refers to a spectrum of heterogeneous conditions. This same heterogeneity of presentation represents the major methodological limit for the correct evaluation of clinical designation and brain functional correlates. At present, no study has investigated clinical clusters due to specific cognitive and behavioural disturbances beyond current clinical criteria.</p> <p>The aim of this study was to identify clinical FTLD presentation, based on cognitive and behavioural profile, and to define their SPECT functional correlations.</p> <p>Methods</p> <p>Ninety-seven FTLD patients entered the study. A clinical evaluation and standardised assessment were preformed, as well as a brain SPECT perfusion imaging study. Latent Profile Analysis on clinical, neuropsychological, and behavioural data was performed. Voxel-basis analysis of SPECT data was computed.</p> <p>Results</p> <p>Three specific clusters were identified and named "pseudomanic behaviour" (LC1), "cognitive" (LC2), and "pseudodepressed behaviour" (LC3) endophenotypes. These endophenotypes showed a comparable hypoperfusion in left temporal lobe, but a specific pattern involving: medial and orbitobasal frontal cortex in LC1, subcortical brain region in LC2, and right dorsolateral frontal cortex and insula in LC3.</p> <p>Conclusion</p> <p>These findings provide evidence that specific functional-cluster symptom relationship can be delineated in FTLD patients by a standardised assessment. The understanding of the different functional correlates of clinical presentations will hopefully lead to the possibility of individuating diagnostic and treatment algorithms.</p

Carpal Tunnel Syndrome: A Review of the Recent Literature

Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging

Gatekeeping access to the midwifery unit: Managing complaints by bending the rules

While poor communication between service users and front-line staff causes many service user complaints in the British National Health Service, staff rarely reflect on the causes of these complaints. We discuss findings from an action research project with midwives which suggest that the midwives struggled to fully understand complaints from women, their partners and families particularly about restricted visiting and the locked door to the midwifery unit. They responded to individual requests to visit out of hours while maintaining the general policy of restricted visiting. In this way, the door was a gatekeeping device which allowed access to the unit within certain rules. The locked door remained a barrier to women and their families and as a result was a common source of informal complaints. We argue that the locked door and restricted visiting to the midwifery unit were forms of gatekeeping and boundary making by midwives which reveals a tension between their espoused woman-centred care and contemporary midwifery practice which is increasingly constrained by institutional values

From transformative learning to social change? Using action research to explore and improve informal complaints management in an NHS trust

Background: The number of complaints from patients and/or carers concerning aspects of care has increased over time. Yet, in spite of a growing body of national and international literature on healthcare complaints, there is a lack of knowledge around how nurses and midwives manage informal complaints at ward level, or staff needs in relation to this. Aim: Using an action research approach with mixed methods, four phases and four cycles, the aim was to explore informal complaints management by nurses and midwives at ward level. We discuss the action research process primarily in connection with learning and service change, drawing from the qualitative data in this paper. Findings: The analysis of the collected qualitative data resulted in three main themes, related to the complexities of complaints and complaints management, staff support needs and the existing ambiguous complaints systems, which are hard for staff and service users to negotiate. The action research approach facilitated learning and change in participants in relation to complaints management, in the collaborating trust. Conclusions: The extant body of research on complaints does not sufficiently recognise the complexity of complaints and informal complaints management, or the complaints systems that are in place. Needs-based staff training can help support staff to manage informal complaints more effectively. Implications for practice: • There needs to be recognition of the complexities involved in complaints management • Complaints systems need to be clearer for the benefit of service users and staff • Staff need training and support that is tailored to their needs to improve their response to complaints, leading to a better patient experience • Limited interventions, informed by staff needs, can lead to change and act as a catalyst for a wider change in informal complaints managemen

Supporting staff to respond effectively to informal complaints: findings from an action research study

Aim and objective To understand how nurses and midwives manage informal complaints at ward level. Background The provision of high quality, compassionate clinical nursing and midwifery is a global priority. Complaints management systems have been established within the National Health Service in the UK to improve patient experience yet little is known about effective responses to informal complaints in clinical practice by nurses and midwives. Design Collaborative action research. Methods Four phases of data collection and analysis relating to primarily one National Health Service trust during 2011–2014 including: scoping of complaints data, interviews with five service users and six key stakeholders and eight reflective discussion groups with six midwives over a period of nine months, two sessions of communications training with separate groups of midwives and one focus group with four nurses in the collaborating trust. Results Three key themes emerged from these data: multiple and domino complaints; ward staff need support; and unclear complaints systems. Conclusions Current research does not capture the complexities of complaints and the nursing and midwifery response to informal complaints. Relevance to clinical practice Robust systems are required to support clinical staff to improve their response to informal complaints and thereby improve the patient experience