A case study analysis to explore the perceptions and experiences of patients, carers and/or family members and healthcare professionals in the management of metastatic spinal cord compression (MSCC)

BackgroundMetastatic spinal cord compression (MSCC) can result in paralysis and is an oncology emergency. Prognosis is poor if not treated early. There are an estimated 1200-2500 new cases of MSCC per year in Scotland. At 2013 there are limited studies which have explored the issues experienced by patients, carers and/or family members and healthcare professionals in the management of MSCC.AimThe aim of this study was to explore the perceptions and experiences of patients, carers and/or family members and healthcare professionals in the management of metastatic spinal cord compression.Research Design and MethodsA case study design approach involving two phases was used. Phase One involved three focus groups with healthcare professionals (n=25) and one-to-one interviews with healthcare professionals (n=7). Phase Two involved interviews with patients (n=8), carers (n=6) and healthcare professionals (n=42). Patients and carers were interviewed twice over a period of six months. Braun and Clarke’s (2006) thematic inductive-data approach was used for data analysis.FindingsPhase One identified an overarching theme of ‘negotiating the care pathway’ with four main themes: what can we do for patients with MSCC; what do we need to ‘trade-off’ to meet the needs of patients; how can guidelines help anyway; and how can we deliver optimum care in the midst of uncertainty? The majority of healthcare professionals viewed the existing National Institute for Clinical Excellence (NICE) guidelines (2008) as inadequate and lacking in a strong evidence base. Healthcare professionals acknowledged the importance of meeting the patient’s preferred needs and goals given the nature of this condition and the short life expectancy of many patients with MSCC. Phase Two identified three main themes: facing uncertainty in MSCC; finding a balance in MSCC and support beyond the treatment of MSCC. A focus on acute management is often at odds with the palliative nature of the patient’s condition and this contributes to the complexity for patients, carers and healthcare professionals. The findings demonstrate the intricacies of uncertainty which affect all the key stakeholders when MSCC presents. There is a constant movement between uncertainty (of the future) and enduring inconsistencies (of information, treatment and advice for the future), which results in a struggle to find a balance.ConclusionsCaring for patients with metastatic spinal cord compression is challenging with uncertainties surrounding the diagnosis of MSCC, spinal instability, treatment and support beyond the treatment of MSCC. A theory of collaborative decision making based on the findings in this thesis is proposed to help reduce uncertainty and enable key stakeholders to make decisions in their journey with MSCC

To assess the efficacy and safety of manual lymphatic drainage in treating breast cancer related lymphoedema.

This is a summary of a Cochrane review of Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD003475. DOI: 10.1002/14651858.CD003475.pub2

Exploration of family carers' experiences of support for rapid discharge arrangements for end-of-life care at home: a qualitative study.

Family carers play an integral role in achieving successful hospital discharge, especially when people would prefer to die at home (Larsson et al. 2018). In the North East of Scotland, there is a lack of information on how prepared family carers were, when their loved ones were discharged rapidly from hospital to home. The aim of this study was to explore these carers' experiences of support for rapid discharge for end-of-life care at home. This presentation was awarded the "Scientific Reviewers' Prize" at the 2022 NHS Grampian Research and Development Conference

Positioning and spinal bracing for pain relief in metastatic spinal cord compression in adults.

Background: This is an updated version of the original Cochrane review published in Issue 3 (Lee 2012) on patient positioning (mobilisation) and bracing for pain relief and spinal stability in adults with metastatic spinal cord compression. Many patients with metastatic spinal cord compression (MSCC) have spinal instability, but their clinician has determined that due to their advanced disease they are unsuitable for surgical internal fixation. Mobilising may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (whether a patient should be managed with bed rest or allowed to mobilise) and whether spinal bracing is helpful, is contradictory. Objectives: To investigate the correct positioning and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC. Search methods: For this update, we searched for relevant studies from February 2012 to 31 March 2015. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In Process, EMBASE, AMED, CINAHL, TRIP, SIGN, NICE, UK Clinical Research Network, National Guideline Clearinghouse and PEDro database. We also searched the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov, UK Clinical Trials Gateway (UKCTG), WHO International Clinical Trials Registry Platform (ICTRP) and Australia New Zealand Clinical Trials Registry (ANZCTR). For the original version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse, and PEDro database, in February 2012. Selection criteria: We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning (mobilisation) and bracing. Data collection and analysis: Two review authors independently assessed each possible study for inclusion and quality. Main results: For the original version of the review, we screened 1611 potentially relevant studies. No studies met the inclusion criteria. Many papers identified the importance of mobilisation, but no RCTs of bed rest versus mobilisation have been undertaken. We identified no RCTs of bracing in MSCC. For this update, we identified 347 potential titles. We screened 300 titles and abstracts after removal of duplicates. We did not identify any additional studies for inclusion. Authors' conclusions: Since publication of the original version of this review, no new studies were found and our conclusions remain unchanged. There is a lack of evidence‐based guidance around how to correctly position and when to mobilise patients with MSCC or if spinal bracing is an effective technique for reducing pain or improving quality of life. RCTs are required in this important area

Association of maternal and cord plasma total, free and bioavailable 25-hyrodroxyvitamin D with neonatal anthropometric measurements at birth: a preliminary study in a private hospital

Introduction: 25-hydroxyvitamin D (25OHD) is the principal biomarker of vitamin D status. In circulation, 25OHD is primarily bound to vitamin D binding protein (VDBP), leaving a small proportion bound to albumin and as free form. Previous studies have suggested that free 25OHD is better correlated with health outcomes. However, in pregnancy where VDBP level is extremely elevated, the correlations between free 25OHD with health outcomes are far from conclusive. Here we show the associations of maternal and cord total, free and bioavailable 25OHD con-currently with neonatal anthropometric measurements in healthy pregnant mothers-neonates pairs. Method: Total 25OHD level was measured by using chemiluminescent immunoassay. Free and bioavailable 25OHD were calculated using published mathematical models. Results: The results showed that birth weight and head circumference were negatively associated with maternal total 25OHD but not significantly associated with free and bioavailable 25OHD. There were no significant associations between cord total, free and bioavailable 25OHD with any of the neonatal anthropometric measurements. Conclusion: The outcomes of this study should encourage further research in a larger sample size. Notably, future research could lead to the establishment of causative relationships and plausible mechanisms between maternal and cord 25OHD with neonatal anthropometric measurements

Factors affecting office rent in Kuala Lumpur (KL)

The oversupply of office space in the Golden Triangle Kuala Lumpur (GTKL) and slow on-going demand has resulted in pressure on rental performance. Studies have shown that there are several strategies to improve rent performance. The purpose of this paper is to obtain a deeper understanding of these strategies and their applicability in the context of GTKL. Questionnaires were distributed to 42 office buildings in the GTKL. A total of 212 tenants completed the questionnaire and secondary data on building certifications and the building average rents were extracted from reliable property website sources. The results suggest that office building rental performance can be improved if the building management charges lower rent to longer-stay tenants, attracts more foreign-owned or bigger-sized firm and gets Multimedia Super Corridor (MSC) or Green certifications. The implications for managers and theories in this regard are then discussed

Assessing technical and functional features of office buildings and their effects on satisfaction and loyalty

This study assesses the service performance of commercial office buildings in the Golden Triangle Kuala Lumpur (GTKL) and understands how they influence tenant satisfaction and loyalty. Literature suggests that the commercial office building leasing context provides more service components compared to goods, hence, the service performance (SERVPERF) framework was used in this study. Data was collected from 250 tenants of 48 buildings using questionnaires. The Structural Equation Model (SEM) technique was used to test the hypothesis and three significant relationships were found. The result indicated that Building Features, Services and Management performance (BFSM), agglomeration performance and Responsive Customer Orientation (RCO) significantly influenced tenant satisfaction, and subsequently resulted in loyalty. The implications for managers and the theories in this regard are then discussed

Determinants of psychological distress in teenagers and young adults affected by cancer: a systematic review and meta-analysis. [Protocol]

The objective of this systematic review is to look at the key determinants of psychological distress in teenagers and young adults (TYAs) affected by cancer. Sources to be searched are MEDLINE, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, EMBASE and PsycARTICLES. Any quantitative studies that assess the association among different factors (including individual and contextual types of factors commonly explored in the available literature in the subject area) with psychological distress will be included e.g. cross-sectional and longitudinal studies. Participants will be teenagers and young adults (TYA) a) aged 13-24 years at cancer diagnosis (in line with Teenage Cancer Trust’s definition b) at any stage of cancer, c) diagnosed with anxiety, depression, or/and PTSD or reported depressive/anxiety/PTSD symptomatology (on a validated self-report or clinician measure)

Supporting rural midwifery practice using a mobile health (mHealth) intervention: a qualitative descriptive study.

Introduction: Hypertensive disorders in pregnancy account for 12% of all maternal deaths globally. The risks of sub-optimal outcomes from these disorders might be greater in rural and remote locations. These potential risks might be related to poor intra and inter-professional communications due to geographic and digital isolation. Studies in low- and middle-income countries (LMICs) suggest that improving communications is essential and that mobile health (mHealth) interventions can improve outcomes. However, for such interventions to be successful they must involve midwives in any design and software development. This study explored how a mHealth intervention might support midwives in the management of women with pre-eclampsia in Scottish rural and remote locations. Methods: A qualitative descriptive approach was adopted. Rural and remote practicing community midwives (n = 18) were recruited to participate in three focus groups. The data were gathered through digital recordings of conversations at these focus groups. Recordings were transcribed and thematically analysed. Themes were agreed by consensus with the research team in an iterative process. Results: Five principal themes were identified: 'working in isolation'; 'encountering women with pre-eclampsia in rural and remote settings'; 'learning on the move'; 'using audio-visual resources' and 'unease with advances in technology'. Conclusion: Geographic and digital isolation poses significant challenges to rural midwifery practice in a high income country such as Scotland. Midwives need to be involved in the development of mHealth interventions for them to be acceptable and tailored to their needs in a rural and remote context. The study highlights how mHealth interventions can support Continuous Professional Development (CPD) whilst on the move with no internet connectivity. However, pride in current practice and unease with advances in mobile technology are barriers to the adoption of a mHealth intervention. mHealth interventions could be of value to other specialised healthcare practitioners in these regions, including GPs, to manage women with complications in their pregnancies