Three-Dimensional Printing in Occupational Therapy: An Instructional Video Series

The three-dimensional printing instructional video series was created for occupational therapy practitioners on how to use 3D printers to print assistive devices.https://soar.usa.edu/otdcapstonesfall2023/1002/thumbnail.jp

Towards manufactured red blood cells for the treatment of inherited anemia

Patients with inherited anemia and hemoglobinopathies (such as sickle cell disease and β-thalassemia) are treated with red blood cell (RBC) transfusions to alleviate their symptoms. Some of these patients may have rare blood group types or go on to develop alloimmune reactions, which can make it difficult to source compatible blood in the donor population. Laboratory-grown RBC represent a particularly attractive alternative which could satisfy an unmet clinical need. The challenge, however, is to produce - from a limited number of stem cells - the 2x1012 RBC required for a standard adult therapeutic dose. Encouraging progress has been made in RBC production from adult stem cells under good manufacturing practice. In 2011, the Douay group conducted a successful proof-of-principle mini-transfusion of autologous manufactured RBC in a single volunteer. In the UK, a trial is planned to assess whether manufactured RBC are equivalent to RBC produced naturally in donors, by testing an allogeneic mini-dose of laboratory-grown manufactured RBC in multiple volunteers. This review discusses recent progress in the erythroid culture field as well as opportunities for further scaling up of manufactured RBC production for transfusion practice

Building the economic evidence case for social prescribing

Understanding the economic impact of social prescribing remains an urgent priority for the National Academy of Social Prescribing (NASP). As yet it is unclear how much data exists within the different systems to enable economic analyses of the impact of social prescribing schemes to be conducted. The complexity in understanding the economic impact of social prescribing—and indeed all non-clinical community-based approaches to health—is compounded by the multisector nature of social prescribing. Furthermore, a variety of approaches are being used to test similar but different understandings of both cost and value, including social value, cost, benefit and economic value. There are a growing range of reports and peer-reviewed publications that focus on the impact of social prescribing on health and social care demand, some of which have economic analyses and some which remain as potential data sets for economic analyses. At least one third of all outcomes (if not more) are directly related to the social determinants of health1,2 (SDH) which are not taken into account with economic analysis focused only on health service usage. This range of outcomes experienced by service users2-4 is driving many researchers to conduct economic analyses that attempt to assign value to outcomes beyond the health sector, for instance using social return on investment (SROI) and proxy values. Other researchers have discussed the evolution in economic analyses at length and suggest additional components to existing methodologies, e.g., multi criteria decision analysis (MCDA) to account for additional complexity of social prescribing5. Further developments are also being trialled such as the Wellbeing-adjusted Life Years (WELLBY) to understand the economic value attached to wellbeing6, as opposed to the Quality Adjusted Life Years (QALY), which reports the economic value of quality of life. We are entering an era of providing personalised support to people in integrated and multidisciplinary systems with different local population needs. As such, there is a need to evolve the approaches to determining cost and value of social prescribing, and to reach agreements on methodologies that all sectors are willing to accept as sound approaches. Furthermore, as discussed by McDaid and colleagues in 2019 7, there is a need to move beyond the immediate benefits of social prescribing and to explore the longer-term benefits of sustained engagement in non-clinical activities and provision of support to address issues linked to the SDH. This would enable more data to inform the preventative role and economic impact that social prescribing may have, which is currently an evidence gap. This rapid scoping review was commissioned by NASP and additional roundtables were supported by the National Centre for Creative Health and UKRI/AHRC’s ‘Mobilising Community Assets to Tackle Health Inequalities’ research programme (led by University College London). It aims to provide an update to the first economic evidence review from NASP and explore economic data and health and social care usage data in more detail. This rapid scoping review aims to ascertain: What the current literature indicates in terms of cost or value of social prescribing schemes or parts of the social prescribing scheme. If there are potential data sets that report the impact of social prescribing on health service usage that could have economic analysis applied to them. Stakeholder opinions on the methodological approaches for creating the current economic evaluation evidence base for social prescribing and potential future developments that are needed. How these findings can inform a larger programme of research that is needed to establish the economic impact and value of social prescribing across all relevant sectors in the community. As this report contains three separate elements to it, each element will be reported with methods and results, and then key themes will be brought together with recommendations

The emerging role of the urban-based Aboriginal peer support worker: A Western Australian study

Purpose: To explore the self-perceived role of the Aboriginal peer support worker working with families with young children. This study was a component of a larger participatory action research study undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting program. Methods: Focus group interviews were carried out with peer support workers using unstructured and semi-structured interviews within Action Learning Sets. Data were analysed using thematic analysis. Results: The overarching theme on the self-perceived role of the Aboriginal peer support worker was Giving Parent Support, with subsidiary themes relating to development and ongoing sustainability of the support. Discussion: The peer support workers viewed their role as providing parent support through enabling strategies which developed client acceptance and trust, delivered culturally relevant support, advocated for families, developed therapeutic engagement and communication strategies, and created safe home visiting practices. They recognised the importance of linking families with community support such as community child health nurses which was important for improving long term physical and psychosocial health outcomes for children. Conclusion: Aboriginal Peer Support Workers identified their emerging integral role in the development of this unique culturally acceptable home visitingsupport for Aboriginal parents. Innovative approaches towards client engagement demonstrated their value in developing creative ways of working in partnership with families, community support services and child health nurses across a range of challenging psychosocial environments

Upheaval in cancer care during the COVID-19 outbreak

On Monday, 23 March 2020, Nigeria recorded its first mortality from the novel global COVID-19 outbreak. Before this, the country reported 36 confirmed cases (at the time of writing) and has discharged home two cases after weeks of care at a government-approved isolation center in Lagos State. This first mortality was that of a 67-year-old man with a history of multiple myeloma, a type of blood cancer. He was undergoing chemotherapy and had just returned to Nigeria following medical treatment in the United Kingdom. The novel COVID-19 pandemic has grounded several global activities including the provision of health care serves to people with chronic conditions such as cancer. Evidence from China suggests that cancer patients with COVID-19 infection are a vulnerable group, with a higher risk of severe illness resulting in intensive care unit admissions or death particularly if they received chemotherapy or surgery. This letter is an attempt to suggests practicable interventions such as the use of existing digital health platforms to limit patients' and oncology professionals’ physical interaction as a way of reducing the risk of COVID-19 infection transmission amongst cancer patients and oncologists, as well as outlining effective strategies to ensure that cancer care is not completely disrupted during the outbreak

A longitudinal, qualitative study exploring sustained adherence to a hand exercise programme for Rheumatoid Arthritis evaluated in the SARAH Trial

Purpose: This study explores the experience of participants taking part in a hand exercise programme for people with rheumatoid arthritis with a focus on adherence. The exercise programme was tested in a randomised controlled trial. This parallel qualitative study will inform future implementation into clinical practice. Method: Twenty-seven semi-structured interviews from 14 participants were undertaken at 2 time points (4 and 12 months after randomisation). We collected data of participants’ experiences over time. This was guided by an interview schedule. Interview data were analysed using interpretative phenomenological analysis which is informed by phenomenological and hermeneutic theory. We recruited participants from National Health Service rheumatology and therapy departments. Results: At 4 months, 11/14 participants reported continuing with the exercises. By 12 months, 7/13 participants still reported exercising. The ability to establish a routine determined whether participants adhered to the exercise programme. This was sometimes influenced by practical issues. We also identified facilitators and barriers to regular exercise in the themes of – the therapeutic encounter, perceived benefit of exercises, attitude of mind, confidence and unpredictability. Conclusions: Establishing a routine was an important step towards participants being able to exercise independently. Therapists provided participants with skills to continue to exercise while dealing with changes in symptoms and schedules. Potential barriers to long term exercise adherence need to be taken into account and addressed for successful implementation of this programme

Polyurethane scaffolds seeded with CD34⁺ cells maintain early stem cells whilst also facilitating prolonged egress of haematopoietic progenitors

We describe a 3D erythroid culture system that utilises a porous polyurethane (PU) scaffold to mimic the compartmentalisation found in the bone marrow. PU scaffolds seeded with peripheral blood CD34+ cells exhibit a remarkable reproducibility of egress, with an increased output when directly compared to human bone scaffolds over 28 days. Immunofluorescence demonstrated the persistence of CD34+ cells within the scaffolds for the entirety of the culture. To characterise scaffold outputs, we designed a flow cytometry panel that utilises surface marker expression observed in standard 2D erythroid and megakaryocyte cultures. This showed that the egress population is comprised of haematopoietic progenitor cells (CD36+GPA−/low). Control cultures conducted in parallel but in the absence of a scaffold were also generally maintained for the longevity of the culture albeit with a higher level of cell death. The harvested scaffold egress can also be expanded and differentiated to the reticulocyte stage. In summary, PU scaffolds can behave as a subtractive compartmentalised culture system retaining and allowing maintenance of the seeded “CD34+ cell” population despite this population decreasing in amount as the culture progresses, whilst also facilitating egress of increasingly differentiated cells