Female Veterans: Satisfying Patterns of Daily Activities as Defined by the Life Balance Model

This phenomenological case study explored the occupational needs and life satisfaction of one female veteran upon reintegration into civilian life. One female veteran, with 23 years of military service, participated in a semi-structured telephone interview. Results demonstrated that military service negatively impacted the participant’s social interactions, physical and mental wellbeing, and ability to cope with stressors, indicating military service posed difficulties for the participant to engage in meaningful occupations upon reintegration. Recommendations included development of occupation-based interventions using the Person Environment and Occupation framework, and further research to identify appropriate services to facilitate successful reintegration into society for female veterans

Enhancing community health through patient navigation, advocacy, and social support: A community health navigator pilot study

Background: The healthcare system is complex and difficult to navigate, particularly for patients with multiple chronic conditions and complex care plans. Patient adherence to care plans and patient health outcomes can be negatively impacted by language, financial, and other social barriers. Community Health Navigators (CHNs) are community members that are hired and trained to navigate the healthcare system, who work with patients to overcome barriers to care and support patient self-management by providing services tailored to needs. While these types of interventions can improve access to care in other settings, they are not well studied in Canada nor in Canadian primary care settings. Objective: For this pilot study, we aimed to determine the feasibility of a CHN intervention for patients with multiple chronic conditions. Our secondary objective was to assess the potential impact of a CHN intervention on patient-reported outcome measures. Methods: We used an observational single arm pre-post study design. Using interviewer-administered patient surveys, we assessed patient-reported outcomes at baseline (pre-enrolment), and 6-months and 12-months post-enrolment. The survey included instruments to assess quality of life (EQ-5D-5L), patient chronic disease care experience (PACIC), social support (mMOS-SS), and cost-related adherence to care (i.e. financial security to pay for care-related costs). Descriptive analysis was performed on survey data, and the sample was restricted to participants who completed both follow-up surveys (6- and 12-month).   Results: Of the 21 participants enrolled in our pilot study, the mean age was 61.3 years, 56% had an annual household income below $30,000, and 68% were born outside of Canada. The three most common conditions reported were hypertension (77%), diabetes (59%), and back problems (55%). The mean number of conditions a patient reported was 5.4 (SD 2.3, range 3-11). Of the sample enrolled, 14 (67%) patients completed both follow-up surveys. Mean social support (scale: 0-100), was 56, 68, and 75 at baseline, 6, and 12 months, respectively—indicating a potential increase in social support after the intervention. Mean self-ranked health (scale: 0-100) did not change over time. Mean patient experience with chronic disease care (scale: 1-3) was 2.01 at baseline; 2.24 at 6 months, and 1.89 at 12 months.  The proportion of patients who reported no difficulty paying for medical expenses increased from 36% at baseline to 79% at 6 months and 86% at 12 months. In other words, fewer patients reported difficulty paying for medical expenses at 6 months and at 12 months. Results presented here are preliminary; further analysis is underway which will include analysis of health outcomes using administrative data, statistical tests of survey data (where appropriate), and qualitative analysis of interview data. Conclusions: CHNs may improve patients’ social and financial support and satisfaction with care. Our pilot study demonstrates that a CHN intervention is feasible to implement in primary care for patients with multiple chronic conditions. These findings informed a large ongoing cluster-randomized pragmatic trial

Examining the Usefulness of Patient Documentation Forms as a Tool for Community Health Navigators: Findings from the ENCOMPASS Pilot Study

Introduction | Effective documentation of patient encounters may influence Community Health Navigators’ (CHNs) success in providing support to patients as well as provide a data source to examine CHN practices. The ENhancing COMmunity health through Patient navigation, Advocacy, and Social Support (ENCOMPASS) study, based in partnership between the University of Calgary and the Mosaic Primary Care Network (MPCN) is evaluating a CHN program to determine whether CHNs improve outcomes for patients with multiple chronic conditions. CHNs support their patients by helping them navigate the health system, connect to community resources, and access culturally appropriate support. The purpose of this study was to examine the quality and usefulness of CHN-patient documentation forms used in the ENCOMPASS pilot study (i.e., Initial Action Planning Form, Follow-up Action Planning Form, Patient Encounter Form, all implemented on the REDCap platform) and revise the documentation process using co-design with the end user. Methods | An iterative co-design quality improvement process was employed across three phases. First, content analyses were conducted on the Patient Encounter Form notes to examine how CHNs were using the forms and how they were documenting their activities. Second, a survey was distributed to CHNs to gather their perspectives about their experiences with the REDCap platform and the three forms. Third, a working group, consisting of four CHNs, met twice with research team members to discuss barriers to use and opportunities for improvement. Results | The REDCap platform and the three CHN-patient encounter forms did not adequately meet the needs of the CHNs. Content analysis revealed significant variation in how the Patient Encounter Form was utilized and various form sections were not completed as intended. In the survey, CHNs reported that the documentation experience was not satisfactory and the training that they had received to date was insufficient. The CHN working group suggested changes to the interface with the REDCap platform and form structure. Revisions were made based on these suggestions, and approved by the working group. Conclusions | The approved changes to REDCap and the three forms will be implemented and introduced to the CHN team. The research team will develop a patient encounter documentation guidelines document and will provide all members of the CHN team with the opportunity to receive re-training. These changes will be reviewed with the CHNs to continue the iterative quality improvement process. Prior to final implementation, consultation with the Clinical Research Unit administrators on the feasibility of the revisions made to the forms and interface with the REDCap platform will be held. The results of this study have the potential to provide a better overall experience for CHNs in the ENCOMPASS program and enhance their work with patients

A third of systematic reviews changed or did not specify the primary outcome : A PROSPERO register study

OBJECTIVES: To examine outcome reporting bias of systematic reviews registered in PROSPERO. STUDY DESIGN AND SETTING: Retrospective cohort study. The primary outcomes from systematic review publications were compared with those reported in the corresponding PROSPERO records; discrepancies in the primary outcomes were assessed as upgrades, additions, omissions or downgrades. Relative risks (RR) and 95% confidence intervals (CI) were calculated to determine the likelihood of having a change in primary outcome when the meta-analysis result was favourable and statistically significant. RESULTS: 96 systematic reviews were published. A discrepancy in the primary outcome occurred in 32% of the included reviews and 39% of the reviews did not explicitly specify a primary outcome(s); 6% of the primary outcomes were omitted. There was no significant increased risk of adding/upgrading (RR 2.14, 95% CI 0.53 to 8.63) or decreased risk of downgrading (RR 0.76, 0.27-2.17) an outcome when the meta-analysis result was favourable and statistically significant. As well, there was no significant increased risk of adding/upgrading (RR 0.89, 0.31-2.53) or decreased risk of downgrading (RR 0.56, 0.29-1.08) an outcome when the conclusion was positive. CONCLUSIONS: We recommend review authors carefully consider primary outcome selection and journals are encouraged to focus acceptance on registered systematic reviews

Urinary, Plasma, and Serum Biomarkers’ Utility for Predicting Acute Kidney Injury Associated With Cardiac Surgery in Adults: A Meta-analysis

BackgroundEarly accurate detection of acute kidney injury (AKI) occurring after cardiac surgery may improve morbidity and mortality. Although several novel biomarkers have been developed for the early detection of AKI, their clinical utility in the critical intraoperative and immediate postoperative period remains unclear.Study DesignSystematic review and meta-analysis.Setting & PopulationAdult patients having cardiac surgery.Selection Criteria for StudiesEMBASE, CINAHL, Cochrane Library, Scopus, and PubMed from January 1990 until January 2015 were systematically searched for cohort studies reporting the utility of novel biomarkers for the early diagnosis of AKI after adult cardiac surgery. Reviewers extracted data for study design, population, timing of biomarker measurement and AKI occurrence, biomarker performance (area under the receiver operating characteristic curve [AUROC]), and risk of bias.Index TestsNovel urine, plasma, and serum AKI biomarkers, measured intraoperatively and in the early postoperative period (<24 hours).Reference TestsAKI was defined according to the RIFLE, AKIN, or 2012 KDIGO criteria.ResultsWe found 28 studies reporting intraoperative and/or early postoperative measurement of urine (n=23 studies) or plasma or serum (n=12 studies) biomarkers. Only 4 of these studies measured biomarkers intraoperatively. Overall, intraoperative discrimination by the urine biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury marker 1 (KIM-1) demonstrated AUROCs<0.70, whereas N-acetyl-β-d-glucosaminidase (NAG) and cystatin C had AUROCs<0.75. In the immediate 24-hour postoperative period, the urine biomarkers NGAL (16 studies), KIM-1 (6 studies), and liver-type fatty acid binding protein (6 studies) exhibited composite AUROCs of 0.69 to 0.72. The composite AUROCs for postoperative urine cystatin C, NAG, and interleukin 18 were ≤0.70. Similarly, the composite AUROCs for postoperative plasma NGAL (6 studies) and cystatin-C (5 studies) were <0.70.LimitationsHeterogeneous AKI definitions.ConclusionsIn adults, known urinary, plasma, and serum biomarkers of AKI possess modest discrimination at best when measured within 24 hours of cardiac surgery

ERPs and their brain sources in perceptual and conceptual prospective memory tasks: commonalities and differences between the two tasks

The present study examined whether Event-Related Potential (ERP) components and their neural generators are common to perceptual and conceptual prospective memory (PM) tasks or specific to the form of PM cue involved. We used Independent Component Analysis (ICA) to study the contributions of brain source activities to scalp ERPs across the different phases of two event-based PM-tasks: (1) holding intentions during a delay (monitoring) (2) detecting the correct context to perform the delayed intention (cue detection) and (3) carrying out the action (realisation of delayed intentions). Results showed that monitoring for both perceptual and conceptual PM-tasks was characterised by an enhanced early occipital negativity (N200). In addition the conceptual PM-task showed a long-lasting effect of monitoring significant around 700 ms. Perceptual PM-task cues elicited an N300 enhancement associated with cue detection, whereas a midline N400-like response was evoked by conceptual PM-task cues. The Prospective Positivity associated with realisation of delayed intentions was observed in both conceptual and perceptual tasks. A common frontal-midline brain source contributed to the Prospective Positivity in both tasks and a strong contribution from parieto-frontal brain sources was observed only for the perceptually cued PM-task. These findings support the idea that: (1) The enhanced N200 can be understood as a neural correlate of a ‘retrieval mode’ for perceptual and conceptual PM-tasks, and additional strategic monitoring is implemented according the nature of the PM task; (2) ERPs associated with cue detection are specific to the nature of the PM cues; (3) Prospective Positivity reflects a general PM process, but the specific brain sources contributing to it depend upon the nature of the PM task

How Design Features in Digital Math Games Support Learning and Mathematics Connections

Current research shows that digital games can significantly enhance children’s learning. The purpose of this study was to examine how design features in 12 digital math games influenced children’s learning. The participants in this study were 193 children in Grades 2 through 6 (ages 8-12). During clinical interviews, children in the study completed pre-tests, interacted with digital math games, responded to questions about the digital math games, and completed post-tests. We recorded the interactions using two video perspectives that recorded children’s gameplay and responses to interviewers. We employed mixed methods to analyze the data and identify salient patterns in children’s experiences with the digital math games. The analysis revealed significant gains for 9 of the 12 digital games and most children were aware of the design features in the games. There were eight prominent categories of design features in the video data that supported learning and mathematics connections. Six categories focused on how the design features supported learning in the digital games. These categories included: accuracy feedback, unlimited/multiple attempts, information tutorials and hints, focused constraint, progressive levels, and game efficiency. Two categories were more specific to embodied cognition and action with the mathematics, and focused on how design features promoted mathematics connections. These categories included: linked representations and linked physical actions. The digital games in this study that did not include linked representations and opportunities for linked physical actions as design features did not produce significant gains. These results suggest the key role of mathematics-specific design features in the design of digital math games

Prediction of winter vitamin D status and requirements in the UK population based on 25(OH) vitamin D half-life and dietary intake data

On a population basis, there is a gradual decline in vitamin D status (plasma 25(OH)D) throughout winter. We developed a mathematical model to predict the population winter plasma 25(OH)D concentration longitudinally, using age-specific values for 25(OH)D expenditure (25(OH)D3t1/2), cross-sectional plasma 25(OH)D concentration and vitamin D intake (VDI) data from older (70+ years; n=492) and younger adults (18-69 years; n=448) participating in the UK National Diet and Nutrition Survey. From this model, the population VDI required to maintain the mean plasma 25(OH)D at a set concentration can be derived. As expected, both predicted and measured population 25(OH)D (mean (95%CI)) progressively declined from September to March (from 51 (40-61) to 38 (36-41)nmol/L (predicted) vs 38 (27-48)nmol/L (measured) in older people and from 59 (54-65) to 34 (31-37)nmol/L (predicted) vs 37 (31-44)nmol/L (measured) in younger people). The predicted and measured mean values closely matched. The predicted VDIs required to maintain mean winter plasma 25(OH)D at 50nmol/L at the population level were 10 (0-20) to 11 (9-14) and 11 (6-16) to 13(11-16)μg/d for older and younger adults, respectively dependent on the month. In conclusion, a prediction model accounting for 25(OH)D3t1/2, VDI and scaling factor for the 25(OH)D response to VDI, closely predicts measured population winter values. Refinements of this model may include specific scaling factors accounting for the 25(OH)D response at different VDIs and as influenced by body composition and specific values for 25(OH)D3 t1/2 dependent on host factors such as kidney function. This model may help to reduce the need for longitudinal measurements

Evaluation of Mental Health First Aid from the Perspective Of Workplace End UseRs—EMPOWER: protocol of cluster randomised trial phase

Background: Mental Health First Aid (MHFA) is a mental health intervention that teaches people how to identify, understand and help someone who may be experiencing a mental health issue. Reviews of the implementation of MHFA found between 68 and 88% of trained Mental Health First Aiders had used their skills when in contact with someone experiencing mental health difficulties. Reviews evaluating the impact of MHFA suggest positive outcomes. However, to date, there has been no systematic, rigorous evaluation of the impact of MHFA on recipients of the intervention, the organisations providing it and the cost-effectiveness of MHFA overall. This trial will evaluate the effectiveness and cost-effectiveness of MHFA. Methods: The study is a multi-centred, two-arm clustered randomised controlled trial. Organisations will be randomly allocated to the control or intervention (estimated sample size 800 recipients). The intervention is the standard MHFA intervention provided by Mental Health First Aid England (MHFAE). The control condition will be organisations having a brief consultation from MHFAE on promoting mental health and well-being in the workplace. The primary outcome is health seeking behaviour, measured using the Actual Help Seeking Questionnaire, at 6 months’ follow-up. Data collection will be undertaken at baseline (T0), post-intervention—up to 3 months (T1), at 6 months (T2), 12 months (T3) and 24 months (T4). The primary analysis will be conducted on those participants who receive MHFA, a per protocol analysis. Discussion: The study is the first to evaluate the effect of MHFA in the workplace on employees with direct and indirect experience of the intervention, when compared with usual practice. Being also the first to assess, systematically, the social impact of MHFA and investigate its cost-effectiveness adds to the originality of the study. The study promises to yield important data, as yet unknown, regarding the effectiveness, cost-effectiveness, implementation issues, and the sustainability of MHFA in the workplace

‘Slappers like you don’t belong in this school’: the educational inclusion/exclusion of pregnant schoolgirls

Policy in England identifies pregnant schoolgirls as a particularly vulnerable group and emphasises the importance of education as a way of improving the life chances of those who become pregnant while young. This paper draws on repeat interviews conducted over a twelve-month period to compare and contrast the stories of four young women. The narratives show that despite a common policy framework, there is great variability between schools in staff attitudes towards and responses to pupil pregnancy which produce different accommodations and support for pregnant girls, and seem likely to produce very different outcomes. We mobilise Iris Marion Young’s five faces of oppression to conduct a second reading of the stories. This situates the specificity of the girls’ school experiences into a wider socio-cultural and economic framing and indicates what might be involved in actually initiating and implementing the kinds of changes that the first ‘face value’ reading suggests are necessary