Care mapping in clinical neuroscience settings: Cognitive impairment and dependency.

Person-centred care can improve the well-being of patients and is therefore a key driver in healthcare developments in the UK. The current study aims to investigate the complex relationship between cognitive impairment, dependency and well-being in people with a wide range of acquired brain and spinal injuries. Sixty-five participants, with varied acquired brain and spinal injuries, were selected by convenience sampling from six inpatient clinical neuroscience settings. Participants were observed using Dementia Care Mapping - Neurorehabilitation (DCM-NR) and categorised based on severity of cognitive impairment. A significant difference in the behaviours participants engaged in, their well-being and dependency was found between the severe cognitive impairment group and the mild, moderate or no cognitive impairment groups. Dependency and cognitive impairment accounted for 23.9% of the variance in well-ill-being scores and 17.2% of the variance in potential for positive engagement. The current study highlights the impact of severe cognitive impairment and dependency on the behaviours patients engaged in and their well-being. It also affirms the utility of DCM-NR in providing insights into patient experience. Consideration is given to developing DCM-NR as a process that may improve person-centred care in neuroscience settings

Co-creating a tailored public health intervention to reduce older adults’ sedentary behaviour

Objective: The increasing health care costs associated with an ageing population and chronic disease burden are largely attributable to modifiable lifestyle factors that are complex and vary between individuals and settings. Traditional approaches to promoting healthy lifestyles have so far had limited success. Recently, co-creating public health interventions with end-users has been advocated to provide more effective and sustainable solutions. The aim of this study was to document and evaluate the co-creation of a public health intervention to reduce sedentary behaviour in older adults. Design: Community-dwelling older adults (N = 11, mean age = 74 years) and academic researchers attended 10 interactive co-creation workshops together. Setting: Workshops took place on university campus and the co-creators completed fieldwork tasks outside the workshops. Method: Workshops were informed by the Participatory and Appreciative Action and Reflection methodology. Data were collected using field notes, video recording and worksheet tasks. Analysis was conducted using a qualitative content analysis approach. Results: The co-creators developed a tailored intervention delivered through a mode congruent with older adults' lives. Key elements of the intervention included (1) education on sedentary behaviour, (2) resources to interrupt sedentary behaviour, (3) self-monitoring, (4) action planning and (5) evaluating the benefits of interrupting sedentary behaviour. Conclusion: Co-creation is a feasible approach to develop public health interventions; however, it is limited by the lack of a systematic framework to guide the process. Future work should aim to develop principles and recommendations to ensure co-creation can be conducted in a more scientific and reproducible way. The effectiveness and scalability of the intervention should be assessed

Arthroscopic washout of the knee: a procedure in decline.

BACKGROUND: Osteoarthritis (OA) of the knee is a chronic, progressive condition which often requires surgical intervention. The evidence for the benefits of arthroscopic debridement or washout for knee OA is weak and arthroscopy is currently only indicated in the UK if there is a history of mechanical locking of the knee. OBJECTIVES: To investigate whether there has been any change in the number of arthroscopies performed in the UK since the 2007 NICE guidance on knee arthroscopy and the 2008 Cochrane review of arthroscopic debridement for OA of the knee. METHODS: We interrogated data from the Hospital Episodes Statistics (HES) database with Office of Population Censuses and Surveys-4 (OPSC-4) codes pertaining to therapeutic endoscopic operations in the 60-74 year old and 75 and over age groups. RESULTS: The number of arthroscopic knee interventions in the UK decreased overall from 2000 to 2012, with arthroscopic irrigations decreasing the most by 39.6 per 100,000 population (80%). However, the number of arthroscopic meniscal resections increased by 105.3 per 100,000 (230%) population. These trends were mirrored in both the 60-74 and 75 and over age groups. CONCLUSIONS: Knee arthroscopy in the 60-74 and 75 and over age groups appears to be decreasing but there is still a large and increasing number of arthroscopic meniscal resections being performed

Research Brief: working in partnership with parents to create inclusive environments for children, aged 0-3 years, with chronic health conditions: parents’ perspectives

This research brief reports on one aspect of the findings from a doctoral research study which explored how practitioners create inclusive environments for children with chronic health conditions. The first stage of the Case Study surveyed 60 day care settings in a geographical area in the West Midlands (UK). There was a 31.5% return rate from the survey and 4 of the respondents went on to the second stage of the study. This briefing reports the findings from a small sample about parents and practitioners working in partnership to create an inclusive environment for children with on-going conditions

Hugræn atferlismeðferð við langvinnu þunglyndi : samanburður á einstaklings- og hópmeðferð í endurhæfingu á geðsviði Reykjalundar

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenTilgangur rannsóknarinnar var að kanna árangur hugrænnar atferlismeðferðar (HAM) við langvinnu þunglyndi hjá sjúklingum sem ekki hafa svarað hefðbundinni meðferð nægjanlega vel (treatment-resistant depression). Bornir voru saman þrír hópar sjúklinga á geðsviði Reykjalundar. Þátttakendur voru samtals 206 sjúklingar með langvinnt þunglyndi. Tveir meðferðarhópar inniliggjandi sjúklinga fengu annað hvort einstaklings HAM (n=68) eða hóp HAM (n=99). Samanburðarhópur (n=39) inniliggjandi sjúklinga fékk ekki HAM en var að öðru leyti í sömu endurhæfingu. Fyrstu niðurstöður sýna góðan árangur hjá öllum hópum en þátttakendur sem fengu einstaklings HAM náðu marktækt betri árangri en þeir sem fengu hóp HAM eða voru í samanburðarhópi. Vera má að hóparnir hafi verið of stórir (12- 14) eða sjúklingarnir með of alvarleg og fjölbreytt vandamál til að hópmeðferð sé nægjanleg. Kanna þarf árangur af minni hópum (7-8) og skoða hvaða sjúklingum gagnast hópar vel og hverjir þurfa einstaklingsmeðferð

Stroke Survivors Who Score below Threshold on Standard Depression Measures May Still Have Negative Cognitions of Concern

Background and Purpose— There has been an increase in screening for depression in the physically ill. We explored whether important negative cognitions may be missed by conventional approaches to screening for depression in 2 independently conducted stroke studies with similar methods. Methods— The Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based stroke incidence study conducted in Auckland, New Zealand, for 12 months in 2002 to 2003. The Stroke Outcomes Study was a prospective, hospital cohort study conducted in Leeds and Bradford, United Kingdom, for 33 months in 2002 to 2005. Symptoms of abnormal mood were assessed at 6 months in ARCOS with a single simple question, “Do you often feel sad and depressed?” and the 28-item General Health Questionnaire administered as part of a structured interview and in the Stroke Outcomes Study with the 28-item General Health Questionnaire and a single question about depressed mood taken from the Present State Examination. Results— Mood data were available at 6 months from 770 ARCOS and 492 Stroke Outcomes Study participants. A significant proportion (up to 28%) of people who did not meet study criteria for depression reported important negative cognitions such as hopelessness, worthlessness, or suicidality. People who were older, dependent in activities of daily living, or not partnered were more likely to report negative cognitions. Conclusions— Important negative cognitions, including suicidal thoughts, may be missed when people are screened for depression after stroke. Screening alone is not an adequate substitute for a sensitive exploration of the psychological impact of stroke on the survivor

Exploration des facteurs contraignants et facilitants, perçus par des professionnels de la santé, à l’implantation d’une unité collaborative d’apprentissage en milieu clinique

Au Québec, les modèles d’enseignement et d’apprentissage en milieu clinique utilisés pour la formation clinique des étudiantes en sciences infirmières sont le modèle du préceptorat et le modèle de groupe (Ha et Pepin, 2008). Bien que ces modèles aient plusieurs avantages, ceux-ci présentent aussi certaines limites (Budgen et Gamroth, 2008). Il est donc pertinent d’explorer la possibilité d’implanter un modèle complémentaire aux modèles actuels. Par conséquent, l’unité collaborative d’apprentissage (UCA), développée et implantée en Colombie-Britannique, présente des caractéristiques intéressantes (Lougheed et Galloway Ford, 2005). Toutefois, aucune étude n’avait été jusqu’ici réalisée au Québec sur ce modèle. Le but de la présente étude était d’explorer les facteurs contraignants et facilitants, perçus par des professionnels de la santé engagés directement ou indirectement dans la formation des étudiantes en sciences infirmières, quant à l’implantation d’une UCA en milieu clinique. Dans le cadre de cette étude exploratoire, cinq professionnels de la santé ont participé à une entrevue individuelle tandis que neuf professionnels de la santé ont participé à un groupe de discussion. Un guide d’entrevue semi-structuré a été utilisé. Le cadre de référence guidant cette étude était la théorie de niveau intermédiaire en sciences infirmières de Love (2014) et l’écrit présenté par National Institute for Health and Clinical Excellence (2007) sur les changements de pratiques dans le domaine de la santé. À la lumière de cette étude, il est possible de regrouper les facteurs contraignants à l’implantation d’une UCA en trois thèmes : non adaptation du modèle de l’UCA au contexte québécois, contexte organisationnel défavorable à l’implantation d’une UCA et préoccupation quant au niveau d’autonomie et à la responsabilité partagée de l’étudiante dans une UCA. Quant aux facteurs facilitants, ceux-ci sont présentés en trois thèmes : adaptation du modèle de l’UCA pour l’implanter dans le contexte québécois, contexte organisationnel favorable à l’implantation d’une UCA et opportunités relatives à l’autonomie et à la responsabilité partagée de l’étudiante dans une UCA. Les résultats de cette étude ont permis de formuler des recommandations pour la pratique, la formation et la recherche en sciences infirmières.In Quebec, the teaching and learning models in clinical settings used for clinical training of nursing students are the preceptorship and group model (Ha and Pepin, 2008). Although these models have several advantages, they also have some limitations (Budgen and Gamroth, 2008). It is therefore pertinent to explore the possibility of implementing a complementary model to these current models. Consequently, the collaborative learning unit (CLU), developed and implemented in British Columbia, has some interesting characteristics (Lougheed and Galloway Ford, 2005). However, to date, no studies have been conducted in Quebec on this model. The purpose of this study was to explore the constraining and facilitating factors perceived by health professionals engaged directly or indirectly in the clinical training of nursing students when it comes to implementing a CLU in the clinical setting. In this exploratory study, five health professionals each participated in an individual interview while nine health professionals participated in a focus group. A semi-structured interview guide was used. The terms of reference guiding this study was Love's Intermediate Level Theory in Nursing (2014) and the National Institute for Health and Clinical Excellence (2007) paper on changing practices in health. In light of this study, it is possible to group the constraining factors for the implementation of a CLU recording to three different themes: non-adaptation of the UCA model to the Quebec context, organizational context unfavorable to the implementation of a UCA and concern about the level of autonomy and shared responsibility of the student in an UCA. Facilitating factors are presented in three themes: adaptation of the model of the UCA to implement it in the Quebec context, organizational context favorable to the establishment of a UCA and opportunities related to autonomy and the shared responsibility of the student in a UCA. The results of this study were used to formulate recommendations for the nursing practice, education and research

Adherence to the Mediterranean diet among employees in South West England: formative research to inform a web-based, work-place nutrition intervention

Objective: The aim of this study is to assess internet usage patterns and adherence to the Mediterranean diet among employees in South West England, UK and their differences by personal characteristics. Method: A cross-sectional survey was conducted in 2014 among 590 adults (428 women, 162 men, mean age 43.8 years), employees of four work-place settings. Mediterranean diet adherence was assessed using a validated food frequency questionnaire. Adherence differences were assessed by gender, marital status, education, number of children and food shopping and preparation responsibility. Results: On average, participants reported moderate adherence to the Mediterranean diet. Higher adherence was reported for alcohol, vegetables, cereals and fruit. Few participants achieved high adherence to the Mediterranean diet recommendations for legumes (5.3%), fish (3.2%), dairy products (4.8%), red meat (11.9%), poultry (11.1%) and olive oil (18.2%). A higher Mediterranean diet score was reported among participants who were married/cohabiting, those with higher education attainment and shared responsibility for food preparation. Conclusion: Improvement in the consumption of several Mediterranean diet components is needed to increase adherence in this sample of adults. The findings have the potential to inform the development of a web-based intervention that will focus on these foods to promote the Mediterranean diet in work-place settings in South West England

Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients

To provide optimal care, nurses need to be prepared to recognize signs and symptoms of patient deterioration so they can obtain assistance from appropriate respondents and initiate rescue interventions when needed. In this paper, we describe the development of a post-simulation educational intervention aimed at improving nurses' and nursing students' recognition and response to patient deterioration. This intervention takes the form of a debriefing after a simulated patient deterioration experience. Following the Medical Research Council's guidance on complex interventions, we reviewed empirical studies of existing educational interventions for content, teaching strategies, and outcomes, as well as for frameworks, theoretical underpinnings, and rationale. Based on those results, we reviewed theoretical literature (Tanner's clinical judgment model and Dewey's theory of experiential learning) that might inform our understanding of our intervention's intended effect (learning outcomes) and of the mechanisms by which the intervention could lead to it. Integrating results from the empirical and theoretical phases helped us define the new intervention's rationale and develop its components according to relevant standards of best practices. The resulting educational intervention, REsPoND, consists in a reflective debriefing after a patient deterioration simulation. It will be tested in an upcoming mixed methods study