Roller coasters and uphill struggles: the impact of the medical management of childhood life-threatening and life-shortening conditions on family relationships, roles and emotional wellbeing

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Healthcare professional and patient co-design and validation of a mechanism for service users to feedback patient safety experiences following a care transfer: a qualitative study

Objective: To develop and validate a mechanism for patients to provide feedback on safety experiences following a care transfer between organisations. Design: Qualitative study using participatory methods (co-design workshops) and cognitive interviews. Workshop data were analysed concurrently with participants and cognitive interviews were thematically analysed using a deductive approach based on the developed feedback mechanism. Participants: Expert patients (n=5) and healthcare professionals (n=11) were recruited purposively to develop the feedback mechanism in two workshops. Workshop one explored principles underpinning safety feedback mechanisms, and workshop two included the practical development of the feedback mechanism. Final design and content of the feedback mechanism (a safety survey) were verified by workshop participants, and cognitive interviews (n=28) were conducted with patients. Results: Workshop participants identified that safety feedback mechanisms should be patient-centred, short and concise with clear signposting on how to complete, with an option to be anonymous and balanced between positive (safe) and negative (unsafe) experiences. The agreed feedback mechanism consisted of a survey split across three stages of the care transfer; departure, journey and arrival. Care across organisational boundaries was recognised as being complex, with healthcare professionals acknowledging the difficulty implementing changes that impact other organisations. Cognitive interview participants agreed the content of the survey was relevant but identified barriers to completion relating to the survey formatting and understanding of a care transfer. Conclusions: Participatory, co-design principles helped overcome differences in understandings of safety in the complex setting of care transfers when developing a safety survey. Practical barriers to the survey’s usability and acceptability to patients were identified, resulting in a modified survey design. Further research is required to determine the usability and acceptability of the survey to patients and healthcare professionals, as well as identifying how governance structures should accommodate patient feedback when relating to multiple health or social care providers. Strengths and limitations of the study: This study developed a safety survey using participatory and co-design methods to bring together patient and healthcare professional perspectives. Cognitive interviews with 28 patients were used to validate and further refine the survey format and questions. Further research is required to pilot the survey to determine whether patients would be willing to be engaged in reporting their experiences of safety following a transfer in care. Due to the nature of organisational care transfers, which potentially include large numbers of organisations, it is unlikely that participants represented all possible types of transfers that patients experience. It was not possible to explore further the governance relationships that exist between different organisations responsible for patients’ care, which could impact on the implementation of the survey into practice

Content analysis of patient safety incident reports for older adult patient transfers, handovers, and discharges: Do they serve organizations, staff, or patients?

Objective The aim of the study was to analyze content of incident reports during patient transitions in the context of care of older people, cardiology, orthopedics, and stroke. Methods A structured search strategy identified incident reports involving patient transitions (March 2014–August 2014, January 2015–June 2015) within 2 National Health Service Trusts (in upper and lower quartiles of incident reports/100 admissions) in care of older people, cardiology, orthopedics, and stroke. Content analysis identified the following: incident classifications; active failures; latent conditions; patient/relative involvement; and evidence of individual or organizational learning. Reported harm was interpreted with reference to National Reporting and Learning System criteria. Results A total 278 incident reports were analyzed. Fourteen incident classifications were identified, with pressure ulcers the modal category (n = 101,36%), followed by falls (n = 32, 12%), medication (n = 31, 11%), and documentation (n = 29, 10%). Half (n = 139, 50%) of incident reports related to interunit/department/team transfers. Latent conditions were explicit in 33 (12%) reports; most frequently, these related to inadequate resources/staff and concomitant time pressures (n = 13). Patient/family involvement was explicit in 61 (22%) reports. Patient well-being was explicit in 24 (9%) reports. Individual and organizational learning was evident in 3% and 7% of reports, respectively. Reported harm was significantly lower than coder-interpreted harm (P < 0.0001). Conclusions Incident report quality was suboptimal for individual and organizational learning. Underreporting level of harm suggests reporter bias, which requires reducing as much as practicable. System-level interventions are warranted to encourage use of staff reflective skills, emphasizing joint ownership of incidents. Co-producing incident reports with other clinicians involved in the transition and patients/relatives could optimize organizational learning

Provider Perspectives in Serving Children Who Are Deaf or Hard of Hearing and Their Families using Tele-Intervention

Purpose: In the second of a two-part survey series, this cross-sectional survey study explored professionals’ perceptions of tele-intervention (TI) services for young children who are deaf or hard of hearing. Using Likert rating scales and open-ended questions, the survey queried professional’s confidence in providing TI services, including their views and recommendations. Data were collected March-May 2020, not realizing the survey release would coincide with the Covid-19 pandemic and the influx of unexpected virtual services. For this reason, data were stratified between those who had been providing TI services for more than versus less than three months. Responses for in-person providers were also evaluated for additional context. Methods: Responses from 123 participants who provided TI and 21 participants who provided in-person services (n=144) were analyzed using descriptive statistics. Cronbach’s alpha showed high internal consistency for all Likert scales; items of each subscale were sum-scored to examine relationships across queried areas of service delivery. Results: Provider perceptions of TI services were largely favorable. However, providers with more than three months’ experience were significantly more confident in coaching and supporting parents through TI, including more overall favorable views of a TI delivery than providers with less than three months of TI experience. There were no differences in provider confidence in coaching and supporting parents between providers with more than three months’ TI experience using TI delivery and in-person providers using in-person delivery. Conclusions: Experienced providers reported confidence in service delivery and positive views of the TI model. Programs seeking to implement virtual services should consider TI training, with a commitment to TI longevity to improve provider efficacy and confidence in TI services

Resistance Training as Therapeutic Management in Women with PCOS: What is the Evidence?

International Journal of Exercise Science 14(3): 840-854, 2021. Polycystic ovary syndrome (PCOS), the most common chronic endocrinopathy and the leading cause of infertility in women, has significant clinical consequences, including cardiovascular, endocrinological, oncological, and psychological co-morbidities. Endocrine Society Clinical Practice Guidelines on the Diagnosis and Treatment of PCOS recommend exercise and physical activity as first-line treatment to combat chronic disease risk. However, details about what type of exercise are not provided. Given the known beneficial effects of resistance training on the management of other chronic diseases, the purpose of this scoping review was to evaluate the scientific evidence about the physical and psychosocial effects of resistance training among women with PCOS. Studies were identified through a systematic search of PubMed, SPORTDiscus, and CINAHL databases. Peer-reviewed research studies published between January 2011 and January 2021 that evaluated a resistance training intervention for premenopausal women with PCOS were included. Studies that offered multi-component programs were excluded. Nine articles met the inclusion criteria of which seven were sub-studies of one larger clinical trial. One article reported findings from a small randomized controlled trial and the last article reported feasibility study findings. Each intervention yielded positive results across a wide range of outcome variables; however, the studies had small sample sizes and assessed different outcome variables. Evidence regarding the effects of resistance training on health outcomes for women with PCOS is positive but preliminary. Adequately powered clinical trials are required to confirm health benefits, answer research questions as to therapeutic dose, and discover behavioral strategies to promote resistance training for therapeutic management

Dynamics of Pyroclastic Density Currents: Conditions That Promote Substrate Erosion and Self-Channelization - Mount St Helens, Washington (USA)

The May 18th, 1980 eruption of Mount St. Helens (MSH) produced multiple pyroclastic density currents (PDCs), burying the area north of the volcano under 10s of meters of deposits. Detailed measurements of recently exposed strata from these PDCs provide substantial insight into the dynamics of concentrated currents including inferences on particle-particle interactions, current mobility due to sedimentation fluidization and internal pore pressure, particle support mechanisms, the influence of surface roughness and the conditions that promote substrate erosion and self-channelization. Four primary flow units are identified along the extensive drainage system north of the volcano. Each flow unit has intricate vertical and lateral facies changes and complex cross-cutting relationships away from source. Each flow unit is an accumulation from an unsteady but locally sustained PDC or an amalgamation of several PDC pulses. The PDCs associated with Units I and II likely occurred during the pre-climactic, waxing phase of the eruption. These currents flowed around and filled in the hummocky topography, leaving the massive to diffusely-stratified deposits of Units I and II. The deposits of both Units I and II are generally more massive in low lying areas and more stratified in areas of high surface roughness, suggesting that surface roughness enhanced basal shear stress within the flow boundary. Units III and IV are associated with the climactic phase of the eruption, which produced the most voluminous and wide-spread PDCs. Both flow units are characteristically massive and enriched in vent-derived lithic blocks. These currents flowed over and around the debris avalanche deposits, as evidenced by the erosion of blocks from the hummocks. Unit III is massive, poorly sorted, and shows little to no evidence of elutriation or segregation of lithics and pumice, suggesting a highly concentrated current where size-density segregation was suppressed. Unit IV shows similar depositional features but typically has a basal lithic-rich region, is variably fines-depleted and contains pumice lobes, suggesting density segregation in a less concentrated current relative to Unit III. Deep, erosive channels cut by the Unit III current and thick lithic levee deposits within Unit IV occur in an area where debris avalanche relief is limited, suggesting self-channelization developed as a function of internal flow dynamics. An increase in the proportion and size of lithic blocks is found (1) downstream of debris avalanche hummocks, suggesting the PDCs were energetic enough to locally entrain accidental lithics from the hummocks and transport them tens of meters downstream, and (2) within large channels cut by later PDCs into earlier PDC deposits, suggesting self-channelization of the flows increased the carrying capacity of the subsequent channelized currents. Finally, the combination of thick, massive deposits with a high percentage of fine ash within Unit III and in the medial-distal depositional regions of Units II-IV suggests the PDCs developed and maintained a high internal pore pressure during transport and deposition. The most important include our ability to understand the role of internal pore pressure on current mobility, the influence of self-channelization on carrying capacity of the currents and the influence of surface roughness on substrate erosion. These observations have critical consequences for understanding the flow dynamics and hazard potential of PDCs

Parents’ Perspectives about Tele-Intervention Services for their Children who are Deaf or Hard of Hearing

Purpose: In the first of a two-part survey series, this cross-sectional survey study explored parent perceptions of tele-intervention (TI) services for their young children who are deaf or hard of hearing. Using Likert rating scales, the survey queried parent confidence in understanding their child’s language development, perceptions of the coaching and support they received, the parent-professional partnership, and overall views and recommendations. Data were collected March-May 2020, not realizing the survey release would coincide with the Covid-19 pandemic and the influx of unexpected virtual services. For this reason, data were stratified between those who had received TI services for more than versus less than three months. Responses for in-person services were also evaluated for additional context. Methods: Responses from 48 participants who received TI and 18 participants who received in-person services (n=66) were analyzed using descriptive statistics. Cronbach’s alpha showed high internal consistency for all Likert scales; items of each subscale were sum-scored to examine relationships across queried areas of service delivery. Results: Ninety-six percent of all respondents were highly or mostly satisfied with their TI services and 90% would definitely or probably recommend TI to other families. Overall positive findings were found across Likert scale queries, with no differences between parent perceptions of TI and in-person services, nor between TI for more than versus less than three months. However, findings also highlighted areas in which TI and in-person providers could improve intervention effectiveness, including coaching and supports to optimize parent confidence in understanding and facilitating their child’s language and communication goals. Conclusions: Parent perceptions of the TI delivery model were favorable. Implications and recommendations for both TI and in-person providers are discussed

Content Analysis of Patient Safety Incident Reports for Older Adult Patient Transfers, Handovers, and Discharges:Do They Serve Organizations, Staff, or Patients?

Objectives: Analyse content of incident reports during patient transitions in the context of care of older people, cardiology, orthopaedics and stroke. Methods: A structured search strategy identified incident reports involving patient transitions (March 2014 – August 2014, January 2015 – June 2015) within two NHS Trusts (in upper and lower quartiles of incident reports/100 admissions) in care of older people, cardiology, orthopaedics and stroke. Content analysis identified: incident classifications; active failures; latent conditions; patient/relative involvement; and evidence of individual or organisational learning. Reported harm was interpreted with reference to National Reporting and Learning System criteria. Results: A total 278 incident reports were analysed. Fourteen incident classifications were identified, with pressure ulcers the modal category (n=101; 36%) followed by falls (n=32, 12%), medication (n=31, 11%) and documentation (n=29, 10%). Half (n=139; 50%) of incident reports related to inter-unit/department/team transfers. Latent conditions were explicit in 33 (12%) reports; most frequently, these related to inadequate resources/staff and concomitant time pressures (n=13). Patient/family involvement was explicit in 61 (22%) reports. Patient well-being was explicit in 24 (9%) reports. Individual and organisational learning was evident in 3% and 7% of reports respectively. Reported harm was significantly lower than coder-interpreted harm (p<0.0001). Conclusions: Incident report quality was sub-optimal for individual and organisational learning. Under-reporting level of harm suggests reporter bias, which requires reducing as much as practicable. System-level interventions are warranted to encourage use of staff reflective skills, emphasising joint ownership of incidents. Co-producing incident reports with other clinicians involved in the transition and patients/relatives could optimise organisational learning

Acute systemic inflammation enhances tissue plasminogen activator release in man

Digitalitzat per Artypla