Equipment use and equipment provision services for people after stroke: A mixed methods study

Background: As people live longer with more complex disability in their own homes, adaptive equipment is one way to enable their safety and participation. However, it is not well understood how people with stroke use adaptive equipment and how they interact with the services which provide equipment. The reasoning used by therapists who issue equipment, the outcomes achieved by equipment provision and the cost of equipment remain ambiguous. A theoretical framework which explains how services for equipment provision currently operate, with specific attention to the relationships between health policy, health provider behaviour, and equipment user experiences and outcomes was required. Aim and objectives: The aim of this study was to explore whether the policies and procedures for provision of adaptive equipment to people with stroke are fit for purpose in terms of maximising safety, independence and choice. The objectives for this research were to: 1) describe who is more likely to receive publicly-funded equipment after stroke and what outcomes are achieved by them using equipment, 2) estimate the annual cost of adaptive equipment prescription for people with stroke, 3) explore the experiences of people with stroke about equipment provision services and, 4) explore the perspectives of therapists who prescribe equipment. Methods: A sequential explanatory mixed methods approach was used to gather data over three phases, initially from people with stroke who use equipment (n = 258 surveyed using a postal survey, with n = 15 interviewed using a semi-structured schedule) and then therapists via six focus groups (n = 30). Results: Findings indicated that no one demographic characteristic significantly increased the likelihood of equipment receipt. The most valued equipment after stroke was mobility related which made people feel safer, more confident and in control. The cost of new equipment for people who had a stroke in 2012 was estimated to be NZD $1.2 million. Overall satisfaction with equipment provision services was high. People with stroke initially relied on their therapist to guide equipment choice as they transitioned out of hospital; thereafter they assumed greater control for decision making regarding equipment. As time passed, equipment became more meaningful in the context of their lives, often happening when equipment enabled community participation. A theoretical framework was developed which illustrated seven inter-related influences on the reasoning of therapists during equipment provision: ‘client engagement (willingness and capacity)’, ‘others (family members and healthcare staff)’, ‘risks vs benefits’, ‘environment (physical and cultural)’, ‘professional philosophy’, ‘equipment provision system’ and the ‘wider health system’. Discussion: Adaptive equipment and equipment services were found to provide a low cost, useful and valued service. Some challenges existed for equipment provision services, however, including a tension between policy objectives to limit costs associated with provision of equipment for use outside of the home and clinical, person-centred objectives to encourage community participation. Challenges like this resulted in moral distress for therapists and raised questions about the degree to which the health system may be increasing disease burden, and potentially long-term health costs, by failing to fully address equipment-related barriers to outdoor mobility and participation

Online-based participatory design: A Case Study of Developing International Standards During a Pandemic

Standards are essential instruments to ensure the safety, efficiency and quality of products, services, systems, processes, and environments. In pre-pandemic times, standard development process used to happen through in-person consultation and meetings, however, the COVID-19 pandemic disrupted the whole routine. A team of technical experts from the National Standards Authority of Ireland trialled an online-based participatory design process to support the review and development of a standard through stakeholder engagement. This article introduces the experience of developing a new standard by leveraging on emerging digital technologies, through stakeholder participation. This research offers a framework, outlining the steps undertaken during the process, to support future online-based standard development processes in co-operation with stakeholders, by respecting cultures, backgrounds, skills, and experiences

Confident, Credible but Lonely – Outcomes Following Postgraduate Interprofessional Education in Rehabilitation

Background: Interprofessional education aims to enhance health service delivery. This study examined whether health professionals changed their clinical practice after completing a postgraduate interprofessional qualification in rehabilitation. Methods & Findings: All graduates of postgraduate qualifications in rehabilitation at University of Otago were invited to complete a questionnaire. Thirteen participants were purposively selected for further in-depth interviews. Questionnaire data were summarized using descriptive statistics. Qualitative responses from questionnaires and interview transcripts were explored using thematic analysis. The survey response rate was 24% (77/315 students). Postgraduate study was reported to have had a positive impact on professional attitudes and commitment to learning (81%), to enhance interdisciplinary collaboration (79%), and to promote change in service delivery (40%). Themes identified from questionnaire responses were: 1) increased confidence, 2) enhanced credibility, and 3) widened view of rehabilitation. Analysis of the interviews identified three contrasting themes: 1) isolation hampers momentum, 2) managers and clinical leaders do not value postgraduate qualifications, 3) implementing change required postgraduate study plus persistence. Conclusions: Educators and employers of health professionals should be aware of the benefits of postgraduate interprofessional education for health professionals and healthcare delivery. Employers should recognize and value these benefits and support health professionals to apply new skills in their clinical practice

Exploring the perspectives of key stakeholders on the design and delivery of an intervention to rehabilitate people with cognitive deficits post-stroke [version 2; peer review: 1 approved, 2 approved with reservations]

Background: Stroke is a leading cause of death and disability worldwide. Cognitive impairment is common post-stroke and can result in negative sequalae such as a lower quality of life, increased carer burden and increased healthcare costs. Despite the prevalence and associated burden of post-stroke cognitive impairment, there is uncertainty regarding the optimum intervention to improve cognitive function post-stroke. By exploring the perspectives of people post-stroke, carers and healthcare professionals on cognitive impairment, this qualitative study aims to inform the design and development of an intervention to rehabilitate cognitive impairment post-stroke. Methods: A qualitative descriptive approach will be applied, using semi-structured interviews with people post-stroke, carers and healthcare professionals. People post-stroke will be recruited via gatekeepers from a local stroke support group and Headway, a brain injury support service. Carers will be recruited via a gatekeeper from a local carers branch. Healthcare professionals will be recruited via gatekeepers from relevant neurological sites and via Twitter. The final number of participants recruited will be guided by information power. Data will be collectively analysed and synthesised using thematic analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines will be used to standardize the conduct and reporting of the research. Conclusions: It is anticipated that exploring the perspectives of people post-stroke, carers and healthcare professionals on cognitive impairment post-stroke will inform the development of an evidence-based optimal intervention to rehabilitate cognitive deficits post-stroke. This study was granted ethical approval from the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick. Study findings will be disseminated locally through presentations at stroke support groups, as well as internationally through academic conferences and peer-reviewed journals

Collaborative approach to Optimise MEdication use for Older people in Nursing homes (COME-ON): study protocol of a cluster controlled trial

BACKGROUND: Ageing has become a worldwide reality and presents new challenges for the health-care system. Research has shown that potentially inappropriate prescribing, both potentially inappropriate medications and potentially prescribing omissions, is highly prevalent in older people, especially in the nursing home setting. The presence of potentially inappropriate medications/potentially prescribing omissions is associated with adverse drug events, hospitalisations, mortality and health-care costs. The Collaborative approach to Optimise MEdication use for Older people in Nursing homes (COME-ON) study aims to evaluate the effect of a complex, multifaceted intervention, including interdisciplinary case conferences, on the appropriateness of prescribing of medicines for older people in Belgian nursing homes. METHODS/DESIGN: A multicentre cluster-controlled trial is set up in 63 Belgian nursing homes (30 intervention; 33 control). In each of these nursing homes, 35 residents (≥65 years) are selected for participation. The complex, multifaceted intervention comprises (i) health-care professional education and training, (ii) local concertation (discussion on the appropriate use of at least one medication class at the level of the nursing home) and (iii) repeated interdisciplinary case conferences between general practitioner, nurse and pharmacist to perform medication review for each included nursing home resident. The control group works as usual. The study period lasts 15 months. The primary outcome measures relate to the appropriateness of prescribing and are defined as (1) among residents who had at least one potentially inappropriate medication/potentially prescribing omission at baseline, the proportion of them for whom there is a decrease of at least one of these potentially inappropriate medications/potentially prescribing omissions at the end of study, and (2) among all residents, the proportion of them for whom at least one new potentially inappropriate medication/potentially prescribing omission is present at the end of the study, compared to baseline. The secondary outcome measures include individual components of appropriateness of prescribing, medication use, outcomes of the case conferences, clinical outcomes and costs. A process evaluation (focusing on implementation, causal mechanisms and contextual factors) will be conducted alongside the study. DISCUSSION: The COME-ON study will contribute to a growing body of knowledge concerning the effect of complex interventions on the use of medicines in the nursing home setting, and on factors influencing their effect. The results will inform policymakers on strategies to implement in the near future. TRIAL REGISTRATION: Current Controlled Trials ISRCTN66138978

Development and implementation of a highly-multiplexed SNP array for genetic mapping in maritime pine and comparative mapping with loblolly pine

<p>Abstract</p> <p>Background</p> <p>Single nucleotide polymorphisms (SNPs) are the most abundant source of genetic variation among individuals of a species. New genotyping technologies allow examining hundreds to thousands of SNPs in a single reaction for a wide range of applications such as genetic diversity analysis, linkage mapping, fine QTL mapping, association studies, marker-assisted or genome-wide selection. In this paper, we evaluated the potential of highly-multiplexed SNP genotyping for genetic mapping in maritime pine (<it>Pinus pinaster </it>Ait.), the main conifer used for commercial plantation in southwestern Europe.</p> <p>Results</p> <p>We designed a custom GoldenGate assay for 1,536 SNPs detected through the resequencing of gene fragments (707 <it>in vitro </it>SNPs/Indels) and from Sanger-derived Expressed Sequenced Tags assembled into a unigene set (829 <it>in silico </it>SNPs/Indels). Offspring from three-generation outbred (G2) and inbred (F2) pedigrees were genotyped. The success rate of the assay was 63.6% and 74.8% for <it>in silico </it>and <it>in vitro </it>SNPs, respectively. A genotyping error rate of 0.4% was further estimated from segregating data of SNPs belonging to the same gene. Overall, 394 SNPs were available for mapping. A total of 287 SNPs were integrated with previously mapped markers in the G2 parental maps, while 179 SNPs were localized on the map generated from the analysis of the F2 progeny. Based on 98 markers segregating in both pedigrees, we were able to generate a consensus map comprising 357 SNPs from 292 different loci. Finally, the analysis of sequence homology between mapped markers and their orthologs in a <it>Pinus taeda </it>linkage map, made it possible to align the 12 linkage groups of both species.</p> <p>Conclusions</p> <p>Our results show that the GoldenGate assay can be used successfully for high-throughput SNP genotyping in maritime pine, a conifer species that has a genome seven times the size of the human genome. This SNP-array will be extended thanks to recent sequencing effort using new generation sequencing technologies and will include SNPs from comparative orthologous sequences that were identified in the present study, providing a wider collection of anchor points for comparative genomics among the conifers.</p

Report on SHAFE policies, strategies and funding

The objective of Working Group (WG) 4 of the COST Action NET4Age-Friendly is to examine existing policies, advocacy, and funding opportunities and to build up relations with policy makers and funding organisations. Also, to synthesize and improve existing knowledge and models to develop from effective business and evaluation models, as well as to guarantee quality and education, proper dissemination and ensure the future of the Action. The Working Group further aims to enable capacity building to improve interdisciplinary participation, to promote knowledge exchange and to foster a cross-European interdisciplinary research capacity, to improve cooperation and co-creation with cross-sectors stakeholders and to introduce and educate students SHAFE implementation and sustainability (CB01, CB03, CB04, CB05). To enable the achievement of the objectives of Working Group 4, the Leader of the Working Group, the Chair and Vice-Chair, in close cooperation with the Science Communication Coordinator, developed a template (see annex 1) to map the current state of SHAFE policies, funding opportunities and networking in the COST member countries of the Action. On invitation, the Working Group lead received contributions from 37 countries, in a total of 85 Action members. The contributions provide an overview of the diversity of SHAFE policies and opportunities in Europe and beyond. These were not edited or revised and are a result of the main areas of expertise and knowledge of the contributors; thus, gaps in areas or content are possible and these shall be further explored in the following works and reports of this WG. But this preliminary mapping is of huge importance to proceed with the WG activities. In the following chapters, an introduction on the need of SHAFE policies is presented, followed by a summary of the main approaches to be pursued for the next period of work. The deliverable finishes with the opportunities of capacity building, networking and funding that will be relevant to undertake within the frame of Working Group 4 and the total COST Action. The total of country contributions is presented in the annex of this deliverable

Coping and Multiple Sclerosis:Individuals with Multiple Sclerosis and their Significant Others

Multiple Sclerosis (MS) is a degenerative condition which affects everyone differently as regards emergence of symptoms. The illness uncertainty associated with MS has ramifications for how those with the condition and those close to them cope with the illness, with each other and with the effect it has on their lives. Health professionals acknowledge that those with MS need to be seen in the context of their families. The perspective of significant others (SOs) need to be acknowledged. However there is a lack of knowledge about what to expect about how people cope as a dyad. This study used Interpretative Phenomenological Analysis (IPA) to explore how those with MS and their SOs cope with this illness in their lives. Seven couples were recruited using purposive sampling through the MS society. Each person in the couple was interviewed separately using a semi-structured interview schedule. The interviews were transcribed and analysed using the principles of IPA to produce overarching themes and sub themes. Peer coding by two supervisors helped to enrich the analysis and contributed to the trustworthiness of the findings. Three overarching themes emerged from the data, two overarching themes with four sub themes and one overarching theme with 3 sub themes. These overarching themes are labelled: Resources and Barriers to Coping, Coping Together: "Peaks and Troughs" and Coping over the Long Haul. Two integrative themes emerged, which were called Faith in Self and Faith in Each Other, encapsulating the participants’ identified primary resources which enabled them to cope. The results of this study will assist health professionals to better comprehend how those with MS cope in an interconnected way with those with whom they share their lives. This research has highlighted the individual preferences about coping style and choice of coping strategies from the perspective of both the person with MS and their significant other. In addition, the nature of the relationship between couples, and the impact this relationship has on their ability to cope, needs to be understood and acknowledged by health professionals. The results of this study indicated that the relationship can be a powerful resource for couples during times of illness related stress. This study adds to the small but growing body of literature about how couples with MS make sense of the disease and how they develop coping strategies relevant to their relationship

Coping and Multiple Sclerosis:Individuals with Multiple Sclerosis and their Significant Others

Multiple Sclerosis (MS) is a degenerative condition which affects everyone differently as regards emergence of symptoms. The illness uncertainty associated with MS has ramifications for how those with the condition and those close to them cope with the illness, with each other and with the effect it has on their lives. Health professionals acknowledge that those with MS need to be seen in the context of their families. The perspective of significant others (SOs) need to be acknowledged. However there is a lack of knowledge about what to expect about how people cope as a dyad. This study used Interpretative Phenomenological Analysis (IPA) to explore how those with MS and their SOs cope with this illness in their lives. Seven couples were recruited using purposive sampling through the MS society. Each person in the couple was interviewed separately using a semi-structured interview schedule. The interviews were transcribed and analysed using the principles of IPA to produce overarching themes and sub themes. Peer coding by two supervisors helped to enrich the analysis and contributed to the trustworthiness of the findings. Three overarching themes emerged from the data, two overarching themes with four sub themes and one overarching theme with 3 sub themes. These overarching themes are labelled: Resources and Barriers to Coping, Coping Together: "Peaks and Troughs" and Coping over the Long Haul. Two integrative themes emerged, which were called Faith in Self and Faith in Each Other, encapsulating the participants’ identified primary resources which enabled them to cope. The results of this study will assist health professionals to better comprehend how those with MS cope in an interconnected way with those with whom they share their lives. This research has highlighted the individual preferences about coping style and choice of coping strategies from the perspective of both the person with MS and their significant other. In addition, the nature of the relationship between couples, and the impact this relationship has on their ability to cope, needs to be understood and acknowledged by health professionals. The results of this study indicated that the relationship can be a powerful resource for couples during times of illness related stress. This study adds to the small but growing body of literature about how couples with MS make sense of the disease and how they develop coping strategies relevant to their relationship