Engaging patients and clinicians through simulation: rebalancing the dynamics of care

This paper proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues. This use of simulation is a radical departure from traditional transmission models of education and training. Instead, we frame simulation as co-development, through which professionals, patients and publics share their equally (though differently) expert perspectives. The paper argues that a process of participatory design can bring about new insights and that simulation offers understandings that cannot easily be expressed in words. Drawing on more than a decade of our group’s research on simulation and engagement, the paper summarises findings from studies relating to clinician-patient collaboration and proposes a novel approach to address the current need. The paper outlines a mechanism whereby pathways of care are jointly created, shaped, tested and refined by professionals, patients, carers and others who are affected and concerned by clinical care

Online Resource to Promote Vocational Interests Among Job Seekers With Multiple Sclerosis: A Randomized Controlled Trial in Australia

© 2017 American Congress of Rehabilitation Medicine Objective: To provide a preliminary evaluation of the effectiveness of an online resource for job seekers with multiple sclerosis (MS). Design: Randomized controlled design. Setting: Community-dwelling cohort. Participants: Adults (N = 95) with relapsing-remitting or progressive MS were randomly assigned to one of two groups. Forty-five accessed an email delivered, 7 module resource, Work and MS, over a 4 week period. Waitlist control participants (n=50) were offered the opportunity to access Work and MS 4 weeks postenrollment. Main Outcome Measures: Primary outcomes focused on vocational interests (My Vocational Situation Scale) and self-efficacy in job-seeking activities (Job-Procurement Self Efficacy Scale). Secondary outcomes focused on perceived workplace difficulties (Multiple Sclerosis Work Difficulties Questionnaire [MSWDQ]), optimism (Life Orientation Test – Revised), and mood (Patient Health Questionnaire-9). Results: Intention-to-treat analyses revealed pre-post gains: participants who accessed Work and MS reported improved confidence in their career goals (My Vocational Situation Scale g=.55; 95% confidence interval [CI],.14–.96; P=.008) and positively reappraised potential workplace difficulties (MSWDQ g range,.42–.47; P range,.023–.042). The effect on job self-efficacy was not significant, but changed in the expected direction (g=.17; 95% CI, –.23 to.57; P=.409). Completer data revealed larger, significant effect estimates (g range,.52–.64; P range,.009–.035). Conclusions: Findings provide preliminary support for the utility of a job information resource, Work and MS, to augment existing employment services. The results also suggest the need to test employment-ready interventions in a larger study population. This might include the addition of online peer support to increase intervention compliance

Mindfulness Therapies for Improving Mental Health in Parents of Children with a Developmental Disability: a Systematic Review

© 2020, Springer Science+Business Media, LLC, part of Springer Nature. Mindfulness offers promise as a therapy approach for parents of children with developmental disabilities (DD), however its effectiveness in managing mental health symptoms remains unclear. This review quantitatively examines the comparative effectiveness of mindfulness-based and informed interventions, drawing on the evidence base from randomised controlled trials (RCTs). Eight RCTs were identified from the Embase, PsycINFO, PubMed and Scopus databases. Risk of bias was assessed using the Cochrane Collaboration tool and Hedges’ g effect sizes, with associated 95% confidence intervals and p values calculated. Parents who completed Mindful Parenting or Mindfulness-Based Stress Reduction programs reported immediate and large to very large reductions in psychological distress (gw range:.39–1.94), with some improvements maintained up to 6 months post-treatment. A single study reported short-term benefits with Acceptance and Commitment Therapy. Evidence for the mental health benefits of mindfulness for parents of children with DD is still at an early stage. Controlled trials are needed to determine the differential effects of specific mindfulness techniques and how to best adapt this approach to best meet the unique needs of a vulnerable caregiver population

Is Poverty Decentralising? Quantifying Uncertainty in the Decentralisation of Urban Poverty

In this paper we argue that the recent focus on the suburbanisation of poverty is problematic because of the ambiguities and inconsistencies in defining suburbia. To improve transparency, replicability and comparability, we suggest that research on the geographical changes to the distribution of poverty should focus on three questions: (1) How centralised is urban poverty? (2) To what extent is it decentralising? (3) Is it becoming spatially dispersed? With respect to all three questions, the issue of quantifying uncertainty has been under-researched. The main contribution of the paper is to provide a practical and robust solution to the problem of inference based on a Bayesian multivariate conditional autoregressive (CAR) model, made accessible via the R-software package CARBayes. Our approach can be applied to spatio-temporally autocorrelated data, and can estimate both levels of and change in global RCIs (relative centralisation index), local RCIs and dissimilarity indices. We illustrate our method with an application to Scotland's four largest cities. Our results show that poverty was centralised in 2011 in Glasgow, Dundee and Aberdeen. Poverty in Edinburgh, however, was decentralised: non-poor households tend to live closer to the centre than poor ones, and increasingly so. We also find evidence of statistically significant reductions in centralisation of poverty in all four cities. To test whether this change is associated with poverty becoming more dispersed, we estimate changes to evenness and local decentralisation of poverty, revealing complex patterns of change

Stereotactic ablative body radiotherapy for the treatment of spinal oligometastases

Abstract not availableJ.H. Chang, S. Gandhidasan, R. Finnigan, D. Whalley, R. Nair, A. Herschtal, T. Eade, A. Kneebone, J. Ruben, M. Foote, S. Siv

Work and SCI: a pilot randomized controlled study of an online resource for job-seekers with spinal cord dysfunction.

STUDY DESIGN:A prospective, parallel randomized controlled trial (RCT). OBJECTIVES:To test the preliminary effects of an online resource targeted to job-seekers with spinal cord injury or disorder (SCI/D), and to determine the feasibility of proceeding to a full-scale RCT. SETTING:A community cohort in Australia. METHODS:Forty-eight adults (M = 42 years, SD = 10.95, 27 males) were randomized to receive 4-weeks access to the Work and SCI resource (n = 25) or to a wait-list control group (n = 23). The Work and SCI intervention involved six stand-alone learning modules which provided job-searching and career-planning information through text, videos, and interactive activities. Self-report measures were administered at baseline and after 4 weeks: Job Procurement Self-Efficacy Scale (JSES), Life Orientation Test-Revised (LOT-R), and Patient Health Questionnaire-9 (PHQ-9). RESULTS:Online usage data identified high uptake of the Work and SCI resource, although study attrition was problematic. Intention-to-treat analyses failed to reach statistical significance, whereas complete data revealed a significant interaction effect for optimism (LOT-R). CONCLUSION:Further research to develop and enhance Work and SCI is indicated. Remediable strategies to optimize recruitment and statistical power in a future definitive RCT are discussed. SPONSORSHIP:This project was funded by the auDA Foundation (project 16019)

Key challenges in simulated patient programs: An international comparative case study

<p>Abstract</p> <p>Background</p> <p>The literature on simulated or standardized patient (SP) methodology is expanding. However, at the level of the program, there are several gaps in the literature. We seek to fill this gap through documenting experiences from four programs in Australia, Canada, Switzerland and the United Kingdom. We focused on challenges in SP methodology, faculty, organisational structure and quality assurance.</p> <p>Methods</p> <p>We used a multiple case study method with cross-case synthesis. Over eighteen months during a series of informal and formal interactions (focused meetings and conference presentations) we documented key characteristics of programs and drew on secondary document sources.</p> <p>Results</p> <p>Although programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments.</p> <p>Conclusion</p> <p>This international case study reveals similarities and differences in SP methodology. Programs were highly contextualised and have emerged in response to local, institutional, profession/discipline and national conditions. Broader trends in healthcare education have also influenced development. Each of the programs experienced challenges in the same themes but the nature of the challenges often varied widely.</p

Protocol for the saMS trial (supportive adjustment for multiple sclerosis): a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis

BackgroundMultiple Sclerosis (MS) is an incurable, chronic, potentially progressive and unpredictable disease of the central nervous system. The disease produces a range of unpleasant and debilitating symptoms, which can have a profound impact including disrupting activities of daily living, employment, income, relationships, social and leisure activities, and life goals. Adjusting to the illness is therefore particularly challenging. This trial tests the effectiveness of a cognitive behavioural intervention compared to supportive listening to assist adjustment in the early stages of MS.MethodsThis is a two arm randomized multi-centre parallel group controlled trial. 122 consenting participants who meet eligibility criteria will be randomly allocated to receive either Cognitive Behavioral Therapy or Supportive Listening. Eight one hour sessions of therapy (delivered over a period of 10 weeks) will be delivered by general nurses trained in both treatments. Self-report questionnaire data will be collected at baseline (0 weeks), mid-therapy (week 5 of therapy), post-therapy (15 weeks) and at six months (26 weeks) and twelve months (52 weeks) follow-up. Primary outcomes are distress and MS-related social and role impairment at twelve month follow-up. Analysis will also consider predictors and mechanisms of change during therapy. In-depth interviews to examine participants’ experiences of the interventions will be conducted with a purposively sampled sub-set of the trial participants. An economic analysis will also take place. DiscussionThis trial is distinctive in its aims in that it aids adjustment to MS in a broad sense. It is not a treatment specifically for depression. Use of nurses as therapists makes the interventions potentially viable in terms of being rolled out in the NHS. The trial benefits from incorporating patient input in the development and evaluation stages. The trial will provide important information about the efficacy, cost-effectiveness and acceptability of the interventions as well as mechanisms of psychosocial adjustment.Trial registrationCurrent Controlled Trials ISRCTN91377356<br/

Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke

Objective: Develop and test a person-centred goal-setting package for discharge care planning in acute and rehabilitation stroke units. Methods: A multidisciplinary, expert working group (n = 15), and consumer group (n = 4) was convened. A multistage iterative approach was used to develop and test the package. Stages included: (i) contextual understanding, (ii) package development, and (iii) clinician training and field-testing in acute and rehabilitation settings. Observational field notes were taken and clinicians\u27 perspectives captured using semi-structured focus groups post-testing. Results: The final package included a 34-item menu aligned with a manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART-GEM); evidence-based strategies; and worked examples. Twenty-three clinicians attended training. Clinician observations (n = 5) indicated that: the package could be incorporated into practice; a range of person-centred goals were set; and opportunities provided to raise additional issues. Clinician feedback (n = 8) suggested the package was useful and facilitated person-centred goal-setting. Enablers included potential for incorporation into existing processes and beliefs that it promoted person-centred care. Barriers included additional time. Conclusion: The package demonstrated potential to facilitate comprehensive person-centred goal-setting for patients with stroke. Innovation: We developed an innovative approach to support structured person-centred goal setting in clinical and research settings