Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

Synthesising practice guidelines for the development of community-based exercise programmes after stroke

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Multiple guidelines are often available to inform practice in complex interventions. Guidance implementation may be facilitated if it is tailored to particular clinical issues and contexts. It should also aim to specify all elements of interventions that may mediate and modify effectiveness, including both their content and delivery. We conducted a focused synthesis of recommendations from stroke practice guidelines to produce a structured and comprehensive account to facilitate the development of community-based exercise programmes after stroke.National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsul

Zur toxikologischen Untersuchung ultrafeiner Partikel: Entwicklung und Einsatz eines realitaetsnahen in vitro Lungenmodells

Das Ziel der vorliegenden Arbeit war die Entwicklung eines realitaetsnahen humanen Zellkulturmodells der Luft/Blut-Schranke. Dazu wurde die Wirkung von ultrafeinen Modellpartikeln (Haematit-, Silicasol- und Quarz-Partikel) auf die Bronchialepithelzelllinie BEAS-2B, die Alveolarepithelzelllinie A549, die Endothelzelllinie ECV304 und die Makrophagenzelllinien THP-1 und Mono Mac 6 untersucht, um geeignete Zelllinien zu finden. Mit dem Transmissionselektronenmikroskop konnte die Aufnahme und der basolateral gerichtete Transport von Partikeln in A549-Alveolarepithelzellen dokumentiert werden. Die Ergebnisse aus umfangreichen Zytotoxizitaetsstudien unterstuetzen die Hypothese, nach der die Wirkung von Partikeln mit abnehmender Groesse zunimmt. Jedoch determiniert die chemische Zusammensetzung den grundsaetzlichen toxischen Effekt der Partikel, deren Wirkung durch eine Dosis-Wirkungs-Beziehung beschrieben werden konnte. Jede Zellinie zeigte eine charakteristische Wirkungsempfindlichkeit. Nach Exposition mit Partikeln setzten die Zellen in fuer die jeweilige Zelllinie charakteristischer Weise die Entzuendungsmediatoren Interleukin-6 und Interleukin-8 frei. In Kokulturen von A549-Alveolarepithelzellen mit THP-1- oder Mono Mac 6-Makrophagen zeigte sich eine um das vielfache gesteigerte Freisetzung der Interleukine. Diese Ergebnisse zeigen die Bedeutung der Interaktion zwischen den verschiedenen Zelllinien bei den Entzuendungsreaktionen nach Exposition mit Partikeln an der Luft/Blut-Schranke. Erste Untersuchungen an der Triple-Zellkultur unterstuetzen diese Befunde. Zudem wurden in elektronenmikroskopischen Aufnahmen erste Hinweise auf eine Translokation von Partikeln durch die Zellschichten gefunden. (orig.)The aim of the present study was the development of a close-to-reality human cell culture model of the air/blood barrier. Therefore, different human cell lines were evaluated regarding their response after exposure to fine and ultrafine model particles (hematite, silicasol and quartz particles). The cell lines under study were the bronchial epithelial cells BEAS-2B, the alveolar epithelial cells A549, the endothelial cells ECV304 and the macrophage-like cells THP-1 and Mono Mac 6. The uptake of hematite particles into A549 alveolar epithelial cells and the basolateral directed transport could be documented by use of light microscopy and transmission electron microscopy. The results from extensive cytotoxicity studies support the hypothesis, that decreasing diameters of the used particles increase the intensity of the cytotoxic effects. However, the chemical composition determines the fundamental toxic impact of the particles. Each cell line showed a characteristic sensitivity to particle exposure in a dose-dependent manner. After exposure to particles, the cells released the inflammatory mediators Interleukin-6 and Interleukin-8 in dependence of the cell line. The co-cultures of alveolar epithelial cells (A549) and macrophage-like cells (differentiated THP-1 or Mono Mac 6) showed an increased sensitivity to particles concerning the cytokine release in comparison to the mono-cultures of each cell line. These results point out the significance of the interactions between the different cell types for inflammatory responses after exposure to particles at the air/blood barrier. First studies using the triple-cell culture system support these findings. Furthermore, transmission electron micrographs of the triple-cell culture system indicate translocation of hematite particles through the cell layers. (orig.)Available from TIB Hannover: ZA 5141(6899) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Consumer Responses to Creative Media Advertising: A Literature Review

This paper provides an overview of the state of knowledge about creative media advertising; choosing a novel medium that implicitly communicates the message. It explains what creative media advertising is and how it differs from other unconventional marketing communication formats. It addresses the theoretical mechanisms that explain how creative media affect consumers. The paper presents a systematic literature review of all the empirical research about creative media advertising that explicitly compares its effectiveness with traditional media advertising. The 11 reviewed articles with 16 experiments appeared between 2005 and 2015. Overall creative media advertising generated positive evaluative outcomes (e.g., brand attitude) and behavior (e.g., word-of-mouth and sales). These effects were often mediated by a feeling of surprise and an increase in positive thoughts. It remains unclear whether creative media are perceived as persuasion attempts. Mixed findings exist for cognitive outcomes. Creative media advertising seems beneficial for creating strong brand associations, but brand memory might suffer from the technique if solving the link between the medium and the message takes away mental resources for the brand elements in the advertisement