Systematic review of the impact of cannabinoids on neurobehavioral outcomes in preclinical models of traumatic and nontraumatic spinal cord injury.

STUDY DESIGN: Systematic review. OBJECTIVES: To evaluate the impact of cannabinoids on neurobehavioral outcomes in preclinical models of nontraumatic and traumatic spinal cord injury (SCI), with the aim of determining suitability for clinical trials involving SCI patients. METHODS: A systematic search was performed in MEDLINE and Embase databases, following registration with PROPSERO (CRD42019149671). Studies evaluating the impact of cannabinoids (agonists or antagonists) on neurobehavioral outcomes in preclinical models of nontraumatic and traumatic SCI were included. Data extracted from relevant studies, included sample characteristics, injury model, neurobehavioural outcomes assessed and study results. PRISMA guidelines were followed and the SYRCLE checklist was used to assess risk of bias. RESULTS: The search returned 8714 studies, 19 of which met our inclusion criteria. Sample sizes ranged from 23 to 390 animals. WIN 55,212-2 (n = 6) and AM 630 (n = 8) were the most used cannabinoid receptor agonist and antagonist respectively. Acute SCI models included traumatic injury (n = 16), ischaemia/reperfusion injury (n = 2), spinal cord cryoinjury (n = 1) and spinal cord ischaemia (n = 1). Assessment tools used assessed locomotor function, pain and anxiety. Cannabinoid receptor agonists resulted in statistically significant improvement in locomotor function in 9 out of 10 studies and pain outcomes in 6 out of 6 studies. CONCLUSION: Modulation of the endo-cannabinoid system has demonstrated significant improvement in both pain and locomotor function in pre-clinical SCI models; however, the risk of bias is unclear in all studies. These results may help to contextualise future translational clinical trials investigating whether cannabinoids can improve pain and locomotor function in SCI patients.NIHR Clinical Doctoral Research Fellowship

The impact of phosphodiesterase inhibition on neurobehavioral outcomes in preclinical models of traumatic and non-traumatic spinal cord injury: a systematic review

Study designSystematic review.ObjectiveThe objective of this study was to evaluate the impact of phosphodiesterase (PDE) inhibitors on neurobehavioral outcomes in preclinical models of traumatic and non-traumatic spinal cord injury (SCI).MethodsA systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was registered with PROSPERO (CRD42019150639). Searches were performed in MEDLINE and Embase. Studies were included if they evaluated the impact of PDE inhibitors on neurobehavioral outcomes in preclinical models of traumatic or non-traumatic SCI. Data were extracted from relevant studies, including sample characteristics, injury model, and neurobehavioral assessment and outcomes. Risk of bias was assessed using the SYRCLE checklist.ResultsThe search yielded a total of 1,679 studies, of which 22 met inclusion criteria. Sample sizes ranged from 11 to 144 animals. PDE inhibitors used include rolipram (n = 16), cilostazol (n = 4), roflumilast (n = 1), and PDE4-I (n = 1). The injury models used were traumatic SCI (n = 18), spinal cord ischemia (n = 3), and degenerative cervical myelopathy (n = 1). The most commonly assessed outcome measures were Basso, Beattie, Bresnahan (BBB) locomotor score (n = 13), and grid walking (n = 7). Of the 22 papers that met the final inclusion criteria, 12 showed a significant improvement in neurobehavioral outcomes following the use of PDE inhibitors, four papers had mixed findings and six found PDE inhibitors to be ineffective in improving neurobehavioral recovery following an SCI. Notably, these findings were broadly consistent across different PDE inhibitors and spinal cord injury models.ConclusionIn preclinical models of traumatic and non-traumatic SCI, the administration of PDE inhibitors appeared to be associated with statistically significant improvements in neurobehavioral outcomes in a majority of included studies. However, the evidence was inconsistent with a high risk of bias. This review provides a foundation to aid the interpretation of subsequent clinical trials of PDE inhibitors in spinal cord injury.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150639, identifier: CRD42019150639

A literature review: readmission of older patients to the acute care setting

Objective: The review identifies current research, issues and gaps in knowledge of older people being readmitted to hospital. The review highlights the need for qualitative work that values the perspective of the older person employing a person centred approach to the research. Context: The literature review was conducted as part of a small qualitative descriptive study of the older person's experience of readmission to the acute care setting. The study informs the work of a Bachelor of Nursing Honours project. Conclusions and Recommendations: There is a lack of comparable data related to the reasons for readmission or the impact that it has on health services or patient outcomes. The paucity of research that considers the older person's experience of this phenomenon indicates the need for further work in this area

Repositioning practice: a discourse analysis of clinical supervision as part of implementing a psychosocial intervention in cancer care

Research Doctorate - Doctor of Philosophy (PhD)This thesis by publication describes a study that used discourse analysis to explore clinical supervision sessions between supervisors and health professionals trained to deliver a psychosocial intervention for a large multi-site randomised control trial. The research questions asked: Does clinical supervision facilitate changes for Health Professionals trained to deliver a psychosocial Intervention? What influence does clinical supervision have on the discourses of Health Professionals and their practice? What might this reveal about change in practice and barriers/enablers to such changes? A systematic review of the barriers to psychosocial care revealed that Health Professionals reported organisational, cultural and individual clinician-related barriers. Clinical supervision is recommended to support Health Professionals in overcoming these barriers. Whilst a review of the clinical supervision literature explored confusion about expectation and the quantifiable outcomes of clinical supervision, there is evidence that multidisciplinary, group clinical supervision provides a forum for sharing of knowledge and generation of shared understandings of healthcare. The participants for the study were thirty Health Professionals (23 nurses, four physio therapists, two radiation therapists and one occupational therapist) and three clinical supervisors who took part in 96 clinical supervision sessions. Discourse analysis was used to critically examine seventeen audio recorded sessions of multidisciplinary, group format clinical supervision. Discourse mapping was used as a vehicle to explore discursive constructions in the data. The method of data collection and analysis represent novel approaches to exploring clinical supervision and its impact on the process of practice change. Findings showed that clinical supervision facilitated non-linear changes in the clinical practice of Health Professionals trained to deliver a new psychosocial Intervention. Changes included using discourse within the clinical supervision sessions to resist the systemic, organisational, cultural and personal barriers that presented themselves as part of delivering a new psychosocial Intervention. Clinical supervision provided a forum for sharing stories that were used to construct new meanings and reposition the Health Professionals within the experience of delivering psychosocial care in the context of adult cancer care. Health Professionals’ language was used to challenge, or accommodate tensions that were seen to govern the behaviours and language used by Health Professionals. Their discourses illustrated a fragility and potential for change. Discourses within supervision negotiated ways of practicing that may accommodate the tensions allowing change in practice

Feeling let down: an exploratory study of the experiences of older people who were readmitted to hospital following a recent discharge

Background: Readmission of older people to hospital following a recent discharge may be an indicator of gaps in services either prior to or after discharge. Aims and objectives: To explore the experiences of older people who have been readmitted to hospital following recent discharge to their homes. Design: A qualitative descriptive study. Method: In-depth interviews were conducted with three older people who were discharged from a large tertiary referral hospital in NSW Australia and readmitted. Interviews were conducted within the hospital setting in a private room. An interview guide was used to explore the reasons for admission and readmission to hospital and experiences upon discharge to home. In particular the researchers were interested in the events that led to readmission. Data were analysed thematically. Results: Three main themes emerged including: being left out, being cared for and feeling let down. Conclusion: While this study was undertaken in only one hospital with only three older people the findings provide valuable insight into their experiences. Nurses need to be proactive in ensuring and promoting a person-centred approach to the care and treatment of older people

Computer and telephone delivered interventions to support caregivers of people with dementia: a systematic review of research output and quality

Background: To assess the scope, volume and quality of research on the acceptability, utilisation and effectiveness of telephone and computer-delivered interventions for caregivers of people living with dementia. Methods: Medline, EMBASE, CINAHL and Cochrane databases were searched (Jan 1990 – Dec 2016). Eligible papers were classified as data-based descriptive, measurement or intervention studies. Intervention studies were first categorised according to mode of delivery (e.g. telephone, computer); then assessed against the Effective Practice and Organisation of Care methodological criteria for research design. Impact on health-related outcomes; and the acceptability, feasibility and utilisation of interventions were also assessed. Results: The number of publications increased by 13% each year (p< 0.001). Half were descriptive studies (n=92, 50%) describing caregiver views on acceptability, access or utilization of technology. The remainder (n=89, 48%) reported on interventions designed to improve caregiver outcomes. Only 34 met EPOC design criteria. Interventions were delivered via computer (n=10), multiple modalities (n=9) or telephone (n=15). Interventions that incorporated various elements of psycho-education, peer support, skills training and health assessments led to improvements in caregiver wellbeing. While largely acceptable, utilisation of computer-based interventions was variable, with use often decreasing over time. Conclusion: Interventions delivered via telephone and computer have the potential to augment existing dementia care. High-quality trials are required to make clear recommendations about the types of interventions that are most effective. Those providing caregiver with access to practical strategies to manage care of the person with dementia and their own wellbeing, to advice and support from peers and/or clinicians and target the dyad should be explored

Exploring the situational complexities associated practice change in health

Purpose - The purpose of this paper is to critically examine multidisciplinary, group clinical supervision sessions and to extend current understandings of the barriers/enablers to the implementation of an innovative psychosocial intervention for distressed adults with cancer.Design/methodology/approach - Discourse analysis was used to analyse audio recordings from clinical supervision sessions delivered as part of a psychosocial intervention within the context of a randomised control trial (RCT).Findings - Examination of subject positions, representation and tensions reveals that Health Professionals can resists the pressures of systemic barriers to provide much-needed psychosocial support for distressed adults with cancer. Critical examination of multidisciplinary clinical supervision sessions describes how Health Professionals are able to construct new meanings and reposition themselves as being able to provide supportive care within the context of their everyday practices.Research limitations/implications - This paper reports only a small part of a larger analysis that aims to explore how discourse maps the current state of psychosocial care for adults with cancer and illustrates the fragility and potential for change in this area.Originality/value - Extension on the previous literature is seen within the data through the presence of positive resistance against systemic barriers. Previous exploration of clinical supervision has not collected data generated within the sessions. It is also novel in the use of discourse analysis being used in association with a randomised controlled trial to understand the situational complexities associated with bringing about practice change

Nurse-led ED support for Residential Aged Care Facility staff: An evaluation study

'Objectives': To evaluate the impact of a nurse-led telephone support service to Residential Aged Care Facilities (RACFs) on a range of measures relating to the transfer of acutely unwell residents to the Emergency Department (ED) of a large tertiary referral hospital in New South Wales, Australia over a 9 month period. 'Methods': A pre- and post-intervention design determined the impact of the telephone service, associated clinical guidelines and education. Data from 4 intervention RACFs using the nurse-led telephone service were compared with 8 control RACFs. Data included the older patient's triage category, presenting problem(s), transfer rates from RACFs, ED admissions, and overall hospital length of stay. Interviews and focus groups with staff from RACFs and EDs were conducted to ascertain their experiences. 'Results': Reduced presentations of older people to the ED from the 4 pilot RACFs occurred. High levels of satisfaction among staff in RACFs were reported

Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review

Objective: To explore the barriers experienced and perceived by health professionals and patients in the delivery of psychosocial care to adults with cancer. Methods: Systematic searches were undertaken using the Psych Info, Medline and CINAHL electronic databases, up to October 2013. Research reporting health professional or patient experiences and perceptions of barriers to psychosocial care are included in the review. The systematic review includes studies that have non-experimental, exploratory and observational designs, as is appropriate to answer the review question. Included studies were critically appraised. The results of individual quantitative studies were aggregated. Qualitative content analysis was used to analyse the qualitative results. Results: Twenty-five papers met the pre-specified inclusion criteria for the final review. The most commonly perceived barrier for patients relates to receiving adequate support from elsewhere and a lack of perceived need for psychosocial care. Health professionals report barriers at an organisational level most frequently followed by cultural and then individual clinician-related barriers. Conclusions: Barriers exist on a variety of levels. People with cancer need clear appropriate information and communication about psychosocial services, including information about the role of psychosocial care in addition to existing supports. Interventions that target the complex interplay of individual, organisational and cultural factors need to be developed. Strategies that improve health professional communication skills, identify clear referral pathways, improve acceptability of interventions and clearly identify the need for services could address many of the barriers identified in this review