Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review

This is the final version of the article. Available from Public Library of Science via the DOI in this record.BACKGROUND: Healthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and "burnout" at work than staff in other sectors. There is a growing call for the 'triple aim' of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom's (UK) Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff. OBJECTIVES: This systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of) these recommendations and determine whether they improve staff health and wellbeing. METHODS: A comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward) in collective activities to improve physical or mental health or promote healthy behaviours. RESULTS: Eleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1) pre-determined (one-size-fits-all) and no choice of activities (two studies); or 2) pre-determined and some choice of activities (one study); 3) A wide choice of a range of activities and some adaptation to local needs (five studies); or, 3) a participatory approach to creating programmes responsive and adaptive to local staff needs that have extensive choice of activities to participate in (three studies). Only five of the interventions included substantial involvement and engagement of leadership and efforts aimed at up-skilling the leadership of staff to support staff health and wellbeing. Incorporation of more of the recommendations did not appear to be related to effectiveness. The heterogeneity of study designs, populations and outcomes excluded a meta-analysis. All studies were deemed by their authors to be at least partly effective. Two studies reported statistically significant improvement in objectively measured physical health (BMI) and eight in subjective mental health. Six studies reported statistically significant positive changes in subjectively assessed health behaviours. CONCLUSIONS: This systematic review identified 11 studies which incorporate at least one of the Boorman recommendations and provides evidence that whole-system healthy workplace interventions can improve health and wellbeing and promote healthier behaviours in healthcare staff.Funding provided in part to the European Centre for Environment and Human Health (part of the University of Exeter Medical School) by the European Regional Development Fund Programme 2007 to 2013 (https://www.gov.uk/guidance/erdf-programmes-and-resources) and European Social Fund Convergence Programme for Cornwall and the Isles of Scilly (http://www.erdfconvergence.org.uk/esf). This research was also funded in part by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (http://clahrc-peninsula.nihr.ac.uk/) at the Royal Devon and Exeter NHS Foundation Trust (http://www.rdehospital.nhs.uk/). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Hot exozodiacal dust resolved around Vega with IOTA/IONIC

Although debris discs have been detected around a significant number of main-sequence stars, only a few of them are known to harbour hot dust in their inner part where terrestrial planets may have formed. Thanks to infrared interferometric observations, it is possible to obtain a direct measurement of these regions, which are of prime importance for preparing future exo-Earth characterisation missions. In this context, we have resolved the exozodiacal dust disc around Vega with the help of infrared stellar interferometry and estimated the integrated H-band flux originating from the first few AUs of the debris disc. Using precise H-band interferometric measurements obtained with the 3-telescope IOTA/IONIC interferometer (Mount Hopkins, Arizona), thorough modelling of both interferometric data (squared visibility and closure phase) and spectral energy distribution was performed to constrain the nature of the near-infrared excess emission. The most straightforward scenario consists in a compact dust disc producing a thermal emission that is largely dominated by small grains located between 0.1 and 0.3 AU from Vega and accounting for 1.23 +/- 0.45% of the near-infrared stellar flux for our best-fit model. This flux ratio is shown to vary slightly with the geometry of the model used to fit our interferometric data (variations within +/-0.19%). Initially revealed by K-band CHARA/FLUOR observations, the presence of hot exozodiacal dust in the vicinity of Vega is confirmed by our H-band IOTA/IONIC measurements at the 3-sigma level. Whereas the origin of the dust is still uncertain, its presence and the possible connection with the outer disc suggest that the Vega system is currently undergoing major dynamical perturbations.Comment: 10 pages, 9 figures, accepted for publication in A&

Debris Disks: Probing Planet Formation

Debris disks are the dust disks found around ~20% of nearby main sequence stars in far-IR surveys. They can be considered as descendants of protoplanetary disks or components of planetary systems, providing valuable information on circumstellar disk evolution and the outcome of planet formation. The debris disk population can be explained by the steady collisional erosion of planetesimal belts; population models constrain where (10-100au) and in what quantity (>1Mearth) planetesimals (>10km in size) typically form in protoplanetary disks. Gas is now seen long into the debris disk phase. Some of this is secondary implying planetesimals have a Solar System comet-like composition, but some systems may retain primordial gas. Ongoing planet formation processes are invoked for some debris disks, such as the continued growth of dwarf planets in an unstirred disk, or the growth of terrestrial planets through giant impacts. Planets imprint structure on debris disks in many ways; images of gaps, clumps, warps, eccentricities and other disk asymmetries, are readily explained by planets at >>5au. Hot dust in the region planets are commonly found (<5au) is seen for a growing number of stars. This dust usually originates in an outer belt (e.g., from exocomets), although an asteroid belt or recent collision is sometimes inferred.Comment: Invited review, accepted for publication in the 'Handbook of Exoplanets', eds. H.J. Deeg and J.A. Belmonte, Springer (2018

Communication skills training for family caregivers of people living with dementia : the experiences of peer facilitators and course attendees

Family caregivers of people with dementia can find the impairments in their relative’s ability to communicate an enormous challenge. Peer facilitated educational interventions are a potentially efficient and effective way to address these complex communication issues. This paper examines the processes required to support the development of peer educators and the impact this has had on facilitators and course attendees. Semi-structured interviews with six participants who facilitated Empowered Conversations (EC) a communication skills educational program for caregivers of people with dementia and 28 participants who attended the program. A qualitative thematic analysis approach identified emergent themes within the data. Three broad findings are reported: first the support that is needed for peer facilitators; second, the impact of the course reported by facilitators and course attendees; and third, suggestions for improvements. The content of the EC program is strong and the reflective cycle encouraged via support mechanisms prior to, during and following the delivery of sessions is effective for supporting facilitators. When upscaling the program it was important to enhance the support structures for new peer facilitators. Introducing a support session focusing on examples of logistical issues experienced and how these could be addressed would be a useful addition to the support mechanisms already devised. Attendees reported positively on participation in the course, particularly valuing the input from facilitators with experience of caregiving. Suggested improvements related to better information about the course and a settling in period, with some specific individual suggestions for content relating to their personal experiences

Systematic calculation of molecular vibrational spectra through a complete Morse expansion

We propose an accurate and efficient method to compute vibrational spectra of molecules, based on exact diagonalization of an algebraically calculated matrix based on powers of Morse coordinate. The present work focuses on the 1D potential of diatomic molecules: as typical examples, we apply this method to the standard Lennard-Jones oscillator, and to the ab initio potential of the H2 molecule. Global cm-1 accuracy is exhibited through the H2 spectrum, obtained through the diagonalization of a 30 x 30 matrix. This theory is at the root of a new method to obtain globally accurate vibrational spectral data in the context of the multi-dimensional potential of polyatomic molecules, at an affordable computational cost.Comment: 30 pages including 6 figure

In vitro culturing of porcine tracheal mucosa as an ideal model for investigating the influence of drugs on human respiratory mucosa

It has been previously shown that fresh mucosa from different mammals could serve as raw material for in vitro culturing with the differentiation of cilia, which are the most important morphological structures for the function of the mucociliary system. Increasing legal restrictions on the removal of human tissue and changing surgical techniques have led to a lack of fresh human mucosa for culturing. Most of the animals that have been used as donors up to now are genetically not very close to human beings and must all be sacrificed for such studies. We, therefore, established a modified system of culturing mucosa cells from the trachea of pigs, which is available as a regular by-product after slaughtering. With respect to the possibility of developing “beating” cilia, it could be shown that the speed of cell proliferation until adhesion to the coated culture dishes, the formation of conjunctions of cell clusters and the proliferation of cilia were comparable for porcine and human mucosa. Moreover, it could be demonstrated that the porcine cilia beat frequency of 7.57 ± 1.39 Hz was comparable to the human mucosa cells beat frequency of 7.3 ± 1.4 Hz and that this beat frequency was absolutely constant over the investigation time of 360 min. In order to prove whether the reaction to different drugs is comparable between the porcine and human cilia, we initially tested benzalkonium chloride, which is known to be toxic for human cells, followed by naphazoline, which we found in previous studies on human mucosa to be non-toxic. The results clearly showed that the functional and morphological reactions of the porcine ciliated cells to these substances were similar to the reaction we found in the in vitro cultured human mucosa

A qualitative evaluation of the impact of a Good Life Club on people living with dementia and care partners

Background: Research suggests there is a lack of post diagnostic support to enable people living with dementia to fulfil social and active lives throughout their dementia journey. Gardening has been found to have many benefits for people living with dementia. Although such research is important, most research frames people with dementia as passive recipients of stimulation. The impact of a community-based gardening group where people living with dementia are active in the development of an outdoor space is underdeveloped. Knowledge about the impact of participating in such groups is also sparse. The Good Life Club (GLC) was co-developed and evaluated to respond to these gaps. Objectives: The primary aim of this paper is to present the findings regarding the impact of attending the GLC on the self-reported wellbeing for people living with dementia and care partners. Methods: Qualitative data were collected via 22 semi-structured interviews. Fourteen interviews were conducted before the GLC and eight after the GLC. Thematic Analysis was used to analyse data. Dementia Care Mapping Data was collected to supplement the interview data. Findings: Four key themes were identified. The first was that participants considered having active participation in social life to be a key aspect of living a good life. The second was that the way the GLC was set up and delivered gave the participants ownership of the GLC and within this they felt able to contribute. The third was the importance of social connectedness and peer support to the wellbeing of both people living with dementia and care partners. Fourth, positive mood and wellbeing was directly experienced through gardening. Conclusions: The combination of long-term investment of time and energy to the GLC, on-going friendships and in-session autonomy, act as key ingredients in creating a group that is relaxed, full of humour and highly valued

Circumstellar discs: What will be next?

This prospective chapter gives our view on the evolution of the study of circumstellar discs within the next 20 years from both observational and theoretical sides. We first present the expected improvements in our knowledge of protoplanetary discs as for their masses, sizes, chemistry, the presence of planets as well as the evolutionary processes shaping these discs. We then explore the older debris disc stage and explain what will be learnt concerning their birth, the intrinsic links between these discs and planets, the hot dust and the gas detected around main sequence stars as well as discs around white dwarfs.Comment: invited review; comments welcome (32 pages