The development of a dementia awareness training package in the Thames Valley region: an evidence based approach

Introduction: Health Education England’s (2014) mandate stipulated that 250,000 healthcare staff required Tier 1 level dementia awareness training. In response, Health Education Thames Valley in the UK commissioned the Dementia Academic Action Group. This consortium, of University of Bedfordshire, Oxford Brookes University, University of Northampton and University of West London, reviewed dementia awareness training, identifying gaps, best practice and barriers to accessing training. This work led to the development of a training model for delivery to health & social care sectors.Method: A scoping review was undertaken to achieve a comprehensive understanding of the range of dementia awareness training currently being delivered. A mixed method approach was employed, consisting of a literature review; review of Tier 1 dementia awareness educational resources (59 training documents); stakeholder interviews (n=32); carer focus groups (n=2) and online staff survey (n=74).Results: The literature and scoping reviews and stakeholder interviews found a wide range of training available. Stakeholders reported this variety made it challenging to confidently identify training which met staff and organisational needs. The review of dementia training identified that most resources included information on signs/symptoms, types/causes, supporting people with dementia and person centred care. Information on policy, legislation and end of life care were less evident. The literature review identified ethnic diversity, learning disability and young onset dementia as gaps in training provision. The stakeholder, staff and carer findings highlighted theneed for greater information on: developing personal communication strategies; information about dementia and how to develop activities to support positive engagement. Finally, staff and stakeholders considered benefits of different training delivery styles, reporting a preference for a blended learning approach, stating this was more suited to developing dementia knowledge and skills, as opposed to a solely online format.Conclusion: Based on the findings, it was identified that there is an apparent need to develop a standard training package, which should be person centred, support enhanced communication approaches and increase understanding of coping with a diagnosis of dementia. This could prove attractive to the health & social care workforce in the Thames Valley Region, across the UK, and to the international arena

The design, delivery and impact of a Tier 1 Dementia Awareness training package delivered in the Thames Valley Region in England, UK

Objectives: As part of Health Education England’s (HEE) response to the 2014 Mandate, Health Education England Thames Valley (HEETV) commissioned four universities to undertake a multi-phase project. The University of West London, Oxford Brookes University, University of Bedfordshire and University of Northampton became partners in the Dementia Academic Action Group (DAAG). Phase 1 of the project consisted of a Scoping Review, reported through a poster at the 2016 ADI. This poster will focus on Phase 2 (design and delivery of the training package) and Phase 3 (evaluation of the impact of training). The DAAG has developed evidence based and quality assured training package based on recognised National UK standards such as Skills for Health Dementia Training Standards (2015). It has also been validated by the Alzheimer Society as meeting the standards for Dementia Friend’s training, and participants are eligible to register as a Dementia Friend on completion of the training. The package is mostly delivered in a 2 hour session, but can also be taken through 8 separate units of learning. A total of 1471 people attended the standard 2 hour training, delivered through 84 different sessions in 34 different venues across the region. Attendees represented a wide range of professionals, from porters, cooks and cleaners to nurses, pharmacists, therapists and doctors. Some sessions were uni- professional but, most had a professionally mixed audience. The number of trainees per session varied from 3 to 112. Subsequent to the training, quantitative and qualitative data was collected through evaluation questionnaires, combined with follow up online questionnaires and individual face to face or telephone interviews 6 weeks after the event. Over 85% of respondents to the follow up questionnaires and interviews reported improved skills, attitudes and confidence in working with people with dementia following the training. 70.2% indicated that they had been able to transfer some of what they had learned in the training to practice. Sustainability was ensured through the development of a trainers guide and ‘train the trainers’ events. The Tier 1 dementia awareness training package is now available for free from the Health Education England website, and it’s ongoing use is subject to continuing evaluation

Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing Hepatitis C transmission in people who inject drugs

Aim To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared to no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom.Design Cost-effectiveness analysis from NHS/ health-provider perspective, utilising a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence.Setting UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%), and Bristol (45%)Population PWIDInterventions Current NSP provision is compared to a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. Measurements HCV infections, and cost per quality adjusted life year (QALY) gained through NSPs over 50 years Findings Compared to a willingness-to-pay threshold of £20,000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78%, 46% and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). Over 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year. Conclusions We projected NSPs avert HCV infections and are highly cost-effective in the UK and could be cost-saving to the NHS and other health care providers. NSPs will remain cost-effective in the UK irrespective of changes in HCV treatment cost and scale-up, meaning that NSPs will continue to be an efficient strategy for preventing HCV transmission in the future

Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Background People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. Methods In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity. Findings We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40–2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28–2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94–1·65) and a 21% increase in HCV (1·21, 1·02–1·43) acquisition risk. Interpretation Incarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID

Extraordinary exposed in early motherhood - a qualitative study exploring experiences of mothers with type 1 diabetes

<p>Abstract</p> <p>Background</p> <p>Women with type 1 diabetes face several challenges during pregnancy, childbirth and in relation to breastfeeding. It is therefore of utmost importance to consider their need for specific support, early postpartum as well as in daily life after discharge from maternity care. Few studies have investigated these aspects of healthcare. The aim of this study was to explore experiences after childbirth regarding breastfeeding, glycemic control, support and well-being in women with type 1 diabetes.</p> <p>Methods</p> <p>A hermeneutic reflective life world research approach was used in this qualitative study. Data was gathered through audio-recorded focus group discussions and individual interviews with 23 women with type 1 diabetes, 6-24 months after childbirth. After verbatim transcription, the text was analyzed in order to identify themes of meaning and a conclusive interpretation of the explored phenomenon.</p> <p>Results</p> <p>Experiences of extraordinary exposure challenged the women with type 1 diabetes in their transition to early motherhood. The exposure included a struggle with breastfeeding, although with a driving force to succeed. Everyday life was filled with uncertainty and unpredictability related to one's own unstable glycemic control and the women down-prioritized their own needs in favor of the child. A feeling of being disconnected from professional care further contributed to the experiences of extraordinary exposure.</p> <p>Conclusion</p> <p>In early motherhood women with type 1 diabetes have a great need for support in managing daily life postpartum, which requires contemporary approaches to overlap insufficient linkage between health care professionals in maternity and child health care, and diabetes care.</p

DNA cruciform arms nucleate through a correlated but non-synchronous cooperative mechanism

Inverted repeat (IR) sequences in DNA can form non-canonical cruciform structures to relieve torsional stress. We use Monte Carlo simulations of a recently developed coarse-grained model of DNA to demonstrate that the nucleation of a cruciform can proceed through a cooperative mechanism. Firstly, a twist-induced denaturation bubble must diffuse so that its midpoint is near the centre of symmetry of the IR sequence. Secondly, bubble fluctuations must be large enough to allow one of the arms to form a small number of hairpin bonds. Once the first arm is partially formed, the second arm can rapidly grow to a similar size. Because bubbles can twist back on themselves, they need considerably fewer bases to resolve torsional stress than the final cruciform state does. The initially stabilised cruciform therefore continues to grow, which typically proceeds synchronously, reminiscent of the S-type mechanism of cruciform formation. By using umbrella sampling techniques we calculate, for different temperatures and superhelical densities, the free energy as a function of the number of bonds in each cruciform along the correlated but non-synchronous nucleation pathways we observed in direct simulations.Comment: 12 pages main paper + 11 pages supplementary dat

Automated Identification of Acute Hepatitis B Using Electronic Medical Record Data to Facilitate Public Health Surveillance

Automatic identification of notifiable diseases from electronic medical records can potentially improve the timeliness and completeness of public health surveillance. We describe the development and implementation of an algorithm for prospective surveillance of patients with acute hepatitis B using electronic medical record data.Initial algorithms were created by adapting Centers for Disease Control and Prevention diagnostic criteria for acute hepatitis B into electronic terms. The algorithms were tested by applying them to ambulatory electronic medical record data spanning 1990 to May 2006. A physician reviewer classified each case identified as acute or chronic infection. Additional criteria were added to algorithms in serial fashion to improve accuracy. The best algorithm was validated by applying it to prospective electronic medical record data from June 2006 through April 2008. Completeness of case capture was assessed by comparison with state health department records.A final algorithm including a positive hepatitis B specific test, elevated transaminases and bilirubin, absence of prior positive hepatitis B tests, and absence of an ICD9 code for chronic hepatitis B identified 112/113 patients with acute hepatitis B (sensitivity 97.4%, 95% confidence interval 94-100%; specificity 93.8%, 95% confidence interval 87-100%). Application of this algorithm to prospective electronic medical record data identified 8 cases without false positives. These included 4 patients that had not been reported to the health department. There were no known cases of acute hepatitis B missed by the algorithm.An algorithm using codified electronic medical record data can reliably detect acute hepatitis B. The completeness of public health surveillance may be improved by automatically identifying notifiable diseases from electronic medical record data

Multiplex Zymography Captures Stage-specific Activity Profiles of Cathepsins K, L, and S in Human Breast, Lung, and Cervical Cancer

<p>Abstract</p> <p>Background</p> <p>Cathepsins K, L, and S are cysteine proteases upregulated in cancer and proteolyze extracellular matrix to facilitate metastasis, but difficulty distinguishing specific cathepsin activity in complex tissue extracts confounds scientific studies and employing them for use in clinical diagnoses. Here, we have developed multiplex cathepsin zymography to profile cathepsins K, L, and S activity in 10 μg human breast, lung, and cervical tumors by exploiting unique electrophoretic mobility and renaturation properties.</p> <p>Methods</p> <p>Frozen breast, lung, and cervix cancer tissue lysates and normal organ tissue lysates from the same human patients were obtained (28 breast tissues, 23 lung tissues, and 23 cervix tissues), minced and homogenized prior to loading for cathepsin gelatin zymography to determine enzymatic activity.</p> <p>Results</p> <p>Cleared bands of cathepsin activity were identified and validated in tumor extracts and detected organ- and stage-specific differences in activity. Cathepsin K was unique compared to cathepsins L and S. It was significantly higher for all cancers even at the earliest stage tested (stage I for lung and cervix (n = 6, p < .05), and stage II for breast; n = 6, p < .0001). Interestingly, cervical and breast tumor cathepsin activity was highest at the earliest stage we tested, stages I and II, respectively, and then were significantly lower at the latest stages tested (III and IV, respectively) (n = 6, p < 0.01 and p < 0.05), but lung cathepsin activity increased from one stage to the next (n = 6, p < .05). Using cathepsin K as a diagnostic biomarker for breast cancer detected with multiplex zymography, yielded 100% sensitivity and specificity for 20 breast tissue samples tested (10 normal; 10 tumor) in part due to the consistent absence of cathepsin K in normal breast tissue across all patients.</p> <p>Conclusions</p> <p>To summarize, this sensitive assay provides quantitative outputs of cathepsins K, L, and S activities from mere micrograms of tissue and has potential use as a supplement to histological methods of clinical diagnoses of biopsied human tissue.</p