Improving access to and uptake of early pulmonary rehabilitation following hospitalisation for acute exacerbations of COPD

Background: Substantial benefits are associated with early pulmonary rehabilitation (PR) following severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) requiring hospitalisation. However, referral for, and uptake of, early PR are poor. Methods and findings: In a prospective cohort study of 291 hospitalisations for AECOPD, COPD discharge bundles delivered by PR practitioners were associated with increased PR referral (60% vs 12%, p<0.001; adjusted odds ratio [OR]: 14.46, 95% confidence interval [CI]: 5.28 to 39.57) and uptake (40% vs 32%, p=0.001; adjusted OR: 8.60, 95% CI: 2.51 to 29.50) compared with non-PR practitioners. In a randomised controlled trial with convergent qualitative interviews, a co-designed education video delivered at hospital discharge did not improve post-hospitalisation PR uptake (41% usual care vs. 34% intervention group; p=0.37), referral, or completion. Six of fifteen interviewed participants from the intervention group did not recall receiving the video. Given the poor uptake of outpatient post-hospitalisation PR, a mixed methods systematic review was conducted to explore the feasibility, acceptability and clinical effectiveness of home-based models of PR in the post-AECOPD setting. Although home-based exercise training appeared to be feasible and acceptable to patients and healthcare professionals (HCPs), there were few trials and data was heterogenous regarding clinical effectiveness. A model of care integrating home-based exercise training and hospital at home care was co-designed by service users and HCPs. This was tested in a mixed methods feasibility study. The model of care was feasible and acceptable to patients, family carers and HCPs, and was not associated with adverse events, suggesting formal evaluation of clinical efficacy is warranted. Conclusions: Both referrer and patient factors contribute to poor referral and uptake rates for post-hospitalisation outpatient PR. Home-based PR is feasible and acceptable to patients, carers and HCPs; further research is needed to explore clinical efficacy and cost-effectiveness of post-hospitalisation home-based PR.Open Acces

The take-up of multiple means-tested benefits by British pensioners. Evidence from the Family Resources Survey

Non take-up of means-tested benefits among pensioners is of longstanding concern. It will assume increased importance from 2003 with the introduction of the new means-tested Pension Credit, which will subsume Income Support and to which about half of all pensioners are expected to be entitled. In this paper we use Family Resources Survey data spanning the period April 1997 to March 2000 to investigate patterns of take-up of the three main means-tested benefits to which pensioners may be entitled – Income Support (IS), Housing Benefit (HB) and Council Tax Benefit (CTB). We find that although 36% of pensioners in our sample are failing to claim their entitlements to at least one of these benefits, only 16% of non claimants are failing to claim amounts worth more than 10% of their income. The proportions by which claiming all entitlements would increase non- claimants’ incomes are more useful indicators than individual benefit take-up rates, of the effectiveness of means-tested benefits. In general take-up is high where entitlement is high. But there are exceptions to this which may reflect the claims process and/or a greater degree of social stigma associated with IS than with HB or CTB.benefit take-up; pensions; means-testing; welfare participation

Evaluating Allied Health Clinical Placement Performance: Protocol for a Modified Delphi Study

Background: University-affiliated student-led health care services have emerged in response to the challenges faced by universities in securing quality clinical placements for health care students. Evidence of the health care benefits and challenges of student-led health care services is growing, while evidence of clinical placement performance remains variable and not generalizable. Though there have been previous attempts to develop a framework for evaluation of clinical placement performance, concerns have been raised about the applicability of these frameworks across the various placement settings. Additionally, the perspectives of all key stakeholders on the critical areas of clinical placement performance have yet to be considered. Objective: This study’s objective is to gather information on areas of measurement related to student learning outcomes, experience of placement, and costs of placement and then develop consensus on which of those areas need to be included in a framework for evaluation of clinical placement performance within the context of student-led health care services. The aim of this paper is to outline a protocol for a modified Delphi study designed to gain consensus on what is important to measure when evaluating an allied health clinical placement. Methods: We will recruit up to 30 experts to a heterogeneous expert panel in a modified Delphi study. Experts will consist of those with firsthand experience either coordinating, supervising, or undertaking clinical placement. Purposive sampling will be used to ensure maximum variation in expert panel member characteristics. Experts’ opinions will be sought on measuring student learning outcomes, student experience, and cost of clinical placement, and other areas of clinical placement performance that are considered important. Three rounds will be conducted to establish consensus on what is important to measure when evaluating clinical placement. Each round is anticipated to yield both quantitative data (eg, percentage of agreement) and qualitative data (eg, free-text responses). In each round, quantitative data will be analyzed descriptively and used to determine consensus, which will be defined as ≥70% agreement. Qualitative responses will be analyzed thematically and used to inform the subsequent round. Findings of each round will be presented, both consensus data and qualitative responses in each subsequent round, to inform expert panel members and to elicit further rankings on areas of measurement yet to achieve consensus. Results: Data analysis is currently underway, with a planned publication in 2024. Conclusions: The modified Delphi approach, supported by existing research and its ability to gain consensus through multiround expert engagement, provides an appropriate methodology to inform the development of a framework for the evaluation of clinical placement performance in allied health service

Experiences of individuals with physical disabilities in natural disasters: an integrative review

People with physical disabilities are highly vulnerable during natural disasters. The interaction of individual, societal and environmental factors impact on their ability to prepare, evacuate and recover from disaster events. This paper provides a review of the current body of knowledge on the lived experiences of adults with a physical disability in natural disasters. Fifty-seven articles were identified in the primary research, with seven studies selected for review. The small body of research to date indicates that natural disasters present challenges to people with physical disabilities, and have significant negative impacts on their lives. However, there are a number of factors that enhance the resilience of people with physical disabilities. The aim of this integrative review as to describe the current body of knowledge on the lived experiences of adults with a physical disability in natural disasters and to identify gaps in the literature to inform future research

To sing of Gilgamesh : the significance of mythic structure for creative practice

Ph. D. ThesisThis practice-based research study investigates the structures underlying both a performance art practice, and the ancient epic of Gilgamesh, revealing the relationship between the form and content of this performance practice. This study has asked: 1) What is mythic structure? 2) What is the form of this performance practice? 3) What is the content of this performance practice? 4) How can mythic structure be related to a creative practice? 5) What is the relationship between the form and the content of this performance practice? Addressing these questions, this researcher produced and reflected upon a new body of performance artworks engaging with the ancient epic of Gilgamesh. Observations were then examined in the context of mythographic research, particularly the three-stage ‘hero’s journey’ advanced by Joseph Campbell. Both strands of research were scrutinised in the light of key concepts including the individual and collective unconscious, Salomean identification, and alogicality. This study discovered that the form and content of this performance practice are linked. Critical aspects of the three-stage structure underpinning some ancient myths (typically a separation, liminal period, and reintegration) were identified in the development and performance of the Gilgamesh Cycle works. The performance content reflects an alogical sphere that characterises Campbells’ liminal period. This alogicality privileges connectivity between persons, materials, ideas, and states. Such connectivity exemplifies what this researcher (extending Kaja Silverman’s analysis of poetry and installation art), has termed Salomean identification. Campbell’s use of ‘hero’ as a figure representing the structure described above, is therefore misguided. This researcher has recast this figure as a ‘medium’: a conduit rather than a conqueror.Finally this study has reflected on the success of the Gilgamesh Cycle as performance art practice, concluding that unanswered questions are necessary for the continued production of work. The increasing elucidation of this body of work has, for this researcher, rendered it finit

Measuring health outcomes, experience of care and cost of healthcare in student-led healthcare services: a literature review

Introduction: In student-led healthcare services, health students take responsibility for the management and delivery of health services as part of clinical training. Like all healthcare services, student-led healthcare services need to be evaluated to ensure they provide high quality, safe and cost-effective services. The aim of this literature review was to understand how student-led healthcare services have been evaluated to date, and to assess alignment of previous evaluations with the Triple Aim framework. The Triple Aim is a conceptual framework, offering a systematic approach to evaluating healthcare services that may be appropriate for evaluation of student-led services. Methods: Electronic databases were searched for articles describing a student-led healthcare service and were screened for studies that evaluated the impact of a student-led healthcare service on patient outcomes. Results: Fourteen of 211 identified articles met the inclusion criteria. All 14 studies met the Triple Aim measurement principles of “a defined population,” “gather data over time” and “distinguish between measures” while only eight of the 14 studies achieved “comparison data”. All 14 studies measured at least one or more of the Triple Aim dimensions. Discussion/Conclusion: There was little consistency across the evaluations of student-led healthcare services, limiting the extent to which the benefits of student-led healthcare services can be shown to be a valuable resource to the healthcare system. Further investigation is required to determine a suitable evaluation framework for student-led healthcare services

Education vs TFP: Empirical evidence from the Sub-Saharan Countries

This single-case, mixed-method study explored the feasibility of self-administered, home-based SMART (sensorimotor active rehabilitation training) Arm training for a 57-yr-old man with severe upper-limb disability after a right frontoparietal hemorrhagic stroke 9 mo earlier. Over 4 wk of self-administered, home-based SMART Arm training, the participant completed 2,100 repetitions unassisted. His wife provided support for equipment set-up and training progressions. Clinically meaningful improvements in arm impairment (strength), activity (arm and hand tasks), and participation (use of arm in everyday tasks) occurred after training (at 4 wk) and at follow-up (at 16 wk). Areas for refinement of SMART Arm training derived from thematic analysis of the participant's and researchers' journals focused on enabling independence, ensuring home and user friendliness, maintaining the motivation to persevere, progressing toward everyday tasks, and integrating practice into daily routine. These findings suggest that further investigation of self-administered, home-based SMART Arm training is warranted for people with stroke who have severe upper-limb disability

Quantity and quality of interaction between staff and older patients in UK hospital wards: A descriptive study

AbstractBackgroundThe quality of staff-patient interactions underpins the overall quality of patient experience and can affect other important outcomes. However no studies have been identified that comprehensively explore both the quality and quantity of interactions in general hospital settings.Aims & objectivesTo quantify and characterise the quality of staff-patient interactions and to identify factors associated with negative interaction ratings.SettingData were gathered at two acute English NHS hospitals between March and April 2015. Six wards for adult patients participated including medicine for older people (n=4), urology (n=1) and orthopaedics (n=1).MethodsEligible patients on participating wards were randomly selected for observation. Staff-patient interactions were observed using the Quality of Interactions Schedule. 120h of care were observed with each 2h observation session determined from a balanced random schedule (Monday-Friday, 08:00-22:00h). Multilevel logistic regression models were used to determine factors associated with negative interactions.Results1554 interactions involving 133 patients were observed. The median length of interaction was 36s with a mean of 6 interactions per patient per hour. Seventy three percent of interactions were categorized as positive, 17% neutral and 10% negative. Forty percent of patients had at least one negative interaction (95% confidence interval 32% to 49%). Interactions initiated by the patient (adjusted Odds Ratio [OR] 5.30), one way communication (adjusted OR 10.70), involving two or more staff (adjusted OR 5.86 for 2 staff, 6.46 for 3+ staff), having a higher total number of interactions (adjusted OR 1.09 per unit increase), and specific types of interaction content were associated with increased odds of negative interaction (p<0.05). In the full multivariable model there was no significant association with staff characteristics, skill mix or staffing levels. Patient agitation at the outset of interaction was associated with increased odds of negative interaction in a reduced model. There was no significant association with gender, age or cognitive impairment. There was substantially more variation at ward level (variance component 1.76) and observation session level (3.49) than at patient level (0.09).ConclusionThese findings present a unique insight into the quality and quantity of staff-patient interactions in acute care. While a high proportion of interactions were positive, findings indicate that there is scope for improvement. Future research should focus on further exploring factors associated with negative interactions, such as workload and ward culture

Hidden meanings of Sheffield's river landscapes : an exploration of how phenomenological philosophy can provide a basis for understanding landscape meaning in landscape architecture theory and contribute to the use and development of the concept of dwelling in landscape practice and research.

This thesis combines the study of a philosophical approach to landscape with an exploration of experience in landscape. It explores the perspective of phenomenology, in particular that defined by Merleau-Ponty, as an approach to understanding relationships with landscapes. This unveils meanings and values in landscapes hidden by other approaches, and suggests how an understanding of dialogue, time and embodiment, with, in and within landscape, can improve and enhance landscape architecture theory and practice. A critique is offered of the ways Enlightenment thinking and its dualisms have influenced approaches in the Landscape discipline, in particular the attitude of the master, the disembodied visual, and the predominance of spatial dimensions. Through an extensive literature review these effects are studied in relation to three problematic themes in Landscape- Nature, Beauty and Time. These related to a phenomenological perspective suggest new approaches to landscape, based on human embodiment, practiced in the concept of Dwelling. Dwelling is defined as a process of immersion and not separation from a position in landscape situated in space and time; it leads to engagement with nature which ultimately leads to care - Heidegger's "concernful dealing with the world". The possibilities for dwelling, or for "Being in the landscape", are explored in four research projects in Sheffield's river landscapes, adopting a methodology drawn from phenomenology. Experience is revealed in moving through the landscape, and sensing with more than one sense together; the subjective view of the researcher is tempered with the subjectivity of others, to produce an intersubjectivity. Stories, the recounting of interpreted events, is a way people express meaning and value, tell of attachment and belonging to landscape, and show freedom from controlling influences and structures. Following concluding assessments of the research and methodology, the study points to ways its findings may redirect and strengthen landscape theory and practice towards an attitude and practice of dwelling