Using quality assessment tools to critically appraise ageing research: a guide for clinicians

Evidence based medicine tells us that we should not accept published research at face value. Even research from established teams published in the highest impact journals can have methodological flaws, biases and limited generalisability. The critical appraisal of research studies can seem daunting, but tools are available to make the process easier for the non-specialist. Understanding the language and process of quality assessment is essential when considering or conducting research, and is also valuable for all clinicians who use published research to inform their clinical practice. We present a review written specifically for the practising geriatrician. This considers how quality is defined in relation to the methodological conduct and reporting of research. Having established why quality assessment is important, we present and critique tools which are available to standardise quality assessment. We consider five study designs: RCTs, nonrandomised studies, observational studies, systematic reviews and diagnostic test accuracy studies. Quality assessment for each of these study designs is illustrated with an example of published cognitive research. The practical applications of the tools are highlighted, with guidance on their strengths and limitations. We signpost educational resources and offer specific advice for use of these tools. We hope that all geriatricians become comfortable with critical appraisal of published research and that use of the tools described in this review – along with awareness of their strengths and limitations – become a part of teaching, journal clubs and practice

Intensification of single cell storms prior to lightning onset

Single cell storms in the UK can produce lightning, despite apparently only having developed to towering cumulus rather than cumulonimbus. Such marginal thunderstorms still present severe weather hazards but are difficult to identify and predict and therefore provide a warning. Observations from the Met Office radar mosaic and ATDNet (Arrival Time Difference Network) show that these single cell storms demonstrate a characteristic increase in the area of high reflectivity storm core during the 15 minutes prior to the first lightning. By using the Met Office Unified Model to investigate reflectivity development in modelled storms, a microphysical explanation for the observed reflectivity increase is identified. During a rapid reflectivity increase, the updraft area at the melting layer, the peak updraft velocity and the storm graupel mass increase. The three quantities examined are linked to each other and to the generation of charge within the storm. The production of graupel is promoted by the increase in updraft area and charge separation is enhanced by the faster peak updraft velocity. This explains some of the physical differences between single cell storms that produce lightning and apparently similar storm systems which do not. It also provides a new basis with which to predict lightning hazard for marginal storms

How important are different non-native conifers in Britain to Common Crossbills Loxia curvirostra curvirostra?

Capsule Pines physically defend their seeds against seed-eating birds and mammals more than spruces or larches. Cone characteristics reflect the rate at which Common Crossbills Loxia curvirostra curvirostra extract seeds from different non-native conifers in Britain. Aims To assess the profitability of different non-native conifers in Britain for Common Crossbills in winter. Methods We measured cone and seed parameters of conifers (Norway Spruce Picea abies, Sitka Spruce Picea sitchensis, Lodgepole Pine Pinus contorta and Japanese Larch Larix kaempferi) introduced into Britain and compared these with the native Scots Pine Pinus sylvestris. Feeding trials with captive Common Crossbills assessed intake rates. Results The pines had thick and long scales, Japanese Larch had thin, short scales but thick seed coats and Sitka Spruce had thin, papery and short scales, and the thinnest seed coat. The two spruce species had more seeds per cone and the kernels had a higher energy content than the pines and larch. Feeding trials, simulating cones in winter, found that Common Crossbills failed to access seeds in closed Scots Pine cones. They also had difficulty in prising the scales of closed Lodgepole Pine cones but were able to forage on partially open cones. They took longer to extract seeds from large, open Lodgepole Pine cones than small ones, reflecting the effect of increasing scale thickness in larger pine cones. They also took longer to extract Lodgepole Pine seeds than Sitka Spruce and larch seeds. Although Common Crossbills could extract seeds quickly from open Sitka Spruce cones, the small seed size made the energy intake rate similar to Japanese Larch, if all seeds contained a kernel. However, after accounting for the proportion of seeds with a kernel, Sitka Spruce was the more profitable. Conclusion The conifer food resource for crossbills in Britain has changed through the planting of non-native conifers. The physical properties of the cones and seeding phenology influence the rate at which Common Crossbills can extract seeds

Fixing the broken image of care homes, could a 'care home innovation centre' be the answer?

The UK has many excellent care homes that provide high-quality care for their residents; however, across the care home sector, there is a significant need for improvement. Even though the majority of care homes receive a rating of ‘good’ from regulators, still significant numbers are identified as requiring ‘improvement’ or are ‘inadequate’. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible—as well as impacting on the career choices of health and social care students. Projections of current demographics highlight that, within 10 years, the part of our population that will be growing the fastest will be those people older than 80 years old with the suggestion that spending on long-term care provision needs to rise from 0.6% of our Gross Domestic Product in 2002 to 0.96% by 2031. Teaching/research-based care homes have been developed in the USA, Canada, Norway, the Netherlands and Australia in response to scandals about care, and the shortage of trained geriatric healthcare staff. There is increasing evidence that such facilities help to reduce inappropriate hospital admissions, increase staff competency and bring increased enthusiasm about working in care homes and improve the quality of care. Is this something that the UK should think of developing? This commentary details the core goals of a Care Home Innovation Centre for training and research as a radical vision to change the culture and image of care homes, and help address this huge public health issue we face

What inpatients want: a qualitative study of what's important to mental health service users in their recovery (Wayfinder Partnership)

Purpose - The purpose of this paper is to present a qualitative analysis of the facilitators of recovery in inpatient psychiatric rehabilitation from the service users' perspective. Design/methodology/approach - Interviews with 31 in-patients were coded and analysed thematically at an interpretive level using an inductive approach. Findings - The dominant themes identified were hope, agency, relationships and opportunity. Totally, 20 subthemes were identified. Agency was more important to men than women and agency, hope and relationships were all more important to detained patients. Research limitations/implications - Interview data were collected in writing rather than taped. The results may not be transferrable to patient populations with significantly different demographic or service factors. Practical implications - Services need to target interventions at the areas identified by service users as important in their recovery. The findings suggest both environmental and relational aspects of care that may optimise recovery. Services also need to be able tomeasure the quality of the care they provide. A brief, culturally valid and psychometrically assessed instrument for measuring the recovery orientation of services is required. Originality/value - As far as the authors are aware no qualitative work to date has examined the recovery experiences of psychiatric rehabilitation in-patient service users in order to understand what services require to do to enable recovery from their perspective. The conceptual framework identified in this paper can be used to develop a service user self-report measure of the recovery orientation of services.sch_occ20pub3779pub