Developing a multimedia learning resource for allied health professionals: exploring the challenges of prolonged disorders of consciousness

Relevance: Recognising the increasing number of people being sustained with prolonged disorders of consciousness (PDoC), this study introduces new research with allied health professionals (AHPs) that is being used to create a range of digital resources to support AHP undergraduate education and practitioner CPD. Purpose: Previous research (Latchem et al., 2015) identified a mismatch between understandings that families of people with a PDoC hold of AHP interventions and the aims and understandings of AHPs delivering those interventions. This study explores a) how AHPs understand and navigate practical, ethical and legal issues surrounding the care of these patients, b) the learning needs of both qualified and pre-registration AHPs and c) uses the data to create e-learning resources for AHPs and their students. Methods/analysis: This qualitative study uses video-taped interviews with 15 physiotherapists, occupational therapists and speech and language therapists purposively sampled from NHS and independent care providers, and workshops conducted with mixed AHP pre-registration students. The interviews/workshops were transcribed and analysed thematically, adopting a grounded-theory approach to examine experience and learning needs surrounding PDoC care. Emergent themes informed the focus and structure of the e-learning resource. Results: AHPs described how the needs of PDoC patients shifted the focus of, and extended their clinical skills. They reported struggling adjusting to, and finding satisfaction in, their work with this client group who don’t ‘improve’, have a clear rehabilitative nor declining trajectory. Satisfaction however was derived through close multidisciplinary team working. The intertwining of their therapeutic work occurred to such an extent that AHPs resisted defining a distinct disciplinary role and instead discussed their work as entirely interdisciplinary. AHPs repeatedly identified the dilemmas faced by families and discussed the tensions in their own thinking as their clinical objectivity clashed with their own sense of and feelings about the patients’ level of consciousness. They highlighted concerns about the ethics of medical ‘advancements’ and life-sustaining treatments and expressed uneasiness and uncertainty regarding their role in treatment withdrawal situations. Pilot workshops are being developed around these key issues and e-learning resources to support needs for training will be ready for dissemination at conference. Discussion and conclusions: Both families and AHPs can question patients’ level of awareness and the rationale of treatments. However, when families expect ongoing therapeutic input for their relative, or conversely see them as ‘irretrievably gone’, this sits in tension with AHP's clinical reasoning or at times, their relentless striving to capture signs of awareness and for ‘rehabilitation’. Ethical, legal, social and clinical dilemmas collide in the care of PDOC patients, challenging much contemporary clinical practice and pre-registration education. This study and the developing multimedia learning resource demonstrate the interplay between these elements and the scope for CPD support. Impact and implications: The research is developing a new multi-media resource to improve understandings of caring for PDoC patients/their families and related ethical/social/clinical issues. The resource builds on Kitzinger and Kitzinger's successful healthtalk.org module for families and has buy-in from the core AHP Professional Bodies. Our aim is that this AHP-facing resource will have high accessibility, MDT value and impact on personal, practice and curricula development

A web-based life-style, exercise and activity intervention for people with progressive multiple sclerosis: Results of a single-arm feasibility study.

BACKGROUND: People with progressive Multiple Sclerosis often struggle to access appropriate and inclusive support for regular physical activity. The Lifestyle, Exercise and Activity Package (LEAP-MS) intervention, is a co-designed web-based physical activity intervention for people with progressive Multiple Sclerosis (MS). It consists of two key components; (1) web-based physical activity coaching with physiotherapists using self-management support strategies and 2) an interactive web-based platform including a physical activity information suite, an activity selection and planning tool and a participant-physiotherapist messaging system. We aimed to evaluate recruitment, retention and uptake, in a single arm feasibility study. METHODS: Participants with primary or secondary progressive MS with an Expanded Disability Status Scale score of 6 to 8 were recruited. Assessments included the MS Impact Scale (MSIS-29) and measures of participation at baseline, three and six months. All participants received the intervention which consisted of up to six web-based physiotherapy- led physical activity coaching sessions alongside access to web-based education and activity suites. Recruitment, retention and uptake data were summarised. Pre-defined progression criteria were used to guide feasibility assessment. Clinical outcome data were analysed descriptively. RESULTS: Fifty-eight percent (21/36) of those submitting expressions of interest were recruited; 76% completed follow-up. Pre-specified progression criteria for retention were met but recruitment did not meet progression criteria. The intervention achieved set fidelity criteria. At three months, 12 participants (75%) reported improvements in routine activities after the intervention. MSIS-29 physical scores improved by an average of eight points (95% CI -12.6 to -3.3). Improvements were also seen in MSIS-29 psychological scores and fatigue. Some improvements were maintained at six months. CONCLUSIONS: The LEAP-MS intervention is feasible and associated with improvements in MSIS-29 scores. The intervention facilitated partnership working between physiotherapists and people with progressive MS. Users developed valuable skills in supported self-management by focussing on enhancing physical activity to support overall wellbeing. This work has laid the foundations for a large-scale evaluation of a co-designed intervention with potential for far reaching impact on the lives of people with progressive MS

Integrating qualitative research within a clinical trials unit: developing strategies and understanding their implementation in contexts

Background/aims: The value of using qualitative methods within clinical trials is widely recognised. How qualitative research is integrated within trials units to achieve this is less clear. This paper describes the process through which qualitative research has been integrated within Cardiff University’s Centre for Trials Research (CTR) in Wales, UK. We highlight facilitators of, and challenges to, integration. Methods: We held group discussions on the work of the Qualitative Research Group (QRG) within CTR. The content of these discussions, materials for a presentation in CTR, and documents relating to the development of the QRG were interpreted at a workshop attended by group members. Normalisation Process Theory (NPT) was used to structure analysis. A writing group prepared a document for input from members of CTR, forming the basis of this paper. Results: Actions to integrate qualitative research comprised: its inclusion in Centre strategies; formation of a QRG with dedicated funding/roles; embedding of qualitative research within operating systems; capacity building/training; monitoring opportunities to include qualitative methods in studies; maximising the quality of qualitative research and developing methodological innovation. Facilitators of these actions included: the influence of the broader methodological landscape within trial/study design and its promotion of the value of qualitative research; and close physical proximity of CTR qualitative staff/students allowing sharing of methodological approaches. Introduction of innovative qualitative methods generated interest among other staff groups. Challenges included: pressure to under-resource qualitative components of research, preference for a statistical stance historically in some research areas and funding structures, and difficulties faced by qualitative researchers carving out individual academic profiles when working across trials/studies. Conclusions: Given that CTUs are pivotal to the design and conduct of RCTs and related study types across multiple disciplines, integrating qualitative research into trials units is crucial if its contribution is to be fully realised. We have made explicit one trials unit’s experience of embedding qualitative research and present this to open dialogue on ways to operationalise and optimise qualitative research in trials. NPT provides a valuable framework with which to theorise these processes, including the importance of sense-making and legitimisation when introducing new practices within organisations

Improving teaching and learning in higher education indonesian-australian experiences: proceedings of the invitational seminar and workshop for university managers, teachers and researchers held at brawijaya university, malang, indonesia 16-18 january 96/

xii, 143 hal.: ill.; tab.: 30 cm

Quality assurance and accreditation in distance education and e-learning : models, policies and research

Comprend des références bibliographiques et un inde

Charge-Dependent Crossover in Aqueous Organic Redox Flow Batteries Revealed Using On-Line NMR Spectroscopy

Aqueous organic redox-flow batteries (AORFBs) are promising candidates for the low-cost grid-level energy storage. However, their widescale deployment is limited by crossover of redox-active material through the separator membrane, which causes capacity decay. Traditional membrane permeability measurements do not capture all contributions to crossover in working batteries, including migration and changes to ion size and charge. Here we present a new method for characterising crossover in operating AORFBs, using on-line 1H NMR spectroscopy. By introducing a separate pump to decouple NMR and battery flow rates, this method opens a route to quantitative time-resolved monitoring of redox-flow batteries under real operating conditions. In this proof-of-concept study of a 2,6-dihydroxyantharquinone(2,6-DHAQ)/ferrocyanide model system, we observed a doubling of 2,6-DHAQ crossover during battery charging, which we attribute to migration effects. This new membrane testing methodology will advance our understanding of crossover and accelerate the development of improved redox-flow batteries