A Secret Emissary from Down East

This article discusses activities during the war of 1812 commissioned by Massachusetts Governor Caleb Strong to explore the possibility of New England negotiating peace terms with Great Britain. It highlights clues to the identity of an emissary sent to Sir John Sherbrooke, Lt. Governor of Nova Scotia and Commander of the Castine expedition

Systematic review of the measurement properties of self-report physical activity questionnaires in healthy adult populations

OBJECTIVE: This systematic review evaluated the measurement properties of current self-report physical activity questionnaires (SRPAQs) completed within healthy adult populations. DESIGN: Two reviewers independently searched seven electronic databases and hand searched for articles investigating measurement properties of a SRPAQ evaluating physical activity over the previous 6 months. Articles published from 1 May 2001 to 4 December 2014 were systematically screened and eligible studies were not limited to English language sources. Articles investigating specific race, gender or socioeconomic populations were excluded. RESULTS: 10 studies investigating 10 SRPAQs were included. The methodological quality of the included studies was evaluated using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and ranged from ‘poor’ to ‘good’. The Recent Physical Activity Questionnaire, International Physical Activity Questionnaires and Physical Activity Assessment Tool demonstrated good/excellent test–retest reliability (intra-class coefficient (ICC)=0.76, p<0.0001; r=0.627–0.91; r=0.618, p<0.001, respectively), but variable criterion validity (r=0.67, p<0.0001; r=−0.02–0.43; r=0.392, p<0.01, respectively). The single-item measure showed significant criterion validity against an accelerometer (for moderate to vigorous physical activity (MVPA) k=0.23, 95% CI 0.05 to 0.41; and physical activity ≥10 min bouts 0.39 (95% CI 0.14 to 0.64). Construct validity of the six-point scale and Human Activity Profile varied significantly with age, marital status and presence of comorbidities (p<0.05, <0.01, <0.000 and p<0.05, <0.05, <0.000, respectively). The 1 week Godlin-Shephard recall demonstrated ‘moderate’ validity with the gold standard measure of accelerometry (r=0.43). CONCLUSIONS: Inconclusive evidence exists. Further investigation of criterion validity of the short-form International Physical Activity Questionnaire is required, as it demonstrated excellent test–retest reliability. PROSPERO NUMBER: CRD42012002484

Family carer experiences of hospice care at home: qualitative findings from a mixed methods realist evaluation

This document is the Accepted Manuscript version of a published work that appeared in final form in [Palliative Medicine]. To access the final edited and published work see https://doi.org/10.1177/02692163231206027Background: Hospice-at-home aims to enable patients approaching end-of-life to die at home and support their carers. A wide range of different service models exists but synthesised evidence on how best to support family carers to provide sustainable end-of -life care at home is limited. Aim: To explore what works best to promote family carers’ experiences of hospice-at-home. Design: Realist evaluation with mixed methods. This paper focuses on qualitative interviews with carers (to gain their perspective and as proxy for patients) and service providers from twelve case study sites in England. Interviews were coded and programme theories were refined by the research team including two public members. Setting/participants: Interviews with carers (involved daily) of patients admitted to hospice-at-home services (n=58) and hospice-at-home staff (n=78). Results: Post bereavement, 76.4% of carers thought that they had received as much help and support as they needed and most carers (75.8%) rated the help and support as excellent or outstanding. Of six final programme theories capturing key factors relevant to providing optimum services, those directly relevant to carer experiences were: integration and co-ordination of services; knowledge, skills and ethos of hospice staff; volunteer roles; support directed at the patient–carer dyad. Conclusions: Carers in hospice-at-home services identified care to be of a higher quality than generic community services. Hospice staff were perceived as having ‘time to care’, communicated well and were comfortable with dying and death. Hands-on care was particularly valued in the period close to death

Optimum Hospice at Home Services for End-of-Life care: realist evaluation and co-production

Overview: Hospice at home (H@H) services aim to enable people to have a “good death” at home. While this accords with UK policy, statutory services are ill-equipped to meet this demand and there is limited evidence from the perspective of service users, as participants or co-producers, of what aspects are most helpful. Our evaluation asked what features of H@H models work, for whom, how and under what circumstances? We combined a realist evaluation with co-production embedded throughout: phase 1 - a national survey to map service provision and models of H@H care; phase 2 - qualitative and economic data collection with commissioners, service providers and patient-carer dyads; phase 3 - national consensus workshops with stakeholders. The funding application was developed in partnership with ten public members. Two of these became co-applicants, both former carers with experience of hospice services. Utilising a co-production approach, the lay co-applicants contributed to all stages of the research process and were an integral part of the project team. This paper focuses on their role in qualitative data analysis (phase 2); developing and refining programme theories and testing context-mechanism-outcome (CMO) configurations. Key points: The co-applicants initially participated in clearly delineated tasks such as commenting on patient/carer resources. At the end of phase 1, they requested greater involvement, which translated into participating in data analysis. Additional training in realist philosophy and data analysis was provided. The co-applicants attended team coding meetings. Preparation included listening to and reading carer interviews, and coded according to provisional CMOs. Co-applicants fed back at coding meetings as part of the iterative process of refining CMOs. They provided a fresh perspective on the data, reflecting on the underlying narrative that proved invaluable in helping researchers to step back from the minutiae of coding and consider the carer’s perspective. Implications: Public members as an integral part of a realist research team add a different lens to interrogating CMO configurations, enhancing rigour in developing programme theories. While the process evolved overtime, we would recommend early discussions around what activities co-applicants would like to participate in, training requirements, time commitment and emotional demands

Optimum models of hospice at home services for end-of-life care in England: a realist-informed mixed-methods evaluation.

Abstract Background Many people prefer to die at home when the time comes. Hospice at home services aim to support patients to achieve this. A range of hospice at home services exist; some services have been evaluated, but there has been limited evidence synthesis. Objectives The main objective was to find out what models of hospice at home services work best, for whom and in what circumstances. Other objectives supported this aim, including an analysis of the health economic costs of hospice at home models. Design The study was an overarching, non-interventional, realist evaluation comprising three phases. Phase 1 was a survey of hospice at home services. Phase 2 involved 12 case studies, grouped into four models on the basis of size and 24 hours per day, 7 days per week (24/7), operations, from which quantitative and health economics data were gathered. Qualitative interview data from bereaved carers, commissioners and providers were analysed to generate context–mechanism–outcome configurations. Phase 3 comprised stakeholder consensus meetings. Setting Hospice at home services across England. Participants A total of 70 hospice at home managers responded to the survey. A total of 339 patient and family/informal carer dyads were recruited; 85 hospice at home providers and commissioners were interviewed. A total of 88 stakeholders participated in consensus meetings. Main outcome measures The quality of dying and death of patients was assessed by bereaved carers (using the Quality of Dying and Death questionnaire). A patient’s use of services was collected using the Ambulatory and Home Care Record. Results Hospice at home services varied; two-thirds were mainly charitably funded, and not all operated 24/7. Most patients (77%) had cancer. Hospice at home services overall provided care that was likely to deliver ‘a good death’, and 73% of patients died in their preferred place. Six context–mechanism–outcome configurations captured factors relevant to providing optimum hospice at home services: (1) sustainability (of the hospice at home service); (2) volunteers (use of, in the hospice at home service); (3) integration and co-ordination (with the wider health and social care system); (4) marketing and referral (of the hospice at home service); (5) knowledge, skills and ethos (of hospice at home staff); and (6) support directed at the carer at home. Key markers of a good service included staff who had time to care, providing hands-on care; staff whose knowledge and behaviour promoted supportive relationships and confidence through the process of dying; and services attending to the needs of the informal carer. Areas of potential improvement for most hospice at home services were the use of volunteers in hospice at home, and bereavement care. Limitations The study had the following limitations – heterogeneity of hospice at home services, variations in numbers and patient clinical statuses at recruitment, a low Quality of Dying and Death questionnaire response rate, and missing data. Only patients with an informal carer involved on a daily basis were eligible for the study. Conclusions Hospice at home services delivered high-quality care and a ‘good death’, with the majority of patients dying in their stated preferred place. Hospice at home providers can improve their impact by focusing on the features identified that deliver the best patient outcomes. Commissioners can facilitate patient preference and reduce the number of hospital deaths by working with hospice at home services to secure their financial sustainability and increase the numbers and range of patients admitted to hospice at home services. Future research Future research should explore the use of volunteers in the hospice at home setting and evaluate approaches to bereavement support. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 24. See the NIHR Journals Library website for further project informatio

Translation of the International Physical Activity Questionnaire to Maltese and reliability testing.

The International Physical Activity Questionnaire (IPAQ) is a widely used self-reported physical activity (PA) measure developed to allow for international cross-country comparisons. Due to its unavailability, the aim of this study was to translate the IPAQ-long to Maltese and undertake reliability testing. The IPAQ-long English version was translated into Maltese following the IPAQ guidelines, which included backwards translation. Maltese-speaking participants, aged between 18 and 69 years, were recruited through convenience sampling (n = 170). Participants completed the IPAQ-long twice within an 8- to 48-hr period. PA was calculated in MET minutes per week, and reliability was calculated using the Spearman correlation, intraclass correlation coefficient, concordance correlation coefficient, and Bland–Altman plots. A total of 155 participants completed the questionnaire at two time points. Spearman correlation was .83 (.76–.88) for total PA and .84 (.77–.89) for total sitting time. The intraclass correlation coefficient was .83 (.76–.88) and the concordance correlation coefficient was .75–.87 for total PA. The lowest reliability was for total transport, with a concordance correlation coefficient of .21−.45. Bland–Altman plots highlight that 95% of the differences fell within 2 SDs from the mean. Since the Maltese IPAQ-long has similar reliability to the English version, the authors recommend that health care professionals and PA practitioners use this tool when examining population-level PA among Maltese-speaking individual