Access and travel burden associated with breast radiotherapy attendance pre- and post-COVID-19 pandemic

It is already well-understood that patients requiring multiple hospital visits deal with several barriers. This paper considers a new methodology for determining the barrier that travel can cause, applying it to the mixed rural-city population of South-West Wales, calculating the travel burden for patients accessing radiotherapy. Travel burden could factor into conversations around optimisation of appointments and the impact of changes to treatment pathways. Patient-specific travel data were calculated using Google Maps, for 1516 patients attending South-West Wales Cancer Centre for radiotherapy, modelled for 5-fraction and 15-fraction regimes. 28% of patients travelled for longer than 60 minutes. Moving to a 5-fraction treatment regime saves 20 one-way trips to the hospital, resulting in an average time saving of 15.9 hours for those travelling by car and 39.3 hours for those travelling by public transport. On average, this reduces carbon dioxide emissions by 91 kg per patient. Implementation of a 5-fraction treatment regime has significantly reduced the travel burden for some patients receiving radiotherapy, as well as emissions related to travel. However, access to radiotherapy services in South-West Wales varies, with certain regions facing substantial travel burdens. Further research exploring other potential options to reduce travel burden is needed

Subjective Cognitive Decline (Preface)

First paragraph: Perceived decline in cognition in the absence of what is commonly termed ‘objective evidence’ is frequently referred to as subjective cognitive decline (SCD). While etiologically heterogeneous and therefore potentially responsive to intervention in some cases, SCD remains primarily associated with an increased risk of developing dementia. It is becoming clear however that, irrespective of cause, SCD can have a detrimental effect upon quality of life. Although there is increasing interest in SCD within both research and clinical arenas, it remains a topic that provokes substantial debate particularly with regard to its definition, diagnosis, and management

Reaction Time Decomposition as a Tool to Study Subcortical Ischemic Vascular Cognitive Impairment

Background:The study of reaction time (RT) and its intraindividual variability (IIV) in aging, cognitive impairment, and dementia typically fails to investigate the processing stages that contribute to an overall response. Applying “mental chronometry” techniques makes it possible to separately assess the role of processing components during environmental interaction.Objective:To determine whether RT and IIV-decomposition techniques can shed light on the nature of underlying deficits in subcortical ischemic vascular cognitive impairment (VCI). Using a novel iPad task, we examined whether VCI deficits occur during both initiation and movement phases of a response, and whether they are equally reflected in both RT and IIV.Methods:Touch cancellation RT and its IIV were measured in a group of younger adults (n = 22), cognitively healthy older adults (n = 21), and patients with VCI (n = 21) using an iPad task.Results:Whereas cognitively healthy aging affected the speed (RT) of response initiation and movement but not its variability (IIV), VCI resulted in both slowed RT and increased IIV for both response phases. Furthermore, there were group differences with respect to response phase.Conclusion:These results indicate that IIV can be more sensitive than absolute RT in separating VCI from normal aging. Furthermore, compared to cognitively healthy aging, VCI was characterized by significant deficits in planning/initiating action as well as performing movements. Such deficits have important implications for real life actions such as driving safety, employment, and falls risk

Distinct Profile Differences in Subjective Cognitive Decline in the General Public Are Associated with Metacognition, Negative Affective Symptoms, Neuroticism, Stress, and Poor Quality of Life

BACKGROUND: Subjective cognitive decline (SCD) is increasingly recognized in both the clinical and research arenas as a risk factor for mild cognitive impairment (MCI) and dementia. Although SCD is etiologically heterogeneous and potentially treatable, in comparison to MCI and Alzheimer’s disease, SCD remains poorly characterized with its clinical relevance often questioned. OBJECTIVE: This study’s aim was to improve the characterization of SCD within the general public. METHODS: Individuals with SCD were compared to those without via a battery of measures. RESULTS: Both the SCD and the non-SCD group correlational analysis identified significant relationships between worse SCD, worse metacognitive dysfunction, negative affective symptoms, and greater levels of stress. The SCD group displayed additional correlational relationships between Cognitive Change Index (Self report) (CCI-S) scores, higher neuroticism scores, and poorer quality of life (QoL). Partial correlation analysis in the SCD group suggests CCI-S scores, anxiety, depression, and metacognition are intercorrelated. Ad hoc analyses using metacognition as the grouping variable found that those experiencing worse metacognitive dysfunction were significantly more likely to experience poorer SCD, psychological and social QoL, greater levels of anxiety, depression, stress, and neuroticism. CONCLUSION: The emerging pattern from the analysis indicates that SCD appears associated with sub-clinical negative affective difficulties, metacognitive, and other psycho-social issues, and poorer QoL. Dysfunctional cognitive control at a meta-level may impact someone’s ability to rationally identify cognitive changes, increase worry about cognitive changes, and allow such changes to impact their lives more than those with superior metacognitive control. Findings could impact SCD assessment, monitoring, early intervention, and ultimately reducing risk of further decline

Early visual processing in ageing and Alzheimer's disease.

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN029928 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

‘Rekindling couplehood’ using a multisensory suitcase of memories:A pilot study of people living with moderate dementia and their partners

Creating individualised activities in partnership with people who have moderate dementia and their partners at home has rarely been achieved, as such interventions are usually pre planned and prepared by researchers or professionals. The academic gap is in the activity design being led by the person who has dementia and their partner and how to pragmatically engage them in a meaningful manner which rekindles positive joint memories and improves the quality of their current relationship. This explores the meaning and significance of recalling holiday memories for people living with moderate dementia and their partners, using multisensory reminiscence. A sensory ethnography research methodology was employed to overcome the challenges of engaging individuals with cognition, decision making and communication difficulties and to enhance co-production of the activity with the person living with dementia and her spouse. This processual and longitudinal methodology allowed individuals, who are often excluded from research, to express themselves and co-design activities over 5 home visits using multisensory reminiscence of shared holiday memories. The co-produced research culminated in the creation of a digital story, the sharing of food and drink and re-enactment through exploration of their holiday memorabilia: which formed their “suitcase of memories” (SOM). The study extends the current academic debate in the subjects of co-produced interventions and identifies the critical themes of Holidays as life; Freedom; View seen, viewpoint heard and Strengthened self-identity with younger self emerged from the research. Such areas of sensory reminiscence have supported positive recollections, discourse, and, when combined, resulted in a beneficial impact on the partners shared relationship. A significant research outcome was the transition from a negative life view dominated by dementia to positively rekindling their relationship as a result of the SOM intervention and sensory methodology. Future research will continue to work with new couples to see if similar results are achieved with more case studies. Key WordsDementia, Couplehood, Reminiscence, Tourism, Sensory, Memories, “Sensory Ethnography