Health open research最新文献

Introduction: With the recognition of the need for palliative care for people with non-malignant conditions, there is an increasing emphasis on interdisciplinary working between geriatric and palliative care teams. This interdisciplinary work has evolved organically; more needs to be known about current working practices. This is of policy and clinical interest as the older patient population continues to grow.

Methods: A case study based on qualitative interviews was undertaken of end-of-life care for older in-patients in a large London NHS Trust. 30 semi-structured qualitative interviews were conducted with staff from palliative care and geriatric medical and nursing teams, two with patients and five with carers. Questions covered: examples and perceptions of collaboration and patient/carer perceptions of clarity as to who was providing care. Interviews were transcribed and thematically analysed focusing on: examples of successful collaboration; areas of tension, duplication or confusion about responsibilities; and suggestions for future practice.

Results: Participants were positive about collaboration. Examples of what works well include: the referral process to the palliative care team; inter-team communication and use of face-to-face handovers; unity between the teams when communicating with patients and families. Areas for potential development include: embedding palliative care within ward multidisciplinary team meetings; continual on-ward education given rotation of staff; and improving collaboration between palliative care, physiotherapy and occupational therapy. It is unclear whether patients' and carers' lack of awareness of the different teams has a detrimental effect on their care or needs.

Conclusions: There is evidence of strong collaborative working between the teams; however, this study highlights potential areas for improvement. An exploration of these relationships in other settings is required to determine if the same themes arise with a view to inform national guidelines and policy to improve care towards the end of life.

Background: Remote cognitive assessments are increasingly used with the rising popularity of teleneuropsychology. Here, we evaluated the performance of the remotely administered Oxford Cognitive Screen (Tele-OCS) compared to in-person administration in adult stroke survivors.

Methods: 40 stroke survivors ( M age = 69.30, SD = 10.44; sex = 30% female) completed in-person and remote versions of the OCS on average 30 days apart, with different trained examiners. The order of administration was counterbalanced. Cohen's d estimates were used to compare performance between modalities.

Results: We found that the proportion of OCS subtasks impaired did not differ across modalities ( d <.001). With regards to raw subtask scores, only the picture naming subtask and executive score from the trail making subtask were found to be statistically different across modalities, though raw differences were minimal (<1 point difference on average). These statistical differences did not affect impairment classifications.

Conclusions: The Tele-OCS classified cognitive impairments in a comparable way to the in-person version. The validation of the Tele-OCS allows for remote assessment to increase accessibility and pragmatically aid in addressing the clinical need for stroke-specific cognitive screening in a wider population.

Background: The pathophysiology and medical management between ischaemic stroke and intracerebral haemorrhage differ as do their functional independence and mortality outcomes. This paper aims to establish whether their respective upper limb motor impairment and recovery differ. This information could inform discussions with patients about their recovery prognosis as well as identify appropriate rehabilitation settings.

Methods: A PROSPERO registered systematic search of three databases (MEDLINE, CINAHL, Embase) identified studies that measured upper limb motor function (Fugl-Meyer assessment scale for upper extremity) in participants with first stroke (ischaemic stroke or intracerebral haemorrhage) within 31 days post-stroke and at least one follow-up assessment. Risk of bias was assessed using the Critical Appraisal Skills Programme.

Results: The search identified 1108 studies of which three met inclusion criteria, with a total of 258 participants (200 ischaemic stroke, 58 intracerebral haemorrhage). All studies had low to moderate risk of bias. At baseline, participants with intracerebral haemorrhage had greater upper limb motor impairment on the Fugl-Meyer assessment scale, but at six months post-stroke, the stroke subtypes reached similar upper limb motor function. Improvements were greatest early after stroke.

Conclusions: Despite greater severity at baseline, intracerebral haemorrhage survivors appeared to reach the same level of arm function at six months post stroke. However, these findings need to be interpreted with caution due to limited studies and small number of participants included in this review and warrant further research.

Prospero registration: CRD42020159110 (19/02/2020).

As the global population ages, and rates of modifiable risk factors for cancer change, cancer incidence and mortality continue to increase. While we understand many modifiable risk factors related to diet, nutrition, bodyweight, and physical activity in adulthood that influence cancer risk, how exposure during childhood, adolescence, and young adulthood impacts cancer risk is less clear. This is partly because the timeline from initial mutation to cancer development and diagnosis can span several decades. This long latency period creates methodological, ethical, and financial issues; as well as resource and feasibility challenges in the design, implementation, and data analysis of lifecourse studies. As such, the large majority of lifecourse studies are observational, often using recall data which has inherent bias issues. Concurrently, a new research era has begun, with mature birth cohort studies that are phenotyped/genotyped and can support studies on adult cancer risk. Several studies and consortia contain information spanning the lifecourse. These resources can support association, mechanistic and epigenetic investigations into the influences of multi-disciplinary (e.g. genetic, behavioural, environmental) factors, across the lifecourse and critical time periods. Ultimately, we will be able to produce high-quality evidence and identify how/when early life risk factors impact cancer development and survival.

Aging populations have increased demand for hospice palliative care and support for dying persons. More broadly, community support is also becoming an increasingly important aspect of public health intervention. Compassionate communities advocate active bottom-up community participation to strengthen communities' assets around death and dying. However, these rapidly growing initiatives face a challenge in putting values such as cultural diversity, relationship, and love into practice and in making a social impact through "meaningful participation" at the community level. Reflecting on our experiences in a recent study of dying at home in Canada, we consider potential challenges for compassionate communities more broadly. We argue that risks related to gendered inequity, neo-liberal discourses around caring work, and an over-emphasis of community resilience need to be deliberated in compassionate community policy and service development. To mitigate these risks, we argue that the eight components of the International Standards for Community Development Practice or ISCDP (from the International Association for Community Development or IACD) provide important direction about putting values into practice, for instance by advocating for service and policy improvement while engaging in practice and research on compassionate communities. We discuss how the international standards can inform compassionate community development in Canada.

Background: The aim of this study was to explore whether sail training using a VSail® simulator would allow people with spinal cord injuries (SCI) to learn to sail in a safe controlled environment and then sail competently on the water in wind of moderate strength (12 knots). A battery of physical tests and questionnaires was used to evaluate possible improvements in health and well-being as a consequence of participation in the trial.

Methods: Twenty participants were recruited with the assistance of their physicians from The International Center for Spinal Cord Injury, Kennedy Krieger Institute. Inclusion criteria were SCI >6 months previously, medically stable, with no recent (1 month or less) inpatient admission for acute medical or surgical issues. All neurological SCI levels (C1-S1) were eligible. All subjects followed a programme of instruction leading to mastery of basic sailing techniques (steering predetermined courses, sail trimming, tacking, gybing and mark rounding).

Results: Not all participants completed the study for various reasons. Those that did were seven males and six females, six with tetraplegia and seven with paraplegia. The mean age was 45 years (23 to 63) and the average time since injury was 14.7 years (2 to 38 years). At the end of the course subjects were able to perform the sailing maneuvers and navigate a triangular racecourse on the simulator's display in 12 knots of wind within a pre-set time. At 6 weeks post completion of training most subjects showed a decrease in depression, physical and social limitations, and an improvement in physical tests. These improvements were maintained or increased in most participants by 12 weeks, but not others.

Conclusions: The primary objective of the trial was achieved as all participants who completed the VSail® training were able to sail on the water at the Downtown Sailing Center in Baltimore.

Background: Our aim was to determine the impact of the COVID-19 pandemic on the publication productivity of neurosurgeons in the United Kingdom and Republic of Ireland.

Methods: Using bibliometric data we quantified and analysed the academic output of neurosurgeons in England, Scotland, Northern Ireland, Wales, and the Republic of Ireland, between two time periods i.e., January 2017 to December 2019 and January 2020 to March 2022, as a representative capture of the academic climate before and after the start of the COVID-19 pandemic. The consultant neurosurgeons were grouped according to their departments, title, sex, subspecialities and additional research qualifications. Using data charts on Scopus author directory, the total number of publications, citations and h-indices of each neurosurgeon were obtained over the two time periods. The median and mean of these 3 parameters were computed and the median values were analysed and tested for significance using a Mann Whitney-U test according to the groups.

Results: Our analysis conveyed a statistically significant increase (2440 publications and between January 2020 and March 2022 there were 2548 publications p<0.05) in the total number of publications after the start of the COVID-19 pandemic compared to before. There was a statistically significant decrease in the mean number of citations (mean 55.24 vs 57.01, p<0.05), after the start of the COVID-19 pandemic. This trend was observed in both sexes, in authors without an additional MD/PhD and in authors who sub-specialized in neuro-oncology. Overall, there was a significant decrease in H-index after the start of the pandemic compared to before (median h-index:1.00 and 2.00; mean h-index:1.8 and 3.4 respectively).

Conclusions: There appears to be an apparent increase in total number of publications after the start of the COVID-19 pandemic, most authors have registered a reduction in citations and h-indices, suggesting a lower impact and unequal distribution of the abovementioned increase.

Background: Digital Health (DH) integrates digital technologies into healthcare to increase efficiency and improve patient experiences, benefiting both primary care and military healthcare systems. However, it raises concerns about the potential shift of healthcare responsibilities onto patients, creating workloads or treatment burdens that affect care, adherence, equity, and resource allocation. It is critical to assess this in the military context to enhance patient-centred care and outcomes.

Objective: To understand military personnel's experience of treatment burden of DH in primary care, to understand the barriers and facilitators of the use of DH, and to map barriers identified to the Burden of Treatment Theory (BOTT).

Design: A systematic literature review. MEDLINE, Psych INFO, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar will be searched. Two independent reviewers will screen papers using inclusion and exclusion criteria, with conflicts decided by a third reviewer. Any retrieved study that meets the inclusion and exclusion criteria will be quality appraised using the appropriate Critical Appraisal Skills Programme (CASP) checklist. The findings will be analysed using thematic synthesis and evaluated in the context of the Burden of Treatment Theory. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA) guidelines have been adhered to in the production of this protocol.

Conclusions: Understanding the experience of treatment burden whilst using DH in the military has the potential to influence health policy, the commissioning of services and interventions, and most importantly, improve patient experience and health outcomes. PROSPERO registration number: CRD42023494297.