Background:
In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such ...carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor.
Aim:
To evaluate the effectiveness of advance care planning with family carers in dementia care homes.
Design:
Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff.
Setting/participants:
A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions.
Results:
The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (−10.5, 95% confidence interval: −16.4 to −4.7; p < 0.001).
Conclusion:
Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.
A review of the literature highlights the important role informal carers play in the provision of palliative care in the community. In order to explore the caring experience of relatives with ...Parkinson’s Disease (PD), interviews were conducted with 26 informal family caregivers. Interviews were taped, transcribed and subjected to content analysis. All caregivers were spouses, the majority female (n = 17) and all were responsible for providing physical, social and emotional care in the home. Although they viewed care giving as their role and duty, the results highlight the widespread burden of providing care on the emotional and physical health of the caregivers. The financial implications for providing care were outlined, with many reporting difficulty in accessing benefits. From the point of diagnosis, which had a huge emotional impact on relatives and carers, carers did not feel health professionals integrated them within the caring journey. Since diagnosis, carers commented on the lack of continued and coordinated care plans for relatives, resulting in symptoms being mismanaged and care opportunities for relatives and carers missed. Stereotypes of the meaning and timing of palliative care were common with many viewing it as being synonymous with cancer and not applicable to a person with PD. As the well-being of the informal carer directly influences the care of the person with PD, support interventions are required to relieve their burden, maximize outcomes and ensure targeting of services.
•Postnatal depression is a complex mental illness that can affect women after childbirth and have lifelong consequences for her baby.•Methods that would assist in identifying women at greater risk of ...postnatal depression would increase early detection rates.•Women with PND appear to be epigenetically sensitive to physiological changes of childbirth or to environmental factors conferred by genotype.•Measuring interaction of epigenetic, genetic, hormonal and environmental factors may improve accuracy of antenatal screening for risk of PND.
Postnatal depression (PND) is common, affects the health of the mother, the development of the infant and places a large financial burden on services. Genetic and epigenetic biomarkers for PND could potentially improve the accuracy of current antenatal screening approaches. The aim of this systematic review is to report on the evidence for an association between genetic or epigenetic factors and postnatal depression.
A systematic search of five databases (Medline, EMBASE, PILOT, PsychINFO and SCOPUS) was carried out using the following (MeSh) terms and keywords: postpartum, depression, postnatal depression, genetics, genetic polymorphisms and epigenetics. Inclusion criteria were applied and quality of studies was assessed using guidelines from the HuGE Review Handbook (Little and Higgins, 2006).
Following removal of duplicate articles, 543 remained; of these 37 met the inclusion criteria. Positive associations have been reported between PND and polymorphisms in the HMNC1, COMT, MAOT, PRKCB, ESR1, SLC6A4 genes in the presence of stressful life events, the BDNF gene when the postnatal period occurs during autumn and winter months and the OXT and OXTR genes in the presence of childhood adversity experienced by the mother. Epigenetic interactions with genotype, estrogen, and childhood adversity were identified that are predictive of PND.
The number of studies investigating some of the markers was small and grey literature was not included.
This review highlights the importance of examining the interaction between epigenetic, genetic, hormonal and environmental factors in order to fully understand the risk factors for PND and to improve the accuracy of current antenatal and early postnatal screening procedures. Women susceptible to PND appear to have heightened epigenetic sensitivity to the physiological changes of childbirth or to environmental factors conferred by genotype.
Aims
To identify the key common components of knowledge transfer and exchange in existing models to facilitate practice developments in health services research.
Background
There are over 60 models ...of knowledge transfer and exchange designed for various areas of health care. Many of them remain untested and lack guidelines for scaling‐up of successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research.
Design
A scoping review was conducted in line with PRISMA guidelines. Key components of knowledge transfer and exchange were identified using thematic analysis and frequency counts.
Data Sources
Six electronic databases were searched for papers published before January 2015 containing four key terms/variants: knowledge, transfer, framework, health care.
Review Methods
Double screening, extraction and coding of the data using thematic analysis were employed to ensure rigour. As further validation stakeholders’ consultation of the findings was performed to ensure accessibility.
Results
Of the 4,288 s, 294 full‐text articles were screened, with 79 articles analysed. Six key components emerged: knowledge transfer and exchange message, Stakeholders and Process components often appeared together, while from two contextual components Inner Context and the wider Social, Cultural and Economic Context, with the wider context less frequently considered. Finally, there was little consideration of the Evaluation of knowledge transfer and exchange activities. In addition, specific operational elements of each component were identified.
Conclusions
The six components offer the basis for knowledge transfer and exchange activities, enabling researchers to more effectively share their work. Further research exploring the potential contribution of the interactions of the components is recommended.
目的
的在于确定已有模式中知识传递和交流的关键通用组分,以促进卫生服务研究的实践发展。
背景为各种医疗保健领域设计了60多种知识转移和交流模式。当中许多吧没有进行测试,也没有指导方针来既扩大研究结果的成功实施,又没有指导方针来扩大已证模型的成功实施,以便于确保患者在当前研究的指导下获得最佳的医疗保健。
设计
根据PRISMA指南进行了范围综述。采用了主题分析和频率计数来确定知识传递和交流的关键组分。
数据来源
在6个电子数据库中搜索了2015年1月之前发表的论文,其中包含四个关键术语/变体:知识、传递、框架、医疗保健。
综述方法
采用了主题分析对数据进行双重筛选,提取和编码,以便确保严谨性。随着进一步确认,利益相关者对调查结果进行了协商,以确保可访问性。
结果
在4288篇摘要中,筛选了294篇全文文章,分析了79篇文章。出现了6个关键组分:知识传递和交流信息、利益相关者和流程组件经常一起出现、而出现于两个上下文组件——内部语境和更广阔的社会,文化和经济语境、不太经常考虑更广阔的语境。最后,很少考虑对知识传递和交流活动的评估。此外,还确定了每个组分的具体操作要素。
结论
这六个组分为知识传递和交流活动提供了基础,使研究人员能够更有效地共享其工作。建议进一步研究探讨组件交互的潜在贡献。
: Background: Women need access to evidence‐based information to make informed choices in pregnancy. A search for health information is one of the major reasons that people worldwide access the ...Internet. Recent years have witnessed an increase in Internet usage by women seeking pregnancy‐related information. The aim of this study was to build on previous quantitative studies to explore women’s experiences and perceptions of using the Internet for retrieving pregnancy‐related information, and its influence on their decision‐making processes.
Methods: This global study drew on the interpretive qualitative traditions together with a theoretical model on information seeking, adapted to understand Internet use in pregnancy and its role in relation to decision‐making. Thirteen asynchronous online focus groups across five countries were conducted with 92 women who had accessed the Internet for pregnancy‐related information over a 3‐month period. Data were readily transferred and analyzed deductively.
Results: The overall analysis indicates that the Internet is having a visible impact on women’s decision making in regards to all aspects of their pregnancy. The key emergent theme was the great need for information. Four broad themes also emerged: “validate information,”“empowerment,”“share experiences,” and “assisted decision‐making.” Women also reported how the Internet provided support, its negative and positive aspects, and as a source of accurate, timely information.
Conclusion: Health professionals have a responsibility to acknowledge that women access the Internet for support and pregnancy‐related information to assist in their decision‐making. Health professionals must learn to work in partnership with women to guide them toward evidence‐based websites and be prepared to discuss the ensuing information. (BIRTH 38:4 December 2011)
Burnout in family doctors (FDs) affects their well-being, patient care, and healthcare organizations, and is considered common worldwide. However, its measurement has been so inconsistent that ...whether the widely divergent prevalence figures can be meaningfully interpreted has been questioned. Our aim was to go further than previous systematic reviews to explore the meaning contribution and usefulness of FD-burnout prevalence estimates. Worldwide literature was systematically reviewed using Levac's scoping framework, with 249 papers undergoing full-text review. Of 176 studies measuring burnout, 78% used the Maslach Burnout Inventory (MBI), which measures burnout as now defined by the World Health Organization. We, therefore, concentrated on the MBI. Its burnout measurement was markedly inconsistent, with prevalence estimates ranging from 2.8% to 85.7%. Researchers made prevalence claims relating to burnout severity and implied diagnoses based on participants' MBI scores, even though the MBI has not been validated as a clinical or diagnostic tool. Except when comparisons were possible between certain studies, prevalence figures provided limited meaning and added little to the understanding of burnout in FDs. Our review revealed a lack of research-supported meaningful information about the prevalence of FD burnout and that care is required to avoid drawing unsubstantiated conclusions from prevalence results. This paper's overall purpose is to propose how obtaining meaningful prevalence estimates can begin, which are recognized as key to developing improved prevention policies and interventions. Researchers must adopt a consistent means to measure burnout, use the MBI as its authors intended, and explore making progress through quantitative and qualitative collaboration.
•There is no consistency in how burnout in family doctors is measured and reported.•Clinical abilities commonly appear wrongly attributed to the MBI in research.•Prevalence claims relating to burnout severity or diagnosis are misplaced.•Unsubstantiated conclusions are often drawn from prevalence results.•Meaningful information about the prevalence of family-doctor burnout is lacking.
Abstract
Older people with dementia have multiple palliative care needs, with pain, agitation, dyspnoea, aspiration and pressure ulcers being common and persistent in advanced dementia. Anticipating ...the person’s possible symptoms requires knowledge of the whole person, including the type of dementia, which is problematic when the dementia type is often not documented.
A palliative care approach to dementia should look at symptoms across the four pillars of palliative care, but in reality, we tend to over-focus on physical and psychological symptoms, while spiritual and emotional needs can be overlooked, especially around the time of diagnosis, where such needs may be significant.
Advance care planning (ACP) is a central tenet of good dementia palliative care, as the person may lose their ability to communicate and make complex decisions over time. Despite this, care planning is often approached too late, and with the person’s family rather than with the person; much of the literature on ACP in dementia is based on proxy decision-making for people in residential care.
Thus, we need a paradigm shift in how we approach dementia, beginning with timely diagnosis that includes the dementia type, and with services able to assess and meet emotional and spiritual needs especially around the time of diagnosis, and with timely ACP as an integral part of our overall approach.
Background
Bullying has been identified as one of the leading workplace stressors, with adverse consequences for the individual employee, groups of employees, and whole organisations. Employees who ...have been bullied have lower levels of job satisfaction, higher levels of anxiety and depression, and are more likely to leave their place of work. Organisations face increased risk of skill depletion and absenteeism, leading to loss of profit, potential legal fees, and tribunal cases. It is unclear to what extent these risks can be addressed through interventions to prevent bullying.
Objectives
To explore the effectiveness of workplace interventions to prevent bullying in the workplace.
Search methods
We searched: the Cochrane Work Group Trials Register (August 2014); Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1); PUBMED (1946 to January 2016); EMBASE (1980 to January 2016); PsycINFO (1967 to January 2016); Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus; 1937 to January 2016); International Bibliography of the Social Sciences (IBSS; 1951 to January 2016); Applied Social Sciences Index and s (ASSIA; 1987 to January 2016); ABI Global (earliest record to January 2016); Business Source Premier (BSP; earliest record to January 2016); OpenGrey (previously known as OpenSIGLE‐System for Information on Grey Literature in Europe; 1980 to December 2014); and reference lists of articles.
Selection criteria
Randomised and cluster‐randomised controlled trials of employee‐directed interventions, controlled before and after studies, and interrupted time‐series studies of interventions of any type, aimed at preventing bullying in the workplace, targeted at an individual employee, a group of employees, or an organisation.
Data collection and analysis
Three authors independently screened and selected studies. We extracted data from included studies on victimisation, perpetration, and absenteeism associated with workplace bullying. We contacted study authors to gather additional data. We used the internal validity items from the Downs and Black quality assessment tool to evaluate included studies' risk of bias.
Main results
Five studies met the inclusion criteria. They had altogether 4116 participants. They were underpinned by theory and measured behaviour change in relation to bullying and related absenteeism. The included studies measured the effectiveness of interventions on the number of cases of self‐reported bullying either as perpetrator or victim or both. Some studies referred to bullying using common synonyms such as mobbing and incivility and antonyms such as civility.
Organisational/employer level interventions
Two studies with 2969 participants found that the Civility, Respect, and Engagement in the Workforce (CREW) intervention produced a small increase in civility that translates to a 5% increase from baseline to follow‐up, measured at 6 to 12 months (mean difference (MD) 0.17; 95% CI 0.07 to 0.28).
One of the two studies reported that the CREW intervention produced a small decrease in supervisor incivility victimisation (MD ‐0.17; 95% CI ‐0.33 to ‐0.01) but not in co‐worker incivility victimisation (MD ‐0.08; 95% CI ‐0.22 to 0.08) or in self‐reported incivility perpetration (MD ‐0.05 95% CI ‐0.15 to 0.05). The study did find a decrease in the number of days absent during the previous month (MD ‐0.63; 95% CI ‐0.92 to ‐0.34) at 6‐month follow‐up.
Individual/job interface level interventions
One controlled before‐after study with 49 participants compared expressive writing with a control writing exercise at two weeks follow‐up. Participants in the intervention arm scored significantly lower on bullying measured as incivility perpetration (MD ‐3.52; 95% CI ‐6.24 to ‐0.80). There was no difference in bullying measured as incivility victimisation (MD ‐3.30 95% CI ‐6.89 to 0.29).
One controlled before‐after study with 60 employees who had learning disabilities compared a cognitive‐behavioural intervention with no intervention. There was no significant difference in bullying victimisation after the intervention (risk ratio (RR) 0.55; 95% CI 0.24 to 1.25), or at the three‐month follow‐up (RR 0.49; 95% CI 0.21 to 1.15), nor was there a significant difference in bullying perpetration following the intervention (RR 0.64; 95% CI 0.27 to 1.54), or at the three‐month follow‐up (RR 0.69; 95% CI 0.26 to 1.81).
Multilevel Interventions
A five‐site cluster‐RCT with 1041 participants compared the effectiveness of combinations of policy communication, stress management training, and negative behaviours awareness training. The authors reported that bullying victimisation did not change (13.6% before intervention and 14.3% following intervention). The authors reported insufficient data for us to conduct our own analysis.
Due to high risk of bias and imprecision, we graded the evidence for all outcomes as very low quality.
Authors' conclusions
There is very low quality evidence that organisational and individual interventions may prevent bullying behaviours in the workplace. We need large well‐designed controlled trials of bullying prevention interventions operating on the levels of society/policy, organisation/employer, job/task and individual/job interface. Future studies should employ validated and reliable outcome measures of bullying and a minimum of 6 months follow‐up.
BackgroundMyanmar has a high maternal mortality rate. Evidence about pregnancy and antenatal care experiences of women in more remote areas, where Covid and conflict have increased poverty and ...restricted travel, is limited. Understanding how women in a camp for internally displaced persons (IDP) navigate pregnancy and antenatal care may inform strategies to improve pregnancy outcomes in remote and fragile contexts.AimTo explore how women living as IDPs experience pregnancy and antenatal care in a remote setting.MethodsA case study approach with an exploratory and descriptive design will be employed using qualitative data collection methods with women in one settled IDP camp. Thematic interviews will be undertaken with internally displaced women, members of a local women’s support network and local data collectors who have been working in women’s health and development. Due to travel restrictions, a pragmatic decision was taken to work online with local data collectors experienced in qualitative research. This arrangement should increase richness of data, strengthen research capacity and reduce the impact of cross-cultural communication in the interview setting. Transcripts will be translated to English and data will be analysed thematically.Expected ResultsPandemic restrictions and disruption to services have increased challenges for displaced women in relation to pregnancy and antenatal care. The study is likely to develop themes related to access difficulties, traditional beliefs and practices, the role of cultural factors in pregnancy and the value of social support networks in women’s experiences of pregnancy in displacement.Current Stage of WorkEthical approval has been granted by Ulster University. A systematic review of qualitative evidence on pregnancy experiences of displaced women is underway. Interview guides have been translated, local language data collectors have been engaged, a site identified and local permissions secured.
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