Thursday, 17 December 2020

Frontiers in Neurology, New Publication: Rehabilitation Before and After Autologous Haematopoietic Stem Cell Transplantation (AHSCT) for Patients With Multiple Sclerosis (MS)

Catch Professor, Susan Mawson, has collaborated with colleagues internationally on the article 'Rehabilitation Before and After Autologous Haematopoietic Stem Cell Transplantation (AHSCT) for Patients With Multiple Sclerosis (MS): Consensus Guidelines and Recommendations for Best Clinical Practice on Behalf of the Autoimmune Diseases Working Party, Nurses Group, and Patient Advocacy Committee of the European Society for Blood and Marrow Transplantation (EBMT)'



Autologous haematopoietic stem cell transplantation (AHSCT) is increasingly used to treat people with multiple sclerosis (MS). Supported by an evolving evidence base, AHSCT can suppress active inflammation in the central nervous system and induce long-term changes in immune cell populations, thereby stabilizing, and, in some cases, reversing disability in carefully selected MS patients.

However, AHSCT is an intensive chemotherapy-based procedure associated with intrinsic risks, including profound cytopenia, infection, and organ toxicity, accompanied by an on-going degree of immuno-compromise and general deconditioning, which can be associated with a transient increase in functional impairment in the early stages after transplantation. Although international guidelines and recommendations have been published for clinical and technical aspects of AHSCT in MS, there has been no detailed appraisal of the rehabilitation needed following treatment nor any specific guidelines as to how this is best delivered by hospital and community-based therapists and wider multidisciplinary teams in order to maximize functional recovery and quality of life.

These expert consensus guidelines aim to address this unmet need by summarizing the evidence-base for AHSCT in MS and providing recommendations for current rehabilitation practice along with identifying areas for future research and development.

Please read the full article here.


Thursday, 3 December 2020

New Publications in BMJ Open, PLOS ONE and Health & Social Care in the Community

Catch member, Dr Steven Ariss, has successfully collaborated with colleagues from the health sector and recently had three papers published in BMJ Open, PLOS ONE and Health & Social Care in the Community.




BMJ Open: Complex programme evaluation of a ‘new care model’ vanguard: a shared commitment to quality improvement in an integrated health and care context

NHS vanguards, under-pressure to perform, required better contracting and data management arrangements with evaluation teams, to ensure that integrated service outcomes could be reported effectively. This communication reflects the experience of evaluating an NHS vanguard and suggests how academic teams can improve capacity for complex programme evaluation of rapid improvements in integrated services. This should be based on a shared commitment to data collection and management. Also, robust knowledge exchange processes can enable systems change and sustainability. The identifying features of the particular site have been withheld.

Please find the paper here.

PLOS One: The identification and treatment of mental health and substance misuse problems in sexual assault services: A systematic review

Specialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders’ views and policy recommendations about optimal SARC practice.

A systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted.

We included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counselling services.

This review suggests that there is big variation in the mental health and substance misuse provision both across and within different sexual assault service models. We found no robust evidence about how sexual assault services can achieve good mental health and substance misuse outcomes for service users. Clearer guidance for service planners and commissioners, informed by robust evidence about optimal service organisations and pathways, is required.

Please find the paper here.

Health and Social Care in the Community: Impact of social prescribing to address loneliness: A mixed methods evaluation of a national social prescribing programme

Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service-users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service-users’ loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service-users could receive up to 12 weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n = 10,643) including pre-post analysis of UCLA data (n = 2,250) and matched comparator work to measure changes in loneliness; (b) semi-structured interviews with service-users, link workers and volunteers (n = 60) and (c) a Social Return on Investment Analysis. The majority of the service-users (72.6%, n = 1634/2250) felt less lonely after receiving support. The mean change in UCLA score was -1.84 (95% CI -1.91 to -1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service-users’ needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service-users experiencing loneliness.

Please find the paper here.




Wednesday, 2 December 2020

Published paper in BMJ Open: Challenges, experience and coping of health professionals in delivering healthcare in an urban slum in India during the first 40 days of COVID-19 crisis; a mixed method study

Catch Professor, Luc de Witte, has collaborated with colleagues from Bangalore Baptist Hospital on a study which has been published by the open access journal BMJ Open, dedicated exclusively to publishing medical research.

Objectives To describe the initial dilemmas, mental stress, adaptive measures implemented and how the healthcare team collectively coped while providing healthcare services in a large slum in India, during the COVID-19 pandemic.

Setting Community Health Division, Bangalore Baptist Hospital, Bangalore.

Study design We used mixed methods research with a quantitative (QUAN) paradigm nested in the primary qualitative (QUAL) design. QUAL methods included ethnography research methods, in-depth interviews and focus group discussions.

Participants A healthcare team of doctors, nurses, paramedical and support staff. Out of 87 staff, 42
participated in the QUAL methods and 64 participated in  the QUAN survey.

Results Being cognizant of the extreme vulnerability of the slums, the health team struggled with conflicting thoughts of self-preservation and their moral obligation to the marginalised section of society. Majority (75%) of the staff experienced fear at some point in time. Distracting themselves with hobbies (20.3%) and spending more time with family (39.1%) were cited as a means of emotional regulation by the participants in the QUAN survey. In the QUAL interviews, fear of death, the guilt of disease transmission to their loved ones, anxiety about probable violence and stigma in the slums and exhaustion emerged as the major themes causing stress among healthcare professionals. With positive cognitive reappraisal, the  health team collectively designed and implemented adaptive interventions to ensure continuity of care. They dealt with the new demands by positive reframing, peer support, distancing, information seeking, response efficacy,
self-efficacy, existential goal pursuit, value adherence and religious coping.

Conclusion The novel threat of the COVID-19 pandemic threw insurmountable challenges potentiating disastrous consequences; slums becoming a threat to themselves, threat to the health providers and a threat for all. Perhaps, a lesson we could learn from this pandemic is to incorporate ‘slum health’ within universal healthcare.

The published study can be found here.



Wednesday, 25 November 2020

Top article in the British Journal of Occupational Therapy

 Catch colleagues receive over 5,000 views and downloads in the British Journal of Occupational Therapy for their article 'Remote Home Visit: Exploring the feasibility, acceptability and potential benefits of using digital technology to undertake occupational therapy home assessments'.


Home assessments are integral to the occupational therapy role, providing opportunities to personalise and integrate care. However, they are resource intensive and declining in number. A 3-month service development within one United Kingdom National Health Service acute hospital setting explored the concept of using digital technology to undertake remote home assessments.

Four work streams explored the concept’s feasibility and acceptability: real-world testing; user consultations; narrative case study collection; traditional visit resource use exploration. Project participants were occupational therapists and patient and public representatives recruited via snowball sampling or critical case sampling. Qualitative data were thematically analysed identifying key themes. Analysis of quantitative data provided descriptive statistics.

The remote home visit concept was feasible within four specific contexts. Qualitative themes suggest acceptability depends on visitor safety, visitor training, visitor induction and standardisation of practice. Consultees perceived the approach to have potential for resource savings, personalisation and integration of care. Barriers to acceptance included data security, data governance, technology failure and threat to occupational therapists’ role and skills.

Applying digital technology to occupational therapy home assessment appears feasible and acceptable within a specific context. Further research is recommended to develop the technology, and test and investigate perceived benefits within wider contexts and stakeholder groups.

Please find the full article here.

Thursday, 12 November 2020

Re-publication with J&R Press: Consent Support Tool

 CATCH colleagues, Rebecca Palmer and Mark Jayes, developed and evaluated a tool to support professionals to engage people with communication difficulties in health research studies.


Communication disorders may be associated with acquired health conditions, including stroke, brain injury, Parkinson’s disease and dementia, and lifelong conditions such as learning disability and cerebral palsy. People with communication disorders have often been excluded from health research studies, perhaps because the process of gaining informed consent from this population is considered to be challenging. This is unethical and limits the generalizability of research findings.

The Consent Support Tool has been developed specifically to facilitate involvement of people with communication disorders in health research studies, and to help health research professionals obtain informed consent from this population. It offers researchers an easy-to-use, practical, clinically evaluated tool which has been designed to help identify individual communication needs, and recommend strategies for providing accessible information about a research study, and for supporting participation within the study.

The accompanying manual explains how and why to use this tool in the context of the Mental Capacity Act (2005), and recommends strategies to help evidence that any consent taken is informed.

The Consent Support Tool book is available to purchase here.


Wednesday, 4 November 2020

New Publication in JMIR 'Acceptability and Effectiveness of NHS-Recommended e-Therapies for Depression, Anxiety, and Stress: Meta-Analysis'

This study, co-written by The University of Sheffield colleagues and, published by the Journal of Medical Internet Research aims to conduct a meta-analytic review of the gold standard evidence of the acceptability and clinical effectiveness of e-therapies recommended for use in the National Health Service (NHS) in the United Kingdom.



There is a disconnect between the ability to swiftly develop e-therapies for the treatment of depression, anxiety, and stress, and the scrupulous evaluation of their clinical utility. This creates a risk that the e-therapies routinely provided within publicly funded psychological health care have evaded appropriate rigorous evaluation in their development.

Systematic searches identified appropriate randomized controlled trials (RCTs). Depression, anxiety, and stress outcomes at the end of treatment and follow-up were synthesized using a random-effects meta-analysis. The grading of recommendations assessment, development, and evaluation approach was used to assess the quality of each meta-analytic comparison. Moderators of treatment effect were examined using subgroup and meta-regression analysis. Dropout rates for e-therapies (as a proxy for acceptability) were compared against controls.

A total of 24 studies evaluating 7 of 48 NHS-recommended e-therapies were qualitatively and quantitatively synthesized. Depression, anxiety, and stress outcomes for e-therapies were superior to controls (depression: standardized mean difference [SMD] 0.38, 95% CI 0.24 to 0.52, N=7075; anxiety and stress: SMD 0.43, 95% CI 0.24 to 0.63, n=4863), and these small effects were maintained at follow-up. Average dropout rates for e-therapies (31%, SD 17.35) were significantly higher than those of controls (17%, SD 13.31). Limited moderators of the treatment effect were found.

Many NHS-recommended e-therapies have not been through an RCT-style evaluation. The e-therapies that have been appropriately evaluated generate small but significant, durable, beneficial treatment effects.

You can read the full study here.

Thursday, 24 September 2020

The British Geriatric Society 2020

Catch PhD Researcher is Highly Commended for their entry in the 2020 British Society of Gerontology Stirling Prize competition.

 


The Stirling Prize, first awarded in 2000 at the conference held at the University of Stirling, is the best poster award for all students presenting at the annual conference. Catch PhD Researcher, Sarah Abdi, is Highly Commended for her entry in the 2020 British Society of Gerontology Stirling Prize competition for best student poster at the Annual Meeting of the Society.

Read the full article here.


Wednesday, 26 August 2020

Computerised speech and language therapy or attention control added to usual care for people with long-term post-stroke aphasia: the Big CACTUS three-arm RCT

 Dr Rebecca Palmer announces The Big CACTUS monograph has been published in Health Technology Assessment. This is a full report of the randomised controlled trial of self managed word finding therapy on a computer. Find details of the computer therapy, study protocol, detailed results, health economic evaluation, fidelity assessment, patient and public involvement and an in depth discussion of how computer therapy can contribute to delivery of speech and language therapy for aphasia. The report also contains links to resources used throughout the study.


The study found that offering therapy on a computer increased the amount of therapy practice people with aphasia achieved as compared to that available through usual face to face care leading to significant improvements in the ability to find personally relevant words. These benefits were maintained for at least 6 months after therapy. Importantly, the study showed that people were able to improve with therapy for many years after their stroke. The study highlighted that support in addition to the computer word finding practice is needed to help people to use their new words in everyday contexts. Cost effectiveness was uncertain, but the study indicated that the computer approach is more likely to be cost effective for people with mild and moderate aphasia. We hope this study will encourage uptake of computerised therapy to increase the opportunity for people with aphasia to reach their potential.
The study was funded by the NIHR HTA programme with additional support from the Tavistock Trust for Aphasia. We would like to thank the funders, Steps Consulting Ltd who designed and produced the software, and the many speech and language therapists, people with aphasia and their carers who participated in the study from across 21 UK NHS trusts.

Please view the full report here



CATCH member’s paper recognised in BJPsych Open as one of the 20 noteworthy publications

Kaufman K. (2020) BJPsych Open fifth anniversary editorial: This editorial celebrates the journal’s fifth anniversary by reviewing the history of BJPsych Open, what has been accomplished and where they strive to go (planned trajectory).


In November 2019, the paper – Social gradients in the receipt of medication for attention-deficit hyperactivity disorder in children and young people in Sheffield (Nunn, S., Kritsotakis, E., Harpin, V., & Parker, J. (2020)) was published.

CATCH is delighted to announce the paper has been recognised in BJPsych Open as one of the 20 noteworthy publications of 360 accepted papers, from more than 6000 submitted manuscripts representing over 53 countries world-wide, BJPsych_Open_fifth_anniversary_editorial_history_a (1) published in the first five years of the journal.

New Publication in JMIR ‘Emerging Technologies With Potential Care and Support Applications for Older People: Review of Gray Literature’

 This review co-written by CATCH members and published by the Journal of Medical Internet Research Aging aimed to gain an overview of emerging technologies with potential care and support applications for older people, particularly for those living at home.


The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care systems. Emerging technological developments have the potential to address some of the care and support challenges of older people. However, limited work has been done to identify emerging technological developments with the potential to meet the care and support needs of the aging population. A scoping gray literature review was carried out by using the databases of 13 key organizations, hand searching reference lists of included documents, using funding data, and consulting technology experts. A narrative synthesis approach was used to analyze and summarize the findings of the literature review. A total of 39 documents were included in the final analysis. From the analysis, 8 emerging technologies were identified that could potentially be used to meet older people’s needs in various care and support domains. These emerging technologies were (1) assistive autonomous robots; (2) self-driving vehicles; (3) artificial intelligence–enabled health smart apps and wearables; (4) new drug release mechanisms; (5) portable diagnostics; (6) voice-activated devices; (7) virtual, augmented, and mixed reality; and (8) intelligent homes. These emerging technologies were at different levels of development, with some being trialed for care applications, whereas others being in the early phases of development. However, only a few documents mentioned including older people during the process of designing and developing these technologies. This review has identified key emerging technologies with the potential to contribute to the support and care needs of older people. However, to increase the adoption of these technologies by older people, there is a need to involve them and other stakeholders, such as formal and informal carers, in the process of designing and developing these technologies.

Please find the published paper here.