bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges that specialist palliative care nurses encounter when caring for patients with advanced dementia
Authors: Barber Jean , Murphy Kathleen
Published: May 2014

Specialist palliative care (SPC) has expanded recently in Ireland to incorporate diseases other than cancer, including dementia. Two care areas that pose specific challenges for SPC nurses when caring for people with advanced dementia are pain and nutrition/hydration. Assessment and management of pain for a patient who has advanced dementia differs greatly from that for a typical palliative care patient. Similarly, nutrition and hydration pose extraordinary ethical and practical dilemmas not encountered when caring for a patient without dementia. This paper reports a literature review which revealed that although evidence-based information related to each of these areas is available, it tends to be written from the perspective of health professionals with an interest in dementia rather than from the perspective of the SPC nurse. SPC nurses require evidence-based palliative care research to guide their practice, but such research appears to be limited for patients with advanced dementia. Knowledge from specialists in both dementia care and palliative care needs to be combined if we are to provide these patients with the best possible end-of-life care. Further research is required and evidenced-based guidelines need to be formulated.
Emotional safety in the workplace: one hospice's response for effective support
Authors: Huggard Jayne , Nichols Jan , Huggard Jayne , Nichols Jan
Published: May 2014

Emotional support is important for health professionals working in the demanding area of hospice/palliative care. While physical safety practices and effective human resource support are generally available to staff, one New Zealand hospice has taken this a step further by developing an emotional safety policy that incorporates personal, professional, and organizational measures designed to protect and promote staff members’ emotional safety and to minimize stress and fatigue. The aim of this paper is to provide the background and rationale for this work, to introduce a case study around best practice, and to describe the development of the emotional safety policy, which provides effective support for all staff working at the hospice.
Quality-of-life trajectory of clients and carers referred to a community palliative care service
Authors: Connell Tanya , Griffiths Rhonda , Fernandez Ritin S , Griffiths Rhonda , Tran Duong , Agar Meera , Harlum Janeane
Published: May 2014

Palliative care clients often have a reduced quality of life (QOL). The purpose of this study was to explore the QOL trajectory of clients and carers newly referred to a community palliative care service. A total of 49 clients and 43 carers respectively completed the McGill QOL scale (MQOL) and the caregiver QOL cancer scale (CQOLC) questionnaires. Baseline data relating to demographics, health status, and QOL are presented for the 49 participants and their 43 carers, and these are compared with follow-up data from 22 clients and 13 carers (matched pairs). On average, there were no significant differences between baseline and follow-up QOL scores in any respects for either clients or carers, including measures of burden, disruptiveness, positive adaptation, and financial concerns. Whether this indicates that the care administered succeeded in cancelling out the worsening of the clients' conditions or whether it indicates a shortcoming of the care was not assessed.
The management of nausea and vomiting in advanced cancer
Authors: Hamling Kathryn
Published: May 2014

Nausea and vomiting are distressing and debilitating symptoms frequently reported in advanced disease. They are also complex and multifactorial in nature, which can make palliation difficult. The primary method of treatment is pharmacological, with current recommendations based on the presumed cause, knowledge of the emetogenic pathways, and matching of the emetogenic stimulus with the drug most likely to act on the relevant receptors. This is often complicated by the difficulty in identifying the cause(s) and the fact that many antiemetics work on multiple receptors. This article offers an overview of the physiology of the emetogenic pathways, the pathophysiology of common aetiologies, the clinical assessment required and tools available, and the pharmacological and non-pharmacological management of these symptoms.
Education in children's palliative care across Europe and internationally
Authors: Downing J , Ling J
Published: May 2014

Ongoing education and training is essential in health care, particularly in palliative care, which is still expanding both in terms of its global reach and its scope. Children's palliative care (CPC) is a specialty in its own right, but one that is still relatively new, and so appropriate and ongoing education and training of CPC staff is especially important. However, such education and training is not always accessible to those who need it, and only recently have significant attempts been made to quantify the extent and nature of these deficiencies. This paper discusses CPC education and training from a European and global perspective, highlighting some of the principles and challenges. It also looks at the recent efforts of the European Association for Palliative Care and the International Children's Palliative Care Network to attain a clearer picture of the state of global CPC education, presenting some initial findings from their research and discussing preliminary recommendations and future directions.
Providing in-home palliative care within a generalist caseload: a chance for nurses to reflect on life and death
Authors: Marchessault Judith , Legault Alain , Martinez Anne-Marie
Published: May 2014

At a time when the need for in-home palliative care is on the rise, the aim of this interpretive phenomenological study was to understand the experiences of homecare nurses providing palliative care within a generalist caseload. Eight such nurses from one district of Quebec were interviewed. Data analysis was carried out according to the phenomenological method developed by Giorgi. Three themes emerged from the analysis: supporting the patient and his/her family, being concerned about providing quality care, and being confronted with death fosters personal development. The findings that gave rise to the first two themes echo similar findings from the literature, but those from which the third theme emerged are more novel. Important considerations for personal and professional development are extrapolated from these findings.
Use of oxygen at the end of life: on what basis are decisions made?
Authors: Quinn-Lee Lisa , Moch Susan D , Mabin Justin , Davey Sarah , Davis Leah , Williams Kelsey , Gianlupi Adriane , Weggel Jeanne
Published: May 2014

Discussing and conducting research on end-of-life issues is often difficult. However, it is important to initiate a dialogue about various topics surrounding death and dying. This paper looks at the available scientific literature relating to oxygen use at the end of life, describes associated attitudes and beliefs, and presents some brief examples of institutional practices. The aim is to stimulate thoughtful reflection and encourage research on this important topic. There is limited research regarding oxygen use at the end of life, and many questions remain. Despite the difficulty with research in this area, there is a need to expand the data and awareness in this field. Several authors have questioned the use of oxygen in end-of-life care, and the evidence that oxygen use may not always be indicated is growing.
Oral care in nursing practice: a pragmatic representation
Authors: Croyère Nicole , Belloir Marie-Noelle , Chantler Lyn , McEwan Lisa
Published: May 2014

Oral care for patients receiving non-specialist palliative care has been reported to be lacking in several respects. The present study explored the oral care social representation of nurses and health-care assistants providing non-specialist palliative care. A mixed methodology utilising a questionnaire and focus groups was adopted. The research identified difficulties in providing oral care in this setting. The participants reported managing their emotions around carrying out oral care. They had resources available and were convinced of the positive effects. However, their personal efficacy needed to be reinforced and they needed to receive positive feedback.
Spiritual support interventions in nursing care for patients suffering death anxiety in the final phase of life
Authors: Kisvetrová Helena , Klugar Miloslav , Kabelka Ladislav
Published: May 2014

Purpose: To investigate which activities from the ‘Spiritual Support’ intervention of the Nursing Interventions Classification (NIC) are used in patients with the nursing diagnosis ‘Death Anxiety’ in the Czech Republic, and which activities could feasibly be implemented into practice.

Method: The study surveyed 468 Czech nurses using a quantitative questionnaire with Likert scales.

Results: The most frequently used activity was ‘Treat individual with dignity and respect’ and the least frequently used was ‘Pray with the individual’. ‘Treat individual with dignity and respect’ was also thought to be the most feasible activity for Czech nursing practice. Significant differences were found between nurses working in hospices and those in other sites and between religious believers and non-believers.

Conclusion: Even in the secularised Czech Republic, nurses can make use of the NIC Spiritual Support intervention in end-of-life care.
Geriatric rehabilitation for patients with advanced COPD: programme characteristics and case studies
Authors: van Dam van Isselt Eléonore F , Spruit-van Eijk Monica , Chavannes Niels H , Achterberg Wilco P , Groenewegen-Sipkema Karin H
Published: May 2014

Considering the worldwide ageing of populations, there is a growing need for rehabilitation programmes specifically designed for geriatric patients. The authors developed and implemented a post-acute geriatric rehabilitation programme in a skilled nursing facility for patients with advanced chronic obstructive pulmonary disease (COPD)—the GR-COPD programme. This paper describes the characteristics of the programme and presents three case studies to illustrate its possible benefits for individual patients. The case studies show that integration of rehabilitation and palliative care components is essential, as patients with advanced COPD admitted to hospital for an acute exacerbation often suffer from high symptom burden, deteriorating quality of life, and poor prognosis. Development and implementation of a post-acute GR-COPD programme is feasible and can offer substantial benefits for patients with advanced COPD admitted to hospital for an acute exacerbation.
Complementary therapy: perceptions of older people with lung or colorectal cancer
Authors: Roulston Audrey , Wilkinson Pauline , Haynes Tommy , Campbell Jim
Published: May 2014

Aim:

To explore how older people with lung and colorectal cancer view registered complementary therapy (CT) services in Northern Ireland.

Background:

A literature review highlighted gaps around information, access, and communication between patients and health professionals regarding CT services.

Methods:

Using structured interviews, a survey of 68 patients in one hospital and one hospice was conducted in Belfast, Northern Ireland.

Results:

All respondents felt that CT services should be better promoted and more easily accessible to older people with cancer. Some patients were concerned about the lack of written information provided regarding CT services, which they believed led to poorer uptake and uncertainty regarding the potential benefits. Others were concerned that engaging in or disclosing CT usage might negatively affect existing relationships with medical professionals.

Conclusion:

Patients should be offered high quality written information on CT services to enable choice, improve knowledge, and promote wider access. Increased physician education may facilitate provision of such information.
Politics and palliative care: Brazil
Authors: Smyth Dion
Published: May 2014

Dion Smyth's review of the internet for palliative nursing
Partnerships in mental health: addressing barriers to social inclusion
Authors: Russell Anneliese , Lloyd Chris
Published: May 2014

Current trends in mental health services emphasize working in partnership with consumers and other government and non-government community organizations for improvement in quality of life for service users. People with a mental illness experience social exclusion, thereby limiting their ability to participate fully in community life. Occupational therapists have a substantial role to play in helping service users to overcome barriers to their community inclusion. Partnerships need to be formed to increase access to community resources and participation in activities that are enjoyed by other members of the community. Such partnerships have a health promotion emphasis and foster the relationship between mental-health services and the wider community, thus shifting the focus from direct occupational therapy service delivery to community-based rehabilitation interventions.

This article describes the development, implementation and evaluation of an Australian healthy lifestyle course devised to meet the identified rehabilitation goals of people with mental illness to lose weight, get fit, commence vocational study and get a job. The course was run in partnership between mental health consumers, occupational therapists from the St George Mental Health Rehabilitation Service and staff and students from the Sutherland College of Technical and Further Education.
Effects of a resistance exercise programme on the performance of inactive older adults
Authors: Kalapotharakos VI , Michalopoulou M , Tokmakidis S , Godolias G , Strimpakos N , Karteroliotis K
Published: May 2014

Although published studies have indicated the effectiveness of strength exercise for improving muscle strength and functional and neuromotor performance in older adults, there is limited evidence concerning the effects and the intensity of a resistance exercise programme. This study aimed to evaluate the effects of a 12-week high- and moderate-resistance exercise programme on functional and neuromotor performance in healthy, inactive older adults.

In total, 33 sedentary people (aged 60–74years) were assigned to one of three groups: control; high resistance exercise; and moderate resistance exercise. All three groups were evaluated in the pre- and post-exercise period using the 6-minute walk test, whole body reaction time and one leg stance time. After the exercise period, both resistance exercise groups significantly improved their lower body strength, functional performance (as measured by the 6-minute walk test), whole body reaction time and one leg stance time. Functional and neuromotor performance improved similarly for both high- and moderate-resistance exercise after the training period. The high-resistance exercise was more effective in increasing the lower body strength than moderate-resistance exercise. Results suggest that functional and neuromotor performance can be significantly improved with both high- and moderate-resistance exercise protocols.
A practical guide to the provision of mattresses and cushions to relieve pressure
Authors: Collins Fiona
Published: May 2014

Pressure damage is largely preventable, but if allowed to develop, individuals have the potential to suffer pain, indignity and even death. Pressure-relieving equipment is available to people at risk of pressure damage. Selection of suitable support surfaces must be based on identified criteria following holistic assessment.

This article aims to provide the reader with a general guide to the provision of pressure-relieving support surfaces. As pressure damage can occur both in the bed and the chair, the qualities of both mattresses and cushions will be discussed.
Effects of dynamic ankle-foot orthoses on standing in children with severe spastic diplegia
Authors: Nslund Annika , Jesinkey Kristina , Hirschfeld Helga , von Wendt Lennart , Sundelin Gunnevi
Published: May 2014

The aim of this study was to investigate whether wearing a dynamic ankle-foot orthosis (DAFO) improved standing posture in six children with severe spastic diplegia. Kinematics and ground reaction forces were recorded with a three-dimensional optoelectronic movement analysis system and two force plates.

The results revealed that on a group level, DAFOs did not improve standing posture, distribution of body weight or lateral standing stability as reflected in the horizontal ground reaction forces. However, some children could benefit from the use of a DAFO through a more equal weight distribution and improved sagittal position of the knee, compared to wearing shoes alone. According to the heterogeneous clinical signs and symptoms in children with severe spastic diplegia, studies on a group level easily lead to negative findings and therefore individual benefits could be showed by using single case designs.
Importance of journal clubs in continuing professional development
Authors: Sherratt Charles
Published: May 2014

Therapists are still encountering problems with accessing relevant research material. There are relatively few therapists who are involved in any form of research on a regular basis. Journal clubs are a means of introducing therapists to research that is relevant to their work area and that forms a substantial part of their continuing professional development (CPD).
Canadian therapists' experiences of community-based rehabilitation services
Authors: Hollis Vivien , Madill Helen , Darrah Johanna , Warren Sharon , Rivard Annette
Published: May 2014

Health policy and demographic trends have produced considerable changes to the delivery of health care in recent years. This focus group study conducted in Alberta and Saskatchewan, Canada, involved 49 occupational therapists and physical therapists who discussed their experiences of current health services in relation to rehabilitation practice.

Therapists' experiences were that regional rehabilitation service provision was variable and that there were client groups that gained from the shift to community-based rehabilitation and those that did not. Therapists reported changes to occupational therapy and physical therapy practice, including an increased focus on assessments, but fewer interventions being carried out and limited input into the provision of services to support clients in maintaining their health. The findings will be of interest to all practitioners and service providers.
Physiotherapy assessment of knee proprioception following stroke
Authors: Piriyaprasarth Pagamas , Morris Meg , Winter Adele , Paratz Jennifer
Published: May 2014

This survey investigates methods used by physiotherapists to assess knee proprioception in stroke patients. Five hundred and seventeen Australian physiotherapists were surveyed using a 12-item survey with 326 surveys returned (63% response rate). Work experience ranged from less than 2 years to more than 20 years. Most physiotherapists assessed both joint position sense and joint movement sense in supine (43.1%), followed by sitting (26.1%) and standing (17.0%). Proprioception at the knee, toe, ankle and hip were measured with the largest proportion of assessments involving the knee joint (38.2%). Testing typically required patients to have their eyes closed, to respond verbally to the direction of movement, to match the position of a joint, as well as to copy movements of the affected limb with the unaffected limb.

Most physiotherapists passively moved the patients' joints for the static and dynamic tests. Three to ten repetitions of each test were used with five repetitions most often chosen.
Background to the post-acute care trial of community hospital rehabilitation for older people
Authors: Green John , Young John , Forster Anne
Published: May 2014

The post-acute care trial of community hospitals (PATCH) study is a multicentre, randomized controlled trial (RCT) comparing outcomes of rehabilitation for older people provided in five district general hospitals (DGHs) and seven associated community hospitals (CHs) in urban and rural settings. This article describes the background to the PATCH study, compares the characteristics of the participating DGHs and CHs and describes the participating patients.

Descriptions of the DGHs and CHs were produced from information obtained from each centre. Recruitment rates, patient characteristics and hospital stays were compared between centres. There was variation in operational policies of the DGHs and in the organizational features of the CHs, such that patient characteristics and lengths of hospital stay differed between centres. Statistical comparisons suggested that these differences were not systematically distributed.

This underpinning study to the PATCH RCT suggests that the variation in study sites and patient characteristics is sufficient to allow generalizable statements about outcomes of CH and DGH rehabilitation care of older people.
Do aqua-aerobics improve gait and balance in older people? A pilot study
Authors: Waters Debra , Hale Leigh
Published: May 2014

Research suggests that aqua-aerobics improves aerobic and muscular capacity of older persons, however, few studies have measured changes in gait and balance with aqua-aerobic activity.

In this pilot study, eleven healthy males and females (70.55 ± 3.6 years) participated in a twiceweekly, 12-week aqua-aerobics programme. Measures of gait and balance, physical activity, mobility history and health-related factors were obtained.

The step test—a reliable test of dynamic balance—significantly improved (P = 0.005) following the programme. In addition, participants reported a range of perceived psychological and physical benefits.
Changing practice for acute hemiplegic shoulder care: A best practice model
Authors: Nicks Rebecca J , DeGruyter Melissa A , Walkenhorst-Maccanti Heidi , Bernhardt Julie
Published: May 2014

This study evaluates the implementation of a best practice management model for hemiplegic shoulder care in acute neurological patients. Following a three-month trial, an existing model was modified and implemented on the neurosciences ward.

Sixty-five patient records were randomly audited to evaluate implementation. Of these, 30 (46%) had signs that indicated use of the model, and of these, the model was used for 28 (93%). Following implementation, the use of outcome measures increased from 25% to 94%, and the consistency of management for the hemiplegic shoulder improved from 69% to 97%.

The management tool for acute hemiplegic shoulder encourages timely identification of risk in patients with upper limb hemiplegia, assists clinicians to prioritize their time and appropriately allocate resources according to best practice.
Internet research and informed consent: An ethical model for using archived emails
Authors: Watson Mohinder , Jones Derek , Burns Lindsey
Published: May 2014

Ethical conduct involving research participants rests on the Belmont principles of autonomy, beneficence and justice. Novel methods present new challenges in safeguarding these principles. The increasing use of data obtained from the internet in health research raises important questions regarding obligations to people posting personal information online. Ethical issues warrant special consideration since guidelines are only beginning to emerge, placing greater onus on the researcher’s discretion.

This paper presents a model (a synthesis of the work of Eysenbach and Till (2001) and Kraut et al (2004)) to assist in decision-making regarding obtaining or waiving informed consent when using archived emails from websites. For illustrative purposes, the application of the model to a PhD project is described.
An audit of botulinum toxin therapy services for adult spasticity
Authors: Sakel Mohamed
Published: May 2014

Audit is a core component of the clinical governance programme, the mechanism to improve the quality of the service and the performance of clinicians in the NHS. The Royal College of Physicians (RCP), UK, has produced national guidelines setting standards for botulinum toxin therapy in adult spasticity. Such therapy is an essential element in treating spasticity.

This article critically explores the experience of the first 3 years of a new service at one acute trust. This is the first reported audit on spasticity or botulinum toxin therapy. The results highlighted areas for improvement and consequent specific action plans have been drawn up for implementation. The data, together with other quality indicators, will support the team to engage with the service commissioners for improvement and further investments in this adult spasticity service. Future audit data from other services can potentially contribute to benchmarking of spasticity services.

The article also considers and explores the potential role of physiotherapist or nurse injectors of botulinum toxin therapy for spasticity treatment; and future research ideas are generated.
Treatment across cultures: Is there a model?
Authors: Core Ludmila
Published: May 2014

Aims: The increase of cultural diversity in countries worldwide impacts on health-care providers, who are required to provide culturally-appropriate care to patients from culturally and linguistically diverse (CALD) backgrounds. Cultural differences may impact both on treatment processes and patient responses to treatment. This article aimed to explore how cultural issues and cultural sensitivity uniquely infl uence the rehabilitation process of individuals from various ethnic and cultural backgrounds; and give an insight into cross-cultural issues pertaining to health-care delivery from an American physical therapy perspective.

Content: A literature review on issues facing health-care providers—;specifi cally physical therapists—;in delivery of culturally-appropriate care was undertaken. Key areas are discussed and a culturally sensitive treatment model for health-care providers to use when working with CALD patients is proposed.

Discussion and conclusions: A review of the literature revealed limited research in this area from physical rehabilitation disciplines; although there was an encouraging proportion of articles on the culture-oriented trend in professional education. It is suggested that professional education of physical therapists should include a cultural component; focusing on particular cultures, culturally sensitive behaviour based on knowledge of cultures, and assistance with return to work or pre-morbid activities. Piloting of the proposed model is suggested to add to the literature in this area.
MOVE towards greater collaboration: Integrating school education and therapy
Authors: Shaw Christine
Published: May 2014

It has long been recognized that effective team working is essential for meeting the needs of a child who has a physical disability or additional needs. The National Service Framework for Children, Young People and Maternity services, Standard 8 (Department of Health, Department for Education and Skills, 2004), states that:
Economy and disability in Tokyo and Manchester
Authors: Scullion Philip
Published: May 2014

The current temporary economic turmoil felt by citizens, therapy providers, their patients, and governments worldwide, has been described as ‘uncharted territory’ (Hames, 2008: 6). This description could equally be applied to the combination of the study of economics with that of disability. However, this area is beginning to be charted, as illustrated by a recent international conference entitled ‘Disability and Economy: Creating a Society for all’. Hosted at Manchester Metropolitan University, the event was part of the Todai Forum 2009, an annual highprofi le event organized by the University of Tokyo, Japan. Selected highlights of the event, along with the refl ections of one of its delegates, are reported below.
Risk assessment for cognitively impaired adults post-brain injury
Authors: Morris Claire
Published: May 2014

Each year, over 600 000 people attend emergency departments in England and Wales with a head injury. Although the survival rate has increased, many are left with impairments in cognitive functioning (Powell et al, 2007). Previous studies have found that cognitive deficits after a brain injury can result in signifi cant functional limitations in all areas of daily living, making it harder to live independently in the community (Landa-Gonzalez, 2001). Survivors of brain injury often demonstrate complex treatment needs that extend beyond discharge from the acute hospital setting (Seale at al, 2002).
Disciplinary developments in New Zealand
Authors: Diesfeld Kate , Godbold Rosemary
Published: May 2014

Background

New Zealand's disciplinary regimen has particular significance because victims of personal injury are almost entirely barred from suing for common law damages in civil proceedings.

Contents

This article examines the New Zealand legal system, and considers how it attempts to maintain the accountability of medical professionals, while preventing the rising tide of litigation seen in other jurisdictions. Generally, New Zealanders do not have recourse to traditional malpractice litigation. One aim of tort litigation is to hold the responsible individuals accountable for their actions. In the absence of malpractice litigation, New Zealand's approach to maintain accountability by health professionals includes a code of consumers' rights, competence assurance legislation, and a disciplinary tribunal. This disciplinary body offers a valuable international comparator because it applies across the health professions. Case studies from select health professions (occupational therapy, osteopathy and physiotherapy) reveal the types of misconduct that qualify for discipline and the corresponding penalties.

Conclusions

New Zealand's disciplinary regimen functions as a form of preventive law on behalf of health providers and their patients. All therapists need to be aware of the relevant rules and regulations in their own jurisdiction, but it is important to consider those of others.
Assessment of back and abdominal pressure, sexual frequency and quality of life
Authors: Kumar Suraj , Sharma Vijai P , Shikla Rakesh , Dev Ravi , Pal Singh Negi Mahendra
Published: May 2014

Aims

The present study was undertaken to determine the extent to which back pressure changes and abdominal pressure changes, sexual frequency and quality of life in patients with lower back pain differ from normal, and recover after a physiotherapy intervention.

Methods

Thirty nine lower back pain patients and 31 without lower back pain (control) were enrolled for this study. Patients were treated with dynamic muscular stabilization technique (DMST), which is an active approach of physical therapy. Pain, back pressure changes, abdominal pressure changes, sexual frequency and quality of life of normal subjects and patients were assessed at baseline and after 180 days of DMST intervention in patients. Data were analysed by Student's t-test, Pearson correlation coefficient (r) and analysis of variance with α=0.05. The control and study groups were age matched (P>0.05).

Findings

The DMST improved all the variables significantly (P<0.01) and the improvement was observed more in females than males.

Conclusions

DMST is an effective intervention for reducing pain, and restoring back pressure changes, abdominal pressure changes, sexual frequency and quality of life to normal levels in patients with lower back pain. Its success, however, does seem to depend on the sex of the patient, which suggests an area for further research.
The interplay of evidence and knowledge for social work practice in a health setting
Authors: Fielding Angela , Crawford Frances , Leitmann Sabina , Anderson Judi
Published: May 2014

Aims

There is a growing body of research and scholarly literature addressing, from a range of philosophical views, the nature and effectiveness of evidence-based practice across health and human services. Influenced by developments in the USA and UK, there is an increasing requirement in Australia for evidence-based accountability from professional practitioners. Following Clifford Geertz's dictum that to understand a practice it is necessary to study what it is that practitioners do, this interpretive study explores how experienced and reputedly effective social workers use knowledge in practice.

Methods

The study was conducted in 2007/08 at a West Australian tertiary hospital. A purposive sample of four social workers, identified by their manager as experienced and effective practitioners, were interviewed on their practice in a case study of their choice. Interview data were transcribed and analysed thematically alongside official case notes to explore the ways in which evidence and knowledge interplay in shaping effective practice and the ways this is recorded for agency purposes.

Findings

Practitioner thick descriptions on two cases revealed mediation and interaction with both empirical and reflective types of knowledge, with a dynamic interplay of evidence, knowledge and knowledge making, and practice wisdom.

Conclusions

The authors argue that social workers are active agents who use and generate knowledge while they are making practice decisions based on their assessment of empirical knowledge, values, principles, and tacit knowledge. In this research project, researchers and practitioners examined and articulated effective social work practice to illustrate the ways in which multiple forms of knowledge are incorporated.
Using Rasch analysis to establish the construct validity of rehabilitation assessment tools
Authors: Mui Lim Sok , Rodger Sylvia , Brown Ted
Published: May 2014

Background

Rasch analysis is a statistical model that can be used in the development of new assessment tools and the evaluation of already existing ones. Rasch analysis can also be used to provide various forms of construct validity evidence. In the revised conceptualization of validity, validity is operationalized as a unitary concept with five types of evidence. This article aims to inform rehabilitation practitioners of the different forms of validity evidence that can be demonstrated using Rasch analysis.

Content

The history and the more recently accepted conceptualization of validity is briefly outlined. Examples of studies in the field of rehabilitation and health care are given to illustrate the varying forms of Rasch-generated validity evidence.

Conclusions

An understanding of Rasch analysis application in the validation of assessment tools will equip rehabilitation practitioners with better skills in interpreting the measurement properties of instruments developed using Rasch analysis. Rehabilitation practitioners are also encouraged to use Rasch analysis to evaluate existing instruments, with the aim of generating equivalent measures of underlying constructs.
Effects of visible vs concealed alphabet cues on speech intelligibility in dysarthria
Authors: Kentner Jenny , Miller Nick
Published: May 2014

Aims

Alphabet cues are often applied to improve communication with people with speech impairment. Uncertainty remains regarding which factors associated with the individual participant applying the technique (e.g. type and severity of dysarthria) or with the technique itself (e.g. visual letter information or altered speech output) impact on outcome. This study examined intelligibility of dysarthric speech with and without visible and concealed cues, and investigated the effects of word frequency, length and complexity on word recognition.

Methods

Twenty-two listeners transcribed words (n=120) of varying length (monosyllabic n=66, disyllabic n=54) and varying complexity (simple onset n=60, complex onset n=60) from an audiorecording of an adult with severe dysarthria associated with amyotrophic lateral sclerosis. Words were spoken with habitual speech, and with simultaneous pointing to the initial letter on an alphabet board (cueing). Intelligibility was tested in three listening conditions: habitual speech (with no cues), cued speech with alphabet cues visible to listeners and cued speech without alphabet cues visible to listeners.

Findings

In total, 46.6% of all the 120 words were correctly identified. Considering all items, visible cues increased intelligibility while concealed cues decreased intelligibility compared to the no cues condition. When examining word subsets, 30% of items with complex onsets and 38% of two-syllable items were correctly recognized. Higher word frequency facilitated recognition.

Conclusions

Visible cues significantly improved intelligibility however, not all words were equally facilitated. The possible issues around the implementation of cues associated with some neurological aetiologies are highlighted.
A holistic and multidisciplinary approach to Huntington's disease management
Authors: Aubeeluck Aimee
Published: May 2014

Huntington's disease (HD) Awareness Week took place in the UK last month, and gave health-care professionals an opportunity to review their practice in the care of patients with this rare and devastating disease. HD is a form of dementia that causes movement abnormalities, cognitive deterioration and affective disturbances (Folstein, 1989). It is a genetic condition inherited as an autosomal dominant trait with variable penetrance, and each child of an affected person has a 50% chance of inheriting the gene. The gene mutation for HD causes the overproduction of a protein called Huntingtin, and damages the nerve cells in the basal ganglia and cerebral cortex (Aylward et al, 1997).
The UK COT annual conferenceand exhibition: Thinking for the future
Authors: Creek Jennifer
Published: May 2014

In June this year, delegates at the College of Occupational Therapists (COT) 33rd annual conference in Brighton, UK, were able to access three additional conferences: People with Learning Disabilities; HIV/AIDS, Oncology and Palliative Care, and Older People. With 775 delegates, this was the largest COT conference to date, providing an exciting selection of papers, workshops, facilitated poster sessions and other events. The large exhibition included three bookstalls and an impressive display of crafts by service users, in addition to the wide range of companies displaying their wares.
Extending the effects of pulmonary rehabilitation in a community setting
Authors: Waterman Kelly
Published: May 2014

Does pulmonary rehabilitation produce better results if offered in a community setting, and can the effects be extended by regular telephone encouragement? These are key questions regularly posed by clinicians treating people with chronic obstructive pulmonary disease (COPD). A group of researchers (Waterhouse et al) from the Royal Hallamshire Hospital in Sheffield were commissioned by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme to investigate this by conducting a clinical trial to answer these questions. They have recently published their findings in the Health Technology Assessment Journal (2010).
An overview of case-control study designs and their advantages and disadvantage
Authors: Morrow Brenda
Published: May 2014

Background

Case-control studies are analytical observational research studies which identify cases of subjects with an outcome or disease of interest, match these with appropriate controls without the condition, and then obtain a history of exposure for both groups.

Contents

This article provides an overview of the design, analysis, interpretation, advantages and disadvantages of case-controlled studies. Readers should appreciate the strengths, weaknesses and potential pitfalls of case-control studies when interpreting results and applying them to clinical practice.

Conclusions

Although lower in the research hierarchy than cohort studies and randomized controlled trials, case-control studies may be the only viable research design for investigating rare conditions within a short time period
Stroke care: a glass half full
Authors: Benveniste Steve
Published: May 2014

Five years ago, a common refrain within the stroke community was that stroke care was a ‘Cinderella’ service. It suffered from a lack of attention from politicians, policy makers, and health and social care commissioners. Stroke patients were not being diagnosed quickly enough, the emergency protocols were outdated, and many patients were not being cared for in stroke units.
Participation in physical activity among inpatients with severe mental illness: a pilot study
Authors: Bonsaksen Tore
Published: May 2014

Tore Bonsaksen

Aims: Severe mental illness is associated with low levels of physical activity. This study explored participation in a physical activity programme among patients with severe mental illness and its relationships to other variables.

Methods: Eighteen hospitalized patients participated in the study. Their level of participation in a physical activity programme was explored and their age and anxiety and depression levels were used to predict participation.

Findings: The patients had low levels of participation. Seventy-eight percent attended 50 percent or less of the activities, while the sample mean level was 28 percent participation. Participation in the programme increased with age.

Conclusions: This pilot study has several limitations, most importantly the limited sample size. A greater variety in activities offered and better inclusion of personal activity preferences may increase motivation to participate among younger patients. Adequate social support may counteract barriers related to anxiety and depression symptoms, and thus increase participation. Recommendations for future research include undertaking larger scale studies exploring the relationships between physical activity and other variables, and to investigate processes of motivation for physical activity among patients in this group.
User evaluation of the Neater Uni-wheelchair in the home environment: an exploratory pilot study
Authors: Mandy Anne , Stew Graham , Michaelis Jon
Published: May 2014

Anne Mandy, Graham Stew, Jon Michaelis

Background: The Neater Uni-wheelchair was designed as an alternative to powered wheelchairs, lever drive and dual handrim wheelchairs for hemiplegic users. It is a standard Action 3 chair to which a kit has been attached which enables users to self-propel and steer independently of attendants. The aim of this pilot study was to explore users’ experiences of the Neater Uni-wheelchair in the home environment.

Methods: Six users from a previous study, carried out in 2009, agreed to evaluate the Neater Uni-wheelchair in their home environments. The methodological approach was micro-ethnography ( Holloway and Wheeler, 2010 ) and data were transcribed and analysed using Framework Analysis ( Ritchie and Spencer, 1994 ).

Findings: Key themes identified were independence and freedom, ease of use and manoeuvrability, usefulness and change in activity. This pilot study would support the notion that the Neater Uni-wheelchair is a viable alternative to those that are currently available to hemiplegic users.

Conclusions: The results from this exploratory study would support the need for a larger study. There are no storage issues, it is a cheaper option than a powered wheelchair and it would appear to increase independence, activity and participation in the short term.
Learning from experience: shared constructs in virtual reality and occupational therapy
Authors: Foran Amanda C
Published: May 2014

Background:

Rehabilitation professionals have long accepted the belief that engagement in meaningful activity contributes to human development and can enhance health and wellbeing. More recently, theorists have begun to discuss the importance not only of engagement in such activities, but the experience one has while engaging in them. With this shift, it is important for scholars of rehabilitation, in particular occupational therapy theorists and clinicians, to develop better ways to describe and measure occupational experience.

Contents:

This article considers how an understanding of occupational experience can be enhanced by taking up constructs in virtual reality theory that are similar to those in occupational therapy and occupational science, such as immersion, presence, flow, and embodiment. Correspondingly, the growing field of virtual reality can benefit from occupational therapists' and occupational scientists' work on occupational presence, therapeutic occupation, and the adaptation of contexts (including virtual contexts) to fit individual needs.

Conclusions:

As both virtual reality and occupational therapy continue to evolve, it is critical that scholars in each field look outside current paradigms to seek knowledge that is mutually beneficial to advancing understandings of human experience.
Stress of caring and nurses' beliefs in the stroke rehabilitation environment: a cross-sectional study
Authors: Joice Sara , Jones Martyn , Johnston Marie
Published: May 2014

Background:

Part of the multidisciplinary stroke unit team nurses report their role as complex and demanding.

Aims:

To explore stress of caring in nursing nurses'and its relationship with perception of the work environment and beliefs about stroke.

Methods:

This cross sectional study recruited a convenience sample of nursing staff from stroke units (n=44), 99% female; mean age 39 years (s.d. 9.6). The Stress of Caring Scale (SCS) and an adapted Illness Perception Questionnaire (IPQ-R: HP) were completed. The responses on the IPQ-R: HP were compared to stroke survivors (n=106) responses to the original IPQ-R completed in an earlier study.

Results:

Nurses' stress was positively correlated with perceptions of demand, strain and effort, and reward imbalance (P<.001) and negatively correlated with decisional control and helpfulness of support (P<05). Nurses believed stroke to incur greater symptoms, consequences, emotional impact, and a longer duration (P<.01) and that the patient's role and their treatment (P<.05) to be less salient than stroke survivors. Stress of caring was associated with the nurses’ beliefs about stroke (P<.05).

Conclusions:

Work environment and discrepancies between patients' and nurses’ beliefs may account for perceived stress and possibly impact on the nurse's role in rehabilitation.
Validity of individual test items of the Addenbrooke's Cognitive Examination-Revised (ACE-R) in stroke
Authors: Ferguson Heather , Lincoln Nadina B
Published: May 2014

Aims:

The Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) have poor validity for detecting cognitive impairment in stroke patients. The aim was to determine whether a combination of individual items could identify stroke patients with overall cognitive impairment or domain specific impairment as well as the full test.

Method:

Data was analysed from 34 stroke patients who completed the ACE-R and a neuropsychological test battery.

Results:

No individual items were found to reliably identify overall cognitive impairment. A combination of nine items from the ACE-R were as effective at identifying overall cognitive impairment and domain specific impairment as the MMSE and the full ACE-R. However these items were not an effective screening measure when compared to the results of the neuropsychological test battery.

Conclusion:

The ACE-R can be reduced to a nine item test with no loss of information but this is still not an adequate cognitive screening measure for detecting cognitive impairment in stroke patients.