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People living with stroke and neurological conditions access rehabilitation at different times but self-management is often viewed as what happens post-discharge. Personalised models that integrate self-management support within everyday care are now advocated but this may require practitioners to change their behaviour to adopt and sustain new ways of working. The People1st project evaluated integration of an existing Supported Self-Management programme ("Bridges") across varied stroke and neurorehabilitation service contexts. Mixed-method evaluation of training for groups of healthcare practitioners across 24 UK National Health Service (NHS) Trusts, exploring how learning from Bridges was assimilated and enacted in practice, on an individual and collective basis. Staff growth in confidence and skill around supported self-management was demonstrated. Transformations to practice included changes to: the structure of, and language used in, patient interactions; induction/training processes to increase potential for sustainability; and sharing of successes. Bridges helped practitioners make changes that brought them closer to their professional ideals. Engaged leadership was considered important for successful integration. Bridges was successfully integrated within a wide range of stroke and neurorehabilitation service contexts, enabled by an approach in line with practitioners' values-based motivations. Further work is required to explore sustainability and impact on service users. Personalised models of care and support for self-management are advocated for people living with stroke and neurological conditions; this requires practitioners to be supported to change behaviour and practices to adopt and sustain new ways of working. Staff from a wide variety of backgrounds in neurorehabilitation and stroke can learn collaboratively about self-management practices via the Bridges programme and can integrate those practices into their service contexts. Bridges can take practitioners closer to their professional ideals of caring and making a difference and empowers them to initiate change. Organisational commitment and engaged leadership are required to facilitate a culture of support for self-management in practice. [ABSTRACT FROM AUTHOR]

Abstract Background Evidence demonstrates that measures are needed to optimise therapy and improve administration of medicines in care homes for older people. The aim of this study is to determine the clinical and cost effectiveness of a novel model of multi-professional medication review. Methods A cluster randomised controlled trial design, involving thirty care homes. In line with current practice in medication reviews, recruitment and consent will be sought from general practitioners and care homes, rather than individual residents. Care homes will be segmented according to size and resident mix and allocated to the intervention arm (15 homes) or control arm (15 homes) sequentially using minimisation. Intervention homes will receive a multi-professional medication review at baseline and at 6 months, with follow-up at 12 months. Control homes will receive usual care (support they currently receive from the National Health Service), with data collection at baseline and 12 months. The novelty of the intervention is a review of medications by a multi-disciplinary team. Primary outcome measures are number of falls and potentially inappropriate prescribing. Secondary outcome measures include medication costs, health care resource use, hospitalisations and mortality. The null hypothesis proposes no difference in primary outcomes between intervention and control patients. The primary outcome variable (number of falls) will be analysed using a linear mixed model, with the intervention specified as a fixed effect and care homes included as a random effect. Analyses will be at the level of the care home. The economic evaluation will estimate the cost-effectiveness of the intervention compared to usual care from a National Health Service and personal social services perspective. The study is not measuring the impact of the intervention on professional working relationships, the medicines culture in care homes or the generic health-related quality of life of residents. Discussion This study will establish the effectiveness of a new model of multi-professional clinical medication reviews in care homes, using novel approaches to recruitment and consent. It is the first study to undertake an examination of direct patient outcomes, together with an economic analysis. Trial Registration ISRCTN: ISRCTN90761620

Objectives: With 70% of care home residents experiencing a medication error every day in the UK, better multi‐professional working between medical practitioners, pharmacists and care homes was recommended. The aim of this study was to determine the effectiveness (falls reduction) and cost‐effectiveness, of a multi‐professional medication review (MPMR) service in care homes for older people. Method: A total of care homes in the East of England were cluster randomised to 'usual care' or two multi‐professional (General practitioner, clinical pharmacist and care homes staff) medication reviews during the 12‐month trial period. Target recruitment was 900 residents with 10% assumed loss to follow‐up. Co‐primary outcome measures were number of falls and potentially inappropriate prescribing assessed by the Screening Tool of Older Persons Prescriptions. Key findings: A total of 826 care home residents were recruited with 324 lost to follow‐up for at least one primary outcome measure. The mean number of falls per resident per annum was 3.3 for intervention and 3.0 for control (P = 0.947). Each resident was found to be prescribed 0.69 (intervention) and 0.85 (control) potentially inappropriate medicines after 12 months (P = 0.046). No significant difference identified in emergency hospital admissions or deaths. Estimated unadjusted incremental mean cost per resident was £374.26 higher in the intervention group. Conclusions: In line with other medication review based interventions in care homes, two MPMRs improved medication appropriateness but failed to demonstrate improvements in clinical outcomes. From a health system perspective costs where estimated to increase overall and therefore a different model of medicines management is required. [ABSTRACT FROM AUTHOR]

Introduction: Studies of prognosis for surgery and corticosteroid injection for carpal tunnel syndrome (CTS) have considered only a limited range of explanatory variables for outcome.Methods: Data were prospectively collected on patient-reported symptoms, physical and psychological functioning, comorbidity, and quality of life at baseline and every 6 months for up to 2 years. Outcomes were patient-rated change over a 6-month period and symptom-severity score at 18 months.Results: In total, 754 patients with CTS completed baseline questionnaires, and 626 (83%) completed follow-up to 18 months. Multivariable modeling identified, independent of symptom severity at outset, higher health utility, fewer comorbidities, and lower anxiety as significant predictors of better outcome from surgery. In patients treated by steroid injection, independent of symptom severity at outset, shorter duration of symptoms and having no prior injection were significant predictors of better outcome.Discussion: These multivariable models of outcome may inform shared decision making about treatment for CTS. Muscle Nerve, 2019. [ABSTRACT FROM AUTHOR]

Objectives The Prediciting factors for response to treatment in carpal tunnel syndrome (PALMS) study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care. Methods Prospective, multicentre cohort study initiated in 2013. We collected baseline data on patient-reported symptom severity (CTS-6), psychological status (Hospital Anxiety and Depression Scale), hand function (Michigan Hand Questionnaire) comorbidities, EQ-5D-3L (3-level version of EuroQol-5 dimension) and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model. Results 753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). National Health Service (NHS) and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity. Conclusions Patient-reported symptom severity in CTS is significantly and positively associated with anxiety, depression, health-related quality of life, and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast, there is little or no evidence of any relationship with objectively derived CTS severity. Future research is needed to understand the impact of approaches and treatments that address psychosocial stressors as well as biomedical factors on relief of symptoms from carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

Food allergy is an increasing problem worldwide. Allergy to peanuts is a particular concern, given that this is rarely outgrown and may be associated with life-threatening anaphylaxis. However, it is unclear what factors are responsible for a perceived increase in prevalence rates. One matter on which scientists agree, however, is that exposure to peanuts early in life is significant - although whether early exposure protects or sensitizes to allergy is unclear. There is no significant research that currently records differences in early life exposure either within or between populations. This exploratory study makes a first step in this direction using focus groups conducted in four countries with disparate 'peanut experiences' to characterize early exposure in these. The ultimate aim is to help in the development of a survey instrument to attain nationally representative samples of consumers and hence to use the results from this to compare with allergy prevalence data collected in other parts of the European Union-funded ' EuroPrevall' project. The results in this study not only reveal considerable similarities across countries (e.g. in terms of lack of knowledge of guidelines; lack of changes in feeding behaviour during/after pregnancy, feelings that diet variety in children is important) but also one or two interesting and potentially important differences, such as increased consumption in Bulgarian (and some Spanish) breastfeeding mothers because of the ability of peanuts to facilitate lactation. Study limitations and future study intentions are also discussed. [ABSTRACT FROM AUTHOR]

Background: Evidence demonstrates that measures are needed to optimise therapy and improve administration of medicines in care homes for older people. The aim of this study is to determine the clinical and cost effectiveness of a novel model of multi-professional medication review.Methods: A cluster randomised controlled trial design, involving thirty care homes. In line with current practice in medication reviews, recruitment and consent will be sought from general practitioners and care homes, rather than individual residents. Care homes will be segmented according to size and resident mix and allocated to the intervention arm (15 homes) or control arm (15 homes) sequentially using minimisation. Intervention homes will receive a multi-professional medication review at baseline and at 6 months, with follow-up at 12 months. Control homes will receive usual care (support they currently receive from the National Health Service), with data collection at baseline and 12 months. The novelty of the intervention is a review of medications by a multi-disciplinary team. Primary outcome measures are number of falls and potentially inappropriate prescribing. Secondary outcome measures include medication costs, health care resource use, hospitalisations and mortality. The null hypothesis proposes no difference in primary outcomes between intervention and control patients. The primary outcome variable (number of falls) will be analysed using a linear mixed model, with the intervention specified as a fixed effect and care homes included as a random effect. Analyses will be at the level of the care home. The economic evaluation will estimate the cost-effectiveness of the intervention compared to usual care from a National Health Service and personal social services perspective.The study is not measuring the impact of the intervention on professional working relationships, the medicines culture in care homes or the generic health-related quality of life of residents.Discussion: This study will establish the effectiveness of a new model of multi-professional clinical medication reviews in care homes, using novel approaches to recruitment and consent. It is the first study to undertake an examination of direct patient outcomes, together with an economic analysis.Trial Registration: ISRCTN: ISRCTN90761620. [ABSTRACT FROM AUTHOR]

Rates of peanut allergy in the Western world have increased over the last 30 years, although it is unclear why. While eating behaviours are likely to be connected to allergy prevalence, the precise relevant factors are uncertain. This study aimed to investigate dietary differences and changes in dietary habits in peanut consumption (in apparent and hidden forms) in four different countries (Bulgaria, Poland, Spain, UK), specifically chosen because of their different ‘peanut experiences’. Focus groups revealed a common perception that dietary habits have become less healthy, with more consumption of processed foods and an increase in snacking. In addition, ethnic cuisine was perceived to have had an important impact on European eating habits, while participants identified an increase in consumption of more ‘exotic’ forms of peanuts and their products. These findings point to an increase in exposure to peanuts, particularly in hidden forms, that superficially parallels increased prevalence rates. However, it was also clear that participants lacked knowledge about the composition of food and non-food products. The dietary trends identified here thus warrant further quantitative investigation, particularly in the context of differential national patterns of allergy prevalence – data on which is currently being gathered within the EC-funded EuroPrevall project. [ABSTRACT FROM AUTHOR]

A recent structured review of the qualitative risk perception literature (Hawkes and Rowe 2008) found that research has tended to focus on a narrow range of samples, using a limited range of techniques, looking at immediate perceptions (rather than changes over time), and focusing upon a limited range of hazards. As such, it may be argued that the risk perception 'universe' remains relatively unexplored. One method little utilised in the risk perception domain is the diary. Diaries are more commonly associated with historical, personal documents, and rarely have been used in wider social research. Nevertheless, contemporary, solicited diaries can provide a different perspective on risk than that acquired through the more traditional route of interviews and focus groups. Diaries may allow the elicitation of narratives of risk contextualised within people's everyday lives, as well as allowing consideration of how people's perceptions of risk develop and change over time. In this paper, we discuss the benefits of diary research, reporting results from a pilot qualitative study about people's everyday concerns. We focus on the comparative nature of the study and contrast the findings from diaries with data attained from interviews, highlighting qualitative and quantitative differences in the results obtained by the two methods. The findings emphasise the importance of taking a multi-method approach to understanding risk perception. [ABSTRACT FROM AUTHOR]

In European countries, there has been growing consumer distrust regarding the motives of food safety regulators and other actors in the food chain, partly as a result of recent food safety incidents. If consumer confidence in food safety is to be improved, a systematic understanding of what consumers perceive to be best practice in risk management is crucial. Previous qualitative and quantitative research has revealed underlying factors determining consumer perceptions of food risk management quality. The aim of the current case studies is to provide 'proof of principles' of these different factors against historic and emerging food safety incidents. Participants in four countries were questioned about country specific case studies, guided by the earlier findings regarding factors that determine perceived good practice in food risk management. In each country, two food safety incidents were selected. Semi-structured interviews with at least 25 participants per case study were conducted in Germany (BSE; nematode worms in fish), Greece (mould in Greek yogurt/carcinogenic honey crisis; avian influenza), Norway (E. coli in meat; contaminants in Norwegian salmon) and the UK (BSE; contaminants in Scottish salmon). The results generally confirm the importance of the previously identified factors, which help to explain relative perceptions of well and poorly managed incidents. Differences and similarities across countries and cases are detailed, and implications for future efforts to communicate about risk management are drawn. [ABSTRACT FROM AUTHOR]

In February 2007, avian influenza arrived in the UK. Following evidence of illness at a turkey farm in Suffolk, around 160,000 birds were slaughtered and poultry movement controls were imposed. Given past food crises (e.g. BSE), it was clearly important to predict UK public response: for example, was mass panic imminent, or would the public respond calmly? Unfortunately, there is currently no theory that enables accurate prediction of public response to novel hazards or to novel manifestations of old hazards (Hawkes and Rowe in press). Furthermore, the speed of the outbreak, and the lack of academic preparedness, undermined social scientists' ability to acquire significant timely data on public perceptions in order to aid theory development or inform policy making. Analysis of initial public opinion is, however, possible, thanks to the recording of responses to open questions about this incident posted on the British Broadcasting Corporation's (BBC) website. In this paper we: (a) justify the relevance and importance of this data, irrespective of deficiencies in its 'representativeness'; (b) provide a content analysis of the more than 3,000 responses, and; (c) summarize initial opinion. Results suggest that 'the public's' initial response largely comprised discontent in how government was managing matters and concern about current farming practices. Indeed, for many, past food scares served as a reference point for understanding the present crisis, providing lessons on issues such as industry greed and governmental/scientific incompetence and misinformation. It is, however, important to recognize that there are data limitations, which need validation through more controlled research processes. [ABSTRACT FROM AUTHOR]

Crises in food risk management have often been attributed to disconnection between the stakeholders involved, as when consumers do not believe risk communications or dispute risk managers' priorities. Before this problem of disconnection can be resolved, however, there is a need to clarify the nature and extent of perceptual discrepancies between stakeholders and to establish whether mutual understanding is attainable. Our recent research has identified that food risk experts and consumers do have different interpretations of what it means for risk management to be effective. Here we describe a study that used telephone interviews to present food risk experts and consumers in four different European countries with statements (derived from our previous work) indicating the different expert and consumer perspectives on food risk management, in order to assess the participants' reactions to these. We found that, though there were areas of agreement between the experts and consumers (for example, they agreed that consumers lack relevant knowledge, that food safety is a shared responsibility and that scientific uncertainty cannot be completely avoided), there were other areas where disagreement remained (for example, on the acceptability of economic interests in food risk management and the role and quality of media reporting). These results indicate the key areas where mutual understanding and appreciation are lacking between significant stakeholders, and hence the areas that should form the target for the activities of organizations like the European Food Safety Authority in order to improve the effective implementation of food risk management practices. [ABSTRACT FROM AUTHOR]

Background: Older people are the highest users of health services but are less likely to use a patient portal than younger people., Objective: This scoping review aimed to identify and synthesize the literature on contextual factors that impact the implementation of patient portals in acute care hospitals and among older people., Methods: A scoping review was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The following databases were searched from 2010 to June 2020: MEDLINE and Embase via the Ovid platform, CINAHL and PsycINFO via the EBSCO platform, and the Cochrane Library. Eligible reviews were published in English; focused on the implementation of tethered patient portals; included patients, health care professionals, managers, and budget holders; and aimed at identifying the contextual factors (ie, barriers and facilitators) that impact the implementation of patient portals. Review titles and abstracts and full-text publications were screened in duplicate. The study characteristics were charted by one author and checked for accuracy by a second author. The NASSS (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability) framework was used to synthesize the findings., Results: In total, 10 systematic reviews published between 2015 and 2020 were included in the study. Of these, 3 (30%) reviews addressed patient portals in acute care hospitals, and 2 (20%) reviews addressed the implementation of patient portals among older people in multiple settings (including acute care hospitals). To maximize the inclusion of the literature on patient portal implementation, we also included 5 reviews of systematic reviews that examined patient portals in multiple care settings (including acute care hospitals). Contextual factors influencing patient portal implementation tended to cluster in specific NASSS domains, namely the condition, technology, and value proposition. Certain aspects within these domains received more coverage than others, such as sociocultural factors and comorbidities, the usability and functionality aspects of the technology, and the demand-side value. There are gaps in the literature pertinent to the consideration of the provision of patient portals for older people in acute care hospitals, including the lack of consideration of the diversity of older adults and their needs, the question of interoperability between systems (likely to be important where care involves multiple services), the involvement of lay caregivers, and looking beyond short-term implementation to ways in which portal use can be sustained., Conclusions: We identified important contextual factors that impact patient portal implementation and key gaps in the literature. Future research should focus on evaluating strategies that address disparities in use and promote engagement with patient portals among older people in acute care settings., (©Zarnie Khadjesari, Julie Houghton, Tracey J Brown, Helena Jopling, Fiona Stevenson, Jennifer Lynch. Originally published in JMIR Aging (https://aging.jmir.org), 03.02.2023.)