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PURPOSE: Communication between people with traumatic brain injury (TBI) and rehabilitation staff can be impacted by cognitive-communication disorders. Communication partner training (CPT) programs hold potential to improve communication between people with TBI and their communication partners. To tailor CPT programs to the rehabilitation environment, it is critical to understand the nature of communicative interactions for staff members. This study explores staff and managers' experiences of communication with people with TBI in the rehabilitation setting. METHOD: Individual semistructured videoconference interviews were carried out with staff members (n = 22) and managers (n = 4) varying in terms of professions and length of work experience. Interviews were guided by a phenomenological approach to gain comprehensive knowledge of staff and managers' lived experiences of communication with people with TBI. RESULTS: Four themes with nine subthemes were generated: (a) cognitive-communication disorders challenge interaction (communication is socially inappropriate, the diversity of presenting symptoms associated with TBI is demanding), (b) staff struggle in communication (there is a breakdown of communicative collaboration, communication increases staff's workload, emotional well-being of staff is at risk), (c) communication context is crucial (tasks affect communication, extending the professional roles), and (d) staff want communication knowledge and skills (needs vary according to work experience, access to tailored strategies, and feedback). CONCLUSIONS: Staff and managers experienced communication with people with TBI as highly demanding. The socially inappropriate communication in people with TBI was perceived to disturb the collaborative aspects of communication and create negative emotional impacts for staff. Staff experiences varied according to discipline, work experience, rehabilitation tasks, and facility. Consequently, staff and managers expressed a need fo

This systematic review aimed to synthesize barriers and facilitators in communicative interactions between staff and people with traumatic brain injury (TBI) in the rehabilitation context. Searches captured published evidence up to November 2022 in MEDLINE, Embase, SCOPUS, Web of Science, CINAHL, AMED, and PsycINFO. Eligible studies reported on the communicative interaction between rehabilitation staff and adults with TBI. In total, 31 studies were included in the review; including quantitative, qualitative, and mixed-methods designs. Quality assessment was carried out using standard checklists. Quantitative studies and quantitative components of mixed-method studies were synthesized descriptively according to reported communication barriers and facilitators. Qualitative studies and qualitative components of mixed-method studies were analysed through an inductive thematic meta-synthesis; generating six main themes with four subthemes. Themes were categorized as barriers or facilitators to communicative interaction. Findings demonstrated that cognitive-communication disorders of people with TBI challenge the communicative interaction between rehabilitation staff and people with TBI. However, the extent to which these disorders create a communicative barrier is closely related to staff's communicative approach. While staff holding a collaborative and acknowledging approach and using supportive strategies may facilitate successful communicative interactions, staff using the opposite approach may exacerbate communication barriers.

Background: People with a severe mental illness (SMI) have shorter life expectancy and poorer quality of life compared to the general population. Most years lost are due to cardiovascular disease, respiratory disease, and various types of cancer. We co-designed an intervention to mitigate this health problem with key stakeholders in the area, which centred on an extended consultations for people with SMI in general practice. This study aimed to1) investigate general practitioners’ (GPs) experience of the feasibility of introducing extended consultations for patients with SMI, 2) assess the clinical content of extended consultations and how these were experienced by patients, and 3) investigate the feasibility of identification, eligibility screening, and recruitment of patients with SMI. Methods: The study was a one-armed feasibility study. We planned that seven general practices in northern Denmark would introduce extended consultations with their patients with SMI for 6 months. Patients with SMI were identified using practice medical records and screened for eligibility by the patients’ GP. Data were collected using case report forms filled out by practice personnel and via qualitative methods, including observations of consultations, individual semi-structured interviews, a focus group with GPs, and informal conversations with patients and general practice staff. Results: Five general practices employing seven GPs participated in the study, which was terminated 3 ½ month ahead of schedule due to the COVID-19 pandemic. General practices attempted to contact 57 patients with SMI. Of these, 38 patients (67%) attended an extended consultation, which led to changes in the somatic health care plan for 82% of patients. Conduct of the extended consultations varied between GPs and diverged from the intended conduct. Nonetheless, GPs found the extended consultations feasible and, in most cases, beneficial for the patient group. In interviews, most patients recounted the

BACKGROUND AND OBJECTIVES: Communication partner training (CPT) is essential in dementia care. Despite families being the largest group of community carers, previous reviews primarily focus on formal carers. This study aimed to understand the characteristics and effectiveness of CPT for families of people with dementia. RESEARCH DESIGN AND METHODS: The systematic review included intervention/protocol studies on dementia CPT for families, excluding formal carers and programs not focused on communication. CINAHL, PsycINFO, SpeechBITE, Medline, SCOPUS, and Embase were searched between 30 th November and 6 th December 2021. After deduplication, 3172 records were screened. Quality assessment used JBI Critical Appraisal tools and the Mixed Methods Appraisal Tool. Data synthesis utilised three reporting tools, the International Classification of Functioning, Disability and Health, and content analysis. RESULTS: Of 30 studies (27 programs) there were 10 quasi-experimental, five RCTs, four mixed-methods, four case studies, four qualitative, and two protocols. Studies were published between 1998-2021 and included 671 family members. Characteristics varied with 7/27 programs including consumers during creation and one program including telehealth. One study included all reporting tool criteria. Programs typically used four intervention functions, with 12/27 programs addressing three behaviour change areas. 33/74 outcome measures targeted the 'Environment' of the person with dementia. Studies showed positive improvements in communication skills and knowledge, with mixed results on behaviour/psychosocial outcomes. Qualitative results identified improvements in conversation and attitudes. DISCUSSION AND IMPLICATIONS: CPT for families improves communication outcomes, however quality of studies varied significantly. Future research should address gaps in telehealth, consumer involvement, and intervention descriptions.

Systemic risk is associated with cascading impacts that spread within and across systems and sectors (e.g. ecosystems, health, infrastructure and the food sector) via the movements of people, goods, capital and information within and across boundaries (e.g. regions, countries and continents). The spread of these impacts can lead to potentially existential consequences and system collapse across a range of time horizons. Globalization contributes to systemic risk affecting people worldwide. The impacts of climate change or COVID-19 show how the challenges of addressing systemic risk go beyond conventional risk management and governance. Critical system interdependencies, amplified by underlying vulnerabilities, highlight that there is a growing need to better understand cascading impacts, systemic risks and the possible political (governance) and societal responses. This includes improving our understanding of the root causes of systemic risk, both biophysical and socio-economic, and related information needs. Addressing contemporary challenges in terms of systemic risk requires integrating different systems perspectives and fostering system thinking, while implementing key intergovernmental agendas, such as the Paris Agreement, the Sendai Framework for Disaster Risk Reduction and the Sustainable Development Goals. This Briefing Note represents an integrated perspective of climate, environmental and disaster risk science and practice regarding systemic risk. It provides an overview of the concepts of systemic risk that have evolved over time and identifies commonalities across terminologies and perspectives associated with systemic risk used in different contexts. Key attributes of systemic risk are outlined without prescribing a single definition, and information and data requirements that are essential for a better and more actionable understanding of the systemic nature of risk are discussed. Finally, the opportunities to connect research and policy for addressing

How can we maximize what is learned from a replication study? In the creative destruction approach to replication, the original hypothesis is compared not only to the null hypothesis, but also to predictions derived from multiple alternative theoretical accounts of the phenomenon. To this end, new populations and measures are included in the design in addition to the original ones, to help determine which theory best accounts for the results across multiple key outcomes and contexts. The present pre-registered empirical project compared the Implicit Puritanism account of intuitive work and sex morality to theories positing regional, religious, and social class differences; explicit rather than implicit cultural differences in values; self-expression vs. survival values as a key cultural fault line; the general moralization of work; and false positive effects. Contradicting Implicit Puritanism's core theoretical claim of a distinct American work morality, a number of targeted findings replicated across multiple comparison cultures, whereas several failed to replicate in all samples and were identified as likely false positives. No support emerged for theories predicting regional variability and specific individual-differences moderators (religious affiliation, religiosity, and education level). Overall, the results provide evidence that work is intuitively moralized across cultures., QC 20220927

Background: People with severe mental illness (SMI) have an increased risk of premature mortality, predominantly due to somatic health conditions. Evidence indicates that primary and tertiary prevention and improved treatment of somatic conditions in patients with SMI could reduce this excess mortality. This paper reports a protocol designed to evaluate the feasibility of a coordinated co-produced care program (SOFIA model, a Danish acronym for Severe Mental Illness and Physical Health in General Practice) in the general practice setting to reduce mortality and improve quality of life in patients with severe mental illness.Methods: The SOFIA pilot trial is designed as a cluster randomized controlled trial targeting general practices in two regions in Denmark. We aim to include 12 practices, each of which is instructed to recruit up to 15 community-dwelling patients aged 18 and older with SMI. Practices will be randomized by a computer in a ratio of 2:1 to deliver a coordinated care program or usual care during a 6-month study period. A randomized algorithm is used to perform randomization. The coordinated care program includes educational training of general practitioners and their clinical staff educational training of general practitioners and their clinical staff, which covers clinical and diagnostic management and focus on patient-centered care of this patient group, after which general practitioners will provide a prolonged consultation focusing on individual needs and preferences of the patient with SMI and a follow-up plan if indicated. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively. Assessments of the outcome parameters will be administered at baseline, throughout, and at end of the study period.Discussion: If necessary the intervention will be revised based on results from this study. If delivery of the intervention, either in its current form or

Objectives: The primary objective of this feasibility study was to identify quality of life (QoL) scores and symptom scales as tools for measuring patient-reported outcomes (PRO) associated with haemoglobin level in chemotherapy-treated cancer patients. Secondary objectives included comparing QoL and symptoms between randomisation arms. Background: Anaemia in cancer patients undergoing chemotherapy is associated with decreased QoL. One treatment option is red blood cell transfusion (RBCT). However, the optimal haemoglobin trigger for transfusion is unknown. Methods: Patients were randomised to a haemoglobin trigger for RBCT of either<9·7gdL-1 (arm A) or

The combination of lomustine and bevacizumab is a commonly used salvage treatment for recurrent glioblastoma (GBM). We investigated the toxicity and efficacy of lomustine plus bevacizumab (lom-bev) in a community-based patient cohort and made a comparison to another frequently used combination therapy consisting of irinotecan plus bevacizumab (iri-bev). Seventy patients with recurrent GBM were treated with lomustine 90 mg/m2 every 6 weeks and bevacizumab 10 mg/kg every 2 weeks. Toxicity was registered and compared to the toxicity observed in 219 recurrent GBM patients who had previously been treated with irinotecan 125 mg/m2 and bevacizumab 10 mg/kg every 2 weeks. The response rate was 37.1% for lom-bev and 30.1% for iri-bev. Median progression-free survival (PFS) was 23 weeks for lom-bev and 21 weeks for iri-bev (p = 0.9). Overall survival (OS) was 37 weeks for lom-bev and 32 weeks for iri-bev (p = 0.5). Lom-bev caused a significantly higher frequency of thrombocytopenia (11.4% grade 3-4) compared to iri-bev (3.5% grade 3-4). Iri-bev patients had more gastrointestinal toxicity with regard to nausea, vomiting, diarrhea, constipation and stomatitis. Within the limitations of the study lom-bev is a well-tolerated treatment for recurrent GBM, although hematological toxicity may be a dose limiting factor. No significant differences between lom-bev and iri-bev were observed with regard to PFS or OS. The differences in toxicity profiles between lom-bev and iri-bev could guide treatment decision in recurrent GBM therapy as efficacy is equal and no predictive factors for efficacy exist.