Using appreciative inquiry to implement person-centred dementia care in hospital wards

Scerri, A. et al. Dementia. Published online: October 6 2016

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The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an appreciative inquiry approach to implement person-centred dementia care in two hospital wards.

Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using appreciative inquiry approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in appreciative inquiry workshops, during which they are listened to and appreciated for what they can contribute.

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Stated values and treatment preferences for end-of-life care: results of a multicentre survey

Heyland, D.K. et al. BMJ Supportive & Palliative Care. Published Online: 6 October 2016

Background: Medical orders for the use of life-supports should be informed by patients’ values and treatment preferences. The purpose of this study was to explore the internal consistency of patients’ (or their family members’) stated values, and the relationship between these values and expressed preferences.

Methods: We conducted a prospective study in 12 acute care hospitals in Canada. We administered a questionnaire to elderly patients and their family members about their values related to end-of-life (EOL) care, treatment preferences and decisional conflict.

Results: Of 513 patients and 366 family members approached, 278 patients (54%) and 225 family members (61%) consented to participate. Participants’ most important stated values were to be comfortable and suffer as little as possible, to have more time with family, to avoid being attached to machines and tubes and that death not be prolonged. The least important stated value was that life be preserved. Based on prespecified expected associations between the various values measured, there were inconsistencies in participants’ expressed value statements. With few exceptions, participants’ expressed values were not associated with expected corresponding treatment preferences. Of the 109 (40%) patients and 95 (42%) family members who had made decisions about use of life-supports, 68 (56%) patients and 60 (59%) family members had decisional conflict.

Conclusions: Decision-making regarding medical treatments at the EOL is inadequate. To reduce decisional conflict, patients and their families need more support to clarify their values and ensure that their preferences are grounded in adequate understanding of their illness and treatment options.

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Palliative care education for medical students: Differences in course evolution, organisation, evaluation and funding

Walker, S. et al. Palliative Medicine. Published online: October 6, 2016

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Background: A proportion of newly qualified doctors report feeling unprepared to manage patients with palliative care and end-of-life needs. This may be related to barriers within their institution during undergraduate training. Information is limited regarding the current organisation of palliative care teaching across UK medical schools.

Aims: To investigate the evolution and structure of palliative care teaching at UK medical schools.

Design: Anonymised, web-based questionnaire.

Settings/participants: Results were obtained from palliative care course organisers at all 30 UK medical schools.

Results: The palliative care course was established through active planning (13/30, 43%), ad hoc development (10, 33%) or combination of approaches (7, 23%). The place of palliative care teaching within the curriculum varied. A student-selected palliative care component was offered by 29/30 (97%). All medical schools sought student feedback. The course was reviewed in 26/30 (87%) but not in 4. Similarly, a course organiser was responsible for the palliative care programme in 26/30 but not in 4. A total of 22 respondents spent a mean of 3.9 h (median 2.5)/week in supporting/delivering palliative care education (<1–16 h). In all, 17/29 (59%) had attended a teaching course or shared duties with a colleague who had done so. Course organisers received titular recognition in 18/27 (67%; no title 9 (33%); unknown 3 (11%)). An academic department of Palliative Medicine existed in 12/30 (40%) medical schools. Funding was not universally transparent. Palliative care teaching was associated with some form of funding in 20/30 (66%).

Conclusion: Development, organisation, course evaluation and funding for palliative care teaching at UK medical schools are variable. This may have implications for delivery of effective palliative care education for medical students.

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No hospital is an island: new models of acute collaboration in the NHS | via @west_jake @nedwards_1 @NuffieldTrust

West, J. & Edwards, N. Nuffield Trust Blog. Published online: 6 October 2016

Encouraged in recent years through the NHS Five Year Forward View, the Dalton and Carter reviews and now Sustainability and Transformation Plans (STPs), hospitals are looking for creative solutions to clinical and financial challenges that they can’t solve on their own.

We recently brought together the 13 acute care collaboration vanguards, who are exploring this issue as part of the new care models programme, in a ‘community of practice’ hosted by the Nuffield Trust and The King’s Fund.

These 13 are a diverse bunch at first glance. Certainly the scope of their collaboration appears different. The four emerging foundation groups, Royal Free London, Salford, Northumbria and Guy’s and St Thomas’, are looking at bringing together full hospitals. Other models focus on single service lines, like EMRAD’s radiology consortium or Moorfield’s network of eye services. But at closer inspection, it looks more like a continuum of collaboration across acute services. The hospital groups are all considering tiered membership options, in which other hospitals could gain some of the group benefits through more limited collaboration options. Meanwhile, other partnerships such as Working Together and Developing One NHS in Dorset are specifically looking at collaborating on a defined cluster of clinical and back office services.

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Association Between Electronic Cigarette Marketing Near Schools and #Ecigarette Use Among Youth | via @JAdolesHealth

Giovenco,D.P. et al. Journal of Adolescent Health. Published online: October 5 2016

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Purpose: Electronic cigarettes (e-cigarettes) are now the most popular tobacco product among youth. Little is known about the relationship between exposure to e-cigarette marketing at the point-of-sale and youth e-cigarette use.

Methods: Research staff collected data on e-cigarette availability and promotion in tobacco retailers within a half-mile of 41 schools participating in the 2014 New Jersey Youth Tobacco Survey. These data were linked with participant responses from the New Jersey Youth Tobacco Survey (n = 3,909) and log-Poisson regression models estimated adjusted prevalence ratios for ever and past-month e-cigarette use.

Results: Nearly a quarter of high school students in New Jersey have tried e-cigarettes (24.1%) and 12.1% were past-month users. Prevalence was highest among males, non-Hispanic whites, and students who have used other tobacco products. After controlling for covariates and the clustered nature of the data, e-cigarette retailer density around schools was positively associated with ever and past-month use of e-cigarettes (p < .05). E-cigarette advertising volume significantly increased the probability of being a past-month e-cigarette user (adjusted prevalence ratio: 1.03, p = .031).

Conclusions: This study suggests that the point-of-sale environment around schools may contribute to e-cigarette use among youth. Policy efforts to restrict tobacco promotion at the point-of-sale may play a role in reducing the use of e-cigarettes.

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Gamification for health promotion: #systematicreview of behaviour change techniques in smartphone apps

Edwards, E.A. et al. BMJ Open. 2016(6) e012447. Published online: 4 October 2016

phone-1537916_960_720Objective: Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques.

Methods: Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price.

Data sources: We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using ‘gamification’ (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals.

Results: 64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5–22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10).

Conclusions: Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes.

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Vitamin E administration may decrease the incidence of pneumonia in elderly males

Hemilä H. (2016) Clinical Interventions in Aging.  2016(11) pp. 1379—1385

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Background: Vitamin E has influenced the immune system in laboratory studies. Dozens of animal experiments have found that vitamin E offered protection against infections caused by viruses and bacteria. Previously, significant heterogeneity was found in the effect of vitamin E supplementation on pneumonia in humans. The aim of this study was to examine how the effect of vitamin E on pneumonia risk depends on age.

Methods: Secondary analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention study in Finland, 1985–1993, was performed. Participants were male smokers aged 50–69 years at the baseline who started to smoke at ≥21 years (N=7,469). Intervention was 50 mg/d of vitamin E for 5–8 years. The outcome was the incidence of hospital-treated, community-acquired pneumonia by the age at the follow-up.

Results: Among 2,216 participants who smoked 5–19 cigarettes per day at baseline and exercised at leisure time, vitamin E supplementation reduced the incidence of pneumonia by 69% (95% confidence interval [CI]: 43%–83%; 57 pneumonia cases). In this subgroup, vitamin E prevented pneumonia in 12.9% of participants by the age of 74 years. Among 5,253 participants who smoked ≥20 cigarettes per day at baseline or did not exercise, the incidence of pneumonia was 14% lower in the vitamin E participants (95% CI: -38% to +21%; 139 cases). One-third of the participants quit smoking for a period, of whom 27 got pneumonia. The incidence of pneumonia was 72% (95% CI: 31%–89%) lower in the vitamin E group, and this benefit was also seen among those males who smoked ≥20 cigarettes per day at baseline or did not exercise.

Conclusion: Although the evidence of benefit from vitamin E against pneumonia in elderly males is strong in this analysis, the overall findings about vitamin E have been complex. Further research on vitamin E in nonsmoking elderly males is warranted.

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The future of dementia risk reduction research

Mitchell, S. et al. The future of dementia risk reduction research: barriers and solutions. Journal of  Public Health (2016). published online 3rd October 2016

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Background:  We examine why dementia prevention and risk reduction are relatively underfunded and suggest potential remediation strategies. The paper is aimed at researchers, funders and policy-makers, both within dementia and also the wider health prevention field.

Method:  A discussion-led workshop, attended by 58 academics, clinicians, funders and policy-makers.

Results: The key barriers identified were the gaps in understanding the basic science of dementia; the complex interplay between individual risk factors; variations in study methodology; disincentives to collaboration; a lack of research capacity and leadership and the broader stigma of the condition. Recommendations were made to encourage strategic leadership, provide greater support for grant applications, promote collaboration and support randomized control trials for the research field.

Conclusion:  Having identified the barriers, the key challenge is how to implement the potential solutions. This will require engagement with decision-makers within funding, policy and research to ensure that action takes place.

Full document: The future of dementia risk reduction research: barriers and solutions