Who accesses complementary therapies and why?: An evaluation of a cancer care service

Introduction

Advances in cancer diagnosis and treatment have resulted in longer survival, meaning patients are living with a chronic-type condition. Therefore the needs of such patients have changed placing greater emphasis on survivorship, such as impact on quality of life and sleep patterns. Evidence suggests complementary therapies positively impact not only on the cancer patient's quality of life but also on family members and friends.

Methodology

This service evaluation examines self-reported benefits following a course of complementary therapy offered by a local cancer charity.

Results

Analysis of self-reported sleep scores and perceived quality of life experiences confirmed a number of trends relating to the demographics of people accessing the complementary therapy service.

Conclusion

Results suggest the complementary therapies provided by Action Cancer significantly improved clients' quality of life. Based on these findings the authors make a number of recommendations in relation to the use of complementary therapies by cancer patients.

Disordered Eating in first year university students: A qualitative study exploring student and support service needs

The paper reports on a qualitative study exploring disordered eating in younger first-year students studying for professional health care related degrees (n=12), and highlights a number of support mechanisms and services required for those students at risk.

Key issues emerging in relation to disordered eating included: concealment; lack of understanding to the nature/risks associated; its use as a stress coping mechanism; isolation; perception as mental health issues with attaching stigma and reticence to acknowledge; invisible experience; wariness of eating in more public refectories. Finally positivity about their arrival at university and that their experience with disordered eating could potentially add to their repertoire as future health care professionals.

Conclusion: The University could; further develop its outreach to new students with a more consistently supportive person-centred program including stress training and more support via student buddying; extend its program on positive mental health; greater awareness particularly the sub-clinical group; consider some small changes and adaptations to the refectory eating areas to better facilitate at- risk students. Finally the University could perhaps better use the first few months of student's arrival at university to help embed a program to develop a stronger sense of coherence and well-being.

The performance of a cathodic protection system in reinforced concrete structure: Monitoring and Service Life Modelling

The use of cathodic protection in reinforced concrete is becoming increasingly common with such systems being installed on a number of structures throughout the United Kingdom and Ireland. However the prescribed design lives (or service life) of each cathodic protection system vary widely. The aim of this project was to assess the effectiveness of a sacrificial anode cathodic protection system and to predict its design life through a series of laboratory based experiments. The experimental plan involved casting a number of slabs which represented a common road bridge structure. The corrosion of the steel within the experimental slabs was then accelerated prior to installation of a cathodic protection system. During the experiment corrosion potential of the steel reinforcement was monitored using half-cell measurement. Additionally the current flow between the cathodic protection system and the steel reinforcement was recorded to assess the degree of protection. A combination of theoretical calculations and experimental results were then collated to determine the design life of this cathodic protection system. It can be concluded that this sacrificial anode based cathodic protection system was effective in halting the corrosion of steel reinforcement in the concrete slabs studied. Both the corrosion current and half-cell potentials indicated a change in passivity for the steel reinforcement once sacrificial anodes were introduced. The corrosion current was observed to be sensitive to the changes to the exposure environment. Based on the experimental variables studied the design life of this sacrificial anode can be taken as 26 to 30 years.

WC/CNT, WC/CNT/Pt Composite Material and Preparation Process Therefor and Use Thereof. (International Patent)

(EN)Disclosed are a WC/CNT， WC/CNT/Pt composite material and a preparation process therefor and use thereof. The WC/CNT/Pt composite material comprises mesoporous spherical tungsten carbide with a diameter of 1-5 microns, carbon nanotubes and platinum nano particles, with the carbon nanotubes growing on the surface of the mesoporous spherical tungsten carbide and expanding outward, and the platinum nano particles growing on the surfaces of the mesoporous spherical tungsten carbide and carbon nanotubes. The WC/CNT composite material comprises mesoporous spherical tungsten carbide with a diameter of 1-5 microns, and carbon nanotubes, with the carbon nanotubes growing on the surface of the mesoporous spherical tungsten carbide and expanding outward. The WC/CNT/Pt composite material of the present invention can be used as an electro-catalyst in a methanol flue battery, significantly improving the catalytic conversion rate and the service life of the catalyst. The WC/CNT composite material can be used as an electro-catalyst in the electro-reduction of a nitro aromatic compound, significantly improving the efficiency of organic electro-synthesis.

WC/CNT, WC/CNT/Pt Composite Material and Preparation Process Therefor and Use Thereof. (US patent)

Disclosed are a WC/CNT， WC/CNT/Pt composite material and a preparation process therefor and use thereof. The WC/CNT/Pt composite material comprises mesoporous spherical tungsten carbide with a diameter of 1-5 microns, carbon nanotubes and platinum nano particles, with the carbon nanotubes growing on the surface of the mesoporous spherical tungsten carbide and expanding outward, and the platinum nano particles growing on the surfaces of the mesoporous spherical tungsten carbide and carbon nanotubes. The WC/CNT composite material comprises mesoporous spherical tungsten carbide with a diameter of 1-5 microns, and carbon nanotubes, with the carbon nanotubes growing on the surface of the mesoporous spherical tungsten carbide and expanding outward. The WC/CNT/Pt composite material of the present invention can be used as an electro-catalyst in a methanol flue battery, significantly improving the catalytic conversion rate and the service life of the catalyst. The WC/CNT composite material can be used as an electro-catalyst in the electro-reduction of a nitro aromatic compound, significantly improving the efficiency of organic electro-synthesis.

What sources of feeding advice do parents use in the first year of life?

There has been restructuring of health visiting services from universal services for all children to targeting families in need. Also, United Kingdom (UK) recommendations on infant feeding have recently changed. With the many sources of information available on feeding babies, it is important to know where parents get feeding advice and which sources they find valuable. In this study, 215 mothers of one-year-old infants were interviewed about where they had obtained feeding advice in the first year of their infant’s life and how useful they found this information. The health visitor was the most commonly cited source of information (70 %), followed by grandparents (53 %). Ten % of mothers relied solely on health visitor advice. This study highlights the importance placed by mothers on the health visitors, which may have implications for the service in the midst of the reorganization of the health visitor’s role.

A study exploring disordered eating patterns in first-year university students: student and service needs

This qualitative study explored disordered eating in a small group of first-year undergraduate students and addresses a gap in the literature by exploring their lived experience.

Aims: To better understand student’s needs in those experiencing or at risk of developing disordered eating during their first year at university and to illustrate what support mechanisms and services are required to better support students experiencing or at risk during their first year at university.

Conclusion: The University could further develop its outreach to new students with a more consistently supportive programme providing better facilities and training for stress appraisal and coping and more support via student buddying. The University could also extend its programme on positive mental health in an attempt to better inform on disordered eating and to reduce a sense of stigma within the student population. Personal tutors and student health care facilities need to be consistently trained in the understanding and person centred approach to students experiencing disordered eating, particularly the sub-clinical group. In addition the University could consider some small changes and adaptations to the refectory eating areas to better facilitate students who may be at risk from disordered eating. Finally the University could perhaps better use the potentially liminal period within the first few months of student's arrival at university (a new beginning) to help embed a program to develop a stronger sense of coherence and well-being.

The use of patient experience survey data by out-of-hours primary care services: a qualitative interview study

Background English National Quality Requirements mandate out-of-hours primary care services to routinely audit patient experience, but do not state how it should be done.

Objectives We explored how providers collect patient feedback data and use it to inform service provision. We also explored staff views on the utility of out-of-hours questions from the English General Practice Patient Survey (GPPS).

Methods A qualitative study was conducted with 31 staff (comprising service managers, general practitioners and administrators) from 11 out-of-hours primary care providers in England, UK. Staff responsible for patient experience audits within their service were sampled and data collected via face-to-face semistructured interviews.

Results Although most providers regularly audited their patients’ experiences by using patient surveys, many participants expressed a strong preference for additional qualitative feedback. Staff provided examples of small changes to service delivery resulting from patient feedback, but service-wide changes were not instigated. Perceptions that patients lacked sufficient understanding of the urgent care system in which out-of-hours primary care services operate were common and a barrier to using feedback to enable change. Participants recognised the value of using patient experience feedback to benchmark services, but perceived weaknesses in the out-of-hours items from the GPPS led them to question the validity of using these data for benchmarking in its current form.

Conclusions The lack of clarity around how out-of-hours providers should audit patient experience hinders the utility of the National Quality Requirements. Although surveys were common, patient feedback data had only a limited role in service change. Data derived from the GPPS may be used to benchmark service providers, but refinement of the out-of-hours items is needed.

Systematic review of the use of behaviour change techniques (BCTs) in home-based cardiac rehabilitation programmes for patients with cardiovascular disease-protocol

BACKGROUND: Cardiovascular diseases (CVDs), including myocardial infarction, heart failure, peripheral arterial disease and strokes, are highly prevalent conditions and are associated with high morbidity and mortality. Cardiac rehabilitation (CR) is an effective form of secondary prevention for CVD but there is a lack of information regarding which specific behaviour change techniques (BCTs) are included in programmes that are associated with improvements in cardiovascular risk factors. This systematic review will describe the BCTs which are utilised within home-based CR programmes that are effective at reducing a spectrum of CVD risk factors.

METHODS/DESIGN: The review will be reported in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidance. Randomised and quasi-randomised controlled trials of home-based CR initiated following a vascular event (myocardial infarction, heart failure, peripheral arterial disease and stroke patients) will be included. Articles will be identified through a comprehensive search of MEDLINE, Embase, PsycINFO, Web of Science and Cochrane Database guided by a medical librarian. Two review authors will independently screen articles retrieved from the search for eligibility and extract relevant data, identifying which specific BCTs are included in programmes that are associated with improvements in particular modifiable vascular risk factors.

DISCUSSION: This review will be of value to clinicians and healthcare professionals working with cardiovascular patients by identifying specific BCTs which are used within effective home-based CR. It will also inform the future design and evaluation of complex health service interventions aimed at secondary prevention in CVD.

Increasing the use of group interventions in a pediatric rehabilitation program: perceptions of administrators, therapists, and parents

Objectives. To explore perceptions related to increased utilization of group interventions as a part of the service reorganization within a pediatric rehabilitation program. Methods. Individual interviews with program administrators (n=13) and focus groups with therapists (n=19) and parents of children with disabilities (n=5) were conducted. Data were analyzed using a coding grid inspired by the organized action systems theory. Results. Administrators and therapists identified several issues including the need to improve the referral process for groups and the coordination across services. Groups considerably modified practice and required substantial efforts from therapists. Administrators felt groups contributed to increased service accessibility. Although therapists had some doubts about service quality in groups, especially in regard to the reduced attention to individual needs, they reported positive benefits on children’s social participation. Generally, parents were satisfied with group interventions. Conclusion. Groups appear to be a promising method of service delivery, but organizational-related issues should be considered.

Development and implementation of a new service delivery model for children with disabilities : implications for DCD

There is a general consensus that new service delivery models are needed for children with developmental coordination disorder (DCD). Emerging principles to guide service delivery include the use of graduated levels of intensity and evidence-based services that focus on function and participation. Interdisciplinary, community-based service delivery models based on best practice principles are needed. In this case report, we propose the Apollo model as an example of an innovative service delivery model for children with DCD. We describe the context that led to the creation of a program for children with DCD, describe the service delivery model and services, and share lessons learned through implementation. The Apollo model has 5 components: first contact, service delivery coordination, community-, group- and individual-interventions. This model guided the development of a streamlined set of services offered to children with DCD, including early-intake to share educational information with families, community interventions, inter-disciplinary and occupational therapy groups and individual interventions. Following implementation of the Apollo model, waiting times decreased and numbers of children receiving services increased, without compromising service quality. Lessons learned are shared to facilitate development of other practice models to support children with DCD.

How has the Personalisation of Social Care Impacted on Service Users with Dementia?

The personalisation agenda is a government initiative aimed at transforming adult social care through giving service users choice and control over the care they receive. A key part of this agenda is the provision of direct payments; cash payments made to individuals eligible for social care services which allow them to manage their own care. Research suggests that direct payments can enable people with dementia to stay in their own home for longer and experience greater choice, flexibility and an improved social life. However very few people with dementia currently access direct payments. The objective of this research was to explore the social care experiences of people with dementia in relation to their access to and use of direct payments. 26 semi-structured interviews were conducted with people with dementia in receipt of social care services in the community, and their carers and social workers, and focus groups held with two community social work teams. It was found that direct payments tended to be seen as a fall-back option, for example as the only alternative to residential care, or as a solution to problems with traditional services. Direct payments appeared to afford particular benefits to people with dementia in terms of flexibility, continuity of care and access to local facilities. It is therefore important that this group are enabled to access direct payments. The second (ongoing) phase of this research comprises the design and pilot testing of an intervention aimed at improving access to direct payments by people with dementia.

Receptivity to Self-Service Technology (SST): A Research Overview and the Way Forward

In a digital era characterised by the need for efficiency and value, self-service technology rises as a delivery interface offered by public and private sector service providers. With the assumption of a win-win situation for both the provider and customers who can ‘do it themselves’ online/offsite and offline/onsite, stereotypes arise concerning antecedents for positive receptivity and impediments in adopting SSTs. The present paper offers a literature-based discussion of some of the existing and emerging perspectives in this domain; it delivers a contextual review of studies conducted, highlights controversial viewpoints that need to be reconsidered, and suggests future research themes that can make use of the emergent digital sources in data collection and analysis. The purpose is to spark future research on the extent to which SST is a champion for different service types, and to systematically study the customer profile to be targeted for its optimal use in value co-creation.

Using a whole person approach to support people with cancer: a longitudinal, mixed methods service evaluation

Introduction: Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this paper is to (1) evaluate short and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC); (2) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods: Longitudinal mixed-methods service evaluation (n=135). Data collected included health related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity - MYCaW); lifestyle behaviour (bespoke questionnaire) and participants’ experiences over 12 months post course. Results: Statistically and clinically significant improvements from baseline - 12 months in severity of MYCaW Concerns (n=64; p<0.000) and mean total HRQoL (n=66; p<0.000). The majority of MYCaW concerns were ‘psychological and emotional’ and about participants’ wellbeing. Spiritual, emotional and functional wellbeing contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. 3-6 months post-course was identified as the time when more support was most likely to be needed. Conclusions: Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behaviour change were also identified. These data then informed wider and more person-centred clinical provision to increase the maintenance of positive long-term behaviour changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed.

Demsi - a demand response simulator in the context of intensive use of distributed generation

Demand response can play a very relevant role in future power systems in which distributed generation can help to assure service continuity in some fault situations. This paper deals with the demand response concept and discusses its use in the context of competitive electricity markets and intensive use of distributed generation. The paper presents DemSi, a demand response simulator that allows studying demand response actions and schemes using a realistic network simulation based on PSCAD. Demand response opportunities are used in an optimized way considering flexible contracts between consumers and suppliers. A case study evidences the advantages of using flexible contracts and optimizing the available generation when there is a lack of supply.