Developing a care home data platform in Scotland: a mixed methods study of data routinely collected in care homes.

BACKGROUND: care homes collect extensive data about their residents, and their care, in multiple ways, for multiple purposes. We aimed to (i) identify what data are routinely collected and (ii) collate care home managers' views and experiences of collecting, using and sharing data. METHODS: we examined data collected in six care homes across Lothian, Scotland. We extracted the meta-data, cross-referenced definitions and assessed the degree of harmonisation between care homes and with data sets currently in use in Scotland and internationally. We interviewed care home managers about their views and experiences of collecting, using and sharing data. RESULTS: we identified 15 core data items used routinely, with significant heterogeneity in tools and assessments used, and very limited harmonisation. Two overarching themes were identified of importance to the development of a care home data platform: (i) the rationale for collecting data, including to (a) support person-centred care, (b) share information, (c) manage workforce and budget and (d) provide evidence to statutory bodies and (ii) the reality of collecting data, including data accuracy, and understanding data in context. DISCUSSION: considerable information is collected by care home staff, in varied formats, with heterogeneity of scope and definition, for range of reasons. We discuss the issues that should be considered to ensure that individual resident-level form the strong foundations for any data platform for care homes, which must also include, robust infrastructure and clear interoperability, with appropriate governance. It must be co-produced by academics, policy makers and sector representatives, with residents, their families and care staff.

The implementation and impact of Holistic Needs Assessments for people affected by cancer: A systematic review and thematic synthesis of the literature.

OBJECTIVE: Globally, cancer services herald the use of Holistic Needs Assessments (HNA). Implementation is, however, heterogeneous. There is a need to understand what effect implementation variation has on patient experience, outcomes and service demand. This is the first study to examine whether the way in which HNA is implemented, impacts on patient outcomes. METHODS: MEDLINE, AMED, CINAHL, PsycINFO and the Psychological and Behavioural Sciences Collection were searched (June 2000-June 2018). Search strategy included international HNA tools and synonyms for "needs." An overview of quality was obtained through application of the Mixed Methods Appraisal Tool. Key themes were identified through thematic synthesis. RESULTS: Twenty studies were included (RCTs [n = 4], service evaluations [n = 8] and feasibility studies [n = 8]). Implementation approaches and assessor actions were identified and through thematic synthesis were defined as detecting, discussing/dealing, directing and downstream care. The way in which HNA is implemented is more important to understanding outcomes than what is implemented. CONCLUSION: There is a need to conceptualise HNA as a means and not an end in itself. Pursuers of HNA-led outcomes must understand and strengthen connections between assessment and outcomes. The conceptual framework can assist development of more insightful measures of both process and outcomes.

Protocol for a longitudinal mixed methods realist evaluation of holistic needs assessment and care planning for people affected by cancer.

BACKGROUND: In 2012, approximately 14 million new cases of cancer were diagnosed. As a result of advances in treatment, screening and prevention programmes the number of people surviving cancer globally is also increasing. The growing understanding of the diversity and scale of the need for support, compounded by the increasing prevalence of cancer survivors has fuelled the development and evaluation of a range of services and models to meet them. A key intervention is the holistic needs assessment and care planning, however there is little homogeneity in its actual delivery to cancer survivors. To fill this evidence gap there is a need to understand any effect implementation variables have on patient experiences, measurable outcomes and resource use. We are exploring this through a realist evaluation of holistic needs assessment and care planning. METHODS: This longitudinal, mixed method realist evaluation has been approached in 4 phases. Phases 1 and 2 have been completed (2014-2017) and a summary of this work is presented. We then provide a detailed protocol for Phases 3 and 4 (2017 onwards). Phase 1: Establishment of programme theory for HNA and care planning; Phase 2: Exploration and documentation of local programme theories; Phase 3: Theory testing and refinement and Phase 4 - Theory validation and dissemination. Phase 3 draws on a range of data derived from 6 study sites. Methods include analysis of patient characteristics and concerns identified, qualitative interviews /fieldwork with local project staff, national stakeholders, professionals using the needs assessment tool and patients, a three-year longitudinal online survey of wider programme stakeholders and a review and synthesis of local project evaluations and patient care plans. DISCUSSION: This intervention is a key component globally of cancer survivorship care. The results of this realist evaluation can be used to optimise the delivery and development of HNA and care planning for people affected by cancer. To our knowledge this is the first study of this type. By utilising the discipline of Realistic Evaluation this mixed methods study will elicit findings with greater potential for generalisability and transferability within Scotland, the UK and beyond.

Practicalities of promoting practice-based learning in end of life care for care home staff: Lessons from "online" supportive conversations and reflection sessions.

INTRODUCTION: Deaths in care homes and "at home" are anticipated to account for a third of UK deaths by 2040. Currently, palliative and end of life care are not part of statutory training in care homes. Reflective practice is a tool that can facilitate practice-based learning and support. Following a feasibly study to test "online" supportive conversations and reflection sessions (OSCaRS) to support care home staff in relation to death/dying during the first months of the COVID pandemic, a one-year practice development follow-up project was undertaken with the aim to create a team of NHS/specialist palliative care (SPC)-based facilitators to lead and support OSCaRS provision in up to 50 care homes in one region in Scotland-the focus of this paper. METHODS: Forty care home managers attended an on-line session explaining the project, with a similar session held for 19 NHS/SPC-based nurses external to care homes. Those interested in facilitating OSCaRS then attended three education sessions. DATA COLLECTED: records of all activities; reflective notes on OSCaRS organised/delivered; a summary of each OSCaRS reflection/learning points; final interviews with NHS/SPC trainee facilitators. RESULTS: A total of 19 NHS/SPC facilitators delivered one or more OSCaRS in 22 participating care homes. However, as of January 2022 only six trained facilitators remained active. Out of the 158 OSCaRS arranged, 96 took place with a total of 262 staff attending. There were three important aspects that emerged: the role, remit, and resources of NHS/SPC supporting OSCaRS; requirements within care homes for establishing OSCaRS; and, the practice-based learning topics discussed at each OSCaRS. CONCLUSION: Attempts to establish a team of NHS/SPC facilitators to lead OSCaRS highlights that end of life care education in care homes does not clearly fall within the contractual remit of either group or risks being missed due to more pressing priorities.

Workplace ageism: discovering hidden bias.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Research largely shows no performance differences between older and younger employees, or that older workers even outperform younger employees, yet negative attitudes towards older workers can underpin discrimination. Unfortunately, traditional "explicit" techniques for assessing attitudes (i.e., self-report measures) have serious drawbacks. Therefore, using an approach that is novel to organizational contexts, the authors supplemented explicit with implicit (indirect) measures of attitudes towards older workers, and examined the malleability of both. METHODS: This research consists of two studies. The authors measured self-report (explicit) attitudes towards older and younger workers with a survey, and implicit attitudes with a reaction-time-based measure of implicit associations. In addition, to test whether attitudes were malleable, the authors measured attitudes before and after a mental imagery intervention, where the authors asked participants in the experimental group to imagine respected and valued older workers from their surroundings. RESULTS: Negative, stable implicit attitudes towards older workers emerged in two studies. Conversely, explicit attitudes showed no age bias and were more susceptible to change intervention, such that attitudes became more positive towards older workers following the experimental manipulation. CONCLUSION: This research demonstrates the unconscious nature of bias against older workers, and highlights the utility of implicit attitude measures in the context of the workplace. In the current era of aging workforce and skill shortages, implicit measures may be necessary to illuminate hidden workplace ageism.

The role of self-efficacy, coping, and lapses in weight maintenance.

PURPOSE: Successful weight maintenance after weight loss is exceedingly rare. The present study aimed to identify psychological predictors of lapses and weight maintenance. METHODS: Self-efficacy, coping, and perceptions of lapses were examined as potential predictors of lapse frequency and weight maintenance (percentage weight loss maintained). Participants included 67 adults (85.3 % women) who had intentionally lost a mean of 16 % of their body weight and had stopped losing weight at least 6 months prior to data collection. Participants completed a 7-day lapse diary tracking the frequency and perceived severity of their dietary and activity lapses, along with questionnaires on self-efficacy, coping, and characteristics of their weight loss. RESULTS: Participants had lost a mean of 13.9 kg, 20.4 months prior to data collection. More frequent lapsing was correlated with lower self-efficacy and greater perceived lapse severity. Lower percentage of weight loss maintained was correlated with lower self-efficacy, poorer coping, greater perceived lapse severity, and longer time since weight loss ended. "Regainers," who maintained <90 % of their weight loss, had poorer self-efficacy, poorer coping, greater lapse frequency, and greater perceived lapse severity, than "maintainers," who maintained at least 90 % of their weight loss. CONCLUSIONS: The results suggest that self-efficacy, coping, and perceived lapse severity are significant predictors of weight maintenance, consistent with the relapse prevention model. The goals of improving self-efficacy and coping skills might be important additions to weight maintenance programs.

Liquid-Metal Solvents for Designing Hierarchical Nanoporous Metals at Low Temperatures.

Metallic nanoarchitectures hold immense value as functional materials across diverse applications. However, major challenges lie in effectively engineering their hierarchical porosity while achieving scalable fabrication at low processing temperatures. Here we present a liquid-metal solvent-based method for the nanoarchitecting and transformation of solid metals. This was achieved by reacting liquid gallium with solid metals to form crystalline entities. Nanoporous features were then created by selectively removing the less noble and comparatively softer gallium from the intermetallic crystals. By controlling the crystal growth and dealloying conditions, we realized the effective tuning of the micro-/nanoscale porosities. Proof-of-concept examples were shown by applying liquid gallium to solid copper, silver, gold, palladium, and platinum, while the strategy can be extended to a wider range of metals. This metallic-solvent-based route enables low-temperature fabrication of metallic nanoarchitectures with tailored porosity. By demonstrating large-surface-area and scalable hierarchical nanoporous metals, our work addresses the pressing demand for these materials in various sectors.

Sensitivity to posed and genuine facial expressions of emotion in severe depression.

The aim of the current study was to investigate whether the ability to distinguish genuine from non-genuine (neutral or posed) facial expressions of emotion (happiness, sadness, fear and disgust) is impaired in depression, and whether improvement in this ability occurs with treatment response. Sixty-eight depressed inpatients and 50 matched healthy controls performed the Emotion Categorisation Task three times over 6 weeks. All participants showed some sensitivity to the meaningful differences between genuine and non-genuine expressions of emotion, with an increasing percentage of faces labelled as genuinely feeling the emotion from neutral to posed to genuine presentations. Depressed patients showed significantly less sensitivity in differentiating non-genuine from genuine expressions of sadness, compared with healthy controls. Performance on the Emotion Categorisation Task did not change over time in treatment responders compared with treatment non-responders. These findings have implications for understanding why depressed individuals may have difficulties in social interactions.

Foundation Level Barriers to the Widespread Adoption of Digital Solutions by Care Homes: Insights from Three Scottish Studies.

The care home sector has great potential to benefit from technological innovations and to be at the forefront of developing novel digital solutions to improve the experiences of care home residents, their families, and the staff caring for them. The COVID-19 pandemic exposed variability in digital capabilities and longstanding data challenges within the care home sector. Paradoxically, however, it also increased the use of digital tools and services to support residents and staff. There are, however, a number of barriers to sustained and widespread adoption of digital solutions by care homes. Here, the focus is on foundation-level barriers and the groundwork required to overcome them. Using data from three Scottish-based studies, foundation-level barriers to the adoption of digital tools and services faced by care homes are discussed. These main barriers are the need for robust basic internet connectivity; capabilities for digital data collection; access to data to inform and drive digital solutions; the need for trust in the use of resident data by commercial companies; and the danger that poorly coordinated strategies undermine efforts to build a care home data platform and the digital solutions it can support. Sustained and widespread adoption of digital solutions by care homes will require these foundation-level barriers to be addressed. Strong and stable data and digital foundations supported by sector-specific scaffolding are major prerequisites to the widespread adoption of digital solutions by care homes.

Social exclusion enhances affiliative signaling.

Reciprocating smiles is important for maintaining social bonds as it both signals affiliative intent and elicits affiliative responses. Feelings of social exclusion may increase mimicry as a means to regulate affiliative bonds with others. In this study, we examined whether feelings of exclusion lead people to selectively reciprocate the facial expressions of more affiliative-looking people. Participants first wrote about either a time they were excluded or a neutral event. They then classified 20 smiles-half spontaneous smiles and half posed. Facial electromyography recorded smile muscle activity. Excluded participants distinguished the two smile types better than controls. Excluded participants also showed greater zygomaticus major (mouth smiling) activity toward enjoyment smiles compared to posed smiles; control participants did not. Orbicularis oculi (eye crinkle) activity matched that of the smile type viewed, but did not vary by exclusion condition. Affiliative social regulation is discussed as a possible explanation for these effects.

Advances in Biosensors for Continuous Glucose Monitoring Towards Wearables.

Continuous glucose monitors (CGMs) for the non-invasive monitoring of diabetes are constantly being developed and improved. Although there are multiple biosensing platforms for monitoring glucose available on the market, there is still a strong need to enhance their precision, repeatability, wearability, and accessibility to end-users. Biosensing technologies are being increasingly explored that use different bodily fluids such as sweat and tear fluid, etc., that can be calibrated to and therefore used to measure blood glucose concentrations accurately. To improve the wearability of these devices, exploring different fluids as testing mediums is essential and opens the door to various implants and wearables that in turn have the potential to be less inhibiting to the wearer. Recent developments have surfaced in the form of contact lenses or mouthguards for instance. Challenges still present themselves in the form of sensitivity, especially at very high or low glucose concentrations, which is critical for a diabetic person to monitor. This review summarises advances in wearable glucose biosensors over the past 5 years, comparing the different types as well as the fluid they use to detect glucose, including the CGMs currently available on the market. Perspectives on the development of wearables for glucose biosensing are discussed.

Why are you smiling at me? Social functions of enjoyment and non-enjoyment smiles.

In three experiments, we investigated the spontaneous attention of perceivers to the nature of targets' facial expressions, specifically whether they were displaying an enjoyment or a non-enjoyment smile. Further, we investigated the social functions of sensitivity to smile type and the consequences of such sensitivity for subsequent interactions. Results demonstrated that perceivers did indeed spontaneously attend to smile type, especially in situations where issues of trust or cooperation were made salient. Further, this sensitivity had an impact both on the evaluations of the target individuals and the cooperative behaviour of individuals towards those displaying enjoyment and non-enjoyment smiles. Participants evaluated individuals displaying enjoyment smiles more positively than those displaying non-enjoyment smiles and had higher rates of cooperation with those displaying enjoyment smiles. These results are discussed in terms of the social functions of facial expressions.

Sensitivity to differences between enjoyment and non-enjoyment smiles in children with autism spectrum disorder.

The sensitivity of male children (5-15 years) with and without autism spectrum disorder (ASD) to the affective state of others was tested using an emotion recognition task. Only children without ASD could reliably differentiate between enjoyment and non-enjoyment smiles. Results are considered in terms of the social impairments of children with ASD.

Factors affecting bowel preparation adequacy and procedural time.

BACKGROUND AND AIM: Poor bowel preparation results in difficult colonoscopies, missed lesions, and repeat procedures. Identifying patient risk factors for poor bowel preparation, such as prolonged runway time and prolonged cecal intubation, will aid in interventions prior to a procedure. METHODS: This was a retrospective, single-center analysis of 3 295 colonoscopies performed between May 2012 and November 2014. Indications for colonoscopy included gastrointestinal bleed and anemia, change in bowel habits, for screening, and others (including planning re-anastomoses, abdominal distension, family history and angioectasias). Data were collected from medical charts and endoscopy reports. Comparisons between patient factors and runway time were made with adequacy of bowel preparation as the primary outcomes. RESULTS: Male and diabetic patients had statistically higher rates of inadequate bowel preparation and prolonged cecal intubation times. A previous history of abdominal surgery also demonstrated prolonged cecal intubation. A runway time of ≤7.63 h was associated with higher rates of adequate bowel preparation by multivariate analysis. The optimal time frame is 3-6 h for the highest success rates. CONCLUSION: Patient risk factors for inadequate bowel preparation or prolonged cecal intubation should signal clinicians to intervene prior to colonoscopy. A runway time between 3 and 6 h is optimal for adequate bowel preparation. This may involve further patient education, along with work flow optimization, to facilitate ideal runway times. Future studies should explore how to avoid repeat endoscopies using protocols enforcing this timeframe.

Brain activation during processing of genuine facial emotion in depression: Preliminary findings.

OBJECTIVE: The current study aimed to examine the neural correlates of processing genuine compared with posed emotional expressions, in depressed and healthy subjects using a novel functional magnetic resonance imaging (fMRI) paradigm METHOD: During fMRI scanning, sixteen depressed patients and ten healthy controls performed an Emotion Categorisation Task, whereby participants were asked to distinguish between genuine and non-genuine (posed or neutral) facial displays of happiness and sadness. RESULTS: Compared to controls, the depressed group showed greater activation whilst processing genuine versus posed facial displays of sadness, in the left medial orbitofrontal cortex, caudate and putamen. The depressed group also showed greater activation whilst processing genuine facial displays of sadness relative to neutral displays, in the bilateral medial frontal/orbitofrontal cortex, left dorsolateral prefrontal cortex, right dorsal anterior cingulate, bilateral posterior cingulate, right superior parietal lobe, left lingual gyrus and cuneus. No differences were found between the two groups for happy facial displays. LIMITATIONS: Relatively small sample sizes and due to the exploratory nature of the study, no correction was made for multiple comparisons. CONCLUSION: The findings of this exploratory study suggest that depressed individuals may show a different pattern of brain activation in response to genuine versus posed facial displays of sadness, compared to healthy individuals. This may have important implications for future studies that wish to examine the neural correlates of facial emotion processing in depression.

Where did that car come from?: Crossing the road when the traffic comes from an unfamiliar direction.

Using a virtual road crossing environment, the reported research investigated the road crossing behavior of 12 male pedestrians in familiar and unfamiliar environments. Environment familiarity was manipulated using traffic direction. Seven of the participants were from a country where traffic flows from right to left and five were from countries were traffic flows from left to right. Each participant was asked to cross the road when traffic was coming from both the familiar and the unfamiliar direction for them. Results showed that pedestrians had lower safety ration, or a lower margin of error, in crossing the road when traffic was flowing in an unfamiliar direction, suggesting that pedestrians might be at greater risk of accident in such environments. Implications of these findings are discussed.

An investigation of road crossing in a virtual environment.

The reported study employed a virtual reality (VR) system, using a head mounted display (HMD), to investigate road crossing behavior in children and young adults. Younger children (aged 5-9 years) made the greatest number of unsafe road crossings and the oldest participants (aged >19 years) the fewest. Overall performance was better (fewer unsafe road crossings) in uniform speed than uniform distance trials, consistent with previous research suggesting that pedestrians base road crossing decisions on inter-vehicle distance rather than vehicle speed. Results are discussed in terms of road crossing behavior and the use of VR simulations in the study of pedestrian behavior.

Modeling and control of the agitation-sedation cycle for critical care patients.

Agitation-sedation cycling in critically ill patients, characterized by oscillations between states of agitation and over-sedation, is damaging to patient health, and increases length of stay and healthcare costs. The mathematical model presented captures the essential dynamics of the agitation-sedation system for the first time, and is statistically validated using recorded infusion data for 37 patients. Constant patient-specific patient parameters are used, illustrating the commonality of these fundamental dynamics over a broad range of patients. The validated model serves as a basis for comparison of sedation administration methods, devices, therapeutics and protocols. Heavy derivative feedback control is shown to be an effective means of managing agitation, given consistent agitation measurement. The improved agitation management reduces the modeled mean and peak agitation levels 68.4% and 52.9% on average, respectively. Some patients showed over 90% reduction in mean agitation level through increased control gains. This improved agitation management is achieved via heavy derivative feedback control of sedation administration, which provides an essentially bolus-driven management approach, aligned with recent sedation practices.