Perceived barriers and enablers to utilising the Australian National Disability Insurance Scheme for adults with an intellectual disability and their families: A scoping review.

BACKGROUND: The introduction of the National Disability Insurance Scheme (NDIS) in Australia in 2013 promised significant improvements in the lives of adults with intellectual disabilities. Although the scheme enables support, there are challenges associated with establishing eligibility and administering funds. This scoping review explored perceived barriers and enablers to effectively utilising the NDIS for adults with intellectual disabilities and their families. METHOD: A scoping review of the empirical literature on the NDIS and intellectual disabilities included nine studies in this review. These papers were subjected to thematic analysis and the findings were presented as a narrative synthesis. RESULTS: The key themes identified were: (1) Limited understanding of the NDIS process; (2) Language use and capacity assumptions; (3) Unrealistic goals and progress, and difficulty utilising plans; (4) Expectations of families and associated workloads; (5) Opening up opportunities not previously available; (6) Knowledgeable planners who actively seek to involve adults and their families. CONCLUSION: Although qualitative studies demonstrate that adults with an intellectual disability and their families are largely satisfied with the increased opportunities the NDIS has afforded them, there are various areas in which accessibility to services can be improved. In order for the NDIS to continue to improve, the results from this scoping review underline the need for adults with an intellectual disability and their support systems to have their voices heard and be utilised.

When and what to eat? A scoping review of health outcomes of fasting in conjunction with a low-carbohydrate diet.

Over the last several decades, there has been an increase in chronic diseases such as neurodegenerative, inflammatory, cardiovascular disease (CVD) and cancer. Two eating patterns, a low-carbohydrate diet (LCD) and fasting, have been researched independently over this period and found to be beneficial in reducing many of these chronic diseases' detrimental effects. However, there have been limited studies about the synergy of these eating patterns. This current scoping review aims to explore the evidence of the health outcomes of using a LCD in conjunction with fasting. Four databases were searched, and fifteen articles were found that fit the inclusion criteria. The articles reported positive effects of combining the two eating patterns for type 2 diabetes, CVD, inflammatory conditions and weight reduction and maintenance. LCD and fasting together provide synergy in decreasing metabolic syndrome (as the key causes of chronic illnesses), such as insulin levels, fasting glucose, blood pressure, TAG and regulating lipid profile. Due to the paucity of research, further high-quality studies are needed to substantiate this evidence.

The effect of video-based multimedia training on knowledge, attitude, and performance in breast self-examination.

BACKGROUND/OBJECTIVES: Breast neoplasm is one of the most common cancers in Iranian women due to the late diagnosis. Awareness of breast neoplasm and using Breast Self-Examination (BSE) assist in the early detection and treatment of cancer. This study examined the effectiveness of video-based multimedia training versus face-to-face training in awareness of breast neoplasm and BSE and possible factors affecting their effectiveness. METHODS: This research was a pre-test, a post-test experimental study comparing the knowledge, attitude, and performance of women about BSE across two training intervention groups (face-to-face versus video-based multimedia). The study was conducted at Shiraz University of Medical Sciences (SUMS), and 100 women between 20 to 60 years old were allocated to each intervention group via multi-stage cluster sampling (n:110). Three valid and reliable researcher-made questioners were used. Data were analyzed using SPSS 24 with independent t-test, paired t-test, and ANOVA. RESULTS: Both video-based multimedia and face-to-face training methods significantly increased the participant's knowledge, attitude, and skills about breast self-examination (P < 0.001). In the sub-categories, the results showed that the face-to-face training improved negligence and forgetfulness in applying BSE (P = 0.03) and correcting or modifying the previous knowledge around the issue (P = 0.02). The effect of the video-based method on participants with university education was more than on non-university (P = 0.04). CONCLUSION: Incorporating video-based multimedia training in awareness of breast neoplasm and breast self-examination provides an easy, flexible, and affordable way for detection, particularly considering crisis restrictions. This can be of particular attention in more populated, developing/low-income countries and rural and remote areas to enhance equitable access to training and facilitation diagnosis and treatment if applicable.

Medical education and COVID-19 pandemic: a crisis management model towards an evolutionary pathway.

The COVID-19 crisis has had a profound effect on higher education, especially medical education due to its sensitive nature, dealing with people's life and wellbeing. This study presented a crisis management model of how to direct medical education during crises. A qualitative design was used via a focus group among 83 medical education administrators at Shiraz University of Medical Sciences. Four major challenges emerged regarding medical education during the COVID-19 pandemic including "The health and wellbeing of faculty members and students"; "Spatial constraints"; "Time constraints", and "Access to resources". A total of 13 strategies were suggested to tackle the challenges, including virtualization, technological support, empowerment, participation, sharing, helping, integration, compression, omission, flexibility and diversity, severance, protection; and monitoring. For a sustainable educational pathway in medical education, personalized approach to education via the incorporation of technology is essential. This provides opportunities to tackle the issues caused by the crisis, by provision of any time and anywhere approach to education via flexible technologies/platforms adjusted based on the audiences. The scope of crisis management expands not only on individual and academic levels but also on social and global relations.

Exploring attitudes towards smoking behaviour and cessation among hospitalised smokers via a socio-ecological framework: A scoping review.

OBJECTIVES: Cigarette smoking is a leading cause of preventable mortality and disability. Smoke-free policies in healthcare settings have been implemented as a public health measure. This scoping review aims to explore attitudes on smokers' cessation in smoke-free healthcare settings using a socio-ecological framework. METHODS: Four databases were searched for terms: smoking cessation, patient attitudes, and smoke-free policy. Of 420 studies, 17 met full inclusion criteria. RESULTS: The review identified four socio-ecological aspects of smoking cessation in smoke-free healthcare settings: Intrapersonal factors (health literacy, health conditions, and self-efficacy), interpersonal factors (social support, peer pressure, and social responsibility), healthcare factors (perceived mixed messages, healthcare setting, clinical, psychosocial and health promotion supports), and societal factors (restrictions on smoking in a public place and social acceptability of smoking). Smoke-free policies effectively encouraged cessation in some patients but were ineffective in those that felt a loss of autonomy. Provision of smoke breaks within smoke-free policies was considered a mixed message. CONCLUSIONS: Holistic strategies are required to interconnect the four socio-ecological dimensions for successful smoking cessation.

Patient decision aids in clinical practice for people with diabetes: a scoping review.

BACKGROUND: People with diabetes need to make regular choices that influence their long-term morbidity and mortality. Patient decision aids are validated tools and when used collaboratively between healthcare professionals, patients and carers, can help guide value-based discussions which encourage choices that are well informed and personally relevant. OBJECTIVE: To explore the use and effect of patient decision aids in the management of diabetes. METHOD: A scoping review design was used. Medline, ProQuest, PsycINFO, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases were searched for peer-reviewed articles published between January 1998 and December 2018. RESULTS: Patient decision aids are not commonly or widely used in diabetes management. They offer a suitable adjunct to practice within the domains of healthcare knowledge, active participation, and communication, and shared decision-making between patients and healthcare professionals. CONCLUSION: Patient decision aids can offer a simple and easy-to-use method to potentially improve diabetes health literacy, through the process of shared decision-making and two-way conversations. However, there are current limitations on using them to positively influence clinical outcomes or long-term changes in self-care behaviors within the management of diabetes. Further research to explore the validity of using patient decision aids long term in these areas is required.

Occupational Therapy Group Interventions in Oncology: A Scoping Review.

IMPORTANCE: Patients with cancer frequently experience difficulties with everyday activities. This scoping review explores occupational therapy group interventions in oncology, an area relevant to occupational therapy practitioners, but one that has limited evidence. OBJECTIVE: This scoping review examines the association between occupational therapy-based oncology groups and improved functional activity of daily living outcomes for adults with cancer. It poses the following research question: Are occupational therapy groups associated with improved functional outcomes for adults with cancer? DATA SOURCES: Searches of MEDLINE, CINAHL, AMED, OTseeker, Health Source: Nursing/Academic Edition, and OTDBase were completed for peer-reviewed articles published from 1997 to 2018. STUDY SELECTION AND DATA COLLECTION: Inclusion criteria were articles published in English and occupational therapy-based groups for adults with cancer. FINDINGS: Eight articles matched the inclusion criteria. The articles reviewed were 2 randomized controlled trials, 1 case study, 1 descriptive exploratory research study, 1 mixed-methods study, 2 pretest-posttest studies, and 1 longitudinal prospective comparative study. CONCLUSIONS AND RELEVANCE: Occupational therapy groups led to a significant increase in occupational performance and satisfaction, an improvement in functioning, and a decrease in fatigue. Engagement in important roles and occupations and sharing the experience with others were also highly valued. This review provides support for the implementation of group-based occupational therapy interventions in oncology. Further research is required in this area, particularly in the inpatient setting with men included in the sample. WHAT THIS ARTICLE ADDS: This scoping review demonstrates the benefits of group-based occupational therapy interventions for adult patients with cancer.

The effect of different levels of leachate on phytoremediation of pyrene-contaminated soil and simultaneous extraction of lead and cadmium.

Pyrene is one of the 16 group combinations of polyaromatic hydrocarbons, which are known as primary pollutants in the U.S. Environmental Protection Agency (USEPA) list. This study aimed to investigate the cross effect of different levels of landfill leachate on phytoremediation of pyrene-contaminated soil using the sorghum bicolor plant. The study parameters included the presence or absence of the plant, different concentrations of pyrene (150, 300, 500, 750, and 1000 mg kg-1), time (30, 60, and 90 days), and different levels of irrigation with leachate (0, 30, 50, 70, and 100%). Soil pyrene was measured every 30 days, and heavy metals (lead and cadmium) added to the soil by irrigation with leachate were measured in the soil and the plant at the end of 90 days. According to the results, pyrene removal efficiency after 90 days was 96% in irrigation treatments with 30% leachate in the presence of the plant and 67% in irrigation treatments with tap water in the presence of the plant. In addition, 95% of lead and 49% of cadmium added to the soil by irrigation with 30% leachate were extracted from the soil by the sorghum bicolor. According to the results, by increasing nutrients and number of soil bacteria during the cross treatment, landfill leachate increased the pyrene removal efficiency significantly during phytoremediation (p < 0.006) and the sorghum bicolor plant extracted the lead and cadmium of the leachate. In non-planting treatments, although adding high levels of leachate to the soil significantly improved the pyrene removal, it caused the levels of heavy metals, such as lead and cadmium, to exceed the allowable limit (p < 0.001).

Nurse practitioner interventions for smokers with chronic hepatitis C.

BACKGROUND: Smoking is a grossly overlooked risk factor for people with chronic hepatitis C with regard to disease progression. It is unclear whether current smoking cessation interventions are effective for this population. PURPOSE: The purpose was to evaluate the effectiveness of a telephone counseling and nicotine replacement therapy (NRT) intervention for smokers with chronic hepatitis C to quit or reduce rates of smoking. METHODS: A randomized controlled trial was conducted with participants randomized and stratified according to heaviness of smoking. Ninety-two eligible adults who smoked cigarettes and attended hepatology outpatient clinics were recruited. The intervention included NRT and telephone counseling compared with telephone counseling alone. Data collection occurred from December 2010 to November 2011. Data were collected at baseline, 6, and 12 weeks to assess smoking cessation. Change scores were analyzed using analysis of variance to examine the differences between smoking interventions. RESULTS: At 6 weeks, both control and intervention groups had quit or reduced the number of cigarettes smoked daily. However, over 12 weeks, the intervention group showed sustained quitting or reduced smoking, with 5.8 (confidence interval [CI]: 2.4, 9.3) fewer cigarettes smoked per day from baseline. The control group maintained an average reduction of 1.6 (CI: -1.9, 5.2) fewer cigarettes per day. IMPLICATIONS FOR PRACTICE: Nicotine replacement therapy and individualized telephone counseling interventions increase the prospects of smoking cessation. Interventions such as these, introduced at routine clinic appointments in the outpatients' setting, by a nurse practitioner (hepatology) showed clinically important results for smoking cessation in this population.