Feasibility of using the Cognitive Orientation to daily Occupational Performance in a population of Danish stroke survivors: Adaptation and study protocol.

BACKGROUND: A need was identified for an occupational therapy intervention for stroke survivors in a Danish municipal healthcare setting with emphasis on its ability to transfer and generalise what is learned in occupational therapy to everyday life post therapy. Being a possible candidate, the Cognitive Orientation to daily Occupational Performance (CO-OP) approach needed to be adapted to the target group and context, and its feasibility needed examination regarding reach, dose, intervention components, fidelity, perceived value, benefits, harms, and potential outcomes. AIM: To adapt the CO-OP to a Danish healthcare setting and present a protocol for examining its feasibility. MATERIAL AND METHODS: The Adapting interventions to new contexts (ADAPT) guidance was followed to (1) Assess the rationale for intervention and consider intervention-context fit, (2) Plan and undertake adaptations, and (3) Plan a feasibility study. RESULTS: Intervention materials and procedures were translated and adapted for home-based occupational therapy with people in the subacute phase of stroke. A protocol was developed to examine feasibility aspects. Quantitative and qualitative evaluations were planned and measurements chosen. CONCLUSIONS AND SIGNIFICANCE: The planned feasibility study will contribute to further developing and refining the intervention before performing a possible large-scale effectiveness study.

A Parkinson care-coordinator may make a difference: A scoping review on multi-sectoral integrated care initiatives for people living with Parkinson's disease and their caregivers.

OBJECTIVE: To identify multi-sectoral integrated care initiatives for people with Parkinson's disease and caregivers. METHOD: Following the Matrix Method we created a synthesis of literature across methodological approaches. The search was conducted in four databases until June 2022, and included studies focusing on multi-sectoral integrated care initiatives, and how they helped people with Parkinson's disease and caregivers in everyday living. RESULTS: The search yielded 5921 articles of which nine were included. We identified four topics describing characteristics of multi-sectoral integrated care initiatives: 1) Peer-support, 2) Personalised care plan, 3) One-off initiatives limited in time and 4) Presence of a coordinator. And four topics describing how the initiatives helped in everyday living: 1) Confidence, trust and support, 2) Positive changes in health outcomes, 3) Quality of life, coping skills & psychosocial adjustment, and 4) A strengthened multi-agent collaboration and personalised assistance. CONCLUSION: Multi-sectoral integrated care initiatives should be ongoing offers, and include a Parkinson care-coordinator, who can enhance multi-sectoral communication and an individualised approach to information about resources responsive to evolving needs at different disease stages. PRACTICE IMPLICATIONS: Initiatives should be multidisciplinary, multi-sectoral and aimed at people with Parkinson's disease and caregivers, preferably facilitated by a care-coordinator to promote cross-sectoral communication.

Strengthening problem-solving skills through occupational therapy to improve older adults' occupational performance - A systematic review.

Background: Evidence supports the role of occupational therapy (OT) for older adults, and therapeutic use of problem solving may provide a way to improve older adult's occupational performance.Aim: To assess the effectiveness and describe the contents of OT interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills.Material and Methods: This systematic review followed the phases recommended by the Cochrane Collaboration. The following databases were searched for clinical trials on OT for populations 65+ years: CINAHL, EMBASE, MEDLINE and PsycINFO. The Cochrane risk-of-bias tool (RoB-2) and the GRADE approach were used to assess the quality of the evidence. Results were presented in tables and by narrative syntheses.Results: Five studies were included comprising a total of 685 participants. In four studies, OT with a problem-solving approach outperformed control conditions post intervention. The interventions involved problem identification, analysis, strategy development and implementation. Although no serious risk of bias was detected in the individual studies, the quality of evidence was deemed low due to inconsistent and imprecise results.Conclusions: Low-quality evidence suggests that strengthening older adults' problem-solving skills may improve their occupational performance.Significance: Further investigation is required before firm practice recommendations can be prepared.

What Does It Take for Research to Be Rehabilitation Research?

Six recommendations to facilitate rehabilitation research and supplement existing research practices were identified. Rehabilitation practice requires research addressing different long-term multi-faceted needs and perspectives of end users, including service users, professionals, politicians, and administrators. Research in rehabilitation should therefore integrate different research traditions and methods. Rehabilitation research with a broad focus is sparse, and most of the research takes its starting point in the biomedical research tradition. Through a nominal group process, we developed recommendations to emphasize important issues in rehabilitation research.

Exploring health and social services in Denmark, Norway, Spain and the United Kingdom for the development of Parkinson's care pathways. A document analysis.

People with Parkinson's disease (PD) may find it difficult to identify and access the wide number of services they need and are entitled to along their complex PD journey. As part of the project OPTIM-PARK - Optimisation of community resources and systems of support to enhance the process of living with Parkinson's Disease, document analysis was developed to create overviews of existing resources and systems of support in Denmark, Norway, Spain and the United Kingdom. Documents on community resources, policies, guidelines and professional recommendations were the main sources of information. They were sought systematically at official websites of the public sector (national and regional levels) and websites of non-governmental organisations and scientific societies; searches were performed in October 2020 and updated in September 2021. A higher-level cross-national content analysis integrated all the country-specific information. Data- and concept-driven coding frames were developed; trial coding and peer review strengthened face validity and reliability. The analysis led to overviews of: (1) Key aims at patient and societal levels. (2) Key elements in form of professional approaches. (3) Community resources. (4) Legally anchored services. In general, clear descriptions of how to implement care pathways and tools to facilitate delivery were missing in the included documents, and pathways and guidelines did not include referral to general social support, social security support or labour and employment support. The results shed light on the complex support systems and resources and can inspire the planning of more comprehensive care pathways for people with PD and other long-term conditions.

A Case of Congenital Pulmonary Vein Stenosis with Secondary Post-Capillary Pulmonary Hypertension and Left Sided Congestive Heart Failure in a Cat.

A five-month-old, 3.8 kg intact male Maine coon cat presented for dyspnea characterized by increased respiratory effort in addition to open-mouth breathing. Thoracic radiographs showed pectus excavatum, enlarged cardiac silhouette, and generalized interstitial patterns. Echocardiography revealed normal left atrial (LA) and left ventricular dimensions. A large tubular structure, suspected to be a distended pulmonary vein (PV), was identified as draining into the LA. Severe eccentric and concentric right ventricular hypertrophy and paradoxical septal motion were noted. Based on Doppler echocardiography, both pulmonary venous and pulmonary artery pressure was severely elevated. Clinical, radiographic, and echocardiographic abnormalities were hypothesized to result from pulmonary vein stenosis (PVS), causing severely elevated pulmonary venous pressures and resulting in clinical signs of left-sided congestive heart failure (L-CHF) and severe post-capillary pulmonary hypertension (Pc-PH). The prognosis for good quality of life was assessed as poor, and the owner elected euthanasia. Necropsy confirmed the presence of PVS with severe dilation of the PVs draining all but the left cranial lung lobe. All lung lobes except the left cranial lobe had increased tissue density and a mottled cut surface. This case report shows that, in rare cases, both L-CHF and Pc-PH may be present without LA enlargement. To the authors' knowledge, this is the first report on PVS in veterinary medicine.

Can strengthening older adults' problem-solving skills through occupational therapy improve their occupational performance? A protocol for a systematic review and meta-analysis.

BACKGROUND: Older adults' occupational performance is challenged due to chronic health conditions, aging processes, and deteriorating functioning. Thus, their occupational performance cannot be expected to remain stable in the long term after an occupational therapy intervention. Older adults may therefore need to strengthen their problem-solving skills during occupational therapy not only to solve current occupational performance issues but also to maintain their improvements and deal with new such issues a later point in time. AIMS: This systematic review and meta-analysis aims to identify, analyse and present current scientific knowledge about the effectiveness and contents of occupational therapy interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills. METHODS: MEDLINE, EMBASE, CINAHL and PsycINFO will be searched systematically to identify trials of occupational therapy interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills. We will include randomized controlled trials and quasi-experimental trials in populations aged 65+. Three reviewers will independently screen and select references, extract data and assess the quality of included studies using the Cochrane Collaboration's risk of bias tool. SIGNIFICANCE: The findings can inform and inspire clinical practice and will help to identify the need for further research.

Occupational therapists' competencies utilised in Danish job centres.

BACKGROUND: Twenty-nine out of 94 Danish job centres employ occupational therapists (OTs) and numbers are increasing. Occupational therapy (OT) vocational rehabilitations are diverse, and a more specific description of OT practice within this field is lacking. AIMS: To explore how OTs employed at Danish job centres describe their own competencies and what they perceive that their colleagues from other professions request from them. MATERIAL AND METHODS: Firstly, working diaries were obtained from 16 OTs working in job centres and analysed using content analysis. Secondly, semi-structured interviews were performed and analysed using systematic text condensation. RESULTS: The 16 OTs described four areas of competencies to their profession's practice within job centres; client-centeredness; a holistic approach; work ability assessments and ergonomics and adaptation. The OTs perceived that their colleagues requested their work ability assessment skills and their competencies as health professionals. CONCLUSION: The OTs had a client-centered and holistic focus on the citizens' whole life situation and used their health professional education and knowledge of ergonomics and adaptation to strengthen their work ability assessments. SIGNIFICANCE: The OTs perceived that they had competencies that supplemented the competencies of the interdisciplinary team. The results therefore support the inclusion of OTs within job centres.

Intensive client-centred occupational therapy in the home improves older adults' occupational performance. Results from a Danish randomized controlled trial.

BACKGROUND: There is growing interest in enabling older adults' occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults. METHODS: An assessor-masked randomized controlled trial among adults 60 + with chronic health issues, who received or applied for homecare services. Recruitment took place September 2012 to April 2014. All participants received practical and personal assistance and meal delivery as needed. In addition, they were randomized to receive either a maximum 22 sessions of occupation-based ICC-OT (N = 59) or to receive usual practice with a maximum three sessions of occupational therapy (N = 60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM). RESULTS: No important adverse events occurred. ICC-OT was accepted by 46 participants (88%), usual practice by 60 (100%). After 3 months, the ICC-OT-group had improved 1.86 points on COPM performance; the Usual-Practice group had improved 0.61 points. The between-group difference was statistically significant (95% confidence interval 0.50 to 2.02), t-test: p = 0.001. CONCLUSIONS: ICC-OT improved older adults' occupational performance more effectively than usual practice. This result may benefit older adults and support programmatic changes.

LED virtual windows are valuable in windowless consultation rooms.

INTRODUCTION: Due to the design of Hvidovre Hospital, the outpatient clinic of the Department of Paediatrics has windowless consultation rooms. Work environment surveys revealed that nurses and doctors working in these windowless rooms considered the lack of natural light a considerable health problem. This study evaluated the effects of installing light-emitting diode (LED) virtual windows in these rooms. METHODS: Four similar windowless consultations rooms located next to each other were used in the study. All had older T-5 fluorescent luminaires installed. In two of these rooms, Servodan LED virtual windows depicting various natural scenes were installed. The illuminance and correlated colour temperature (CCT) of each room's lighting was measured, and a work environment questionnaire was filled out by nurses and doctors working in each room. RESULTS: A total of 113 questionnaires were collected and evaluated. LED virtual windows produced an improved perception of lighting conditions, both at the desk (p < 0.001) and in the rooms in general (p < 0.001) and improved the overall positive experience of the rooms (p = 0.02). A tendency towards concentration difficulties was reported less often in the rooms with LED virtual windows, (p = 0.11). Retinal illuminance (p = 0.02) as well as CCT at the desk (p < 0.005) and at the retina (p < 0.01) alike were increased in rooms with LED virtual windows. CONCLUSIONS: LED virtual windows improved the lighting experience, the impression of the space, the retinal illuminance and the CCT at the desk and at the retina in the windowless rooms. FUNDING: none. TRIAL REGISTRATION: not relevant.

Anxiety and depression in spine surgery-a systematic integrative review.

BACKGROUND: Symptoms of preoperative anxiety and depression occur in approximately one-third of patients with chronic back pain undergoing surgery. In the last 2 decades, several studies have established that preoperative anxiety and depression are important outcome predictors of greater pain and physical impairments, and lower health-related quality of life in patients undergoing spine surgery. To accommodate symptoms of anxiety and depression and thereby better surgical outcomes, we need to identify factors associated with these symptoms. PURPOSE: We aimed to identify factors associated with symptoms of anxiety and depression in adults both before and after undergoing spinal surgery. STUDY DESIGN: An integrative literature review was carried out. METHODS: The independent charity Helsefonden supported this literature review by contributing $45,000 to remunerate a dedicated investigator. A systematic literature search was conducted in PubMed, CINAHL, PsycINFO, Embase, Scopus, Cochrane, and Web of Science. A three-step selection and assessment process was conducted; titles and abstracts of 1,124 articles were skimmed for relevance and of these, 53 articles were found to be of relevance and were read in full. Articles not meeting the inclusion criteria (n=26) were excluded. The 31 articles were critically appraised for methodological validity; 14 of these were synthesized and analyzed using a convergent qualitative design to transform both qualitative and quantitative articles into qualitative findings. RESULTS: Fourteen studies were included, reporting results based on 4,833 participants, 3,017 men and 1,816 women, whose mean age was approximately 49 years. From these results, we extracted 75 individual findings, which we then divided into five categories of factors associated with anxiety and depression both before and after undergoing spine surgery: pain, information, disability, employment, and mental health. CONCLUSIONS: Five categories of interacting factors that influenced symptoms of anxiety and depression both before and after surgery were identified: pain, lack of information, disability, return to work, and mental health. Information appears to have a regulating effect on anxiety and depression.

What are the short-term and long-term effects of occupation-focused and occupation-based occupational therapy in the home on older adults' occupational performance? A systematic review.

BACKGROUND: There is a lack of evidence-based knowledge about the effectiveness of home-based OT for older adults aimed at improving occupational performance by practicing activities and tasks. AIM: This review synthesizes and discusses evidence for the effectiveness of occupation-focused and occupation-based OT for older adults at home. MATERIAL AND METHODS: Peer-reviewed quantitative papers were included. PARTICIPANTS: ≥ 60-year-old adults with functional limitations. INTERVENTION: OT aiming at improving occupational performance, primarily through the practice of activities and tasks. OUTCOME: Occupational performance. CONTEXT: Home. Three reviewers critically appraised 13 of 995 detected papers. Extracted data were presented and summarized descriptively. RESULTS: Eight high-quality papers showed that occupation-focused and occupation-based OT using cognitive, behavioral and environmental strategies may significantly improve occupational performance in older, home-dwelling adults with physical health problems. Maintaining achieved improvements was a consistent challenge. CONCLUSIONS AND SIGNIFICANCE: Evidence suggests that older adults' occupational performance can be significantly improved through low-intensity occupation-focused and occupation-based intervention. It is recommended to develop and test high-intensity OT programs and maintenance programs.

High-frequency ultrasound of Peyer's patches in the small intestine of young cats.

OBJECTIVES: A previously unreported, asymmetrically positioned hypoechoic extra layer (APHEL) in the submucosa of the feline distal jejunum and ileum has been recognised using high-frequency ultrasound. The objectives of this study were to characterise the APHEL histologically, and to describe the prevalence and ultrasonographic features of the APHEL in a population of clinically healthy young cats. METHODS: In an anatomical study, two cats were autopsied and histopathology of the small intestine was performed. An APHEL was detected with ultrasound in the distal jejunum and ileum ante-mortem in the first cat and post mortem in the second cat. Samples for histopathology were obtained from these areas. In the second, prospective part of the study, to document the presence or absence of an APHEL, high-frequency (18 MHz) ultrasound was performed of the intestinal tract in 20 other cats. These cats were client-owned cats aged 6-18 months presented for neutering. The cats were included in the study based on a normal clinical examination, lack of previous or concurrent signs of disease, and having no abnormalities detected at abdominal ultrasound. RESULTS: Histopathology from the distal jejunum and ileum in the two cats in the anatomical part of the study showed that the APHEL represented asymmetrically positioned normal lymphatic tissue (Peyer's patches) in the lamina propria and submucosa. In the second part of the study, an APHEL was identified in the submucosa of the distal part of the jejunum and ileum in all 20 cats. Additionally, a similar layer could also be seen further proximally in the jejunum in 10 (50%) of the cats. The thickness of the APHEL was 1.0 mm in both jejunum and ileum. CONCLUSIONS AND RELEVANCE: Presumed normal lymphatic tissue in the small intestinal submucosa can be seen with high-frequency ultrasound and is a common finding in young cats.

Treating umbilical granuloma with topical clobetasol propionate cream at home is as effective as treating it with topical silver nitrate in the clinic.

AIM: There is a lack of evidence on the best treatment option for umbilical granuloma. The primary aim of this study was to compare three treatments for umbilical granuloma: standard treatment with topical silver nitrate, clobetasol propionate cream (0.05%) and ethanol wipes. The secondary aim was to evaluate whether the treatment could be successfully administered by a parent at home, rather than in the outpatient clinic. METHODS: A total of 109 infants were randomised to one of three groups and 94 infants completed the assigned treatment: 30 infants received standard treatment with silver nitrate (99%) in the outpatient clinic, 30 infants had topical clobetasol propionate cream (0.05%) applied at home, and 34 infants received cleansing with ethanol wipes (82%) at home. RESULTS: Silver nitrate and clobetasol propionate cream (0.05%) were significantly superior to ethanol wipes, with shorter healing times and higher resolution rates (p = 0.0001). Healing time and resolution rates were identical for silver nitrate and clobetasol propionate cream (0.05%). Mild side effects were occasionally reported, all of which were self-limiting. CONCLUSION: Treating umbilical granuloma with topical clobetasol propionate cream (0.05%) at home is as effective as treating it with topical silver nitrate (99%) in the clinic.

Only 5 southern Greenland shelf edge glaciations since the early Pliocene.

Much uncertainty exists about the history of the Greenland Ice Sheet (GIS), particularly as to the frequency of extreme shelf edge glaciations. Because the last glaciation removed most of the record of earlier GIS extent on land and shelf exploration of the older GIS glacial record requires the use of deeper marine archives. Here we present seismic evidence for the frequency of extreme shelf edge glaciations offshore southwest Greenland. Our findings reveal that since the GIS formation only 5 glaciations were characterized by an ice sheet covering the entire shelf of southern Greenland. We estimate an age of around 4.5 million years (my) for the oldest episode and found that such extreme GIS expansions may have occur here only 3 times within the past c. 1.5 my. We thus conclude that the first large shelf edge glaciation of southern Greenland did occur prior to the Pliocene warmth epoch.

Progress and prediction of occupational performance in women with distal radius fractures: a one-year follow-up.

Abstract To describe the occupational performance and pain during the first year after a distal radius fracture, an observational follow-up study was performed among 37 mainly elderly Danish women. They were assessed at cast removal and reassessed at three and 12 months post-injury with COPM, DASH, and validated questions on pain. The number of performance problems fell from median 18 at cast removal to median 3 at 12 months. COPM performance and satisfaction scores improved significantly to 8.6 and 9.2 at 12 months. Also the DASH score improved significantly to 14.2 at 12 months. The largest improvements in occupational performance and disability took place within the first three months. Pain decreased significantly during the follow-up period. In spite of these positive results, at 12 months 78% of the women still had performance problems and 62% still had some degree of pain due to the fracture. At cast removal, a number of ≥10 performance problems at 12 months could be predicted in women with ≥20 performance problems (RR 2.41) or with a pain intensity described as "moderate" or worse (RR 3.71). The findings of this study suggest that occupational therapy services might still be of relevance perhaps as follow-up sessions through the first year post-injury.

Occupational performance, pain, and global quality of life in women with upper extremity fractures.

To examine pain, occupational performance problems, and quality of life (QoL) and possible associations between these variables, 41 elderly women with acute pain due to a fracture of the upper extremity were assessed with COPM, DASH, validated questions on pain, and a global question on QoL. The participants reported 802 performance problems: 38% within self-care, 52% within productivity, and 10% within leisure. Strength demanding bilateral activities in cleaning, hygiene, and cooking were most frequently reported. The median COPM performance and satisfaction scores were 2.8 and 3.4; the mean DASH score was 44.27. Pain frequency and intensity as well as QoL correlated moderately with the number of performance problems on the COPM. QoL was in general not very reduced and correlated only negligibly with pain. The DASH score correlated moderately with the total number of performance problems on the COPM and with the COPM satisfaction score, and it can be argued that a finding of a low DASH score in elderly women with upper extremity fractures should be followed up by a referral to occupational therapy. Future studies, preferably follow-up studies, are called for to further explore the multiple factors leading to performance problems in women with fractures of the upper extremity and to explore possible associations between activity performance and QoL.