Adapting to change: exploring perceptions and demands of the coronavirus (COVID-19) workforce changes - an Australian multi-institutional radiation oncology survey.

ObjectiveTo evaluate the perceptions of the coronavirus disease 2019 (COVID-19) initiated workplace strategies implemented in radiation oncology departments across Australia.MethodsA multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies on areas such as patient care, staff education, well-being, flexible working arrangements, and research. The survey was conducted from November 2020 to April 2021.ResultsOut of 210 respondents from seven institutions, 45% reported burnout and 57% experienced work work-related stress. A significant majority of respondents were in favour of continued remote work (86%, 131/153). Radiation oncologists identified administrative or non-clinical work (92%, 34/37), telehealth clinics (32%, 12/37), or radiation therapy planning (22%, 8/37) as suitable for remote work. Additionally, 54% (21/39) of the radiation oncologists plan to use telehealth more frequently, with 67% (26/39) feeling more confident with the technology. The majority (81%, 171/210) of participants favoured continuation of hybrid in-person and virtual meetings. Virtual solutions were adopted for quality assurance activities (72%, 118/165) and 52% (60/116) indicated preference for ongoing utility of virtual platforms. However, 38% (79/210) of the respondents expressed concerns about the negative impact on junior staff training.ConclusionThese findings reveal a strong inclination towards technological advancements and remote work arrangements to enable flexible working conditions. Our study suggests the need for ongoing reforms, focusing on improving clinical service delivery efficiencies and enhancing job satisfaction among clinicians.

Benefits of supportive strategies for carers of people with high-grade glioma: a systematic review : Strategies for addressing the needs of high-grade glioma carers.

PURPOSE: To systematically review and examine current evidence for the carer-reported benefits of supportive care strategies for carers of adults with high-grade glioma (HGG). METHODS: Four databases (CINAHL, EMBASE, PubMed, PsycINFO) were searched for articles published between January 2005 and April 2022 that assessed strategies for addressing the supportive care needs of carers of adults with HGG (WHO grade 3-4). Study selection and critical appraisal were conducted independently by three authors (DJ/MC, 2021; DJ/RJ 2022). Data extraction was conducted by one author (DJ) and checked by a second author (RJ). Results were synthesised narratively. RESULTS: Twenty-one studies involving 1377 caregivers were included, targeting the carer directly (n = 10), the patient-carer dyad (n = 3), or focused on people with HGG + / - their carers (n = 8). A paucity of high-quality evidence exists for effective and comprehensive support directly addressing outcomes for carers of adults with HGG. Strategies that demonstrated some benefits included those that built carer knowledge or provided emotional support, delivered by health professionals or through peer support. Supportive and early palliative care programmes have potential to reduce unmet carer needs while providing ongoing carer support. CONCLUSION: Strategies incorporating an educational component, emotional support, and a regular needs assessment with corresponding tailored support are most valued by carers. Future practice development research should adopt a value-based approach and exceed evaluation of efficacy outcomes to incorporate evaluation of the experience of patients, carers, and staff, as well as costs.

Surveying keratose sponges (Porifera, demospongiae, Dictyoceratida) reveals hidden diversity of host specialist barnacles (Crustacea, Cirripedia, Balanidae).

Sponges represent one of the most species-rich hosts for commensal barnacles yet host utilisation and diversity have not been thoroughly examined. This study investigated the diversity and phylogenetic relationships of sponge-inhabiting barnacles within a single, targeted host group, primarily from Western Australian waters. Specimens of the sponge order Dictyoceratida were surveyed and a total of 64 host morphospecies, representing four families, were identified as barnacle hosts during the study. Utilising molecular (COI, 12S) and morphological methods 42 molecular operational taxonomic units (MOTUs) of barnacles, representing Acasta, Archiacasta, Euacasta and Neoacasta were identified. Comparing inter- and intra-MOTU genetic distances showed a barcode gap between 2.5% and 5% for COI, but between 1% and 1.5% in the 12S dataset, thus demonstrating COI as a more reliable barcoding region. These sponge-inhabiting barnacles were demonstrated to show high levels of host specificity with the majority being found in a single sponge species (74%), a single genus (83%) or a single host family (93%). Phylogenetic relationships among the barnacles were reconstructed using mitochondrial (12S, COI) and nuclear (H3, 28S) markers. None of the barnacle genera were recovered as monophyletic. Euacasta was paraphyletic in relation to the remaining Acastinae genera, which were polyphyletic. Six well-supported clades of molecular operational taxonomic units, herein considered to represent species complexes, were recovered, but relationships between them were not well supported. These complexes showed differing patterns of host usage, though most were phylogenetically conserved with sister lineages typically occupying related hosts within the same genus or family of sponge. The results show that host specialists are predominant, and the dynamics of host usage have played a significant role in the evolutionary history of the Acastinae.

An annotated checklist and integrative biodiversity discovery of barnacles (Crustacea, Cirripedia) from the Moluccas, East Indonesia.

To contribute to the taxonomic knowledge of barnacles in this understudied area, the first checklist of barnacles from the Moluccas is presented, including additional information on morphology, distribution, and substrate as well as molecular data. The species of barnacles from the Moluccas have been determined using morphological analysis and DNA sequences. During 19 field trips conducted between January 2016 and September 2017, 1,513 specimens of 24 species of intertidal and one species of deep-sea barnacles were collected from 51 localities from the islands. Morphological and molecular analysis of the collected material detected members of three families of stalked barnacles and four families of acorn barnacles. In addition to sampling in the field, we also surveyed the literature on barnacles from the Moluccas. In total, our checklist comprises 97 species from the Moluccas including 23 new records, two of them yet to be described species. Results suggest that the Moluccas have a much higher diversity of barnacles than previously known, for example, from the reports of Challenger and Siboga expeditions. For further work, routine application of molecular systematics could aid the detection of cryptic species, while increased sampling of more islands and a taxonomic revision of several groups would likely lead to an even higher number of species than currently known.

Description of a new species of Membranobalanus (Crustacea, Cirripedia) from southern Australia.

A new species of sponge-inhabiting barnacle, Membranobalanus porphyrophilus sp. nov., is described herein. This species can be distinguished from all other congeners by a combination of characters, in particular by the shapes of the tergum and scutum and the armament of the cirri. COI sequence data from the type specimens have been lodged with GenBank and a morphological key to the species of Membranobalanus is provided to aid future research. The host of the new species is the southern Australian endemic demosponge Spheciospongia purpurea. The new species of barnacle is thought to be host species specific.

The Perceptions and Rehabilitation Experience of Older People After Falling in the Hospital.

PURPOSE: Falls are a major cause of disability and mortality due to injury. To reduce fall rates and improve health outcomes, it is important to design services based on patient experience and engagement. This study aimed to explore the experiences of older patients who fell during their hospital stay. DESIGN: Five patients from two rehabilitation wards in the United Kingdom participated in this qualitative study. METHODS: Semistructured interviews, incident reports, and medical records provided information about each fall. Thematic, discourse, and descriptive analysis were used to analyze data. FINDINGS: The data demonstrated how a fall impacted patients' experience of rehabilitation and resulted in changes to mobility, self-confidence, management of falls risk, avoidance of daily activities, and increased assistance from others. CONCLUSIONS: Falling in hospital can influence patients' ability to reach their potential of an optimal level of functioning. CLINICAL RELEVANCE: There is a need to place an equal and mutual understanding on the physical, psychological, and social impact of falling to reduce falls and improve functional outcomes.

Open communication strategies between a triad of 'experts' facilitates death in usual place of residence: A realist evaluation.

BACKGROUND: In order to meet policy drivers on death in usual place of residence, it is key to understand how shared decision-making can be facilitated in practice. An integrated care pathway was implemented in primary care in the North East of England to facilitate death in usual place of residence. AIM: To understand how, for whom and in which circumstances death in usual place of residence is facilitated. DESIGN: A mixed method realist evaluation was employed. Local primary care practice death audit data were analysed to identify outcomes using a mixed effects logistic regression model. Focus groups and interviews with staff of the integrated care pathway and bereaved relatives were analysed to identify the related contexts and mechanisms. SETTING/PARTICIPANTS: Death audit data of 4182 patients were readily available from 14 general practitioner practices. Three focus groups were conducted with primary and secondary care staff, voluntary sector organisations and care home representatives. Interviews with bereaved relatives were carried out in participants' homes ( n = 5). RESULTS: A mixed effects logistic regression model indicated a significant effect of year on death in usual place of residence when compared to a model without year using an analysis of deviance ( p = 0.016). Qualitative analysis suggested that this outcome was achieved when a triad of 'experts' (comprising patient, family members/family carers/formal carers and healthcare professionals) used open communication strategies. CONCLUSION: An empirically supported theory of how, for whom and in which circumstances death in usual place of residence happens is provided, which has important implications for both policy and practice.

An Exploration of Comfort and Discomfort Amongst Children and Young People with Intellectual Disabilities Who Depend on Postural Management Equipment.

BACKGROUND: The natural response to the intrusive bodily sensation is positional change. This study explored how children and young people (CYP) with intellectual disabilities had their comfort needs met when using adaptive positioning equipment. METHODS: Thirteen qualitative case studies were undertaken. A parent, a teacher/key worker and a therapist for each CYP were interviewed, and daily routines were observed, with selective video recording. Single case and cross case analyses were undertaken. RESULTS: Attentive caregivers read the behavioural expressions of the CYP and responded reassuringly, safeguarding them from discomforting experiences. Threats to comfort include the restrictive nature of some equipment accessories, positioning errors and procedural stretching. CONCLUSIONS: The same item of equipment can be both comfortable and uncomfortable. Given the social and interactional world in which the CYP live and learn, it is others who must accept responsibility for ensuring their optimal level of comfort.

Healthcare professional and patient codesign and validation of a mechanism for service users to feedback patient safety experiences following a care transfer: a qualitative study.

OBJECTIVE: To develop and validate a mechanism for patients to provide feedback on safety experiences following a care transfer between organisations. DESIGN: Qualitative study using participatory methods (codesign workshops) and cognitive interviews. Workshop data were analysed concurrently with participants, and cognitive interviews were thematically analysed using a deductive approach based on the developed feedback mechanism. PARTICIPANTS: Expert patients (n=5) and healthcare professionals (n=11) were recruited purposively to develop the feedback mechanism in 2 workshops. Workshop 1 explored principles underpinning safety feedback mechanisms, and workshop 2 included the practical development of the feedback mechanism. Final design and content of the feedback mechanism (a safety survey) were verified by workshop participants, and cognitive interviews (n=28) were conducted with patients. RESULTS: Workshop participants identified that safety feedback mechanisms should be patient-centred, short and concise with clear signposting on how to complete, with an option to be anonymous and balanced between positive (safe) and negative (unsafe) experiences. The agreed feedback mechanism consisted of a survey split across 3 stages of the care transfer: departure, journey and arrival. Care across organisational boundaries was recognised as being complex, with healthcare professionals acknowledging the difficulty implementing changes that impact other organisations. Cognitive interview participants agreed the content of the survey was relevant but identified barriers to completion relating to the survey formatting and understanding of a care transfer. CONCLUSIONS: Participatory, codesign principles helped overcome differences in understandings of safety in the complex setting of care transfers when developing a safety survey. Practical barriers to the survey's usability and acceptability to patients were identified, resulting in a modified survey design. Further research is required to determine the usability and acceptability of the survey to patients and healthcare professionals, as well as identifying how governance structures should accommodate patient feedback when relating to multiple health or social care providers.

Reducing inequalities in care for patients with non-malignant diseases: Insights from a realist evaluation of an integrated palliative care pathway.

BACKGROUND: The need for palliative care is growing internationally with an increasing prevalence of non-malignant diseases. The integrated care pathway was implemented in primary care by multidisciplinary teams from 2009 in a locality in the North East of England. Fourteen general practitioner practices provided data for the study. AIM: To find whether, how, and under what circumstances palliative care registrations are made for patients with non-malignant diseases in primary care. DESIGN: General practitioner practice data were analysed statistically and qualitative data were collected from health care professionals and members of relevant organisations. FINDINGS: A mixed-effects logistic model indicated a significant difference beyond the 0.1% level (p < 0.001) in registrations between the malignant and non-malignant groups in 2011, with an odds ratio of 0.09 (=exp(-2.4266)), indicating that patients in the non-malignant group are around 11 times (1/0.09) less likely to be registered than patients in the malignant group. However, patients with non-malignant diseases were significantly more likely to be registered in 2012 than in 2011 with an odds ratio of 1.46, significant beyond the 1% level. Qualitative analyses indicate that health care professionals find registering patients with non-malignant diseases stressful, yet feel that their confidence in treating this population is increasing. CONCLUSION: The integrated care pathway began to enable the reduction in inequalities in care by identifying, registering and managing an increasing number of palliative patients with non-malignant diseases. Consensual and inclusive definitions of palliative care were developed in order to legitimise the registration of such patients.

What's in a mechanism? Development of a key concept in realist evaluation.

BACKGROUND: The idea that underlying, generative mechanisms give rise to causal regularities has become a guiding principle across many social and natural science disciplines. A specific form of this enquiry, realist evaluation is gaining momentum in the evaluation of complex social interventions. It focuses on 'what works, how, in which conditions and for whom' using context, mechanism and outcome configurations as opposed to asking whether an intervention 'works'. Realist evaluation can be difficult to codify and requires considerable researcher reflection and creativity. As such there is often confusion when operationalising the method in practice. This article aims to clarify and further develop the concept of mechanism in realist evaluation and in doing so aid the learning of those operationalising the methodology. DISCUSSION: Using a social science illustration, we argue that disaggregating the concept of mechanism into its constituent parts helps to understand the difference between the resources offered by the intervention and the ways in which this changes the reasoning of participants. This in turn helps to distinguish between a context and mechanism. The notion of mechanisms 'firing' in social science research is explored, with discussions surrounding how this may stifle researchers' realist thinking. We underline the importance of conceptualising mechanisms as operating on a continuum, rather than as an 'on/off' switch. The discussions in this article will hopefully progress and operationalise realist methods. This development is likely to occur due to the infancy of the methodology and its recent increased profile and use in social science research. The arguments we present have been tested and are explained throughout the article using a social science illustration, evidencing their usability and value.

Adverse event reporting in studies of penetrating acupuncture during pregnancy: a systematic review.

BACKGROUND: Acupuncture within pregnancy has frequently been investigated, often finding this to be more effective than standard care. However, the adverse event severity, types and occurrence are unclear. OBJECTIVE: To investigate the quality of reporting adverse events and to attempt to identify occurrence, type and severity of adverse events in acupuncture and non-acupuncture groups. DATA SOURCES: MEDLINE, CINAHL, Allied and Complementary Medicine Database, and Physiotherapy Evidence Database (PEDro) were searched for relevant studies between 2000 and 2014. STUDY SELECTION: Seventeen studies using penetrating acupuncture and making comment on adverse events experienced were included. Quality appraisal of the selected publications was performed using either the PEDro scale or the Downs and Black checklist. Quality of reporting was evaluated against STRICTA and CONSORT guidelines, with data on adverse events extracted in accordance with CONSORT and Good Clinical Practice adverse event guidelines. RESULTS: Overall quality of reporting of adverse events was poor, with information describing the adverse events often lacking in detail. A number of trends were noted: adverse events occurring within a treatment session was 3-17% in the acupuncture groups and 4-25% in the non-acupuncture groups. The percentage of women affected by an adverse event was between 14 and 17% in the acupuncture groups and between 15 and 19% in non-acupuncture groups. CONCLUSIONS: Adverse event reporting within acupuncture trials is generally poor. The trends noted were that adverse events do occur, but would appear to be largely minor and comparable to non-acupuncture-related interventions.

Knowledge, Beliefs and Feelings about Breast Cancer: The Perspective of African American Women.

A naturalistic qualitative research study was conducted focusing on young African American women with breast cancer and their biological mothers. Semistructured interviews were conducted with 14 participants to identify their knowledge, beliefs and feelings of breast cancer. Several women reported issues of medical distrust; limited treatment options; breast cancer is a death warrant. Social support was essential for survival. Implications of the research for nursing education and the medical profession are discussed.

Two new deep-sea stalked barnacles, Arcoscalpellum epeeum sp. nov. and Gymnoscalpellum indopacificum sp. nov., from the Coral Sea, with descriptions of the penis in Gymnoscalpellum dwarf males.

The present study describes a new species of Arcoscalpellum Hoek, 1907, and a new species of Gymnoscalpellum Newman & Ross, 1971, collected by deep-sea expeditions led by the Muséum national d'Histoire naturelle (Paris) in the Coral Sea off New Caledonia, Papua New Guinea (PNG), the Solomon Islands and Vanuatu. Arcoscalpellum epeeum sp. nov. differs from all described species of Arcoscalpellum by the presence of a long, sharp, sword-shaped carina, which extends beyond the apices of the terga by 1/3 to 1/4 of their length. The species is dioecious, with large females and dwarf males that are sac-like, lack shell plates and are housed in paired receptacles at the inner edges of the scutal plates. Arcoscalpellum epeeum sp. nov. was collected in the waters of New Caledonia and Vanuatu. Gymnoscalpellum indopacificum sp. nov. differs from the six currently described species of Gymnoscalpellum by having a very small inframedian latus and a branched upper latus. The species is dioecious, with large females and dwarf males, the latter composed of 4 shell plates and housed in paired receptacles at the inner edges of the scutal plates. The penis of the dwarf males of G. indopacificum sp. nov. is about 0.8 of the total length of the male and has five side branches extending out along its length. Gymnoscalpellum indopacificum sp. nov. is distributed in the waters of Papua New Guinea, the Solomon Islands and Vanuatu, and represents the first record of this genus in the Indo-Pacific region.

Molecular phylogeny, systematics and morphological evolution of the acorn barnacles (Thoracica: Sessilia: Balanomorpha).

The Balanomorpha are the largest group of barnacles and rank among the most diverse, commonly encountered and ecologically important marine crustaceans in the world. Paradoxically, despite their relevance and extensive study for over 150years, their evolutionary relationships are still unresolved. Classical morphological systematics was often based on non-cladistic approaches, while modern phylogenetic studies suffer from severe undersampling of taxa and characters (both molecular and morphological). Here we present a phylogenetic analysis of the familial relationships within the Balanomorpha. We estimate divergence times and examine morphological diversity based on five genes, 156 specimens, 10 fossil calibrations, and six key morphological characters. Two balanomorphan superfamilies, eight families and twelve genera were identified as polyphyletic. Chthamaloids, chionelasmatoid and pachylasmatoids split first from the pedunculated ancestors followed by a clade of tetraclitoids and coronuloids, and most of the balanoids. The Balanomorpha split from the Verrucidae (outgroup) in the Lower Cretaceous (139.6 Mya) with all the main lineages, except Pachylasmatoidea, having emerged by the Paleocene (60.9 Mya). Various degrees of convergence were observed in all the assessed morphological characters except the maxillipeds, which suggests that classical interpretations of balanomorphan morphological evolution need to be revised and reinterpreted.

What is the evidence of the experience of having a fall across the life course? A qualitative synthesis.

BACKGROUND: Alleviating the economic and human impacts of falls and fear of falling are critical health and social care issues. Despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low and attrition high. There is a need for greater understanding of social, cultural and individual, life course positioning of falling, actual or perceived. OBJECTIVE: To address the question: what is the evidence of the experience of having a fall across the life course? METHOD: A qualitative evidence synthesis with key electronic databases searched from 1990 to 2011 using terms related to the experience of falls and falling. Selected papers presented data from the perspective of the person who had fallen. Synthesis included collaborative coding of 'incidents' related to falling, theoretical sampling of studies to challenge emerging theories, and constant comparison of categories to generate explanations. RESULTS: The initial focus was to access and assess the evidence for the experiences of a fall across the life course but the authors' systematic search revealed that the vast majority of the published literature focuses on the experience of a fall in later life. Only 2 of the 16 studies included, provided perspectives of falling from a life stage other than that of older adults. However older adults' perceptions of their falls experiences are likely to be influenced by lifelong attitudes and beliefs about falling and older age. Synthesis identified that a falls incident or fear of falling induces explicit or implicit 'Fear.' Consequences are related to notions of 'Control' and 'Social standing.' Recovery work involves 'Adaptation,' 'Implications,' 'Social standing' and 'Control.' 'Explanation' is sought. CONCLUSIONS: How and why people make sense of falling across the life course should have positive impacts on developing falls intervention programmes that people will want to engage with and adhere to.

Promoting self-management and adherence with strength and balance training for older people with long-term conditions: a mixed-methods study.

RATIONALE, AIMS AND OBJECTIVES: In the context of an ageing population, increasing numbers of older people with long-term conditions are presenting to secondary health care facilities in the United Kingdom having experienced a fall or fall-related injury. Despite such observations, falls and long-term conditions have traditionally been regarded as entirely separate entities. The purpose of this study was to explore the process of behaviour change in a small sample of older people with the fall-associated chronic liver disease primary biliary cirrhosis (PBC) receiving either a standard or an enhanced programme of strength and balance training (SBT). METHODS: A qualitatively driven mixed-methods approach was employed that juxtaposed semi-structured interviews with graphical representations of patient-reported outcome measures collected during the course of an experimental case series in nine older people with the fall-associated chronic liver disease PBC. RESULTS: Participants receiving both the standard and enhanced intervention completed the programme of SBT as instructed throughout the course of the case series. However, only the enhanced intervention, which focused on self-determination and self-management support, was associated with continued active participation on completion of the programme. CONCLUSIONS: Longer, but not necessarily more intensive, periods of clinical intervention are necessary to support individuals at risk of falling to move through the incremental stages of behaviour change. Effective self-management support should focus on the development of a wide range of strategies and behaviours to empower older people with long-term conditions develop an ongoing active commitment to SBT.

Self-management and adherence with exercise-based falls prevention programmes: a qualitative study to explore the views and experiences of older people and physiotherapists.

PURPOSE: The aim of this study was to involve older people and physiotherapists in the development of acceptable strategies to promote uptake and adherence with an exercise-based falls prevention programme. METHOD: Focus groups were conducted with older people attending a regional falls and syncope service (3 groups, total 12 participants) and local physiotherapists (4 groups, total 18 participants). Framework analysis was undertaken to identify why uptake and adherence with an exercise-based falls prevention programme is currently poor and to provide suggestions for how it might be improved. RESULTS: The older people participated in an exercise-based falls prevention programme to remain independent in activities of daily living. They valued approaches that promoted self-efficacy and self-management. In contrast, the physiotherapists perceived that many older people were reluctant to participate in an exercise-based falls prevention programme. While it was acknowledged that older people should be encouraged to take greater responsibility for the maintenance of their own health, the physiotherapists demonstrated a conflicting desire to remain in control of the treatment programme. CONCLUSIONS: A focus on self-management support may provide the key to promoting uptake and adherence with an exercise-based falls prevention programme. Physiotherapists should move from being "experts" to "enablers" who use their professional knowledge and expertise to support older people at risk of falling to maintain optimum levels of health and independence. Implications for Rehabilitation Despite the established efficacy of exercise-based falls prevention programmes, their impact remains limited by low levels of uptake and adherence. Clinical encounters between physiotherapists and older people at risk of falling offer the opportunity for the exchange of new information to promote patient empowerment and shared decision-making. Physiotherapists need to move away from being experts who care for and do to their patients to enable us to use their professional knowledge and expertise to maintain optimum levels of health and independence for older people at risk of falling.