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IntroductionNational Early Warning Score 2 (NEWS2) is widely used to monitor and trigger assessment throughout a patient’s hospital journey. Since the development and role out of NEWS2, its ability to predict mortality has been assessed in several settings, although to date not within an undifferentiated ED population.MethodsWe conducted a retrospective observational study of all adult ED attendees at two EDs in Northern England, between March and November 2019. Multilevel multiple logistic regression analyses were conducted on patient episode data to assess the relationship between mortality at 2, 7 and 30 days from attendances; and maximum NEWS2, adjusting for age, sex, arrival mode and triage priority.ResultsData were collected from 91 871 valid patient episodes associated with 64 760 patients. NEWS2 was a significant predictor of mortality at 2 days (OR 1.75; 95% CI 1.58 to 1.93); at 7 days (OR 1.69; 95% CI 1.59 to 1.80); at 30 days (OR 1.58; 95% CI 1.52 to 1.64). For the analyses of categorised NEWS2, NEWS2 of 2–20 was significantly associated with mortality at 2, 7 and 30 days compared with none assigned: OR 3.54 (95% CI 2.15 to 5.85) at 2 days; OR 6.05 (95% CI 3.92 to 9.34) at 7 days; OR 12.4 (95% CI 7.91 to 19.3) at 30 days. Increasing age, male sex, arrival by ambulance and higher triage categories were also associated with significantly increased mortality. Area under the receiver operating characteristic curve values of 0.963, 0.946 and 0.915, respectively, were recorded for mortality outcomes, with optimum likelihood ratios associated with a trigger of 4 NEWS2 points.ConclusionsNEWS2 is an effective predictor of mortality for patients presenting to the ED. Findings suggest that maximum NEWS2 of 4 and over may be the best trigger point for escalation of treatment. Findings also suggest a NEWS2 of 0–1 can identify a very low-risk group within the ED.

Wound assessment and treatment are essential aspects of nursing care. Dressing-associated complications can delay wound healing, causing unnecessary patient distress. Despite evidence suggesting that dressings should be changed infrequently, there still remains a tendency for healthcare professionals to remove dressings regularly, increasing the risk of complications and the cost of wound care.To understand the experiences and current practices of tissue viability nurses (TVNs) involved in wound care and dressing wear time in the acute and community settings.This quality improvement project used a mixed-methods design. A retrospective audit was undertaken to establish nurse rationale for the renewal of foam dressings on patients with acute/chronic wounds. Semistructured qualitative interviews were conducted with registered TVNs (n = 12) working in acute and community care settings and focused on their experiences with all dressing types.The analysis identified several key themes, including Training and Education (including the subthemes of TVN Experience and TVN Training), Knowledge and Information, Lack of Confidence (including the subthemes Reasons for Dressing Change and Ritualistic Practice), and Dressing Choice.Fundamental changes in staff attitudes and beliefs about dressing wear time are essential to optimizing dressing performance and increasing patient quality of care. Flexible community services that are reflective of the needs of the service are central to changing practice and increasing dressing wear time in these settings.

Community nursing caseloads are vast, with differing complexities. The Sheffield Caseload Classification Tool (SCCT) was co-produced with community nurses and nurse managers to help assign patients on a community caseload according to nursing need and complexity of care. The tool comprises 12 packages of care and three complexities. The present study aimed to test the inter-rater reliability of the tool. This was a table top validation exercise conducted in one city in South Yorkshire. A purposive sample of six community nurses assessed 69 case studies using the tool and assigned a package of care and complexity of need to each. These were compared with pre-determined answers. Cronbach's alpha for the care package was 0.979, indicating very good reliability, with individual nurse reliability values also being high. Fleiss's kappa coefficient for the care packages was 0.771, indicating substantial agreement among nurses; it was 0.423 for complexity ratings, indicating moderate agreement. The SCCT can reliably assign patients to the appropriate skilled nurse and care package. It helps prioritise and plan a community nursing caseload, ensuring efficient use of staff time to deliver appropriate care to patients with differing needs.

The forthcoming birth of a new baby and the life changes that occur can present parents with a range of challenges. While recognised in mothers, postnatal depression is not well researched in fathers; especially considering that up to 25% of men report experiencing depression in the ante and postnatal periods. The aim of this study was to test a self-screening tool and referral pathway pamphlet for expectant women and their partners. We used a single blinded randomised controlled study design. The sample, comprised 70 dyads, was randomised to either care as usual or to the self-screening tool and referral pathway pamphlet intervention. The self-screening tool included the Edinburgh Postnatal Depression Scale (EPDS). Other questionnaires used to survey the dyads were the Kessler Psychological Distress (Kessler-10) and the Maternity Social Support Scale (MSSS). The gender differences in the EPDS, Kessler-10 and MSSS scales are represented by differences of 1.0 points on EPDS, 1.0 points on Kessler-10, fathers were reporting less psychological distress than mothers in all cases. No difference was observed in perceived social support. The attrition between time-points was mostly men. Cultural and socio-demographic factors may affect generalisability of the findings. The self-screening tool and referral pathway pamphlet provided to dyads may have some benefit in assisting couples in the perinatal period to detect and seek help for early symptoms of distress.

Aim: this study examined a brief lifestyle self-management intervention, based on self-determination theory, to manage seizure frequency, and its effects on health-related quality of life and resilience in people with epilepsy aged over 18 years. Background: most people with epilepsy can identify factors that may trigger seizures and may try to avoid these; however, education from clinicians on this varies. Design: a cohort study with control design. Method: sixty participants were purposively sampled and allocated to an intervention or a control group. Results: moderate correlations were found, particularly between: resilience and satisfaction with life; medication adherence and psychological quality of life; and psychological quality of life and satisfaction with life. The mean seizure occurrences between the control and intervention groups were 12.71 (SD 24.55) and 6.76 (SD 13.40) respectively after the intervention. While the study was not powered to assess this, the intervention may be most effective regarding medication adherence and physical health quality of life. Conclusion: the relationship between self-efficacy and seizure management appeared to be strengthened by the programme. This study is the first known to measure resilience in relation to lifestyle self-management for seizure control in people with epilepsy. Relevance to practice: nurses are well placed to work with patients' strengths towards self-efficacy and potentially resilient coping.

Background The Back-Pain Attitudes (Back-PAQ) questionnaire measures back beliefs across 6 domains. Our previous study showed that manual handling advisors (MHAs) have more negative beliefs than physiotherapists (PTs), and those who think straight back lifting is safer than a rounder back have more negative beliefs. However, exactly which domains of the Back-PAQ are most negative is unknown. Objectives Gain deeper understanding of how MHAs and PTs construct their back beliefs, and relate this safe lifting posture beliefs. Design Data was collected via an electronic survey. Method Participants' back beliefs were collected via the Back-PAQ. They were also asked to select the safest lifting posture from four options: two with a straight back; two with a rounder back. Back beliefs were analysed in the 6 domains that construct the Back-PAQ. Relationships were investigated using multiple linear and regression models. Results 400 PTs and MHAs completed the survey. MHAs scored higher (more negative beliefs) than PTs across all 6 domains, and those who perceive straight back lifting as safest scored higher across five of the 6 domains. The belief to keep active with back pain was common among all groups, but MHAs and those who prefer straight back lifting believe the back is vulnerable and more in need of protection. Conclusion While all believe staying active is beneficial for back pain, residual negative beliefs regarding the vulnerability of the spine persist. Education campaigns may need to emphasise a ‘trust your back’ message rather than a ‘protect your back’ message while encouraging activity.

The aims of this study were to investigate the influence of reduced-exertion, high-intensity interval training (REHIT), comparing a novel shortened-sprint protocol (SSREHIT) against a traditional protocol (TREHIT), on perceptual responses and to determine if changes in peak oxygen uptake (V˙O2peak) are attenuated with shorter sprints. Twenty-four healthy men undertook 15 sessions of SSREHIT or TREHIT. V˙O2peak was determined at baseline and after completion of each exercise condition. Affective (pleasure-displeasure) responses and perceived exertion were assessed during exercise to capture peak responses. Enjoyment was recorded 5-min after cessation of exercise. Compared to baseline, V˙O2peak increased in both groups (6% for SSREHIT [d=− 0.36] and 9% for TREHIT [d=− 0.53], p=0.01). Affective responses were more favourable for SSREHIT (p=0.001, d=1.62), but both protocols avoided large negative peaks of displeasure. Peak ratings of perceived exertion were lower for SSREHIT (p=0.001, d=− 1.71), although there were no differences in enjoyment (d=0.25). The results demonstrate both exercise conditions can increase V˙O2peak without overly compromising perceptual responses. Decreased sprint duration might further circumvent negative perceptual responses but might also attenuate physiological adaptations.

Background: Percutaneous coronary intervention is a common revascularisation technique. Serious complications are uncommon, but death is one of them. Seeking informed consent in advance of percutaneous coronary intervention is mandatory. Research shows that percutaneous coronary intervention patients have inaccurate perceptions of risks, benefits and alternative treatments. Aim: To assess cardiologists’ and patients’ views about the informed consent process and anticipated treatment benefits. Methods: Two cross-sectional, anonymous surveys were distributed in England: an electronic version to a sample of cardiologists and a paper-based version to patients recruited from 10 centres. Results: A sample of 118 cardiologists and 326 patients completed the surveys. Cardiologists and patients shared similar views on the purpose of informed consent; however, over 40% of patients and over a third of cardiologists agreed with statements that patients do not understand, or remember, the information given to them. Patients placed less value than cardiologists on the consent process and over 60% agreed that patients depended on their doctor to make the decision for them. Patients’ and cardiologists’ views on the benefits of percutaneous coronary intervention were significantly different; notably, 60% of patients mistakenly believed that percutaneous coronary intervention was curative. Conclusions: The percutaneous coronary intervention informed consent process requires improvement to ensure that patients are more involved and accurately understand treatment benefits to make an informed decision. Redesign of the patient pathway is recommended to allow protected time for health professionals to engage in discussions using evidence-based approaches such as ‘teach back’ and decision support which improve patient comprehension.

Background Peripheral arterial disease affects the lower limb and is associated with diabetes, high cholesterol, smoking and obesity. It increases the risk of cardiovascular morbidity and mortality. It can be symptomatic causing intermittent claudication, but often there are few clinical signs. Podiatrists are able to detect the presence of peripheral arterial disease as part of their lower limb assessment and are well placed to give advice on lifestyle changes to help reduce disease progression. This is important to improve health outcomes and is offered as a prevention/public health intervention. Method We describe the clinical and patient-centred outcomes of patients attending a podiatry-led integrated care pathway in a multi-use clinic situated in a venue supported by the National Centre for Sports and Exercise Medicine in the UK. At the baseline appointment, patients were given a full assessment where symptoms of intermittent claudication using the Edinburgh Intermittent Claudication Questionnaire, foot pulses, Doppler sounds, Ankle Brachial Pressure Indices, glycated haemoglobin (HbA1c) and cholesterol levels, and smoking status were recorded. A tailored treatment plan was devised, including referral to an exercise referral service, smoking cessation programmes (if applicable) and each participant was also seen by a dietician for nutritional advice. Participants were followed up at 3 and 6 months to assess any improvement in vascular status and with each completing the EQ-5D quality of life questionnaire and a simple satisfaction questionnaire at the end of the study. As this was a complex intervention a pilot study design was adopted to evaluate if the method and outcomes were suitable and acceptable to participants the results of which will then inform the design of a larger study. Results Data was collected on 21 individuals; 15 men (71.4%) and 6 women (28.6%) across the 6-month study period. Eleven participants were referred onto the exercise referral service; 16 participants saw the dietician for nutritional advice at baseline and had one-to-one or telephone follow-up at 3 months. Five out of 14 participants had reduced scores from baseline of intermittent claudication during the study period. No evidence for substantive changes in Doppler sounds or ABPI measurements was revealed. Quality of life scores with the EQ-5D improved in 15 participants; this was statistically significant (p = 0.007) with 14 participants who completed the simple satisfaction questionnaire expressing a positive view of the programme. Of the four people who were smokers, two stopped smoking cigarettes and moved to e-cigarettes as part of smoking cessation advice. Conclusion As this was a pilot study the sample size was low, but some statistically significant improvements with some measures were observed over the 6-month study. Podiatrists are able to provide a comprehensive vascular assessment of the lower limb and accompanying tailored advice on lifestyle changes including smoking cessation and exercise. Locating clinics in National Centres for Sports and Exercise Medicine enables easy access to exercise facilities to encourage the adoption of increased activity levels, though the long term sustainability of exercise programmes still requires evaluation. This study was reviewed and approved by London Brent Ethics Committee IRAS ID 204611 and received research governance approval from the sponsor, Sheffield Teaching Hospitals NHS Foundation Trust Research and Innovation Office STH19410.

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. A common barrier to exercise is “lack of time”. Accordingly, interest in low-volume, high-intensity training has grown exponentially since this activity is considered time-efficient. However, the high-intensity nature of this exercise may frequently result in feelings of displeasure creating another barrier for many people. The purpose of this study was to compare affective (pleasure-displeasure) responses to three low-volume, high-intensity exercise conditions, including a novel shortened-sprint protocol. Using a within-subjects, randomised crossover experiment, healthy participants (N = 36) undertook a single bout of: 1) traditional reduced-exertion, high-intensity interval training (TREHIT), 2) a novel, shortened-sprint REHIT (SSREHIT) protocol, and 3) sprint continuous training (SCT). Affect and perceived efforts were recorded throughout exercise using the Feeling Scale (FS) and the 15-point Borg Rating of Perceived Exertion (RPE) scale, respectively. Enjoyment was recorded 5 min post-exercise using the Exercise Enjoyment Scale (EES). Differences were found for FS (condition by time interaction: P = 0.01GG, η2 = 0.26), RPE (P = 0.01GG, η2 = 0.23), and enjoyment (P < 0.01) with all outcomes favouring SSREHIT. Shortened-sprint protocols may diminish feelings of displeasure and might be a time-efficient yet tolerable exercise choice to help motivate some people to increase their physical activity and fitness.

Families have a crucial role supporting a relative with alcohol and/or other drug misuse, but the role has adverse implications for family members' coping, which in turn, affects their ability and willingness to support the relative. The aim of this study was to assess the coping behaviours of affected family members of relatives with alcohol and/or other drug misuse and to assess if there was a relationship between the level of coping and family member type and support-giving experience. A cross-sectional survey design was used, and 90 respondents completed the questionnaire. Results suggest the following associations: that 'Other' family members made more frequent use of maladaptive coping strategies than intimate partners (P = 0.012); family members whose role had a negative effect on their physical health made more frequent use of maladaptive coping strategies than those whose role did not have this effect (P = 0.014); and family members whose role had a negative effect on their ability to socialise used maladaptive coping strategies more often than those whose role did not have this effect (P = 0.003). Engaged and tolerant-inactive maladaptive coping strategies had a significantly greater adverse influence on family members' physical health and/or socialising than withdrawal coping strategies. Affected family members should be supported to use adaptive coping strategies to mitigate the detrimental effects of their support-giving role and to sustain them in this crucial support-giving role. Family and friends, mental health nurses, and other clinicians in the alcohol and other drug field have an important role in supporting family members in this context.

AimsTo assess the ‘Okay to Stay’ plan to investigate if this reduces visits to emergency departments, unplanned admissions and elective admission to hospital in elderly patients with long-term health conditions.BackgroundThe incidence of long-term conditions is rising as the elderly population increases, resulting in more people from this group attending emergency departments and being admitted to hospital. Okay to Stay is a simple plan for people with long-term conditions to help them remain in their own home if they suffer an acute exacerbation in their health. It was co-designed with professional and patient representatives with the aim of empowering patients and their carers to more effectively manage their long-term conditions.MethodsData from 50 patients (20 males, 30 females, mean baseline age 77.5 years) were compared 12 months before implementation of the plan and in the subsequent 12 months, with the significance of effects assessed at the 5 per cent significance level using t-tests.FindingsVisits to emergency departments were reduced by 1.86; unplanned emergency admissions were reduced by 1.28 and planned elective admissions were raised by 0.22 admissions per annum. The reduction in visits to the emergency department was significant (p = 0.009) and the reduction in emergency admissions was significant (p = 0.015). The change in elective admissions was not significant (p = 0.855). The Okay to Stay plan is effective in reducing visits to the emergency department and unplanned hospital admissions in people with long-term conditions. This is a positive step to supporting vulnerable and complex patients who are cared for at home, and facilitates the recognition by the individual of the possibility to stay at home with the support of health professionals. There are potential cost benefits to the investment of initiating an Okay to Stay plan through the avoidance of visits to the emergency department and non-elective admissions to hospital.

Objective High levels of environmental noise in hospitals disturbs sleep. We aimed to identify, critically appraise and summarise primary research that reports studies that tested interventions to reduce night-time noise levels in ward-settings. Design Systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources Key health-related and specialist acoustic databases (CINAHL, EMBASE, MEDLINE, The Cochrane Library, PsycINFO, NHS Evidence, Knovel, Journal of the Audio Engineering Society, Journal of the Acoustical Society of America, IEEE Xplore Digital Library, Acta Acustica and Acoustics in Practice) were searched from their inception to April 2017, with no language restrictions. Review methods Experimental, quasi-experimental and observational study designs assessing the effect of noise reduction interventions on patient outcomes and/or environmental noise levels were included. Two reviewers independently conducted a quality appraisal using a published framework. Results In total, 834 records were identified with nine studies meeting inclusion criteria. Quality appraisal showed that the level of evidence was generally weak. A range of noise reduction interventions were identified: one study implemented a single intervention, whilst the remainder were complex, multi-faceted interventions. Findings from individual studies showed mixed results but preliminary evidence suggests that noise reduction interventions can reduce environmental noise levels in ward settings and improve patients' sleep ratings. Quantitative data from 6 studies were pooled. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in total hours sleep (no intervention – intervention) was −0.11 h (95% CI −0.46 to 0.25 h; p = 0.556), with moderate statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in awakenings per night (no intervention – intervention) was 0.05 (95% CI −0.20 to 0.29; p = 0.715), with negligible statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the odds ratio for disturbed nights (no intervention: intervention) was 0.75 (95% CI 0.55 to 1.01; p = 0.059), with low statistical heterogeneity. Conclusions Individual studies show that noise reduction interventions are feasible in ward settings and suggest they have potential to improve patients' in-hospital sleep experiences. However meta-analyses show insufficient evidence to support the use of such interventions at present. There is a lack of appropriately designed studies to test intervention effectiveness. Robust studies are required to identify the most effective interventions to address this significant and ubiquitous problem. What is known about the topic • Noise levels in hospital impact on quantity and quality of sleep and patient experience. • Disturbed sleep can have a detrimental impact on health and extend patient recovery. • Noise reduction interventions do not receive the priority they deserve. What this paper adds • A comprehensive review of noise reduction interventions used in general ward settings. • Noise reduction interventions show the potential to reduce environmental noise and improve patient sleep ratings. • Appropriately designed studies are required to provide definitive evidence to demonstrate the effectiveness of noise reduction intervention in ward settings.

Summary Objective: This study aimed to determine how the abilities of the Charlson Index and Elixhauser comorbidities compared with the chronic health components of the Acute Physiology and Chronic Health Evaluation (APACHE II) to predict in-hospital 30 day mortality among adult critically ill patients treated inside and outside of Intensive Care Unit (ICU). Methods: A total of 701 critically ill patients, identified in a prevalence study design on four randomly selected days in five acute care hospitals, were followed up from the date of becoming critically ill for 30 days or until death, whichever occurred first. Multiple data sources including administrative, clinical, pathology, microbiology and laboratory patient records captured the presence of acute and chronic illnesses. The exponential, Gompertz, Weibull, and log-logistic distributions were assessed as candidate parametric distributions available for the modelling of survival data. Of these, the log-logistic distribution provided the best fit and was used to construct a series of parametric survival models. Results: Of the 701 patients identified in the initial prevalence study, 637 (90.9%) had complete data for all fields used to calculate APACHE II score. Controlling for age, sex and Acute Physiology Score (APS), the chronic health components of the APACHE II score, as a group, were better predictors of survival than Elixhauser comorbidities and Charlson Index. Of the APACHE II chronic health components, only the relatively uncommon conditions of liver failure (3.4%) and immunodeficiency (9.6%) were statistically associated with inferior patient survival with acceleration factors of 0.35 (95% CI 0.17, 0.72) for liver failure, and 0.42 (95% CI 0.26, 0.72) for immunodeficiency. Sensitivity analyses on an imputed dataset that also included the 64 individuals with imputed APACHE II score showed identical results. Conclusion: Our study suggests that, in acute critical illness, most co-existing comorbidities are not major determinants of shortterm survival, indicating that observed variations in ICU patient 30-day mortality may not be confounded by lack of adjustment to pre-existing comorbidities.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. The UK nursing workforce is facing a crisis. More nurses are leaving than entering the profession, and there are tens of thousands of unfilled vacancies. Political factors are having a significant impact on numbers, in particular the decision to withdraw bursaries for nursing undergraduates, and a steep decline in EU nurses registering to work in the UK post-Brexit. Against this backdrop, there is a stark gender imbalance in the workforce, with only around 11% of registered nurses being male. We surveyed UK higher education institutions to try to identify whether the gendered nature of nursing was considered a concern and whether steps were being taken to address it. We sent an electronic survey to every UK university offering undergraduate nurse training validated by the Nursing and Midwifery Council (NMC). With a response rate of 42%, the majority of respondents felt that nursing departments should take much more responsibility to increase the proportion of male nurses entering the nursing profession. More needs to be done to diversify the workforce and make nursing an appealing career choice for men and women.

Limited data is available in the literature on the radiographic results of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment of degenerative scoliosis. The objective of our study was to evaluate the segmental and global correction achieved with MPLIF in the treatment of degenerative scoliosis. Between 2009 and 2014, 42 patients underwent correction of degenerative scoliosis with MPLIF. Several radiological parameters were measured pre- and post-operatively by two independent observers. A statistical analysis was performed to assess the inter-observer reliability of the measurements and to determine the degree of segmental correction achieved at each intervertebral disc. Using sagittal vertical axis (SVA) less than 47 mm; lumbar lordosis (LL) within 11° of pelvic incidence (PI); and pelvic tilt (PT) no more than 22° as radiological criteria for procedural acceptability, we determined predictive factors for a favourable radiological outcome. Forty-two patients (34 female) were included in our study. The average amount of correction per segment was 6.2°. The overall correction achieved with MPLIF was 16.6°. Twenty-six of the 42 patients (61.9 %) had post-operative SVA values less than 47 mm. Nineteen of the 42 patients (45.2 %) had average post-operative LL within 11° of the PI. Sixteen of the 42 patients (38.1 %) had PT less than 22°. Younger age, female gender and a low pre-operative PT were significantly associated with the attainment of a satisfactory sagittal alignment. Our results demonstrate that a satisfactory correction can be achieved in degenerative scoliosis with MPLIF. In addition, our results show that it is significantly more likely to achieve a satisfactory radiological outcome in younger, female patients with low pre-operative PT.

The identification of genes influencing fitness is central to our understanding of the genetic basis of adaptation and how it shapes phenotypic variation in wild populations. Here, we used whole-genome resequencing of wild Rocky Mountain bighorn sheep (Ovis canadensis) to >50-fold coverage to identify 2.8 million single nucleotide polymorphisms (SNPs) and genomic regions bearing signatures of directional selection (i.e. selective sweeps). A comparison of SNP diversity between the X chromosome and the autosomes indicated that bighorn males had a dramatically reduced long-term effective population size compared to females. This probably reflects a long history of intense sexual selection mediated by male-male competition for mates. Selective sweep scans based on heterozygosity and nucleotide diversity revealed evidence for a selective sweep shared across multiple populations at RXFP2, a gene that strongly affects horn size in domestic ungulates. The massive horns carried by bighorn rams appear to have evolved in part via strong positive selection at RXFP2. We identified evidence for selection within individual populations at genes affecting early body growth and cellular response to hypoxia; however, these must be interpreted more cautiously as genetic drift is strong within local populations and may have caused false positives. These results represent a rare example of strong genomic signatures of selection identified at genes with known function in wild populations of a nonmodel species. Our results also showcase the value of reference genome assemblies from agricultural or model species for studies of the genomic basis of adaptation in closely related wild taxa.

Aim To evaluate the effectiveness of a cognitive behaviour therapy guided self-help manual for enhancing the experience of caregiving of family carers of individuals with depression. Background The prevalence of depression is increasing markedly in Thailand. While primary carers give most of the support for individuals with depression, they receive little support from mental health services in this critical role. Design A randomized controlled trial. Method Carers were randomized to guided self-help (n = 27), while the control group received standard information and support (n = 27). Both groups also received a short weekly telephone call. Participants were assessed at three time points; the outcome measure was the Experience of Caregiving Inventory. A doubly multivariate analysis of variance (anova) procedure, including between-group and within-group factors, was implemented. Fieldwork was from October 2007–May 2008. Results Fifty-four carers completed the study and intent-to-treat analyses were undertaken. The findings showed there was a significant reduction in the total negative experience of caring, from baseline to post-treatment, in the intervention group recipients of the manual compared with the control group and treatment effects were maintained at one-month follow-up. Similarly, a significant improvement in the total positive experience of caring occurred, from baseline to post-treatment, in the intervention group in contrast with the control group and these outcomes were sustained at one-month follow-up. Conclusion Guided self-help strengthen carers’ positive and reduces their negative, experience of caring. The study contributes to the limited evidence base about this approach in a developing country such as Thailand.

Aims and objectives To explore young adults' knowledge and attitudes of cardiovascular disease and its risk factors. Background Cardiovascular disease morbidity is rising and mortality is declining among young adults. However, the knowledge of cardiovascular disease by young adults is not well known. Design A systematic review with meta‐analysis was used. Methods The databases of CINHAL, MEDLINE Complete, PsycINFO and Psycarticles were searched for all studies published before June 2016. Search terms included cardiovascular disease, young adult, attitude and knowledge. Papers were included if they were published in English and reported quantitative research with a study population between the ages of 18–34 years, with a focus on knowledge and attitudes to cardiovascular disease. Meta‐analyses were conducted to assess the extent of knowledge of risk factors on heart disease. Results Nine risk factors for cardiovascular disease were identified by the respondents; smoking (synthesised estimate of 55% of respondents identifying as a risk factor, 95% confidence interval of synthesised estimate 45%–65%); obesity (27%, 95% CI, 26%–29%); high blood cholesterol (33%, 95% CI, 12%–54%); high blood pressure (25%, 95% CI, 18%–32%); genetic factors (26%, 95% CI, 23%–29%); physical inactivity (39%, 95% CI, 30%–47%); stress (49%, 95% CI, 48%–51%); advancing age (10%, 95% CI, 8%–12%) and diet (55%, 95% CI, 54%–56%). Conclusion Young adults demonstrate limited knowledge and poor attitudes regarding cardiovascular disease and its risk factors. The finding of this review demonstrates that there is an urgent need to build knowledge of cardiovascular risk identification in this population group. Relevance to clinical practice Increasing cardiovascular disease in young adults will put stress in the healthcare system financially and economically. There is a need of awareness of cardiovascular disease in this population group.

Objective: To provide an in-depth understanding of patients' views about the impact of transcatheter aortic valve implantation on self-reported quality of life. Background: Transcatheter aortic valve implantation is considered to be the gold standard of care for inoperable patients diagnosed with severe symptomatic aortic stenosis. Mid- to long-term clinical outcomes are favourable and questionnaire data indicates improvements in quality of life but an in-depth understanding of how quality of life is altered by the intervention is missing. \ud \ud Methods: A mixed methods study design with a total of 89 in-depth qualitative interviews conducted with participants (39% male; mean age 81.7 years), 1 and 3 months post TAVI, recruited from a regional centre in England. Data were triangulated with questionnaire data (SF-36 and EQ5D-VAS) collected, pre, 1 and 3 months post implantation.\ud \ud Results: Participants' accounts were characterised by four key themes; shortened life, extended life, limited life and changed life. Quality of life was changed through two mechanisms. Most participants reported a reduced symptom burden and all explained that their life expectancy was improved. Questionnaire data supported interview data with gradual improvements in mean EQ-5D scores and SF-36 physical and mental domain scores at 1 and 3 months compared to baseline. \ud \ud Conclusion: Findings suggest that TAVI was of variable benefit, producing considerable improvements in either mental or physical health in many participants, while a smaller proportion continued to deteriorate.

Objective: To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature, interface pressure (IP) and tissue reperfusion (TR). Also to determine the relationship in critically ill patients between: Sequential Organ Failure Assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, IP and TR. Methods: This study took place in a 27-bed intensive care unit (ICU) of an Australian tertiary hospital. IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates. Results: We recruited 23 low- and high-acuity ICU patients and nine healthy adult volunteers. Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults; the association was not substantive when controlling for age and BMI. Age was a significant variable (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were observed. However, temperature was revealed to be related to TR (p=0.091). Conclusions: Although not powered to detect significant effects, this pilot analysis has determined several associations of importance, with differences in outcomes observed between low- and high-acuity ICU patients; and between ICU patients and healthy volunteers.

Background: It is commonly believed lifting is dangerous and the back should be straight during lifting. These beliefs may arise from healthcare professionals, yet no study has evaluated the lifting and back beliefs of manual handling advisors (MHAs) and physiotherapists (PTs).\ud \ud Objectives: To evaluate (i) what lifting technique MHAs and PTs perceive as safest, and why, and (ii) the back pain beliefs of MHAs with PTs.\ud \ud Design: Data was collected via an electronic survey.\ud \ud Method: Participants selected the safest lifting posture from four options: two with a straight back and two with a more rounded back, with justification. Back beliefs were collected via the Back-Pain Attitudes Questionnaire (Back-PAQ). Relationships were investigated using multiple linear and logistic regression models.\ud \ud Results: 400 PTs and MHAs completed the survey. 75% of PT and 91% of MHAs chose a straight lifting posture as safest, mostly on the basis that it avoided rounding of the back. MHAs scored significantly higher than PTs on the Back-PAQ instrument (mean difference = 33.9), indicating more negative back beliefs. Those who chose the straight back position had significantly more negative back beliefs (mean 81.9, SD 22.7) than those who chose a round back lift (mean 61.7, SD 21.1). \ud \ud Conclusion: Avoiding rounding the back while lifting is a common belief in PT and MHA, despite the lack of evidence that any specific spinal posture is a risk factor for low back pain. MHAs, and those who perceived a straight back position as safest, had significantly more negative back beliefs.

Background Context Metastatic spine tumor surgery (MSTS) is associated with substantial blood loss, therefore leading to high morbidity and mortality. Although intraoperative cell salvage with leukocyte depletion filter (IOCS-LDF) has been studied as an effective means of reducing blood loss in other surgical settings, including the spine, no study has yet analyzed the efficacy of reinfusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS. Purpose This study aimed to analyze the efficacy, safety, and cost-effectiveness of using IOCS-LDF in MSTS. Study Design This is a retrospective controlled study. Patient Sample A total of 176 patients undergoing MSTS were included in the study. Methods All patients undergoing MSTS at a single center between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications, and procedural costs. The key predictor variable was whether IOCS-LDF was used during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumor type, number of diseased vertebrae, approach, number and site of stabilized segments, operation time, preoperative anemia, American Society of Anesthesiologists (ASA) grade, age, gender, and body mass index (BMI). No funding was obtained and there are no conflicts of interest to be declared. Results Data included 63 cases (IOCS-LDF) and 113 controls (non–IOCS-LDF). Intraoperative cell salvage with LDF utilization was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=.03). Intraoperative cell salvage with LDF was cost neutral (p=.88). Average hospital stay was 3.76 days shorter among IOCS-LDF patients (p=.03). Patient survival and complication rates were comparable in both groups. Conclusions We have demonstrated that the use of IOCS-LDF in MSTS reduces the need for postoperative allogenic blood transfusion while maintaining satisfactory postoperative hemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy, and potential cost benefit.

Background\ud Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (

Background Up to 50% of people with rheumatoid arthritis (RA) have foot symptoms at diagnosis, hence early foot health intervention is recommended and this should include patient education. This study identifies, for the first time, the foot health education (FHE) needs of people with RA. Methods An online survey of people with RA (n = 543) captured quantitative data in relation to the aims, methods of delivery, content, timing and accessibility of FHE. Results The majority concurred about the aims of FHE. Verbal delivery and websites were the most common methods. Written and verbal FHE were perceived to be the most effective methods. The point of diagnosis was the preferred time to receive it. Lack of access to FHE included minimal focus on foot health during consultations by both health practitioners and patients with RA. Participant gender, age, disease duration and living situation had a statistically significant influence on the results. Conclusion Foot health education is rarely considered within the medical consultation. There is a lack of patient and/or health professional awareness of this need with a detrimental impact on foot health. Patients require health professionals to identify their foot education health needs. Tailored foot health education should begin at initial diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s13047-017-0193-6) contains supplementary material, which is available to authorized users.

The growing incidence of depression in developing countries, such as Thailand, is placing increasing pressure on public mental health services, and those living in rural areas have limited access to mental health services and specialised support. Resilience is integral to the recovery of people with depression and to caregivers. This parallel group randomised controlled trial evaluated the effectiveness of a guided self-help manual in improving resilience in adults diagnosed with moderate depression and their primary caregivers in Thailand. Our findings indicate that the approach is an accessible and low-cost approach to increasing resilience in adults with depression and their caregivers.

Purpose: To evaluate the accuracy of intraocular lens power estimation in eyes having phacovitrectomy for rhegmatogenous retinal detachment.\ud \ud Methods: Retrospective case review of 100 consecutive eyes that underwent phacovitrectomy for rhegmatogenous retinal detachment. Axial lengths were measured using optical biometry and/or ultrasound A-scan. Achieved and predicted refraction were compared to calculate the mean postoperative refractive prediction error and the mean absolute prediction error. Factorial analysis of variance models were developed to assess outcome on the whole and that between the subgroups.\ud \ud Results: Ninety-five eyes had postoperative refraction: 41 macula-on (43%) and 54 macula-off (57%). The mean postoperative prediction error was -0.34 +/- 0.89 diopters. There was no statistical significant difference in the refractive outcomes between macula-on and macula-off groups (P > 0.05). Overall, using mean absolute prediction error as the outcome measure, optical biometry was more accurate than ultrasound (P = 0.040). However, significantly more ultrasound-measured axial lengths were selected for intraocular lens power estimation in macula-off group compared with the macula-on group (P = 0.016).\ud \ud Conclusion: Combined phacovitrectomy in rhegmatogenous retinal detachment included a small biometric error that was within the tolerable range in most cases. Both optical biometry and ultrasound should be used to estimate axial lengths, for macula-off rhegmatogenous retinal detachment cases, to improve the accuracy of intraocular lens power calculation.

Measuring movement performance in people with neurological damage requires a tool that reflects physiotherapy assessment and clinical reasoning. The Leeds Movement Performance Index (LMPI) was previously developed by a group of neurological physiotherapists to fulfill these requirements.To assess the reliability of the LMPI for use in neurological physiotherapy practice.Twelve senior neurological physiotherapists were trained to use the LMPI and then asked to measure the movement performance of five patients whose movement had been previously video-recorded for this purpose. A retest session was completed after two weeks. Data were analysed to establish internal and external reliability.Internal reliability was assessed using Cronbach's alpha coefficient, applied to the entire scale (0.862) and to each item (range 0.795-0.892). External (inter-rater) reliability was assessed by a calculation of the intraclass correlation coefficient for scores awarded by multiple raters (0.959), with individual item reliability ranging from 0.874 to 0.968. External (test-retest) reliability was assessed by calculating the Spearman's rank correlation coefficient between scores obtained on two testing occasions (0.792) with values of individual items ranging from 0.397 to 0.674. A variance components analysis partitioned variance into components arising from between-patient variability (55.2%) between-therapist variability (7.8%) and between-testing variability (2.8%).RESULTS indicate that the LMPI is a reliable measurement tool when used by senior neurological physiotherapists.

Purpose\ud \ud To establish whether early vitrectomy for epiretinal membrane (ERM) is preferable to delayed surgery.\ud \ud Methods\ud \ud We carried out a retrospective study of 120 eyes from 120 patients with pre-operative visual acuity (VA) of 6/60 or better. Pre-operative logMAR score was considered to act as an appropriate proxy measure for time of surgical procedure, with scores of 0.3 or less considered to represent early surgery, scores of 0.4 or 0.5 considered to represent medium surgery, and scores of 0.6 or more considered to represent late surgery for ERM. Patients were either pseudophakic at the time of vitrectomy or underwent combined phaco-vitrectomy for symptomatic ERM.\ud \ud Results\ud \ud Evaluation of parameter coefficients indicated that controlling for other factors, a delay of the surgical procedure from a state of early to medium corresponded to an increase (ie, disbenefit) of 0.074 units in post-operative logMAR score (95% confidence interval −0.001–0.15). A delay of the surgical procedure from a state of early to late corresponded to an increase (ie, disbenefit) of 0.21 units in post-operative logMAR score (95% confidence interval 0.13–0.29). Mean post-operative VA for early surgery was 0.16, out of which 36.2% of patients had a LogMAR score of 0.1 or better. This is in comparison to 17.2% in late ERM (those with a pre-operative logMAR score of 0.6 or more).\ud \ud Conclusion\ud \ud We conclude that early surgery is associated with a lower (ie, better) post-operative logMAR score. Vitrectomy for early symptomatic ERM, in carefully selected patients, is beneficial in preserving excellent vision and allows quicker visual rehabilitation.

Aim To present the anatomical and visual outcomes of patients with hypo-reflective cystic defects in outer fovea (outer foveal defect; OFD) in macular holes repaired with non-posturing vitrectomy and short term gas tamponade. To identify the incidence and risk factors for developing OFD foveal defect. Method A prospective consecutive case series of 58 patients undergoing macular hole surgery was undertaken. OFD detected on 2-week postoperative Optical coherence tomography (OCT) was measured. In these patients OCT was performed monthly until resolution of OCT. Results 27 eyes (46.6%) had an outer defect at 2 weeks, the presence of which was significantly associated with macular holes with larger base diameters preoperatively (p=0.006). All defects closed spontaneously without further intervention, and the final vision was not affected by the presence of an OFD. Visual recovery was only slightly (and not significantly) delayed by the presence of an outer defect. Conclusions This is the first study of outcomes of OFDs following macular hole surgery in patients who did not posture postoperatively. OFDs are common but do not adversely affect visual outcomes.

Purpose\ud \ud To describe the incidence and features of intraoperative retinal breaks caused by induction of posterior hyaloid face (PHF) separation during 23-gauge pars plana vitrectomy (PPV).\ud \ud Methods\ud \ud A prospective, consecutive, single surgeon, observational study of patients undergoing 23-gauge transconjunctival sutureless vitrectomy for macular pathology or floaters, was carried out between 2009 and 2011 at Calderdale Royal Hospital, UK. PHF separations were categorised as either suction induced or requiring membrane blue (DORC Limited) with suction (adherent). The outcome measure was dichotomised into retinal break or tear and no retinal break or tear. Forced entry and parsimonious multiple logistic regression analyses were conducted, using statistical software, to test for significance of association of the set of recorded factors and covariates with the dichotomised outcome measure.\ud \ud Results\ud \ud Data were collected and analysed from 137 patients. The incidence of iatrogenic retinal breaks associated with PHF separation during 23-gauge PPV was 18.2%. Under both forced entry and parsimonious multiple logistic regression models, the odds of a retinal break or tear reduce by about 3–4% for each increasing year of age. Findings also showed some substantive association in the forced entry model, with the odds of a retinal break or tear for adherent cases being around 3.8 times those for suction-only cases.\ud \ud Conclusions\ud \ud Mechanical detachment of the PHF represents an important risk factor in the formation of retinal breaks. Particular care should be taken to examine intraoperatively for iatrogenic breaks in order to prevent missed breaks and subsequent rhegmatogenous retinal detachments.

Background\ud Surgical site infection (SSI) is a serious potential complication of spinal surgery. SSI can impact significantly on in-patient hospitalisation and the costs associated with extra care.\ud Aim\ud To investigate the management of patients experiencing SSI following surgery for spinal metastatic tumours, and to estimate the costs associated with SSI in this context.\ud Methods\ud Patients experiencing SSI following spinal tumour surgery at a large spinal surgery centre between January 2009 and December 2012 were identified. Existing case notes were reviewed and patient and procedural data, details of the infection and treatment interventions were collected. A bottom-up approach to calculating costs associated with infection was used for patients experiencing SSI and compared with a quasi-random sample of similar patients without SSI.\ud Findings\ud The mean cost of treating patients with SSI was significantly greater than costs associated with those without SSI (p=0.019). Mean cost of in-patient hospital stay was 60% higher in patients with SSI compared to those without SSI (p=0.004). In-patient hospital stay alone accounted for 59% of total costs. Return to theatre was the second most costly intervention overall, accounting for 38% of costs, and was the most expensive single intervention involved in the treatment of SSI.\ud Conclusion\ud SSI significantly increases healthcare costs for patients undergoing surgery for spinal metastasis, with prolonged in-patient hospitalisation and return to theatre for wound management being major contributors. The actual total cost to society derived from SSI in this patient group is likely to be far beyond just the direct costs to healthcare providers.

Background An investigation was undertaken to compare the effect of multi-component compression bandages and compression hosiery kits on individuals’ range of ankle motion whilst wearing typical and medical footwear, and barefoot. Methods A convenience sample of 30 healthy individuals recruited from the staff and student population at the University of Huddersfield, UK. Plantarflexion/dorsiflexion range of ankle motion (ROAM) was measured in participants over 6 steps in every combination of typical, medical and no footwear; and multi-component bandages, compression hosiery and no garments. Results Controlling for age, gender and garments, the use of typical footwear was associated with a mean increase in ROAM of 2.54° at best estimate compared with barefoot; the use of medical footwear was associated with a mean decrease in ROAM of 1.12° at best estimate compared with barefoot. Controlling for age, gender and footwear, the use of bandaging was associated with a mean decrease in ROAM of 2.51° at best estimate compared with no garments. Controlling for age, gender and footwear, the use of hosiery was not associated with a significant change in ROAM compared with no garments. Conclusions Bandages appear to restrict ROAM more than hosiery when used in conjunction with a variety of footwear types. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0151-8) contains supplementary material, which is available to authorized users.

Summary Background Patients with metastatic spinal tumours have a limited prognosis. Surgical complications that may result in prolonged hospitalization or readmission are highly undesirable. Surgical site infection (SSI) is one such complication, which can, in extreme cases, lead to death. Aim To assess the impact of SSI on patient survival after surgery for spinal metastases. Methods Demographic, operative, and survival data were collected on 152 patients undergoing surgery for spinal metastasis at a large UK tertiary referral centre. American Society of Anesthesiologists (ASA) grade and the Revised Tokuhashi Score (RTS) were determined as measures of health status and prognosis, respectively, at baseline. A semi-parametric Cox proportional hazards survival analysis was used to assess the relationships between covariates and survival. Findings Seventeen patients (11.2%) experienced SSI. Overall, median survival time from operation was 262 days (95% confidence interval: 190–334 days) and 12-month survival was 42.1%. RTS (hazard ratio: 0.82; 95% confidence interval: 0.76–0.89; P P =0.028) were significantly associated with survival, with better survival found in patients with higher RTS and lower ASA scores. Infection status was of substantive importance, with better survival in those without SSI ( P =0.075). Conclusion Twelve-month survival in patients undergoing surgery for spinal metastasis is ∼42%. RTS and ASA scores may be used as indicators of patient survival either in combination or individually. Whereas SSI has some negative impact on survival, a larger study sample would be needed to confirm whether this is statistically significant.

To investigate the clinical effectiveness of silver nitrate (95%) for the treatment of verruca pedis comparing professional and self-application treatments.A single-centre, two-armed randomized evaluation was conducted at a University podiatry clinic. A total of 113 participants (101 analysed) with verruca pedis were included. Participants were randomized to either a clinical group, where silver nitrate was applied by a healthcare professional or a home group, where silver nitrate was self-applied. The main outcome measure was post-treatment pain, controlling for pre-treatment pain, and resolution of the verruca. Secondary outcome measures were participant satisfaction, partial reduction in the verruca and ease of use of the product.The study showed no significant difference between home treatment and clinically applied treatment for the treatment of verruca pedis in either primary outcome; however, a substantive difference in resolution between groups was recorded, with 34.0% full resolution and 26.4% partial resolution in the clinical treatment group, and 18.8% full resolution and 37.5% partial resolution in the home treatment group. Participants widely reported general ease of use of the product. All participants reported a reduction in pain as a result of the intervention.Silver nitrate has been shown to be a safe and effective treatment for verruca pedis, with equal success rates when compared between home and clinical applications.

Background Context\ud \ud Corrective surgery for adolescent idiopathic scoliosis (AIS) leads to vertical growth arrest of the instrumented spine. This might be offset by the immediate gain in spinal height (SH) as a result of correction of the curvature.\ud \ud Purpose\ud \ud This study aimed to identify predictors of gain in SH following corrective surgery for AIS. We present a unique model to predict postoperative height prior to intervention, which could contribute to the preoperative counseling and consenting process.\ud \ud Study Design\ud \ud This was a retrospective case series. All surgeries were performed by one of four substantive pediatric spinal surgeons within a single regional center over a 3.5-year period.\ud \ud Patient Sample\ud \ud There were 104 patients who had instrumented posterior spinal fusion for AIS included. There were 93 females, and the age range was from 11 to 17 years. All patients had posterior instrumented fusion using rods and anchors (pedicle screws±hooks).\ud \ud Outcome Measures\ud \ud Postoperative SH was the primary outcome measure. The SH (C7–L5) and Cobb angles were measured from a pre- and postoperative standing X-ray of each patient.\ud \ud Methods\ud \ud Variables associated with patients (demographic and radiological) and the surgical constructs were analyzed for predictability of height gain. A model was derived including only significant predictors of substantive importance using hierarchical regression methods. Cross-validation procedures verified the adequacy of the model fit. Analysis was performed using IBM SPSS Statistics for Windows version 20.0 (IBM Corp. Armonk, NY, USA).\ud \ud Results\ud \ud The major curve was thoracic in 90% of cases. The number of vertebrae fused ranged from 5 to 15. The average preoperative Cobb angle was 66°, with an average correction of 45°. The average change in SH was 4.66 cm (SD 2.13 cm). The model presented included preoperative height, preoperative Cobb angle, and number of vertebrae within the construct, with coefficients of 1.00 (95% CI: 0.90, 1.09), 0.067 (95% CI: 0.039, 0.095), and 0.26 (95% CI: 0.11, 0.41), respectively. This model had an adjusted-R2 value of 0.83 and a R2 for prediction of 0.79, and can be shown to have similar predictive capability as a model comprising a wider range of predictors.\ud \ud Conclusion\ud \ud The greatest postoperative height values following posterior spinal fusion for AIS could be expected from a patient with greater preoperative height and Cobb angle, and whose construct spans a large number of vertebrae.

Caring for a person with a mental illness can have adverse effects on caregivers; however, little is known about how best to help such caregivers. The aim of the present study was to examine the efficacy of a cognitive behaviour therapy-guided self-help manual in increasing resilience in caregivers of individuals with depression, in comparison to caregivers who receive routine support only. A randomized, controlled trial was conducted, following CONSORT guidelines, with 54 caregivers allocated to parallel intervention (self-help manual) (n = 27) or control (standard support) (n = 27) groups. Resilience was assessed at baseline, post-test (week 8), and follow up (week 12). Intention-to-treat analyses were undertaken. Repeated-measures ANOVA indicated a significant difference in resilience scores between the three time points, showing a large effect. Pairwise comparisons between intervention and control groups indicated resilience to be significantly different between baseline and post-test, and between baseline and follow up, but not between post-test and follow up. Overall, the intervention group showed a slightly greater increase in resilience over time than the control group; however, the time-group interaction was not significant. Guided self-help is helpful in improving caregivers' resilience and could be used as an adjunct to the limited support provided to carers by mental health nurses and other clinicians.

Background\ud Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). The purpose of this study was to evaluate cardiac outcomes, health related quality of life (HRQoL), resilience and adherence behaviours in patients who have undergone a PCI at two time points (6 and 12 months) following their procedure.\ud \ud Methods\ud A longitudinal pilot study was conducted to observe the cardiac outcomes across a cohort of patients who had undergone a percutaneous coronary intervention (PCI). Participants who had undergone PCI 6 months prior were invited. Those participants who met the inclusion criteria and provided consent then completed a telephone survey (time point 1). These participants were then contacted 6 months later (i.e. 12 months post-intervention, time point 2) and the measures were repeated.\ud \ud Results\ud All patients (n = 51) were recorded as being alive at time point 1. The multiple model indicated that controlling for other factors, gender was significantly associated with a linear combination of outcome measures (p = 0.004). The effect was moderate in magnitude (partial-η2 = 0.303), where males performed significantly better than females 6 months after the PCI procedure physically and with mood. Follow-up univariate ANOVAs indicated that gender differences were grounded in the scale measuring depression (PHQ9) (p = 0.005) and the physical component score of the short form measuring HRQoL (SF12-PCS) (p = 0.003). Thirteen patients were lost to follow-up between time points 1 and 2. One patient was confirmed to have passed away. The pattern of correlations between outcome measures at time point 2 revealed statistically significant negative correlation between the PHQ instrument and the resilience scale (CD-RISC) (r = -0.611; p

Aims and objectives- The aim of this meta-analysis was to identify the factors that related to aggression (verbal abuse, or physical abuse/assault) perpetrated against the nurse or other health professional by patients/relatives or staff. In light of the paucity of systematic reviews on this common issue in nursing, the objective was to present a comprehensive systematic review and meta-analysis of these papers.\ud Background – Aggression towards nurses is common around the world and can be the impetus for nurses leaving the profession or developing anxiety when working in particular settings.\ud Design- Systematic review with meta-analysis\ud Data Sources- The databases of Medline (1966 to 2015), CINAHL (1982 to 2015) and PsychInfo (1920 to 2015).\ud Methods- Meta-analyses were conducted to assess the effect of the factors of gender and context (dichotomised as mental health/psychiatric or non-mental health/psychiatric).\ud Results - A total of 1571 papers were screened by two reviewers. At the final decision 14 were selected for analysis. A higher proportion of female nurses than male nurses were reported to be the victims of verbal abuse, with the difference in proportions being statistically significant. A statistically significant higher proportion of male nurses than female nurses were reported to be the victims of physical abuse. There was a significantly higher proportion of mental health nurses reported experiencing physical abuse as compared to non-mental health nurses.\ud Conclusions – The analysis reveal female nurses have greater odds of verbal abuse than male nurses and male nurses have greater odds of physical abuse than female nurses. Overall mental health nurses had 3 times higher odds of physical assault than other nurses.\ud Relevance to clinical practice- In light of the findings it is recommended organisational support improve in high aggression potential clinical areas and for nursing curriculums to incorporate education about the management of challenging behaviours in undergraduate programs.

Background/Aims To compare several methods of macular hole measurement using optical coherence tomography (OCT), and to assess their predictive capability against anatomical and visual outcomes in a single cohort of patients. Methods A retrospective study of 50 eyes undergoing standardised macular hole surgery. All patients underwent preoperative OCT scanning with measurement of macular hole inner opening diameter, minimum linear diameter, base diameter and macular hole height. Values were calculated for the macular hole index and the tractional hole index. Results Logistic regression analyses indicated that the preoperative base diameter, macular hole inner opening and minimum linear diameter were associated with both anatomical and visual success. Derived parameters as alternatives to these basic ophthalmic parameters add little to the modelling of either anatomical or visual success. Conclusion Base diameter, macular hole inner opening and minimum linear diameter can each be used to predict anatomical and/or functional success in macular hole surgery. Preoperative base diameter is the most useful variable in this regard, as it holds the strongest association with anatomical and visual outcome and is easily measured on a OCT scan.

Recently methods of caries quantification in the primary dentition have moved away from summary ‘whole mouth’ measures at the individual level to methods based on generalised linear modelling (GLM) approaches or survival analysis approaches. However, GLM approaches based on logistic transformation fail to take into account the time-dependent process of tooth/surface survival to caries. There may also be practical difficulties associated with casting parametric survival-based approaches in a complex multilevel hierarchy and the selection of an optimal survival distribution, while non-parametric survival methods are not generally suitable for the assessment of supplementary information recorded on study participants. In the current investigation, a hybrid semi-parametric approach comprising elements of survival-based and GLM methodologies suitable for modelling of caries occurrence within fixed time periods is assessed, using an illustrative multilevel data set of caries occurrence in primary molars from a cohort study, with clustering of data assumed to occur at surface and tooth levels. Inferences of parameter significance were found to be consistent with previous parametric survival-based analyses of the same data set, with gender, socio-economic status, fluoridation status, tooth location, surface type and fluoridation status-surface type interaction significantly associated with caries occurrence. The appropriateness of the hierarchical structure facilitated by the hybrid approach was also confirmed. Hence the hybrid approach is proposed as a more appropriate alternative to primary caries modelling than non-parametric survival methods or other GLM-based models, and as a practical alternative to more rigorous survival-based methods unlikely to be fully accessible to most researchers.

Nurses on registration are expected to have sufficient knowledge and skills in medicine management to practice safely and competently. This article reports on research involving midwifery and nursing students, who were asked to complete a questionnaire related to their experiences of medicines-related training and education, and how it prepared them for practice. The results showed an overall satisfaction with the pre-registration delivery, but differences emerged in the perceived efficacy of different educational strategies. Clinically-based and simulated aspects of the programme delivery were highly rated, with theoretical delivery scoring poorly in contrast. A stepped approach is suggested, with medicine course delivery needing to be strongly highlighted as a lead up to safe and competent nursing interventions when administering medication and all other related interventions. A grant from the innovation fund at the University of Huddersfield funded an evaluation of students' experiences of medicines management education and training using a self-administered questionnaire.

This paper outlines a risk assessment of a lead-contaminated residential site in Lake Macquarie, New South Wales, near the Pasminco Metals-Sulphide lead and zinc smelter. The assessment includes a hazard identification and a dose-response assessment based on recent research findings; an exposure assessment based on two interrelated indicators, soil/dust lead and blood lead; a risk characterisation; and finally, a discussion of environmental and behavioural options for the management of risk. The exposure assessment showed lead concentrations of 20 to 21,460 parts per million in soil survey samples, 23 to 35,870 parts per million in household dust, and a range of mean values for blood lead concentration of 11 micrograms/dl to 17 micrograms/dl, in four study groups. The proportions of children within these groups having blood lead concentrations of 10 micrograms/dl or greater, the current level of known health effect, ranged from 57 per cent to 85 per cent. The decision by the National Health and Medical Research Council in June 1993 to set a goal for blood lead of below 10 micrograms/dl has important implications for the definition and the management of the environmental health risk from 'living with lead' in the area assessed.

In recent years a strategy of selective, symptom-based intervention of carious primary teeth has been developed amongst some British general dental practitioners. Practice-based studies appear to provide evidence that policies of restoration of symptomless carious primary teeth do not confer any significant benefits above those associated with non-restorative care. However, results from these studies contrast with those of many clinical trials and prospective studies of primary molar restorations. In the current investigation, cohort study data from 5,168 carious primary molar teeth from 2,654 British children aged 4–5 years at baseline, augmented with Dental Practice Board treatment data, was utilised to assess the effect of restorative treatment on the likelihood of carious teeth subsequently progressing to either exfoliation or extraction. The effect of demographic and tooth level covariates on the fate of these teeth was also assessed. Multivariate multilevel parametric survival models were applied to the analysis of the carious-exfoliation and carious-extraction transitions to which the teeth were subject, assuming an underlying data hierarchy with teeth nested within individuals. Time of occurrence of caries affected survival experience, with teeth in which caries occurred later in life being associated with higher survival rates to extraction. Amongst filled teeth, later fillings were also associated with higher survival rates to extraction. Demographic and tooth level variables had a limited effect on survival experience. Treatment was found to be significantly associated with survival with respect to extraction, with survival rates of over 80% at 14 years, double those of untreated teeth.

We report a quantitative proteomic study to investigate the changes induced in membrane rafts by the inhibition of glycogen synthase kinase-3. Sensitive quantitation of membrane raft proteins using isobaric tagging chemistries was enabled by a novel hybrid proteomic method to isolate low-microgram (10-30 microg) membrane raft protein preparations as unresolved bands in a low-density acrylamide gel. Samples were in-gel digested, differentially tagged and combined for 2-D LC and quantitative MS. Analysis of hippocampal membrane preparations using this approach resulted in a sixfold increase in sensitivity and a threefold increase in the number of quantifiable proteins compared with parallel processing using a traditional in-solution method. Quantitative analysis of membrane raft preparations from a human neuronal cell line treated with glycogen synthase kinase-3 inhibitors SB415286 or lithium chloride, that have been reported to modulate processing of the Alzheimer amyloid precursor protein, identified several protein changes. These included decreases in lamin B1 and lamin B receptor, as well as increases in several endosome regulating rab proteins, rab5, rab7 and rab11 that have been implicated in processing of the amyloid precursor protein in Alzheimer's disease.

Objective: The AeroChamber Plus (AC) valved holding chamber has been enhanced to include the Flow-Vu (FV) inspiratory flow indicator that provides visual inhalation feedback during use. We have investigated if FV alters asthma control and whether parents accept it. Methods: At visit 1, children with asthma, age 1–5 years, used an AC with their pressurised metered dose inhaler and 2 weeks later (visit 2) they were randomised to use either AC or FV. Subjects returned 6 (visit 3) and 12 (visit 4) weeks later. The Asthma Control (ACQ) and Paediatric Asthma Caregiver’s Quality of Life (PACQLQ) questionnaires were scored at each visit, and their peak inhalation flow (PIF) when they used their spacer was measured. Results: Forty participants in each group completed the study. There was no difference in the ACQ scores from visits 2 to 4 between the two groups. The improvements in the PACQLQ scores were greater in the FV group (p = 0.029). The mean difference (95% confidence interval) for the change from visits 2 to 4 between FV and AC groups was 0.05 (−0.33, 0.43) and 0.39 (0.035, 0.737) for the ACQ and PACQLQ, respectively. Most parents preferred the FV (p

Wound infection rates are generally higher in patients undergoing surgery for spinal metastasis. Risk factors of wound infection in these patients are poorly understood.\ud \ud Purpose\ud To identify demographic and clinical variables that may be associated with patients experiencing a higher wound infection rate.\ud \ud Study design\ud Retrospective study with prospectively collected data of spinal metastasis patients operated consecutively at a University Teaching Hospital, adult spine division which is a tertiary referral centre for complex spinal surgery.\ud \ud Patient sample\ud Ninety-eight patients were all surgically treated, consecutively from January 2009 to September 2011. Three patients had to be excluded due to inadequate data.\ud \ud Outcome measures\ud Physiological measures, with presence or absence of microbiologically proven infection.\ud \ud Methods\ud Various demographic and clinical data were recorded, including age, serum albumin level, blood total lymphocyte count, corticosteroid intake, Malnutrition Universal Screening Tool (MUST) score, neurological disability, skin closure material used, levels of surgery and administration of peri-operative corticosteroids. No funding was received from any sources for this study and as far as we are aware, there are no potential conflict of interest-associated biases in this study.\ud \ud Results\ud Higher probabilities of infection were associated with low albumin level, seven or more levels of surgery, use of delayed/non-absorbable skin closure material and presence of neurological disability. Of these factors, levels of surgery were found to be statistically significant at the 5 % significance level.\ud \ud Conclusion\ud Risk of infection is high (17.9 %) in patients undergoing surgery for spinal metastasis. Seven or more vertebral levels of surgery increase the risk of infection significantly (p < 0.05). Low albumin level and presence of neurological disability appear to show a trend towards increased risk of infection. Use of absorbable skin closure material, age, low lymphocyte count, peri-operative administration of corticosteroids and MUST score do not appear to influence the risk of infection.

Latent inhibition (LI) is a model of attention, which is a cognitive process that can be modulated by stressors such as chronic intermittent broadband noise, e.g. caused by building work, which is particularly stressful to rats. The aim of this study was to analyse the effect of chronic noise stress, caused by a building project, on LI, and its interaction with SR 46,349B, a 5-HT2A receptor antagonist. Control groups from LI experiments conducted during periods of chronic intermittent noise were compared with control groups from LI experiments conducted in normal quiet conditions. The interaction of SR 46,349B with the effects of chronic noise stress was then tested. Chronic intermittent noise attenuated LI, an effect which was partially reversed by SR 46,349B, 2.4 mg/kg i.p. Attenuation of LI by chronic intermittent noise and reversal of this effect by SR 46,349B support suggestions that stress can modulate attention and that 5-HT2A receptors are involved in mediating the effects of chronic stress.

Following transection of peripheral nerve, rats exhibit autotomy, which is considered to be the animal model of postdenervation pain syndrome. It has been suggested that phantom limb pain is a result of peripheral denervation leading to reorganization of somatosensory pathways, particularly in the cerebral cortex, which is shown to depend upon central noradrenergic activity. In this study, sciatic and saphenous nerves were sectioned in the left hindpaw of 30 adult rats resulting in complete loss of pain sensation in the hindpaw. A group of rats received normal saline, compared to another group which received N-(2-) Chloroethyl-N-ethyl-2-bromobenzylamine (DSP4) injection 24 h prior to transection. The latter group was also compared to a third group whose central noradrenergic system were also blocked by bilateral injection of 6-OHDA into the ascending noradrenergic bundle 1 week prior to transection. A fourth group received contralateral cortical ablation in addition to peripheral nerve transection and was compared to the first group whose cortex remained intact. The animals were observed daily for 60 days and autotomy was scored in accordance to the system of Wall et al. [42]. After 1 week, control animals began to exhibit autotomy. In contrast, autotomy was absent in rats treated with DSP4, similar to rats which received 6-OHDA. Rats which had contralateral cortical ablation showed a considerably delayed onset of autotomy and a reduction in final autotomy scores. We conclude that autotomy, as a model of postdenervation pain syndrome, can be prevented by blockade of noradrenergically mediated cortical reorganization. The clinical implications of this finding are discussed.

The aim of this study was to evaluate mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination (OSCE) in assessing their administration of medicine competence. Learning disability (n = 24) and mental health (n = 46) students from a single cohort were invited to evaluate their experience of the OSCE. A 10-item survey questionnaire was used, comprising open- and closed-response questions. Twelve (50%) learning disability and 32 (69.6%) mental health nursing students participated. The OSCE was rated highly compared to other theoretical assessments; it was also reported as clinically real and as a motivational learning strategy. However, it did not rate as well as clinical practice. Content analysis of written responses identified four themes: (i) benefits of the OSCE; (ii) suggestions to improve the OSCE; (iii) concern about the lack of clinical reality of the OSCE; and (iv) OSCE-induced stress. The themes, although repeating some of the positive statistical findings, showed that participants were critical of the university setting as a place to conduct clinical assessment, highlighted OSCE-related stress, and questioned the validity of the OSCE as a real-world assessment. The OSCE has an important role in the development of student nurses' administration of medicine skills. However, it might hinder their performance as a result of the stress of being assessed in a simulated environment.