Remotely Supported Prehospital Ultrasound : Real-Time Communication Technology for Remote and Rural Communities

Highlands & Islands Enterprise, UK Technology Strategy Board’s Space and Life Sciences Catapult, University of Aberdeen’s dot.rural Digital Economy HubPeer reviewedPublisher PD

A Conceptual Model on Risk Perception Among Older South Asians with Type 2 Diabetes

Research has shown that an underestimation of personal health risk can reduce the motivation to change behaviour and reduce risk factors. This paper describes a conceptual model on risk perception among older South Asian people (representing Bangladesh, India and Pakistan) with type 2 diabetes living in the UK; this model was developed using qualitative research. Risk perception in this study is interpreted in terms of risk awareness and risk engagement. This research indicated that the concordance/empowerment model of diabetes management, which advocates self-management towards long-term risk prevention, needs further exploration in older people from minority ethnic groups with type 2 diabetes

Participants’ perspectives on mindfulnessbasedcognitive therapy for inflammatorybowel disease: a qualitative study nestedwithin a pilot randomised controlled trial

Background: Mindfulness-based interventions have shown to improve depression and anxiety symptoms as well asquality of life in patients with inflammatory bowel disease (IBD). However, little is known about the experiences ofthis group of patients participating in mindfulness interventions. This paper sets out to explore the perspectives ofpatients with IBD recruited to a pilot randomised controlled trial (RCT) of mindfulness-based cognitive therapy(MBCT) about the intervention. Methods: In a qualitative study nested within a parallel two-arm pilot RCT of mindfulness-based cognitive therapyfor patients with IBD, two focus group interviews (using the same schedule) and a free text postal survey wereconducted. Data from both were analysed using thematic analysis. Data and investigator triangulation wasperformed to enhance confidence in the ensuing findings.Forty-four patients with IBD were recruited to the pilot RCT from gastroenterology outpatient clinics from twoScottish NHS boards. Eighteen of these patients (ten from mindfulness intervention and eight from control group)also completed a postal survey and participated in two focus groups after completing post interventionassessments. Results: The major themes that emerged from the data were the following: perceived benefits of MBCT for IBD,barriers to attending MBCT and expectations about MBCT. Participants identified MBCT as a therapeutic, educationaland an inclusive process as key benefits of the intervention. Key barriers included time and travel constraints. Conclusions: This qualitative study has demonstrated the acceptability of MBCT in a group of patients with IBD.Participants saw MBCT as a therapeutic and educational initiative that transformed their relationship with the illness.The inclusive process and shared experience of MBCT alleviated the sense of social isolation commonly associatedwith IBD. However, time commitment and travel were recognised as a barrier to MBCT which could potentiallyinfluence the degree of therapeutic gain from MBCT for some participants. Keywords: Inflammatory bowel disease, Mindfulness, MBCT, Focus groups, Qualitative stud

Co-designing inflammatory bowel disease(Ibd) services in Scotland : findings from anationwide survey

Background: The Scottish Government’s ambition is to ensure that health services are co-designed with thecommunities they serve. Crohn’s and Colitis UK and the Scottish Government acknowledged the need to reviewand update the current IBD care model. An online survey was conducted asking IBD patients about theirexperiences of the NHS care they receive. This survey was the first step of co-designing and developing a nationalstrategy for IBD service improvement in Scotland. Aim: To explore IBD patients’ experiences of current services and make recommendations for future servicedevelopment. Methods: This study was part of a wider cross-sectional on-line survey. Participants were patients with IBD acrossScotland. 777 people with IBD took part in the survey. Thematic analysis of all data was conducted independentlyby two researchers. Results: Three key themes emerged:Quality of life: Participants highlighted the impact the disease has on quality of life and the desperate need for IBDservices to address this more holistically.IBD clinicians and access: Participants recognised the need for more IBD nurses and gastroenterologists along withbetter access to them. Those with a named IBD nurse reported to be more satisfied with their care.An explicit IBD care pathway: Patients with IBD identified the need of making the IBD care pathway more explicit toservice users. Conclusions: Participants expressed the need for a more holistic approach to their IBD care. This includesintegrating psychological, counselling and dietetic services into IBD care with better access to IBD clinicians and amore explicit IBD care pathway. Keywords: Inflammatory bowel disease, Co-designing, Qualitative study, Patient survey, Crohn’s disease, Ulcerative coliti

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Tackling health literacy: adaptation of public hypertension educational materials for an Indo-Asian population in Canada

<p>Abstract</p> <p>Background</p> <p>Indo-Asians in Canada are at increased risk for cardiovascular diseases. There is a need for cultural and language specific educational materials relating to this risk. During this project we developed and field tested the acceptability of a hypertension public education pamphlet tailored to fit the needs of an at risk local Indo-Asian population, in Calgary, Alberta, Canada.</p> <p>Methods</p> <p>A community health board representing Calgary's Indo-Asian communities identified the culturally specific educational needs and language preferences of the local population. An adaptation of an existing English language Canadian Public Hypertension Recommendations pamphlet was created considering the literacy and translation challenges. The adapted pamphlet was translated into four Indo-Asian languages. The adapted pamphlets were disseminated as part of the initial educational component of a community-based culturally and language-sensitive cardiovascular risk factor screening and management program. Field testing of the materials was undertaken when participants returned for program follow-up seven to 12 months later.</p> <p>Results</p> <p>Fifty-nine English-speaking participants evaluated and confirmed the concept validity of the English adapted version. 28 non-English speaking participants evaluated the Gujarati (N = 13) and Punjabi (N = 15) translated versions of the adapted pamphlets. All participants found the pamphlets acceptable and felt they had improved their understanding of hypertension.</p> <p>Conclusions</p> <p>Involving the target community to identify health issues as well as help to create culturally, language and literacy sensitive health education materials ensures resources are highly acceptable to that community. Minor changes to the materials will be needed prior to formal testing of hypertension knowledge and health decision-making on a larger scale within this at risk community.</p

Transcultural Diabetes Nutrition Therapy Algorithm: The Asian Indian Application

India and other countries in Asia are experiencing rapidly escalating epidemics of type 2 diabetes (T2D) and cardiovascular disease. The dramatic rise in the prevalence of these illnesses has been attributed to rapid changes in demographic, socioeconomic, and nutritional factors. The rapid transition in dietary patterns in India—coupled with a sedentary lifestyle and specific socioeconomic pressures—has led to an increase in obesity and other diet-related noncommunicable diseases. Studies have shown that nutritional interventions significantly enhance metabolic control and weight loss. Current clinical practice guidelines (CPGs) are not portable to diverse cultures, constraining the applicability of this type of practical educational instrument. Therefore, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed and then customized per regional variations in India. The resultant India-specific tDNA reflects differences in epidemiologic, physiologic, and nutritional aspects of disease, anthropometric cutoff points, and lifestyle interventions unique to this region of the world. Specific features of this transculturalization process for India include characteristics of a transitional economy with a persistently high poverty rate in a majority of people; higher percentage of body fat and lower muscle mass for a given body mass index; higher rate of sedentary lifestyle; elements of the thrifty phenotype; impact of festivals and holidays on adherence with clinic appointments; and the role of a systems or holistic approach to the problem that must involve politics, policy, and government. This Asian Indian tDNA promises to help guide physicians in the management of prediabetes and T2D in India in a more structured, systematic, and effective way compared with previous methods and currently available CPGs

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016

© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30–30·30 million) new cases of TBI and 0·93 million (0·78–1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331–412) per 100 000 population for TBI and 13 (11–16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40–57·62 million) and of SCI was 27·04 million (24·98–30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (−0·2% [–2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (−3·6% [–7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0–10·4 million) YLDs and SCI caused 9·5 million (6·7–12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82–141) per 100 000 for TBI and 130 (90–170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. Funding: Bill & Melinda Gates Foundation