330 research outputs found
Psychological Interventions Added to Standard Care Improve Pain and Function Outcomes in Knee Osteoarthritis: A Systematic Review and Meta‐Analysis
No full textObjective: Knee osteoarthritis is a primary cause of disability across the world and current standard care fails to address all biopsychosocial contributions to pain. The current review aims to evaluate randomised controlled trials examining the effect of adding cognitive behavioural therapy or pain coping skills training to standard care on pain and function outcomes for individuals with knee osteoarthritis. Data sources: Systematic searches were conducted of CINAHL, EMBASE (OVID), Medline (EBSCO) and PsycINFO databases until July 2024 with no date restrictions. Methods: This systematic review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Risk of bias was assessed using the Risk of bias 2 tool. Meta-analysis using a random-effects model was carried out using the Statistical Package for the Social Sciences, and effect sizes from standardised mean differences were calculated using Cohen\u27s d statistic. Heterogeneity was assessed using I-squared and Tau-squared tests. Results: Four randomised controlled trials met eligibility criteria (n = 628, mean age 62.91), demonstrating a low risk of bias. The addition of cognitive behavioural therapy or pain coping skills training to standard care for knee osteoarthritis produced statistically significant changes in standardised mean differences (p \u3c 0.001), showing small to medium effect sizes in pain (0.488) and function (0.340) between 3- and 6-month time points. Heterogeneity measured by I -squared and Tau-squared was low for pain and function. Conclusion: Adding psychological interventions to standard care for knee osteoarthritis improves outcomes in both pain and function. These findings support the integration of psychological interventions into clinical practice
Cauda Equina Syndrome: A Survey of Guideline Utilisation in Primary Care in England
No full textBackground: Cauda equina syndrome (CES) is a spinal emergency. Over half of known cases first present to primary care for initial assessment. In February 2023, the Getting It Right First Time (GIRFT) national programme launched new CES guidelines, which included an important change in practice: a new urgent referral route. Aim: This study aims to explore the awareness and use of the GIRFT guidelines in a primary care setting in England. Design and Setting: A cross-sectional online survey was used to collect data from primary care clinicians working across England. Method: Using purposive sampling, the survey was shared with primary care clinicians across England and conducted between 21-10-2024 and 24-12-2024. The RE-AIM framework underpinned the survey design. Descriptive analysis was employed to interpret frequency and Likert data. Results: A total of 515 responses were received from across all 42 integrated care boards in England. Of the 515 participants, 452 (88%) were aware of a CES guideline or pathway, with 297/515 (58%) being aware of the GIRFT guidelines. Two-thirds had access to a local CES pathway (n = 304/452, 67%). Nearly all clinicians highlighted that consulting either a local CES pathway or national guidelines supported their clinical decision making. Conclusion: This is the first study to investigate the awareness and utilisation of the GIRFT guidelines in primary care across England. The use of locally agreed CES pathways was shown to increase adherence to their recommendations in primary care. These findings suggest that using up-to-date local CES pathways can increase adherence to the GIRFT guidelines
The global food chain
No full textJonathon Porritt is Founder Director of Forum for the Future www.forumforthefuture.org.uk; Chairman of the UK Sustainable Development Commission www.sd-commission.org.uk; and author of Capitalism as if the World Matters (Earthscan, 2007)
The Acceptability of Musculoskeletal Community Appointment Days: A Mixed-Methods Service Evaluation.
No full textThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properlycited.
© 2025 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.Background
Musculoskeletal (MSK) conditions represent an increasing challenge within the NHS. Rising demand has driven a national shift towards more community-based care and supported self-management. Community Appointment Days (CAD) are community-based, full-day events providing access to clinical expertise, community partners and voluntary sector services. The collaborative ethos facilitates a personalised and holistic approach to musculoskeletal health. This evaluation aimed to explore the acceptability of the CAD model.
Methods
Following a CAD in the Southwest of England, patient experience was collected using the Friends and Family test and CollaboRATE measure for level of shared decision-making. Interviews were conducted with patients, and a focus group was held with staff. The Theoretical Framework of Acceptability (TFA) informed the interview and focus group guides, and data analysis. Thematic analysis employed a hybrid deductive/inductive approach.
Results
The CAD was attended by 130/160 (81%) patients. Experience measures were completed by 97/130 (75%) patients. The Friends and Family test demonstrated that most patients were ‘extremely likely’ (n = 63, 65%) or ‘likely’ (n = 32, 33%) to recommend a CAD. The average CollaboRATE score was 10.8/12. One-to-one interviews were completed with 13 patients, and a focus group with 10 staff. Four themes were identified: (1) a positive response to the CAD ethos; (2) the importance of effective planning and communication; (3) effective implementation of the CAD; and (4) potential impact and integration with existing musculoskeletal pathways.
Conclusion
The CAD was perceived as an acceptable, personalised, and holistic model of care that supports self-management and cross-sector collaboration for supporting MSK health
A novel approach to expedite emergency investigation for suspected cauda equina syndrome referrals from community and primary care services: a service evaluation
No full textIntroduction
Although a rare spinal emergency, cauda equina syndrome (CES) can result in significant physical, emotional, and psychological sequalae. Introducing a CES pathway enhances diagnosis but may increase Radiology and Orthopaedic workload. To address this, one NHS hospital in England introduced a novel CES pathway. Utilising a criteria-led pathway, patients were referred directly from community/primary care, via the Emergency Department, for an emergency MRI scan.
Objective
To compare the outcomes of patients referred via an original and redesigned Community and Primary Care CES pathway.
Design
A retrospective service evaluation was undertaken of all emergency MRI scans investigating suspected CES via either pathway.
Methods
Two 3-month time periods were analysed; pre-(original) and post-implementation of the redesigned pathway; time to surgery was reviewed over two 12-month periods.
Results
Increased MRI scan utilisation was seen following the implementation of the redesigned pathway: original n = 50, redesigned n = 128, increasing Radiology workload. However, the redesigned pathway resulted in a reduction in time to MRI from 3h:01m to 1h:02m; reduction in time spent in ED 4h:55m to 3h:24m; reduction in time to surgery 18h:05m to 13h:38m; reduction in out-of-hour scanning from 10 to 2 patients during the evaluation period; and a reduction in on-call Orthopaedic involvement by 38%.
Conclusion
All timed outcomes were improved with the implementation of this novel pathway. This suggests expediting MRI scans can result in substantial downstream benefits; albeit while increasing MRI scan utilisation. This pathway aligns with the emergency management of suspected CES under the new national CES pathway in England
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Destination-Based Brand Equity: The Impact of Destination Image on the destination stakeholders
No full textDr Jonathon Day
Dr Jonathon Day is an Associate Professor in Purdue’s School of Hospitality and Tourism Management. In addition to over 45 academic articles and chapters, he is the author of “Introduction to Sustainable Tourism and Responsible Travel” and co-author of “The Tourism System 8th Edition” . Dr Day’s research interests focus on sustainable tourism and responsible travel.
Gurpreet Kour
Gurpreet is an assistant professor at the Indian Institute of Management, Shillong. Her research interests include destination barnding and destination governance. Destination image has been an important topic in tourism research. The appeal of a destination’s image can contribute to a destination’s competitiveness. A wide range of factors contribute to the strength of the destination image, and the value extends beyond consumers to destination stakeholders. While a range of issues around destination image have been examined, there remains much to be explored. There is a paucity of research on the value created for these stakeholders by the brand image. There is also a gap in our understanding of the impact of destination image on destination stakeholder behavior. It is anticipated that operators in destinations with an image that emphasizes nature, and the environment will be more likely to undertake environmentally sustainable activities. This study aims to understand how the stakeholder perceives the value of the destination image and the impact of image considerations on stakeholders' actions in a destination
Temporal changes in the fatty acid composition and fluidity of gill and hemocyte membranes during thermal acclimation of the sea scallop, Placopecten magellanicus
No full textThe fatty acid composition and fluidity of gill phospholipids and hemocyte membranes of a eurytherrnal bivalve, Placopecten magellanicus, were investigated following a 10°C reduction in acclimation temperature. The time course of the acclimation response from 15 to 5°C was also monitored over a 21-day period. Membrane physical properties were measured by means of an electron spin resonance (ESR) spin-labeling technique, using 5-doxyl stearic acid (5-SASL) as a probe. Changes in the fluidity of gill membranes were analyzed by incorporating 5-SASL into vesicles made from total gill phospholipid (PL). Membrane fluidity measurements showed that cold-acclimated scallop membranes were more fluid than those of warm-acclimated animals. However, the order parameter of 5-SASL was greatest during the first six days of the reduction in temperature, indicating a more rigid gill membrane structure. The fluidity of gill and hemocyte membranes were negatively correlated with the proportion of 20:5n-3 (r = -0.714, P < 0.001, n = 24) and the unsaturated to saturated fatty acid ratio (r = -0.775, P < 0.05, n =8) respectively in the lipids of these tissues. Acclimation to reduced temperature for a prolonged period resulted in an increase in polyunsaturated fatty acid and a decrease in monounsaturated fatty acid content, in particular 20:5n-3 and C₂₀ monoenoic fatty acids. Maximum changes in PL fatty acid levels required 15-21 days following acclimation to 5°C. Scallop gill and hemocyte membranes underwent progressive changes in their membrane fluidity and fatty acid composition, an observation which is consistent with homeoviscous adaptation following a reduction in acclimation temperature.Bibliography: leaves 80-90
A conceptual review of interprofessional expertise in child safeguarding
No full textIt is increasingly accepted that practitioners across a range of professional fields must work together in order to promote children's welfare and protect them from harm. However, it has also become apparent that interprofessional working is a challenging area of practice that cannot simply be prescribed through protocols and procedures, nor acquired as a set of technical competences. This article develops the concept of interprofessional expertise in order to explain how practitioners become more proficient at working with others to manage complex child welfare issues. Key principles are outlined with reference to relevant theoretical frameworks, including models of skill acquisition. The article concludes by discussing some potential implications for future research and contemporary developments in child safeguarding practice
Allylic C—H activation to access anti-1,3-amino alcohol motifs
No full text1,3-Amino alcohols are common motifs in a variety of biologically active molecules including antivirals, antibiotics, antifungals, and various alkaloids. Due to their prevalence and utility as synthetic intermediates, a variety of methods have been developed to access these motifs in a diastereoselective fashion, which are outlined in detail herein.
This thesis documents a novel approach to access anti-1,3-amino alcohols through an intramolecular palladium (II)/sulfoxide-oxazoline catalyzed C—H functionalization between a terminal olefin and an N-tosyl carbamate, generating anti-1,3-oxazinanones. These motifs can be further elaborated upon, making this method ideal for the late stage diversification of complex molecules and pharmaceuticals. This new method can be carried out in the presence of reactive functionality that is not well tolerated by existing methods.Submission published under a 24 month embargo labeled 'Closed Access', the embargo will last until 2020-05-01The student, Jonathon Young, accepted the attached license on 2018-04-25 at 09:29.The student, Jonathon Young, submitted this Thesis for approval on 2018-04-25 at 09:40.This Thesis was approved for publication on 2018-04-25 at 14:08.DSpace SAF Submission Ingestion Package generated from Vireo submission #12470 on 2018-08-31 at 17:30:26Made available in DSpace on 2018-09-04T20:47:30Z (GMT). No. of bitstreams: 2
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Data and script for Van Berkel et al: Can starlings use a reliable cue of future food deprivation to adaptively modify foraging and fat reserves?
No full textSupporting materials for:
Can starlings use a reliable cue of future food deprivation to adaptively modify foraging and fat reserves?
Menno van Berkela, Melissa Batesona, Daniel Nettlea and Jonathon Dunna*
aCentre for Behaviour and Evolution & Institute of Neuroscience, Newcastle University, Newcastle, UK
*Author for correspondence (email: [email protected]; telephone: (+44)7730015855; postal address: Institute of Neuroscience, Henry Wellcome Building, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne, UK, NE2 4HH).
R script and 3 .csv files.</p
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