Restraint has been used within health care settings for many centuries. Initially physical restra... more Restraint has been used within health care settings for many centuries. Initially physical restraint (PR) was the method of choice, in present times. Within critical care units PR and chemical restraint are used, frequently in tandem. Restraint is not a benign intervention and PR specifically is associated with physical and psychological trauma towards those receiving it. Healthcare staff also suffer psychological consequences. This paper has reviewed the literature (using the terms ‘physical restraint'; ‘hospital'; ‘care home critical care'; ‘intensive care' ‘attitudes'; ‘knowledge' ‘use of'; ‘healthcare') to investigate the reasons for the use of restraints, its consequences and the attitudes of healthcare professionals' attitudes towards physical restraint currently present in critical care. Restraint use remains common practice in Critical Care Units (for ‘patient safety’), initiated outside of institutional protocols, despite evidence questioning its effectiveness and the resulting harm to patients and staff.
Perspectives of the ASHA Special Interest Groups, 2016
The replacement of fluids (usually water), may be undertaken in one of three ways: orally: People... more The replacement of fluids (usually water), may be undertaken in one of three ways: orally: People may drink it or it may be administered via an enteral tube; intravenously where fluid is provided v...
Introduction: By 2050 it is estimated that there will be 16 million people over the age of 65 yea... more Introduction: By 2050 it is estimated that there will be 16 million people over the age of 65 years. With the expansion in the older population and improvements in health care the number people living with a chronic health condition (Long Term Condition, LTC) is increasing. Many people will have more than one LTC e.g. diabetes and cardiac disease. With pressure on the health economy and available resources increasing, managing as many people outside of hospital as appropriately possible is essential. The white paper "Our health our care our say" (DH 2006), challenges local health and social care communities to deliver more care closer to the patients own home. The Kent Telehealth pilot study, undertaken in 2005, investigated whether the use of Telehealth in the UK health care setting could replicate the outcomes of the Veterans Administration programme in the US. Methods: The pilot examined the role of Telehealth in supporting users and their carers, and assessed its impact on hospital admissions, length of stay, GP contact and nursing visits. Patients acted as their own controls. SF12 and QuIL were used for the qualitative evaluation. Health Ethics approval was granted. All participants provided informed consent. Those meeting the eligibility criteria-of at least one LTC (diabetes, COPD, heart failure) were recruited, equipment was provided to record their vital signs. Vital signs parameters were agreed for individual users with their clinician. Data were automatically uploaded to a web based server, accessible to health care staff responsible for the care of the individual. The frequency of data review was dependent on the service delivery model and appropriate communications were undertaken with the user to facilitate any change in their agreed management plan. Results: Two hundred and fifty users were recruited, data were available for 202 users for the final analysis. There were 88 less A&E visits and 536 bed days were saved. If admitted the length of stay was shorter by up to 4 days. There was a 28% reduction in calls to the GP, a 23% reduction in visits to the surgery, and an 18% reduction in home visits. It has been estimated that over a six-month period, Telehealth intervention saved an average of £1878 per user (£1038 to £2718, p=0.01). Using Hospital Episode Statistics estimates savings that could be generated across Kent (2006-2007 prices) could be £7.56 million (CI £4.18 million to £10.942 million) annually. Users reported an increased peace of mind, increase quality of life with increased empowerment and self management with improvements in SF12 scores improved for General Health +5.7, for Physical health +8.7. Conclusions: Telehealth is a potentially valuable adjunct in the management of people with LTCs. Patients become more empowered and independent and as a result, reduced their reliance on primary and secondary care. There is the potential for significant financial gains to be realised, through improved working and reduction in attendance at hospital for admission and or outpatient consultations. Patient quality of life also improved which impacts on how and when they interact with services.
Barer 1989 Barer D. The natural history and functional consequences of dysphagia after hemisphere... more Barer 1989 Barer D. The natural history and functional consequences of dysphagia after hemisphere stroke.
Background: Post-stroke dysphagia is common, associated with poor outcome, and patients often req... more Background: Post-stroke dysphagia is common, associated with poor outcome, and patients often require non-oral feeding/fluids. The relationship of feeding status on outcome, and treatment with transdermal glyceryl trinitrate (GTN) was studied in the ENOS trial. Methods: ENOS assessed GTN (5 mg vs none for 7 days) in 4,011 patients with acute stroke and high blood pressure. Feeding status (oral = normal diet, soft diet; non-oral = nasogastric tube, percutaneous endoscopic gastrostomy tube, parenteral fluids, none) was assessed at baseline and day 7. The primary outcome was the modified Rankin Scale (mRS) measured at day 90. Analyses of outcomes were adjusted for baseline covariates. †2p<0.001. Results: In comparison with oral feeding, non-oral patients (N=1331, 33.2%) were older (73.9 vs 68.5 years†), more likely to be female (47.3 v 40.4%†) and had more severe stroke (Scandinavian Stroke Scale 24.6 v 38.3†). By day 7, 56.8% patients had improved from non-oral to oral feeding, and...
Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited rese... more Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited research on the prevalence of dysphagia using electronic health records. To investigate associations between dysphagia, as recorded in electronic health records and age, frailty using the electronic frailty index, gender and deprivation (Welsh index of multiple deprivation). A Cross-sectional longitudinal cohort study in over 400,000 older adults was undertaken (65 +) in Wales (United Kingdom) per year from 2008 to 2018. We used the secure anonymised information linkage databank to identify dysphagia diagnoses in primary and secondary care. We used chi-squared tests and multivariate logistic regression to investigate associations between dysphagia diagnosis and age, frailty (using the electronic Frailty index), gender and deprivation. Data indicated
Detailed characteristics of direct intervention EDWINA (Eating and Drinking Well IN dementiA) inc... more Detailed characteristics of direct intervention EDWINA (Eating and Drinking Well IN dementiA) included studies. (DOCX 125 kb)
Full systematic review methodology for EDWINA (Eating and Drinking Well IN dementiA) systematic r... more Full systematic review methodology for EDWINA (Eating and Drinking Well IN dementiA) systematic review. (DOCX 30Â kb)
A multi-centre randomised after recruitment. The secondary outcome measures include: functional a... more A multi-centre randomised after recruitment. The secondary outcome measures include: functional ability, mobility, the number of journeys (monthly travel diaries), satisfaction with outdoor mobility, mood, health-related quality of life, resource use of
Restraint has been used within health care settings for many centuries. Initially physical restra... more Restraint has been used within health care settings for many centuries. Initially physical restraint (PR) was the method of choice, in present times. Within critical care units PR and chemical restraint are used, frequently in tandem. Restraint is not a benign intervention and PR specifically is associated with physical and psychological trauma towards those receiving it. Healthcare staff also suffer psychological consequences. This paper has reviewed the literature (using the terms ‘physical restraint'; ‘hospital'; ‘care home critical care'; ‘intensive care' ‘attitudes'; ‘knowledge' ‘use of'; ‘healthcare') to investigate the reasons for the use of restraints, its consequences and the attitudes of healthcare professionals' attitudes towards physical restraint currently present in critical care. Restraint use remains common practice in Critical Care Units (for ‘patient safety’), initiated outside of institutional protocols, despite evidence questioning its effectiveness and the resulting harm to patients and staff.
Perspectives of the ASHA Special Interest Groups, 2016
The replacement of fluids (usually water), may be undertaken in one of three ways: orally: People... more The replacement of fluids (usually water), may be undertaken in one of three ways: orally: People may drink it or it may be administered via an enteral tube; intravenously where fluid is provided v...
Introduction: By 2050 it is estimated that there will be 16 million people over the age of 65 yea... more Introduction: By 2050 it is estimated that there will be 16 million people over the age of 65 years. With the expansion in the older population and improvements in health care the number people living with a chronic health condition (Long Term Condition, LTC) is increasing. Many people will have more than one LTC e.g. diabetes and cardiac disease. With pressure on the health economy and available resources increasing, managing as many people outside of hospital as appropriately possible is essential. The white paper "Our health our care our say" (DH 2006), challenges local health and social care communities to deliver more care closer to the patients own home. The Kent Telehealth pilot study, undertaken in 2005, investigated whether the use of Telehealth in the UK health care setting could replicate the outcomes of the Veterans Administration programme in the US. Methods: The pilot examined the role of Telehealth in supporting users and their carers, and assessed its impact on hospital admissions, length of stay, GP contact and nursing visits. Patients acted as their own controls. SF12 and QuIL were used for the qualitative evaluation. Health Ethics approval was granted. All participants provided informed consent. Those meeting the eligibility criteria-of at least one LTC (diabetes, COPD, heart failure) were recruited, equipment was provided to record their vital signs. Vital signs parameters were agreed for individual users with their clinician. Data were automatically uploaded to a web based server, accessible to health care staff responsible for the care of the individual. The frequency of data review was dependent on the service delivery model and appropriate communications were undertaken with the user to facilitate any change in their agreed management plan. Results: Two hundred and fifty users were recruited, data were available for 202 users for the final analysis. There were 88 less A&E visits and 536 bed days were saved. If admitted the length of stay was shorter by up to 4 days. There was a 28% reduction in calls to the GP, a 23% reduction in visits to the surgery, and an 18% reduction in home visits. It has been estimated that over a six-month period, Telehealth intervention saved an average of £1878 per user (£1038 to £2718, p=0.01). Using Hospital Episode Statistics estimates savings that could be generated across Kent (2006-2007 prices) could be £7.56 million (CI £4.18 million to £10.942 million) annually. Users reported an increased peace of mind, increase quality of life with increased empowerment and self management with improvements in SF12 scores improved for General Health +5.7, for Physical health +8.7. Conclusions: Telehealth is a potentially valuable adjunct in the management of people with LTCs. Patients become more empowered and independent and as a result, reduced their reliance on primary and secondary care. There is the potential for significant financial gains to be realised, through improved working and reduction in attendance at hospital for admission and or outpatient consultations. Patient quality of life also improved which impacts on how and when they interact with services.
Barer 1989 Barer D. The natural history and functional consequences of dysphagia after hemisphere... more Barer 1989 Barer D. The natural history and functional consequences of dysphagia after hemisphere stroke.
Background: Post-stroke dysphagia is common, associated with poor outcome, and patients often req... more Background: Post-stroke dysphagia is common, associated with poor outcome, and patients often require non-oral feeding/fluids. The relationship of feeding status on outcome, and treatment with transdermal glyceryl trinitrate (GTN) was studied in the ENOS trial. Methods: ENOS assessed GTN (5 mg vs none for 7 days) in 4,011 patients with acute stroke and high blood pressure. Feeding status (oral = normal diet, soft diet; non-oral = nasogastric tube, percutaneous endoscopic gastrostomy tube, parenteral fluids, none) was assessed at baseline and day 7. The primary outcome was the modified Rankin Scale (mRS) measured at day 90. Analyses of outcomes were adjusted for baseline covariates. †2p<0.001. Results: In comparison with oral feeding, non-oral patients (N=1331, 33.2%) were older (73.9 vs 68.5 years†), more likely to be female (47.3 v 40.4%†) and had more severe stroke (Scandinavian Stroke Scale 24.6 v 38.3†). By day 7, 56.8% patients had improved from non-oral to oral feeding, and...
Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited rese... more Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited research on the prevalence of dysphagia using electronic health records. To investigate associations between dysphagia, as recorded in electronic health records and age, frailty using the electronic frailty index, gender and deprivation (Welsh index of multiple deprivation). A Cross-sectional longitudinal cohort study in over 400,000 older adults was undertaken (65 +) in Wales (United Kingdom) per year from 2008 to 2018. We used the secure anonymised information linkage databank to identify dysphagia diagnoses in primary and secondary care. We used chi-squared tests and multivariate logistic regression to investigate associations between dysphagia diagnosis and age, frailty (using the electronic Frailty index), gender and deprivation. Data indicated
Detailed characteristics of direct intervention EDWINA (Eating and Drinking Well IN dementiA) inc... more Detailed characteristics of direct intervention EDWINA (Eating and Drinking Well IN dementiA) included studies. (DOCX 125 kb)
Full systematic review methodology for EDWINA (Eating and Drinking Well IN dementiA) systematic r... more Full systematic review methodology for EDWINA (Eating and Drinking Well IN dementiA) systematic review. (DOCX 30Â kb)
A multi-centre randomised after recruitment. The secondary outcome measures include: functional a... more A multi-centre randomised after recruitment. The secondary outcome measures include: functional ability, mobility, the number of journeys (monthly travel diaries), satisfaction with outdoor mobility, mood, health-related quality of life, resource use of
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