Protective and risk factors of mental health of working age adults with adventitious total bilateral blindness and low vision: A scoping review protocol

Vision loss has been associated with mental health problems such as depression, anxiety, and post-traumatic stress disorder, which significantly impact lives of working age adults with adventitious total bilateral blindness and low vision. It is imperative, therefore, to prioritize the mental health in this population by exploring and understanding the factors that impact on their mental health. Hence, the objective of this scoping review is to identify and chart existing literature on the protective and risk factors of mental health of working age adults with adventitious total bilateral blindness and low vision. We developed this scoping review protocol in line with the Joanna Briggs Institute guidance. This scoping review will include publications in English language with no date restrictions exploring the protective and risk factors of mental health of our study population. A three-step search strategy will be employed. Searches will be carried out in the following databases: Medline, Embase, PsycInfo, PsycArticles, CINAHL and Web of Science. Search for grey literature will be conducted in Google, Google Scholar and Websites dedicated to information on visual impairment. Collated results will be imported into Endnote Basic (Clarivate) for deduplication. Two reviewers will independently conduct double screening of all the titles and abstracts in Rayyan- a web application, and full texts in Endnote while three other reviewers will conduct screening of a subset of for example 10% of titles and abstracts and full texts. Furthermore, two reviewers will independently conduct double data extraction while three other reviewers will revise, cross check, and correct any extraction errors. Extracted data will be presented in tabular formats and summarized descriptively in line with the research objectives. This scoping review will generate evidence on factors impacting the mental health of the working age adults with adventitious total bilateral blindness and low vision as well as critically highlight gaps in the literature. The findings will inform and critically underpin future empirical research which will explore the lived experiences of working age people with adventitious total bilateral blindness. Additionally, evidence from this review will inform the development of interventions in the promotion of mental health as well as assisting rehabilitation specialists and workers, public health practitioners and other relevant stakeholders in addressing the mental health needs of working age adults with adventitious total bilateral blindness and low vision.

User Experiences in a Digital Intervention to Support Total Skin Self-examination by Melanoma Survivors: Nested Qualitative Evaluation Embedded in a Randomized Controlled Trial

BACKGROUND

Melanoma is a relatively common cancer type with a high survival rate, but survivors risk recurrences or second primaries. Consequently, patients receive regular hospital follow-up, but this can be burdensome to attend and not optimally timed to detect arising problems. Total skin self-examination (TSSE) supports improved clinical outcomes from melanoma via earlier detection of recurrences and second primaries, and digital technology has the potential to support TSSE. Recent research with app-based interventions aimed at improving the well-being of older adults has found that they can use the technology and benefit from it, supporting the use of digital health care in diverse demographic groups. Thus, the Achieving Self-directed Integrated Cancer Aftercare (ASICA) digital health care intervention was developed. The intervention provided melanoma survivors with a monthly prompt to perform a TSSE as well as access to a dermatology nurse who provided them with feedback on photographs and descriptions of their skin.

OBJECTIVE

We aimed to explore participants' attitudes, beliefs, and experiences regarding TSSE practices. Furthermore, we explored how participants experienced technology and how it influenced their practice of TSSE. Finally, we explored the practical and technical experiences of ASICA users.

METHODS

This was a nested qualitative evaluation within a dual-center randomized controlled trial of the ASICA intervention. We conducted semistructured telephone interviews with the participants during a randomized controlled trial. The participants were purposively sampled to achieve a representative sample with representative proportions by age, sex, and residential geography. Interviews were transcribed verbatim and analyzed using a framework analysis approach applied within NVivo 12.

RESULTS

A total of 22 interviews were conducted with participants from both groups. In total, 40% (9/22) of the interviewed participants were from rural areas, and 60% (13/22) were from urban areas; 60% (13/22) were from the intervention group, and 40% (9/22) were from the control group. Themes evolved around skin-checking behavior, other people's input into skin checking, contribution of health care professionals outside ASICA and its value, ideas around technology, practical experiences, and potential improvements. ASICA appeared to change participants' perceptions of skin checking. Users were more likely to report routinely performing TSSE thoroughly. There was some variation in beliefs about skin checking and using technology for health care. Overall, ASICA was experienced positively by participants. Several practical suggestions were made for the improvement of ASICA.

CONCLUSIONS

The ASICA intervention appeared to have positively influenced the attitudes and TSSE practices of melanoma survivors. This study provides important qualitative information about how a digital health care intervention is an effective means of prompting, recording, and responding to structured TSSE by melanoma survivors. Technical improvements are required, but the app offers promise for technologically enhanced melanoma follow-up in future.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03328247; https://clinicaltrials.gov/ct2/show/NCT03328247?term=ASICA&rank=1.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-019-3453-x.

943 Gender Inequalities in Surgery: A Literature Review and Social Media Analysis

Aim

This study identified the current barriers to women in surgery in the UK and evaluated the hashtags that are broadcast via Twitter to expose gender bias within surgery.

Method

A literature review was conducted using key terms to identify the barriers to women in surgery. A Twitter search was conducted via NVivo and Ncapture using keywords to identify the hashtags categorising gender bias and sexism in the surgical profession. Tweet content was qualitatively evaluated to assess gender-based inequalities in surgery in the UK. Tweets were further evaluated to identify evidence of trolling or dismissive behaviour towards surgical sexism.

Results

The literature review identified work-family imbalance, lack of female surgical role models, inflexibility of working hours, the gender pay gap, and female objectification as key barriers to women in surgery. Twitter analysis demonstrated evidence of surgical gender bias throughout UK surgical training using #Surgical#Sexism #HammerItOut #CutItOut and #NHSMeToo, with minimal evidence of trolling and dismissive comments. Twitter provided a platform to support and praise users that speak out against surgical gender bias, including whistleblowers.

Conclusions

Twitter as a social media platform can provide an environment to support users who may be experiencing gender-based bias within their surgical workplace. Twitter may also demonstrate further purpose as a useful aid in whistleblowing within healthcare.

"Sometimes I don't have a pulse … and I'm still alive!" Interviews with healthcare professionals to explore their experiences of and views on population-based digital health technologies

Background

Digital technologies are increasingly becoming an integral part of our daily routine and professional lives, and the healthcare field is no exception. Commercially available digital health technologies (DHTs - e.g. smartphones, smartwatches and apps) may hold significant potential in healthcare upon successful and constructive implementation. Literature on the topic is split between enthusiasm associated with potential benefits and concerns around privacy, reliability and overall effectiveness. However, little is known about what healthcare professionals (HCPs) have experienced so far with patients and what they perceive as the main advantages and disadvantages of adoption. This study therefore aims to investigate current perceptions of HCPs towards self-tracked health-related outputs from devices and apps available to the public.

Methods

Nine HCPs volunteered to take part in semi-structured interviews. Related data were thematically analysed, following a deductive approach with the construction of a framework based on expected themes from the relevant literature, and themes identified from the first two interviews.

Findings

The following main themes in relation to DHTs were identified and explored in detail: HCPs' experience, knowledge and views; advantages and disadvantages; barriers towards healthcare implementation and potential solutions; future directions. While most participants were adopters of DHTs and held positive views about them, their overall experience with patients and the technology was limited. Potential reasons for this were explored, including factors such as time/resources; colleagues' mindset; lack of evidence of effectiveness for practice; data security concerns.

Conclusions

The potential advantages of DHTs' adoption in healthcare are substantial, e.g. patient autonomy, time/resources saving, health and behaviour change promotion, but are presently premature. Therefore, future research is warranted, focussing on addressing barriers, minimising disadvantages, and assessing the clinical value of commercially available DHTs.

“Sometimes I don’t have a pulse, and I’m still alive!” Healthcare providers on digital health techs

Background

Digital health technologies (DHTs) are increasingly becoming an integral part of our lives, healthcare field included. The WHO recently has even released the first digital health guidelines for worldwide intervention. Commercially available DHTs (e.g. smartphones, smartwatches, apps) may hold significant potential in healthcare, upon successful and constructive integration. Literature on the topic is split between enthusiasm for the potential benefits, and concerns about reliability and effectiveness. Little is known about what healthcare professionals (HCPs) have experienced so far with patients and what they believe the main issues for implementation may be. This study aims to investigate current perceptions of HCPs towards self-tracked health-related outputs from devices and apps available to the public.

Methods

Nine HCPs volunteered to take part in semi-structured interviews. Data were thematically analysed adopting a pre-constructed framework (deductive approach) based on current (April 2019) literature and the findings from the first two interviews.

Results

The following main themes were identified and explored in detail: HCPs' experience, perceived knowledge and views on DHTs; advantages and disadvantages; barriers towards healthcare implementation and solutions; future perspectives. While most participants were adopters of DHTs and held positive views about them, their overall experience with patients and the technology was limited. Potential reasons for this included factors such as time/resources availability; colleagues' mindset; lack of evidence of effectiveness for practice; privacy/data security concerns.

Conclusions

The potential advantages of DHTs' adoption in healthcare are substantial - e.g. patient autonomy, time/resources saving, health and behaviour change promotion. However, future research is warranted focussing on addressing barriers, minimising disadvantages, and assessing the clinical value of commercially available DHTs.

Key messages

We explored healthcare providers’ views on the role of commercial digital health techs in clinical practice. Despite some privacy and reliability concerns, commercial digital health techs show promise.

The 2016 HIGh Heels: Health effects And psychosexual BenefITS (HIGH HABITS) study: systematic review of reviews and additional primary studies

Background

High-heeled shoes (high heels) are frequently worn by many women and form an important part of female gender identity. Issues of explicit and implicit compulsion to wear high heels have been noted. Previous studies and reviews have provided evidence that high heels are detrimental to health. However, the evidence base remains fragmented and no review has covered both the epidemiological and biomechanical literature. In addition, no review has considered the psychosexual benefits that offer essential context in understanding the public health challenge of high heels.

Methods

We searched seven major bibliographic databases up to November 2016, in addition to supplementary searches. We initially identified all review articles of any design that assessed either the psychosexual benefits or negative musculoskeletal health effects of high heels, the latter looking at both the epidemiological and biomechanical perspectives. We additionally considered additional primary studies on areas that had not been reviewed before or in which a marked lack of evidence had been noted. Data were extracted onto standardised forms. Proportionate second review was conducted.

Results

A total of 506 unique records were identified, 27 full-text publications were screened and 20 publications (7 reviews and 13 additional studies) were included in our evidence synthesis. The most up-to-date epidemiological review provides clear evidence of an association between high heel wear and hallux valgus, musculoskeletal pain and first-party injury. The body of biomechanical reviews provides clear evidence of changes indicative of increased risk of these outcomes, as well as osteoarthritis, which is not yet evidenced by epidemiological studies. There were no reviews on psychosexual benefits, but all five identified original studies provided evidence of increased attractiveness and/or an impact on men’s behaviour associated with high heel wear. With regard to second-party injury, evidence is limited to one descriptive study and eight case reports.

Conclusions

Our evidence synthesis clearly shows that high heels bring psychosexual benefits to women but are detrimental to their health. In light of this dilemma, it is important that women’s freedom of choice is respected and that any remaining issues of explicit or implicit compulsion are addressed.

We need to talk about purpose: a critical interpretive synthesis of health and social care professionals' approaches to self-management support for people with long-term conditions

BACKGROUND

Health policies internationally advocate 'support for self-management', but it is not clear how the promise of the concept can be fulfilled.

OBJECTIVE

To synthesize research into professional practitioners' perspectives, practices and experiences to help inform a reconceptualization of support for self-management.

DESIGN

Critical interpretive synthesis using systematic searches of literature published 2000-2014.

FINDINGS

We summarized key insights from 164 relevant papers in an annotated bibliography. The literature illustrates striking variations in approaches to support for self-management and interpretations of associated concepts. We focused particularly on the somewhat neglected question of the purpose of support. We suggest that this can illuminate and explain important differences between narrower and broader approaches. Narrower approaches support people to manage their condition(s) well in terms of disease control. This purpose can underpin more hierarchical practitioner-patient communication and more limited views of patient empowerment. It is often associated with experiences of failure and frustration. Broader approaches support people to manage well with their condition(s). They can keep work on disease control in perspective as attention focuses on what matters to people and how they can be supported to shape their own lives. Broader approaches are currently less evident in practice.

DISCUSSION AND CONCLUSION

Broader approaches seem necessary to fulfil the promise of support for self-management, especially for patient empowerment. A commitment to enable people to live well with long-term conditions could provide a coherent basis for the forms and outcomes of support that policies aspire to. The implications of such a commitment need further attention.

Quantitative surface EMG in the diagnosis of neuromuscular disorders

This paper describes a non-invasive quantitative method for the diagnosis of neuromuscular disorders using surface EMG (sEMG). We found sEMG to be a reliable method that can be used to differentiate neuropathic and myopathic patients from the normal subjects. The multivariate discriminant analysis of sEMG data assisted in separating myopathic from neuropathic disorders. Nevertheless sEMG is not robust enough to replace needle EMG as a stand-alone diagnostic tool. However quantitative sEMG that is described in this paper could be adopted as a simple, rapid and non-invasive technique to be used in the out patients clinic by EMG-naive clinicians as a screening method for neuromuscular disorders, before referring the patients for detailed clinical neurophysiological examinations.

Human breast-cancer cells stimulate the fusion, migration and resorptive activity of osteoclasts in bone explants

A central event in bone resorption is the recruitment of osteoclasts to future resorption sites. Breast-cancer cells invariably metastasise to the skeleton and induce extensive bone destruction by osteoclasts. However, our understanding of the mechanisms by which cancer cells interact with osteoclasts remains unclear. Consequently, we compared the effects of conditioned medium (CM) from 2 human breast-cancer cell lines, MB-MDA-231 and MCF-7, with those of a normal human breast epithelial cell line, HME, on osteoclastic fusion, resorptive activity and migration from the periosteum to the developing marrow cavity of fetal mouse metatarsals in culture. Osteoclastic resorptive activity was assessed by pre-labelling 17-day-old fetal metatarsal explants with 45Ca, whilst fusion and migration were monitored by histomorphometry and osteoclasts were identified by their tartrate-resistant acid phosphatase activity. CM from TPA-stimulated breast-cancer cell lines produced a significant increase in osteoclastic resorptive activity, whilst the normal breast cell line produced a minimal increase. The breast-cancer cell lines also stimulated osteoclastic fusion and migration in the metatarsal explants, but the normal breast cell line was without effect. The stimulatory effect of CM from MDA-MB-231 cells on osteoclastic fusion, but not migration, was partially inhibited by preventing prostaglandin and leukotriene synthesis by cells within the bone explants. In contrast, a synthetic matrix metalloproteinase (MMP) inhibitor, but not a cysteine proteinase inhibitor, prevented the migration of osteoclasts to the calcified centre of the metatarsal explants in response to CM from MDA-MB-231 cells. MDA-MB-231 cells also induced an increase in the expression of MMP-9 by migrating osteoclasts. Fractionation of the TPA-stimulated breast cancer cell CM established that the resorptive activity was associated with factors of m.w. >3 kDa. We determined by immuno-assay that human breast-cancer cells secrete parathyroid hormone-related protein (PTH-rP), tumour necrosis factor-alpha (TNF-alpha) and interleukins (ILs) 6 and 11. Neutralizing experiments with human antibodies to these cytokines established that PTH-rP and TNF-alpha production by MDA-MB-231 cells were responsible for mediating their effects on osteoclastic migration and ultimately bone resorption in the metatarsal explants.

Gamma-ray scattering for mandibular bone density measurement

There has been considerable interest in the measurement of bone density in the mandible, either to study bone resorption following tooth loss or to determine the relationship between mandibular and skeletal bone mineral density. Measurements mostly have been made on dental radiographs but more significant correlations between mandibular and skeletal bone density have been obtained when more sophisticated techniques have been used, such as quantitative CT and dual energy X-ray absorptiometry. The present work investigates the feasibility of using gamma-ray scattering measurements to estimate mandibular bone density. Using a phantom to simulate the jaw, an 241Am source and a hyperpure germanium detector it is shown that bone density may be measured with a precision of about 1%.

In vivo dosimetry using diodes as a quality control tool--experience of 2 years and 2000 patients

This paper reports the use of diodes as a quality control tool on more than 95% of patients undergoing megavoltage radiotherapy during the past 2 years. The paper describes a simple method for using the diodes, a number of possible pitfalls and a quality issue raised by the measurements. In general, the results have been reassuring with very few patients falling outside a +/- 5% action level.

Gamma-ray backscatter for body composition measurement

The purpose of this study was to examine the potential of using backscatter information to assess regional body composition at selected sites. Two measurement techniques are examined: the measurement of the ratio of coherent to Compton scatter, and the measurement of the Compton scatter profile. Two possible applications are considered: the measurement of trabecular bone mineral density, and the measurement of the average fat/muscle ratio in a tissue volume. The results presented indicate that the analysis of coherent and Compton backscattered gamma-ray spectra from an 241Am source has the potential for measuring both trabecular bone mineral density and average fat/muscle ratio in a tissue volume, with a low absorbed dose to the subject.

Gamma-ray scattering for fat fraction measurement

The work reported examines the potential of using gamma-ray photon backscatter information to measure in vivo the percentage of fat in specific tissue volumes. 241Am gamma rays are used as the source and the backscatter detected with a hyperpure germanium detector, with ethanol (approximately 80% fat, 20% muscle) and water (muscle) being used as tissue substitutes. Two measurement techniques are examined; the measurement of the ratio of coherent scatter to Compton scatter and the measurement of the Compton scatter profile. Both are shown to be sensitive to the composition difference between ethanol and water. For the coherent-Compton scatter ratio, the measured difference between water and ethanol is 1.85:1, close to the value calculated (about 2:1). A similar difference in the coherent-Compton ratios between muscle and fat is calculated (2.2:1). The FWHM of the Compton profile has also been shown to vary with tissue composition with a difference of 0.10 keV (5%) between the ethanol and water profile widths.

Dose rates and energy spectra in the maze of a linear accelerator treatment room

When designing an entrance maze for a linear accelerator facility, it is useful to be able to estimate both the dose rate at the entrance and, in case further shielding is necessary, the energy spectrum of the scattered photons reaching the maze entrance. This study examines the applicability of the commonly used empirical formula contained in the National Council on Radiation Protection and Measurements (NCRP) Report No. 51 for estimating the dose rates at the maze entrance in a typical treatment room, and proposes an improvement allowing for the fact that the initial scattering event occurs most often in the patient at the isocentre. The X-ray energy spectrum at the maze entrance is also measured and shown to have a lower average energy than is assumed in NCRP Report No. 51.

Non-invasive quantitative EMG

The EMG information obtained by surface recording is compared to needle derived data processed in an identical manner. Such quantitative analysis of EMG activity has been undertaken using needle electrodes and is a well recognised technique for clinical purposes (16). Results of a study comparing data collected simultaneously by surface and needle electrodes from normal healthy volunteers are presented as a preliminary to a similar study of neuropathic and myopathic patients. The EMG interference pattern during maximum voluntary contraction was analysed for turns and zero crossings as well as from frequency spectral data, and the results displayed on-line using an inexpensive novel transputer aided PC. It was found that quantitative studies of surface and needle data were directly comparable in one muscle such as tibialis anterior but very different in another, such as rectus femoris, where there were changes in signal characteristic at different depths. The variability between individuals appeared to be less marked when surface electrodes were used. Data from surface recordings also show a high degree of repeatability when collected over a period of time.

Quality assurance of computer controlled radiotherapy treatments

There is a need in conformal therapy, as in any radiation therapy, for adequate quality assurance of the treatment plan and the delivery of the treatment. This paper examines quality assurance of two methods of conformal treatment, on a cobalt treatment unit using computer control. Each of the two methods demonstrates a different aspect of computer controlled treatments. Following completion of each treatment plan, an additional "quality assurance plan" is prepared. This is used to assess the integrity of the treatment plan, and the precision with which the computer controls the treatment unit. A simple method, using solid state detectors in a Perspex phantom, is used to validate the dosimetry of the "quality assurance plan". Quality assurance of the computer control is performed daily prior to treatments. At each treatment, parameters identifying the start position and final position of the computer controlled couch movements and the exposure time are noted by the radiographers. Comparison of the recorded movement of the treatment couch and the exposure time with that intended during each course of treatment has demonstrated, inter alia, limitations on couch speed control at speeds of less than 10 mm per min.

Treatment of medulloblastoma using a computer-controlled tracking cobalt unit

Radiation therapy of the length of the spinal column presents various clinical and physical problems. The completed plan may be complicated to set up, be time-consuming and require daily variation to achieve reasonable dose homogeneity. A case of medulloblastoma is used to illustrate the steps in producing a plan for dynamic treatment using a computer-controlled tracking cobalt unit. After definition by computed tomography, the target is considered in segments in order to develop a plan which keeps the spinal cord constantly positioned at the beam isocentre. The main computer is used to develop the patient treatment file and information is transferred to a second computer which controls and monitors the safe functioning of the cobalt unit. The cranial fields are treated separately in a conventional way. Good and consistent control of the dose distribution is achieved along the entire target volume. This technique is a marked improvement over all existing methods of treating the spinal axis.

Endocardial fibroelastosis with embolism

The clinical and pathological features of an unusual type of infantile endocardial fibroelastosis with intra-cardiac thrombus formation and peripheral emboli are described as encountered in a Scottish boy aged 10 months. The rarity of this condition in Europe and America is contrasted with its frequency in Africa.