How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions.

PURPOSE: We investigated stroke rehabilitation clinician's perceptions of the patient as an active partner in setting goals within stroke rehabilitation and factors that influence patient engagement. METHODS: Semi-structured interviews, subject to general inductive analysis with 20 Clinicians' working in three UK based stroke rehabilitation teams (one in-patient ward and two community based rehabilitation teams). RESULTS: There were three key themes that impacted on the patients active involvement in setting goals for rehabilitation after stroke: Patient barriers to goal setting (knowledge of the patient and family, who is the patient and the stroke's impact); How we work as a team (the role of the patient in setting goals, the effect of clinician attributes on goal setting); and How systems impact goal setting (goal-setting practice, home versus hospital, and professional/funder expectations of clinicians'). CONCLUSIONS: Goal setting served a range of different, sometimes conflicting, functions within rehabilitation. Clinicians' identified the integral nature of goals to engage and motivate patients and to provide direction and purpose for rehabilitation. Further, there was an identified need to consider the impact of prioritizing clinician-derived goals at the expense of patient-identified goals. Lastly the reliance on the SMART goal format requires further consideration, both in terms of the proposed benefits and whether they disempower the patient during rehabilitation. Implications for rehabilitation Goal setting is often promoted as a relatively simple, straightforward way to structure interactions with patients Patient-related factors together with resourcing constraints are significant barriers to patient-centered goal setting, particularly during inpatient rehabilitation Clinicians need to have pragmatic tools that can be integrated into practice to ensure that goal-setting practice can be maximized for patients with different intrinsic characteristics.

What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis.

OBJECTIVE: To identify the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries. DATA SOURCES: AMED, Proquest, CINAHL and MEDLINE. REVIEW METHODS: Two reviewers independently screened, extracted data and assessed study quality using the Mixed Methods Appraisal Tool and undertook thematic content analysis for papers examining the barriers and facilitators to goal-setting during stroke/neurological rehabilitation (any design). Last searches were completed in May 2016. RESULTS: Nine qualitative papers were selected, involving 202 participants in total: 88 patients, 89 health care professionals and 25 relatives of participating patients. Main barriers were: Differences in staff and patients perspectives of goal-setting; patient-related barriers; staff-related barriers, and organisational level barriers. Main facilitators were: individually tailored goal-setting processes, strategies to promote communication and understanding, and strategies to avoid disappointment and unrealistic goals. In addition, patients' and staff's knowledge, experience, skill, and engagement with goal-setting could be either a barrier (if these aspects were absent) or a facilitator (if they were present). CONCLUSION: The main barriers and facilitators to goal-setting during stroke rehabilitation have been identified. They suggest that current methods of goal-setting during inpatient/early stage stroke or neurological rehabilitation are not fit for purpose.

Iron indenyl carbonyl compounds: CO-releasing molecules.

New CO-releasing molecules, CO-RMs, based on indenyl iron carbonyls have been identified. Half-lives for carbon monoxide (CO) release, (1)H NMR, (13)C NMR, IR, mass spectra, elemental analysis and biological data have been determined for the compounds. Limited correlations have been made between half-lives and ΔG(‡) for CO release and spectroscopic parameters, ν(CO) and δ((13)CO). X-ray structures have been determined for [Fe(η(5)-C(9)H(7))(CO)(2)L][BF(4)] where L is CO, NCMe, PPh(3), P(OPh)(3), NC(5)H(5) or 1-methylimidazole. Improved preparations of [Fe(η(5)-C(9)H(7))(CO)(2)](2) and [Fe(η(5)-C(9)H(7))(CO)(3)][BF(4)] are reported.

Tris(5-methyl-3-phenyl-1H-pyrazol-1-yl)methane.

The first crystal structure of a second-generation tris-(pyrazol-yl)methane, namely the title compound, C(31)H(28)N(6), is reported. The mol-ecule exhibits a helical conformation with an average twist of 35.1°. In addition, there are C-H⋯π inter-actions of 3.202 (2) Šbetween the pyrazole C-H group and neighbouring phenyl groups.