I do like to be beside the seaside

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Use of selective gut decontamination in critically ill children:PICnIC a pilot RCT and mixed-methods study

Background: Healthcare-associated infections are a major cause of morbidity and mortality in critically ill children. In adults, data suggest the use of selective decontamination of the digestive tract may reduce the incidence of healthcare-associated infections. Selective decontamination of the digestive tract has not been evaluated in the paediatric intensive care unit population. Objectives: To determine the feasibility of conducting a multicentre, cluster-randomised controlled trial in critically ill children comparing selective decontamination of the digestive tract with standard infection control. Design: Parallel-group pilot cluster-randomised controlled trial with an integrated mixed-methods study. Setting: Six paediatric intensive care units in England. Participants: Children (&gt; 37 weeks corrected gestational age, up to 16 years) requiring mechanical ventilation expected to last for at least 48 hours were eligible for the PICnIC pilot cluster-randomised controlled trial. During the ecology periods, all children admitted to the paediatric intensive care units were eligible. Parents/legal guardians of recruited patients and healthcare professionals working in paediatric intensive care units were eligible for inclusion in the mixed-methods study. Interventions: The interventions in the PICnIC pilot cluster-randomised controlled trial included administration of selective decontamination of the digestive tract as oro-pharyngeal paste and as a suspension given by enteric tube during the period of mechanical ventilation. Main outcome measures: The decision as to whether a definitive cluster-randomised controlled trial is feasible is based on multiple outcomes, including (but not limited to): (1) willingness and ability to recruit eligible patients; (2) adherence to the selective decontamination of the digestive tract intervention; (3) acceptability of the definitive cluster-randomised controlled trial; (4) estimation of recruitment rate; and (5) understanding of potential clinical and ecological outcome measures. Results: A total of 368 children (85% of all those who were eligible) were enrolled in the PICnIC pilot cluster-randomised controlled trial across six paediatric intensive care units: 207 in the baseline phase (Period One) and 161 in the intervention period (Period Two). In sites delivering selective decontamination of the digestive tract, the majority (98%) of children received at least one dose of selective decontamination of the digestive tract, and of these, 68% commenced within the first 6 hours. Consent for the collection of additional swabs was low (44%), though data completeness for potential outcomes, including microbiology data from routine clinical swab testing, was excellent. Recruited children were representative of the wider paediatric intensive care unit population. Overall, 3.6 children/site/week were recruited compared with the potential recruitment rate for a definitive cluster-randomised controlled trial of 3 children/site/week, based on data from all UK paediatric intensive care units. The proposed trial, including consent and selective decontamination of the digestive tract, was acceptable to parents and staff with adaptations, including training to improve consent and communication, and adaptations to the administration protocol for the paste and ecology monitoring. Clinical outcomes that were considered important included duration of organ failure and hospital stay, healthcare-acquired infections and survival. Limitations: The delivery of the pilot cluster-randomised controlled trial was disrupted by the COVID-19 pandemic, which led to slow set-up of sites, and a lack of face-to face training. Conclusions: PICnIC’s findings indicate that a definitive cluster-randomised controlled trial in selective decontamination of the digestive tract in paediatric intensive care units is feasible with the inclusion modifications, which would need to be included in a definitive cluster-randomised controlled trial to ensure that the efficiency of trial processes is maximised.</p

Social Science as a Kind of Writing

The purpose of this paper is twofold: to argue for the value of (1) social science as part of the intellectual activity of writing (rather than righting) and (2) the practice of fi ction to that intellectual activity. Writing is a mode of representation that eludes our complete and objective knowledge and always remains partial and temporary. While righting, in contrast, is concerned with the absolute truth and the revelation of the right answer. This paper argues that writing is a more productive, creative, and necessary way of engaging with reality than righting, and that it can offer insights and perspectives for both theory and praxis. Drawing on Stephen King’s view on writing fiction, this paper will also argue that fiction constitutes a kind of writing and employs a particular form of truth that is conceived as a relation between representation and reality. The paper will conclude by suggesting the need for criminologists—and social scientists more generally—to adopt the perspective of writing to gain a better understanding of the phenomena with which they are concerned

The Effects of Covid19 on Public and Paratransit Drivers in Developing Countries

IntroductionPublic and paratransit services in low- and middle-income countries were severely hit by COVID-19 and related mitigation measures. This has affected both passengers and service providers. While there is now an abundance of studies investigating the effects on passengers, the literature on the impacts of the pandemic on drivers or service providers is scarce. As such, this study investigates the implications of the pandemic for commercial passenger vehicle drivers in the global south taking one South Asian country (Bangladesh) and one African country (Nigeria) as case study countries.MethodsThe study employed Interpretative Phenomenological Analysis (IPA) qualitative approach to explore and explicate the subjective experiences of drivers using semi-structured interviews. Using purposive sampling technique, thirty participants were recruited between March and April 2021. The recorded interviews were transcribed and thematically analysed using NVivo software.ResultsThe analyses identify key challenges faced by drivers into five distinct themes including personal and social, physical, and operational, health and wellbeing, governance and regulation, and bad enforcement and policing related challenges. Participants reported immense hardship due to the bans on operations and lack of passengers, eliminating or reducing their only opportunities for earning a livelihood. There was a consensus among participants that they were abandoned by their governments during the pandemic and were left with no other choice than to work in risky situations. They either had to use the little savings they had or borrow money to feed their families, further reducing their opportunities for the future. Apart from facing reduced income, debt crisis, and unsustainable workload challenges, drivers reported mental health consequences of the pandemic including depression, suffering anxiety, fear of risk infection and helplessness.ConclusionsThis research concludes the impacts of the COVID-19 outbreak and its following containment measures on the health and wellbeing, personal and working lives of public and paratransit drivers in developing countries are substantial. The pandemic has seriously affected transport workers, which also amplified earlier inequalities. Development of non-discriminatory policies, fair and stringent enforcement, and provision of targeted financial support along with awareness raising campaigns are essential to reduce the effect pandemic had on drivers.<br/

Multi-Dimensional Model of Cooperative Learning

This study was an attempt to apply a multi-dimensional model of cooperative learning to motivate students in five steps and increase their engagement in active classroom activities. However, it was conducted in face-to-face (F2F) contexts. We believe the findings are applicable in virtual and hybrid contexts

The evaluation of training oral and maxillofacial trainees in head and neck cancer doctor-patient communication using the Patient Concerns Inventory.

AbstractHead and neck cancer has a significant impact on a patient’s health related quality of life (HRQOL). The head and neck specific Patient Concerns Inventory (PCI-HN) has been utilised to enhance doctor-patient dialogue in routine consultations. To date there has been no formal training for oral and maxillofacial surgery (OMFS) surgical trainees in the use of the PCI-HN in consultations. The aim of the study was to evaluate training for OMFS surgical trainees in the use of the PCI-HN, using simulated follow-up HNC consultations, in order to improve doctor-patient communication skills.Material and methodsTen oral and maxillofacial surgical trainees completed actor simulated HNC consultations before and after training. A study-specific mark scheme was developed based on the ComOn-Coaching rating scales and used to score the doctor-patient interaction. A group debrief afterwards explored the trainee’s experiences of the training and consultations. ResultsAll trainees showed an improvement in doctor-patient communication scores following their training. Overall, the six participants who were Specialty registrars, year 3 (ST3) or above, scored higher, than the four Specialty registrars, year 1-2 (ST1-2). The scores were higher if fewer PCI-HN items were discussed (3-4). The most frequently avoided PCI-HN items were intimacy and relationships. The trainees considered that their training was useful for organising their consultations and for providing holistic care. ConclusionAlthough training improved surgeon-patient communication, further evaluation is required with a larger number of trainees and actual consultations in clinic.<br/

Understanding the importance of therapeutic alliance during physiotherapy treatment for musculoskeletal pain in children: a scoping review.

IntroductionMusculoskeletal pain affecting children is common. Rehabilitation and treatment effectiveness can be influenced by multiple individual and contextual factors. The need for more rigorous evaluation of physiotherapy treatment for children’s pain, identification of the role of specific techniques, and exploration of the influence of the therapeutic alliance is needed. This scoping review of research aimed to examine: (1) What are the perceptions of children, parents, and physiotherapists about the importance of therapeutic alliance during musculoskeletal pain treatment? (2) What are the key characteristics of therapeutic alliance during a child’s musculoskeletal pain treatment from the perspectives of children, parents, and physiotherapists? and (3) What are the perceived impacts of therapeutic alliance (positive and negative) during a child’s physiotherapy treatment for musculoskeletal pain? MethodsThe scoping review, based on Arksey and O’Malley’s framework and reporting was guided by PRISMA-ScR. The search strategy was based on three concept blocks: (1) Study population: Children (&lt;18 years); (2) Medical condition: Any musculoskeletal pain (acute, chronic primary, chronic secondary); (3) Intervention: Qualitative exploration of experience of physiotherapy treatment delivered by a physiotherapist from the perspective of a child, parent, or physiotherapist. The search (no date limit) was conducted in February 2024 across Medline, AMED and CINAHL. ResultsFollowing duplicate removal and assessment of eligibility of the initial 236 articles, nine articles were included; of these, only one specifically aimed to explore therapeutic alliance and it was the only paper to directly mention therapeutic alliance. All nine articles presented the child’s experience. One overarching theme ‘Finding resilience within me through therapeutic alliance’ and three main themes: ‘A trusted guide through the ups and the downs of rehabilitation’; ‘Having a route map’; and ‘Take me seriously but make it fun’ were identified. DiscussionTherapeutic alliance was considered important by children, parents and physiotherapist and it influenced child and parent perceptions of physiotherapy and overall treatment outcomes. Physiotherapists can foster the children’s resilience when experiencing musculoskeletal pain by providing disciplinary expertise, connecting and collaborating with the child by becoming their trusted guide, and co-creating a route map for rehabilitation by helping them to learn about their body, pain and recovery timeline.<br/

‘Humour can open the door to conversations’: Exploring the Role of Comedy in Breaking Down Barriers to Employment for Young Disabled People

Young disabled people encounter many barriers in their transition to adulthood, including having access to the world of work. According to recent data, only 4.8% of adults with a learning disability are in paid work. We wanted to explore how we might address one of the initial barriers, the employment recruitment process. Eleven young disabled people were invited to work with The Comedy Trust to make their own video Curriculum Vitae (CV). We hoped to explore how we could draw on the art form of comedy to not only produce video CVs but also to share the voices of young people with a learning disability. Young people with learning disabilities have a desire to work and have the skills necessary to succeed in the workplace with appropriate support. This paper highlights the importance of employers and those who support young disabled people, having the opportunity to hear the voices of young people so they can consider how to make their recruitment process more inclusive and to address the barriers that are experienced