Developing and implementing an integrated delirium prevention system of care:a theory driven, participatory research study

Background: Delirium is a common complication for older people in hospital. Evidence suggests that delirium incidence in hospital may be reduced by about a third through a multi-component intervention targeted at known modifiable risk factors. We describe the research design and conceptual framework underpinning it that informed the development of a novel delirium prevention system of care for acute hospital wards. Particular focus of the study was on developing an implementation process aimed at embedding practice change within routine care delivery. Methods: We adopted a participatory action research approach involving staff, volunteers, and patient and carer representatives in three northern NHS Trusts in England. We employed Normalization Process Theory to explore knowledge and ward practices on delirium and delirium prevention. We established a Development Team in each Trust comprising senior and frontline staff from selected wards, and others with a potential role or interest in delirium prevention. Data collection included facilitated workshops, relevant documents/records, qualitative one-to-one interviews and focus groups with multiple stakeholders and observation of ward practices. We used grounded theory strategies in analysing and synthesising data. Results: Awareness of delirium was variable among staff with no attention on delirium prevention at any level; delirium prevention was typically neither understood nor perceived as meaningful. The busy, chaotic and challenging ward life rhythm focused primarily on diagnostics, clinical observations and treatment. Ward practices pertinent to delirium prevention were undertaken inconsistently. Staff welcomed the possibility of volunteers being engaged in delirium prevention work, but existing systems for volunteer support were viewed as a barrier. Our evolving conception of an integrated model of delirium prevention presented major implementation challenges flowing from minimal understanding of delirium prevention and securing engagement of volunteers alongside practice change. The resulting Prevention of Delirium (POD) Programme combines a multi-component delirium prevention and implementation process, incorporating systems and mechanisms to introduce and embed delirium prevention into routine ward practices. Conclusions: Although our substantive interest was in delirium prevention, the conceptual and methodological strategies pursued have implications for implementing and sustaining practice and service improvements more broadly

The role of older persons in the management of HIV and AIDS: An assesment of their contribution and support needs in three South African Provinces

Includes bibliographical references

Engineering egress data considering pedestrians with reduced mobility

To quantify the evacuation process, evacuation practitioners use engineering egressdata describing the occupant movement characteristics. These data are typicallybased to young and fit populations. However, the movement abilities of occupantswho might be involved in evacuations are becoming more variable—with the buildingpopulations of today typically including increasing numbers of individuals: withimpairments or who are otherwise elderly or generally less mobile. Thus, there willbe an increasing proportion of building occupants with reduced ability to egress. Forsafe evacuation, there is therefore a need to provide valid engineering egress dataconsidering pedestrians with disabilities. Gwynne and Boyce recently compiled aseries of data sets related to the evacuation process to support practitioner activitiesin the chapter Engineering Data in the SFPE Handbook of Fire Protection Engineering.This paper supplements these data sets by providing information on and presentingdata obtained from additional research related to the premovement and horizontalmovement of participants with physical-, cognitive-, or age-related disabilities. Theaim is to provide an overview of currently available data sets related to, and keyfactors affecting the egress performance of, mixed ability populations which could beused to guide fire safety engineering decisions in the context of building design

Barriers to leisure participation for people with dementia and their carers: An exploratory analysis of carer and people with dementia's experiences.

Leisure has emerged as a prominent research theme within the growing body of knowledge on dementia, with a focus on physical activity. Yet participation in any form of leisure presupposes an ability to freely choose to partake in activities and to negotiate one's way around key barriers. In the case of dementia, the ability to undertake leisure activities is subject to a greater range of barriers, structured in a hierarchical manner that contributes to social exclusion if not addressed. This study based on focus groups with people with dementia and their family members conducted in Dorset, UK illustrates a range of barriers to leisure participation. How to create or maintain leisure opportunities for those living with dementia where households affected by dementia do not adopt avoidance behaviour, compounding a sense of isolation and exclusion is a challenge. Leisure can be an important strategy framed as a form of resistance to the social disabilities experienced by those living with dementia and it is potentially isolating impact

2010 Population and Housing Census Report: Millennium Development Goals in Ghana

According to the 2010 Population and Housing Census (PHC) report, Ghana?s population stood at 24,658,823 at the time of the 2010 census. The country has ten administrative regions and 170 districts. Ghana has one of the highest GDP per capita in West Africa and is ranked as a Lower-Middle Economy by the World Bank. The country has a diverse and rich resource base with gold, cocoa, timber, diamond, bauxite, and manganese being the most important source of foreign trade. In 2007, an oilfield which could contain up to 3 billion barrels of light oil was discovered. Although oil and gas exploration in Ghana dates back to a century, it is this latest discovery and many more afterward that have catapulted the country to be counted among the league of oil producing countries across the globe. Yet, in spite of the abundance of natural resources, a quarter of the population lives below the poverty line. However, the country has made considerable progress in reducing poverty over the last two decades. Successive nationally representative living standards surveys conducted between 1992 and 2006 (respectively, GLSS3 in 1991/2, GLSS4 in 1998/9 and GLSS5 in 2005/6) suggest that monetary poverty (measured by the level of per capita consumption) has significantly reduced. The number of poor went down from 7.9 million people (or 52 percent of the population at that time) in 1992 to 6.3 million people in 2006 (or 29 percent of the population at that time). With the rapid economic growth since the last survey in 2006, it is likely there is a further poverty reduction. Structurally, Ghana?s economy has undergone some significant transformation over the last couple of years. Ghana?s economy which until 2006 was dominated by agriculture is now led by service accounting for about 51% of national output. Agriculture accounts for about 30% (although about 55% of employed are engaged in the sector) while industry trail with only 19% of total national output. The informal economy accounts for about 86% of total employment while gold and cocoa remain the leading export earnings. This is expected to change with the commencement of oil production in commercial quantities in 2010

The Impact of Water, Sanitation, and Hygiene on Key Health and Social Outcomes: Review of Evidence

This evidence paper looks at 10 areas identified collaboratively with the United Nations Children's Fund (UNICEF) on which WASH can plausibly have a strong impact: diarrhea, nutrition, complementary food hygiene, female psychosocial stress, violence, maternal and newborn health, menstrual hygiene management, school attendance, oral vaccine performance, and neglected tropical diseases. Together, these areas cover the most significant sector outcomes associated with the distinct life course phases that UNICEF seeks to help to address through its WASH activities

Review of state of knowledge regarding the safety, access and usability needs of children with disabilities

Within European countries and the European Union, there is wide recognition that special consideration must be given to the needs of both people with disabilities and to young people. In terms of ergonomics design, consideration needs to be given to access to public buildings, safety in the home, school buildings and educational services, ability to make use of public transport, etc. This research focused on children who also have disabilities, an area that is less well understood and where it is uncertain whether standards or legislation exist. Interviews and discussions with experts were conducted to locate knowledge about design for disabled children in different contexts. This document reports the results of the research sponsored by ANEC (www.anec.org). The study identified relevant standards, legislation or guidelines within Europe and outside which could potentially be employed by the standards bodies within the European Union and promulgated more widely. The report also showed that there are gaps in knowledge indicating a requirement for further research to be carried out to generate suitable guidelines for standards bodies to consider