A study of a move from hospital to community based care for people with a mental handicap

This thesis presents findings from a study examining some effects of a move to community based care on a group of 39 residents of Aycliffe Hospital; each person leaving was matched with two people who remained in the hospital. Both groups were studied before and at least 12 months after leaving the hospital. A number of measures were taken that describe the characteristics of the subjects and homes. These include a novel method to describe the location of facilities around the homes. A time budget methodology was used to measure activity outside of the home before subjects left the hospital, this was repeated at follow-up. The time budget consisted of a week long record of each occasion that the person left the home, also recorded were the destination, duration, mode of transport and people accompanying on each trip. At follow-up a novel method was used to gain qualitative and quantitative data concerning subjects' familiarity with their neighbourhood. This involved accompanying the subjects' on walks around their neighbourhoods and required them to identify a standard list of facilities. Further measures at follow-up involved direct time sample observation of activity within the home. Semi-structured interviews were used to establish subjects’ views of the move and of their current pattern of activities. The outcomes for the movers are generally encouraging. Although they loose some independence they do not engage in less activity. They use more unsegregated facilities, and a range of maintenance facilities that not used in the hospital; some use unsegregated work and leisure facilities. Within the home movers have more opportunity for and engage in more domestic and personal behaviour. Of those that gave interviews, more movers than controls indicated that they were satisfied with their new homes, and in comparison with controls few movers would like to live elsewhere

Cognitive mediation in people with dementia:Development, structural, and construct validity of the first dementia‐specific measure

OBJECTIVES: Anxiety and depression are common and deleterious comorbidities in people living with dementia (PLWD). Cognitive behavioural therapy (CBT) is one of the few promising treatments; however, it is unclear whether PLWD have the necessary prerequisites to engage in this. Having an understanding of cognitive mediation, that a thought mediates the relationship between an antecedent event and its emotional consequence, is key for engaging with CBT and is also a critical component of emotion regulation. There are no measures of this construct validated for PLWD. This study aims to adapt and validate an existing measure for this population. A secondary aim is to assess its applicability in older adults (OA) without a recognised neurocognitive impairment. // METHODS: A measure of cognitive mediation was adapted via expert and service user consultation for use in PLWD. A total of 102 PLWD and 77 OA without neurocognitive impairments completed the adapted measure along with two measures of emotion recognition and reasoning. Factor structure was examined separately in both samples, and the measure reduced, with convergent validity assessed. // RESULTS: A final measure of 10 items (named the CM-Dem) was subject to factor analysis yielding a single factor solution. The measure showed good psychometric properties in PLWD, including good model fit, high internal consistency, inter-rater reliability, and moderate convergent validity with related constructs. In contrast, poor validity was found in OA, especially a lack of convergent validity. // CONCLUSIONS: The CM-Dem has clinical and research utility as a measure of cognitive mediation in PLWD, but less so in OA

Patients admitted to more research-active hospitals have more confidence in staff and are better informed about their condition and medication: results from a retrospective cross-sectional study

Rationale, aims and objectives: Clinical research activity in hospitals is associated with reduced mortality and improved overall care quality. In England, the latter is a compound score of several elements and both staff and inpatient feedback form part of the Care Quality Commission (CQC) ratings. The objective of this study was to determine if NHS Trusts' National Institute for Health Research (NIHR) study activity data correlates with specific outcomes from national NHS staff and patient surveys. Method: Retrospective cohort design involving data for 129 English NHS hospital Trusts, including scores from recent national NHS staff and inpatient surveys and NIHR data. Statistical approach involved Spearman correlation analyses, with cut‐off P value ≤ 0.01 for qualification for subsequent principal component analysis (correlation coefficient cut‐off value 0.20). Results: Outcomes of one staff survey question (staff recommendation of the organization as a place to work or receive treatment) and multiple outcomes of inpatient survey questions were positively associated with increased NIHR‐adopted clinical research activity. Better quality of information provision to patients was the dominant theme, though a higher degree of observed staff teamwork, more confidence in the treating doctors, and a better overall inpatient experience also correlated significantly. The number of different studies contributed more to positive associations with survey outcomes compared with the number of recruited participants into research. Conclusions: Survey elements of the CQC appraisal of English NHS Hospital Trusts are significantly associated with increased clinical research activity levels; it appears to drive better information provision to inpatients—particularly around medicine management—and contribute to a better inpatient experience overall, whilst staff are more likely to recommend their own organization. Despite clinical research activity forming a very small fraction of overall NHS activity, it has an indirect positive effect on staff and Trust performance that is measurable at patient level

Using high fidelity simulation to impact occupational therapy student knowledge, comfort, and confidence in acute care

Background: As the demand for occupational and physical therapists in acute care settings is increasing, students are reporting a need for increased educational preparation to handle the complexities they may face in this setting. This pretest/posttest study examines the impact of an inter-professional high fidelity simulation experience on perceived levels of knowledge, comfort, and confidence among occupational therapy doctorate students when handling an acutely ill patient in an ICU setting. Methods: Two cohorts of occupational therapy students participated in an inter-professional acute care scenario with high fidelity simulation mannequins (Cohort 1, n = 19; Cohort 2, n = 27). Before and after the simulation, the students rated their perceived level of knowledge, comfort, and confidence with handling acutely ill patients. Results: A two-tailed Wilcoxin Signed-Ranks indicated that posttest ranks were statistically significantly higher than pretest ranks with α = .05 indicating improvement in students’ perceived levels of knowledge, comfort, and confidence after participating in an acute care simulation. Conclusion: High fidelity simulation can positively impact students’ perceptions of their knowledge, comfort, and confidence in handling acutely ill patients

Training therapists to work with people with intellectual disability in Improving Access to Psychological Therapies (IAPT) services

BACKGROUND: Current policy in the England suggests that people with intellectual disabilities should, where possible, access mainstream mental health services; this should include access to mainstream therapy services. It is likely that mainstream therapists will need training and support to work with people with intellectual disabilities. METHOD: Sixty-eight therapists working in an English Improving Access to Psychological Therapies (IAPT) service received one- or 2-day training on working with people with intellectual disabilities. Measures of confidence, general therapeutic self-efficacy and attitudes to people with intellectual disabilities' use of mainstream mental health services were completed pre-training, post-training and at 3-month follow-up; at which time, 12 participants were interviewed about the impact of the training on their practice. RESULTS: There was a significant positive change in all measures immediately post-training which was maintained at 3-month follow-up. CONCLUSIONS: Training considerations for mainstream therapists who may work with people with intellectual disabilities are discussed

The effect of diagnostic label on care staff’s perceptions of cause of challenging behaviour in individuals with learning disabilities

Background: This study investigated whether care staff’s causal attributions and emotional reactions to the challenging behaviour displayed by service users was influenced by the service user’s diagnostic label. Materials and Method: One hundred and twenty care staff were randomly allocated to one of three conditions. Participants viewed a video of a senior staff member describing a service user, varying only in diagnostic label (autism, learning disability or Down syndrome). Participants then rated their endorsement of possible causes and emotional reactions to challenging behaviour. Results: Participants in the Autism and Down syndrome groups made more use of biomedical causes and less use of learned behaviour as an explanation for challenging behaviour than those in the Learning Disabilities group. Those in the former groups reported more positive and fewer negative emotions than those in the Learning Disabilities group. Conclusions: The way staff viewed people with learning disabilities was affected by their diagnostic label. Implications for further research and training has been discussed

Investigation of an outbreak of type 3 wild poliovirus in Cote d'Ivoire in 2011

Background: Côte d'Ivoire had no type 3 wild poliovirus (WPV3) outbreak since 1999. In 2011, the country was reinfected by WPV3. The objective of this study is to explore the reasons behind the occurrence of WPV3 outbreak in Côte d'Ivoire in 2011.Method: Data on WPV3 cases were obtained from specific investigation records during the outbreak investigation. Data on AFP cases was obtained from AFP routine investigation forms. Information on polio immunization was extracted from National EPI databases and documents. Univariate analyses were done to summarize characteristics of AFP and WPV3 cases. Bivariate and multivariable analyses were done to compare polio cases to non-polio AFP cases. Finally, the proportion of non-vaccinated children in routine immunization from 2006 to 2010 was calculated.Results: In the Côte d'Ivoire outbreak, from January to July 2011, 36 WPV3 cases were notified. The median age was two years old (interquartile range two to four years old). Among these cases, 29 had received less than three polio vaccine doses. The majority of WPV3 cases were living in precarious socio-economic conditions. Regarding vaccination status of AFP cases, the polio cases had a statistically significant higher risk to have less than three doses of polio vaccine compared to non-polio cases, OR: 16.9 [95% CI: 2.3 – 125.0]. More than 27% of the children of less than one year old who were expected to be vaccinated in the country were not vaccinated from 2006 to 2010.Conclusion: Despite the limitations, this study shows that a country that has interrupted polio transmission for one type of poliovirus can still be at high risk for polio outbreaks of this same type following an importation. This can occur when routine immunization coverage is low, polio supplementary immunization activities are done with only the poliovirus vaccine against the circulating poliovirus, people live in precarious socio-economic conditions and AFP surveillance is poorly performed. Côte d'Ivoire experienced this outbreak as many of these conditions occurred together.Keywords: Wild poliovirus, epidemic, occurrence, Côte d'Ivoir

What next for Shared Lives? Family-based support as a potential option for older people

With an ageing population and limited resources the challenge for policy makers and practitioners is how best to provide for the care and support needs of older people. This article draws on findings from two studies, a scoping study of the personalisation of care services and another which aimed to generate evidence about the potential use of family-based support schemes (Shared Lives, SL) for certain groups of older people. Forty-three schemes participated in a survey to gather information about services provided and the extent to which this included older people and their carers, and six staffs were interviewed across two schemes about issues for expanding provision for older people in their local areas. It was evident that SL schemes were already supporting a number of older people and there was support for expansion from both schemes and local authorities. Adequate resources, awareness raising, management commitment, and a pool of suitable carers would be needed to support any expansion effort. There is also still a need for SL to be more widely known and understood by care managers if it is to be considered part of mainstream provision for older people

Species, Clusters and the 'Tree of Life': A graph-theoretic perspective

A hierarchical structure describing the inter-relationships of species has long been a fundamental concept in systematic biology, from Linnean classification through to the more recent quest for a 'Tree of Life.' In this paper we use an approach based on discrete mathematics to address a basic question: Could one delineate this hierarchical structure in nature purely by reference to the 'genealogy' of present-day individuals, which describes how they are related with one another by ancestry through a continuous line of descent? We describe several mathematically precise ways by which one can naturally define collections of subsets of present day individuals so that these subsets are nested (and so form a tree) based purely on the directed graph that describes the ancestry of these individuals. We also explore the relationship between these and related clustering constructions.Comment: 19 pages, 4 figure