Self-neglect and safeguarding adult reviews: towards a model of understanding facilitators and barriers to best practice

Purpose – One purpose is to update the core dataset of self-neglect safeguarding adult reviews and accompanying thematic analysis. A second purpose is to draw together the learning available from this dataset of reviews to propose a model of good practice that can be used as the basis for subsequent safeguarding adult reviews. Design/methodology/approach – Further published reviews are added to the core dataset from the web sites of Safeguarding Adults Boards. Thematic analysis is updated using the four domains employed previously. A sufficient number of reviews have been done from which to construct an evidence-based model of good practice. A framework is presented with the proposition that this can be used as a proportional methodology for further safeguarding adult reviews where self-neglect is in focus. Findings – Familiar findings emerge from the thematic analysis. This level of analysis, constructed over time and across reviews, enables a framework to be developed that pulls together the findings into a model of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners involved in such cases. This framework can then be used as an evidence-based model with which to review new cases where safeguarding adult reviews are commissioned.   Research limitations/implications – The national database of reviews commissioned by SABs is incomplete and does not contain many of the safeguarding adult reviews reported in this evolving dataset. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. It is possible, therefore, that this dataset is also incomplete. Drawing together the findings from the reviews nonetheless enables conclusions to be proposed about the components of effective practice, and effective policy and organisational arrangements for practice. Future reviews can then explore what enables such effective to be achieved and what barriers obstruct the realisation of effective practice. Practical implications – Answering the question “why” is a significant challenge for safeguarding adult reviews. A framework is presented here, drawn from research on safeguarding adult reviews featuring self-neglect, that enables those involved in reviews to explore the enablers and barriers with respect to an evidence-based model of effective practice. The framework introduces explicitly research and review evidence into the review process. Originality/value – The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also proposes a new approach to safeguarding adult reviews by using the findings and recommendations systematically within a framework designed to answer “why” questions – what promotes and what obstructs effective practice.   Keywords: Safeguarding adult reviews, evidence, self-neglect, proportionality Paper type: Research pape

Re-charting the Course: First Report of the Presidential Task Force on Employment of Adults with Disabilities

DisabilitiesRechartingtheCourse1998.pdf: 589 downloads, before Oct. 1, 2020

Re-charting the Course: If Not Now, When?

DisabilitiesRechartingTheCourse1999.pdf: 474 downloads, before Oct. 1, 2020

Common Core Assessments in follow-up studies of adults born preterm-Recommendation of the Adults Born Preterm International Collaboration

Background Of all newborns, 1%-2% are born very preterm (VP;Peer reviewe

Children and young people with perinatal HIV in Europe: epidemiological situation in 2014 and implications for the future

Accurate ascertainment of the number of children living with human immunodeficiency virus (HIV) is important to plan paediatric and adolescent health services. In Europe, the first generation of perinatally HIV-infected survivors are transferring to adult care and their health needs are unknown. We undertook an online survey of HIV cohort studies participating in the EuroCoord Network of Excellence to ascertain the number of perinatally HIV-infected (pHIV) patients included, to compare it with those published by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) and to assess the ability of countries to follow up pHIV patients after transfer to adult care. At the end of 2013, 16 countries in EuroCoord reported 8,229 pHIV patients in follow-up in cohorts, compared with 5,160 cumulative diagnoses reported by the ECDC in the same area. Follow-up of pHIV patients after transfer to adult care varied. It is likely that the number of diagnoses of perinatal HIV reported to ECDC is an underestimate, although this varies by country. Further work is needed to refine estimates and encourage follow-up in adult HIV cohorts to investigate long-term outcomes and improve the care of the next generation of children with HIV

Polypharmacy, potentially serious clinically relevant drug-drug interactions, and inappropriate medicines in elderly people with type 2 diabetes and their impact on quality of life

The aim of the study is to investigate the patterns of polypharmacy, clinical-relevant drug-drug interactions (DDIs), and potentially inappropriate medicines (PIMs), and whether polypharmacy, potential serious clinically-relevant DDIs, or PIMs can be associated with low quality of life (QoL) index scores of older adults with type 2 diabetes (T2D). A cross-sectional study was conducted using data of 670 elderly T2D sub-cohort from a nationwide pharmacy-based intensive monitoring study of inception cohort of T2D in Portugal. 72.09% were found on polypharmacy (≥5 medicines). Participants on polypharmacy were mostly females (P = .0115); more obese (P = .0131); have more comorbid conditions (P < .0001); more diabetes complications (P < .0001); and use more of glucose lowering drugs (P = .0326); insulin (P < .0001); chronic medicines (P < .0001); and have higher diabetes duration (P = .0088) than those without polypharmacy. 10.59% of the participants were found to have potential serious clinically relevant DDIs. The most frequent drug-combinations were angiotensin-converting enzyme (ACE) inhibitors with angiotensin-receptor blockers (ARBs), aspirin with Selective serotonin reuptake inhibitors (SSRIs), and clopidogrel with calcium channel blockers. PIMs are found in 36.11% of the participants. The most common PIMs were benzodiazepines, long-acting sulfonylureas, and iron overdose. The adjusted multivariate models show that Polypharmacy, PIMs, and potential serious clinically relevant DDIs were associated with lower QoL index scores (OR 1.80 95% CI 1.15-2.82), (OR 1.57 95% CI 1.07-2.28), and (OR 1.34 95% CI 0.73-2.48) respectively. The study shows that polypharmacy, potential serious clinical-relevant DDIs, and PIMs may correlate with risk of reduced health related QoL outcome of older adults with T2D.publishersversionpublishe

Achievement of multiple therapeutic targets for cardiovascular disease prevention. Retrospective analysis of real practice in Italy

Background: Pharmacological therapy in patients at high cardiovascular (CV) risk should be tailored to achieve recommended therapeutic targets. Hypothesis: To evaluate individual global CV risk profile and to estimate the control rates of multiple therapeutic targets for in adult outpatients followed in real practice in Italy. Methods: Data extracted from a cross-sectional, national medical database of adult outpatients in real practice in Italy were analyzed for global CV risk assessment and rates of control of major CV risk factors, including hypertension, dyslipidemia, diabetes, and obesity. CV risk characterization was based on the European SCORE equation and the study population stratified into 3 groups: low risk ( 40 (males)/>50 (females) mg/dL (OR: 0.926, 95% CI: 0.895–0.958), triglycerides <160 mg/dL (OR: 0.925, 95% CI: 0.895–0.957), and BMI <25 kg/m2(OR: 0.888, 95% CI: 0.851–0.926), even after correction for diabetes, renal function, pharmacological therapy, and referring physicians (P < 0.001). Conclusions: Despite low prevalence and optimal medical therapy, individuals with high to very high SCORE risk did not achieve recommended therapeutic targets in a real-world practice

Connections

On February 15, 2005, Parents and Adults Inspiring Reading Success (PAIRS) was successfully launched. Research and experience confirm that positive influences on student achievement occur, not only in the classroom, but through extracurricular and informal learning experiences. PAIRS had emerged as a result of community meetings the EOC held in each of the 46 counties. This newsletter covers the years from March 2005 through December 8, 2008