Patients’ Views: Peer Support Worker On Inpatient Wards

Purpose: To explore patients’ experiences of intentional mental health peer support (PS) Design/methodology/approach: Seven in depth interviews were carried out by an independent researcher with individual inpatients who volunteered via a PS worker following leaflet and poster distribution explaining the research on the two wards. Each recorded interview of thirteen questions was transcribed verbatim by the researcher and analysis identified common themes across the interviews. Findings: An overarching theme of communication with patients was identified together with six main themes: person centeredness, practical support, building connections, emotional support, modelling hope, and recovery interventions. There were no negative comments expressed by interviewees. Research limitations/implications: Small scale qualitative research allows in-depth exploration of experiences which is valuable in informing the further development of peer support. Originality/value: There are very few published reports of inpatient experiences of peer support in inpatient settings

An investigation of oral sex as a risk factor for recurrent vaginitis: a case study

Background: Recurrent Vaginitis is defined as having three or more confirmed episodes within a year. Recurrence rates of vaginitis have been reported in up to 60% of previously infected women. The most common bacterial cause is due to Gardnerella vaginalis, while Candida albicans is the most common fungal cause; both microorganisms can cause opportunistic infections when imbalances occur in the vaginal environment. Commonly known risk factors include multiple sex partners, unprotected sex, douching, recent antibiotic use, and estrogen therapy. Case Presentation: A healthy 34-year-old female is complaining of recurrent episodes of vaginitis since the birth of her son two years ago. Vaginal irritation is typically accompanied by thick off-white vaginal discharge. She attributes her recurring symptoms to her intrauterine device (IUD) placed six-weeks postpartum. Symptoms occur after sexual intercourse, approximately once or twice a month. Her husband has incorporated oral sex into their routine sexual practice to help counteract the reduced libido she developed since having their son. She is married and monogamous with her husband. She has no prior history of sexually transmitted infection. She denies fevers, unintentional weight change, menstrual irregularity, rash or genital lesions, dyspareunia, or urinary complaints. Her vital signs are within normal range. A pelvic exam reveals mild suprapubic tenderness, erythema of the vaginal introitus, and thick off-white vaginal discharge with slight odor. No abnormal masses or cervical motion tenderness are noted on the bimanual exam. Urinalysis shows leukocyte esterase. Urine pregnancy test is negative. Vaginal swabs for gonorrhea and chlamydia are negative. Clue cells are seen on saline wet mount, and pseudohyphae with budding yeast are noted on potassium hydroxide preparation. For her concurrent bacterial vaginosis and Candidal vaginitis, she is prescribed a week of oral metronidazole 500 mg twice daily, and one dose of oral fluconazole 150 mg, respectively. Additionally, her husband is advised to thoroughly gargle with mouthwash prior to engaging in oral sex. On follow-up, the patient reports no further postcoital vaginitis episodes. Discussion: Current data is inconsistent regarding whether oral sex is considered a risk factor for recurrent vaginitis. The lack of research in this area could be due to the sensitive nature of discussing detailed sexual practices with patients, but these discussions provide a significant part of a patient’s history. Anecdotal evidence from our patient case prompted further investigation into the interactions between oral sex and recurrent vaginitis. An extensive literature review suggests that dysbiosis in vaginal flora resulting in vaginitis may be due to the direct inoculation of oral microbes, or the indirect effects of their byproducts. Furthermore, studies have shown that the use of mouthwash can effectively eliminate oral flora known to impact the vaginal microbiota. We plan to conduct a meta-analysis to further investigate the effects of varying vaginal and oral flora compositions on many aspects of the vaginal environment. A future case-control study can also be done to investigate the effectiveness of using mouthwash prior to oral sex for the prevention of recurrent vaginitis

National early warning scores in care homes: do policy imperatives reflect a genuine need?

Background the National Early Warning Score (NEWS) is a tool based on vital signs that aims to standardise detection of, and response to, clinical deterioration in adults. NEWS has been adopted in hospitals but not adapted for other settings. This study aimed to explore the feasibility of measuring the NEWS in care homes and describe the distribution of NEWS readings amongst care home residents. Methods descriptive analysis of all NEWS readings recorded in a 30-month period (2016–19) across 46 care homes in one Clinical Commissioning Group in England. Comparisons were made between measurements taken as a routine reading and those prompted by concern about acute illness. Results a total of 19,604 NEWS were recorded from 2,424 older adults (≥65 years; mean age 85). Median NEWS was 2. Two thirds (66%) of residents had a low NEWS (≤2), and 28% had a score of 0. Of the total NEWS readings, 6,277 (32%) were known to be routine readings and 2,256 (12%) were measured because of staff concerns. Median NEWS was 1 for routine and 2 for concern recordings. Overall, only 12% of NEWS were high (≥5), but a higher proportion were elevated when there were concerns about acute illness (18%), compared with routine recordings (7%). Conclusions use of NEWS in care homes appears to be feasible. The majority of NEWS were not elevated, and the distribution of scores is consistent with other out-of-hospital settings. Further work is required to know if NEWS is triggering the most appropriate response and improving care home resident outcomes. Keywords care homes, track and trigger systems, National Early Warning Score, older people Topic internship and residencyprecipitating factorsvital signselderlymedical residenciesnational early warning score (news

High field effects of GaN HEMTs.

This report represents the completion of a Laboratory-Directed Research and Development (LDRD) program to develop and fabricate geometric test structures for the measurement of transport properties in bulk GaN and AlGaN/GaN heterostructures. A large part of this study was spent examining fabrication issues related to the test structures used in these measurements, due to the fact that GaN processing is still in its infancy. One such issue had to do with surface passivation. Test samples without a surface passivation, often failed at electric fields below 50 kV/cm, due to surface breakdown. A silicon nitride passivation layer of approximately 200 nm was used to reduce the effects of surface states and premature surface breakdown. Another issue was finding quality contacts for the material, especially in the case of the AlGaN/GaN heterostructure samples. Poor contact performance in the heterostructures plagued the test structures with lower than expected velocities due to carrier injection from the contacts themselves. Using a titanium-rich ohmic contact reduced the contact resistance and stopped the carrier injection. The final test structures had an etch constriction with varying lengths and widths (8x2, 10x3, 12x3, 12x4, 15x5, and 16x4 {micro}m) and massive contacts. A pulsed voltage input and a four-point measurement in a 50 {Omega} environment was used to determine the current through and the voltage dropped across the constriction. From these measurements, the drift velocity as a function of the applied electric field was calculated and thus, the velocity-field characteristics in n-type bulk GaN and AlGaN/GaN test structures were determined. These measurements show an apparent saturation velocity near to 2.5x10{sup 7} cm/s at 180 kV/cm and 3.1x10{sup 7} cm/s, at a field of 140 kV/cm, for the bulk GaN and AlGaN heterostructure samples, respectively. These experimental drift velocities mark the highest velocities measured in these materials to date and confirm the predictions of previous theoretical models using ensemble Monte Carlo simulations

Implementation of the National Early Warning Score in UK care homes:a qualitative evaluation

BACKGROUND: The National Early Warning Score (NEWS) is a tool for identifying and responding to acute illness. When used in care homes, staff measure residents' vital signs and record them on a tablet computer, which calculates a NEWS to share with health services. This article outlines an evaluation of NEWS implementation in care homes across one clinical commissioning group area in northern England. AIM: To identify challenges to implementation of NEWS in care homes. DESIGN AND SETTING: Qualitative analysis of interviews conducted with 15 staff members from six care homes, five health professionals, and one clinical commissioning group employee. METHOD: Interviews were intended to capture people's attitudes and experiences of using the intervention. Following an inductive thematic analysis, data were considered deductively against normalisation process theory constructs to identify the challenges and successes of implementing NEWS in care homes. RESULTS: Care home staff and other stakeholders acknowledged that NEWS could enhance the response to acute illness, improve communication with the NHS, and increase the confidence of care home staff. However, the implementation did not account for the complexity of either the intervention or the care home setting. Challenges to engagement included competing priorities, insufficient training, and shortcomings in communication. CONCLUSION: This evaluation highlights the need to involve care home staff and the primary care services that support them when developing and implementing interventions in care homes. The appropriateness and value of NEWS in non-acute settings requires ongoing monitoring

Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

Background: The COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness in care homes plays a particularly important role in the care of residents during a pandemic. Digital recording of a National Early Warning Score (NEWS), which involves the measurement of physical observations, started in care homes in one area of England in 2016. Implementation of a NEWS intervention (including equipment, training and support) was accelerated early in the pandemic, despite limited evidence for its use in the care home setting. Objectives: To understand how a NEWS intervention has been used in care homes in one area of North-East England during the COVID-19 pandemic, and how it has influenced resident care, from the perspective of stakeholders involved in care delivery and commissioning. Methods: A qualitative interview study with care home (n=10) and National Health Service (n=7) staff. Data were analysed using thematic analysis. Results: Use of the NEWS intervention in care homes in this area accelerated during the COVID-19 pandemic. Stakeholders felt that NEWS, and its associated education and support package, improved the response of care homes and healthcare professionals to deterioration in residents’ health during the pandemic. Healthcare professionals valued the ability to remotely monitor resident observations, which facilitated triage and treatment decisions. Care home staff felt empowered by NEWS, providing a common clinical language to communicate concerns with external services, acting as an adjunct to staff intuition of resident deterioration. Conclusions: The NEWS intervention formed an important part of the care home response to COVID-19 in the study area. Positive staff perceptions now need to be supplemented with data on the impact on resident health and well-being, workload, and service utilisation, during the pandemic and beyond

Towards a multi-arm multi-stage platform trial of disease modifying approaches in Parkinson's disease

An increase in the efficiency of clinical trial conduct has been successfully demonstrated in the oncology field, by the use of multi-arm, multi-stage trials allowing the evaluation of multiple therapeutic candidates simultaneously, and seamless recruitment to phase 3 for those candidates passing an interim signal of efficacy. Replicating this complex innovative trial design in diseases such as Parkinson’s disease is appealing, but in addition to the challenges associated with any trial assessing a single potentially disease modifying intervention in Parkinson’s disease, a multi-arm platform trial must also specifically consider the heterogeneous nature of the disease, alongside the desire to potentially test multiple treatments with different mechanisms of action. In a multi-arm trial, there is a need to appropriately stratify treatment arms to ensure each are comparable with a shared placebo/standard of care arm; however, in Parkinson’s disease there may be a preference to enrich an arm with a subgroup of patients that may be most likely to respond to a specific treatment approach. The solution to this conundrum lies in having clearly defined criteria for inclusion in each treatment arm as well as an analysis plan that takes account of predefined subgroups of interest, alongside evaluating the impact of each treatment on the broader population of Parkinson’s disease patients. Beyond this, there must be robust processes of treatment selection, and consensus derived measures to confirm target engagement and interim assessments of efficacy, as well as consideration of the infrastructure needed to support recruitment, and the long-term funding and sustainability of the platform. This has to incorporate the diverse priorities of clinicians, triallists, regulatory authorities and above all the views of people with Parkinson’s disease

Proton and sodium MRI assessment of emerging tumor chemotherapeutic resistance

The ultimate goal of any cancer therapy is to target the elimination of neoplastic cells. Although newer therapeutic strategies are in constant development, therapeutic assessment has been hampered by the inability to assess, rapidly and quantitatively, efficacy in vivo . Diffusion imaging and, more recently, sodium MRI have demonstrated their distinct abilities to detect therapy-induced alterations in tumor cellularity, which has been demonstrated to be indicative of therapeutic efficacy. More importantly, both imaging modalities detect tumor response much earlier than traditional methodologies that rely on macroscopic volumetric changes. In this study, the correlation between tumor sodium and diffusion was further tested to demonstrate the sensitivity of sodium imaging to gauge tumor response to therapy by using a 9L rat gliosarcoma treated with varying doses of BCNU [1,3-bis(2-chloroethyl)-1-nitrosourea]. This orthotopic model has been demonstrated to display variability in response to BCNU therapy where initial insult has been shown to lead to drug-resistance. In brief, a single 26.6 mg/kg BCNU dose yielded dramatic responses in both diffusion and sodium MRI. However, a second equivalent BCNU dose yielded a much smaller change in diffusion and sodium, suggesting a drop in tumor sensitivity to BCNU. The MRI responses of animals treated with 13.3 mg/kg BCNU were much lower and similar responses were observed after the initial and secondary applications of BCNU. Furthermore, these results were further validated using volumetric measurements of the tumor and also ex vivo determination of tumor sensitivity to BCNU. Overall, these experiments demonstrate the sensitivity and applicability of sodium and diffusion MRI as tools for dynamic assessment of tumor response to therapy. Copyright © 2006 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55899/1/1074_ftp.pd

Towards a multi-arm multi-stage platform trial of disease modifying approaches in Parkinson's disease

An increase in the efficiency of clinical trial conduct has been successfully demonstrated in the oncology field, by the use of multi-arm, multi-stage trials allowing the evaluation of multiple therapeutic candidates simultaneously, and seamless recruitment to Phase 3 for those candidates passing an interim signal of efficacy. Replicating this complex innovative trial design in diseases such as Parkinson's disease is appealing but in addition to the challenges associated with any trial assessing a single potentially disease modifying intervention in PD, a multi-arm platform trial must also specifically consider the heterogeneous nature of PD, alongside the desire to potentially test multiple treatments with different mechanisms of action. In a multi-arm trial, there is a need to appropriately stratify treatment arms to ensure each are comparable with a shared placebo/standard of care arm, however in PD there may be a preference to enrich an arm with a subgroup of patients that may be most likely to respond to a specific treatment approach. The solution to this conundrum lies in having clearly defined criteria for inclusion in each treatment arm as well as an analysis plan that takes account of pre-defined subgroups of interest, alongside evaluating the impact of each treatment on the broader population of PD patients. Beyond this, there must be robust processes of treatment selection, and consensus derived measures to confirm target engagement and interim assessments of efficacy, as well as consideration of the infrastructure needed to support recruitment, and the long-term funding and sustainability of the platform. This has to incorporate the diverse priorities of clinicians, triallists, regulatory authorities and above all the views of people with Parkinson's disease

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions.

BACKGROUND: Preterm birth complications are the leading cause of deaths for children under five years. Antenatal corticosteroids (ACS) are effective at reducing mortality and serious morbidity amongst infants born at 75%) reported very major or significant bottlenecks. Health information systems should include improved gestational age assessment and track ACS coverage, use and outcomes. Better health service delivery requires clarified policy assigning roles by level of care and cadre of provider, dependent on capability to assess gestational age and risk of preterm birth, and the implementation of guidelines with adequate supervision, mentoring and quality improvement systems, including audit and feedback. National essential medicines lists should include dexamethasone for antenatal use, and dexamethasone should be integrated into supply logistics