School Counselors\u27 Perceptions about lnterventions for At-Risk Students Including Grade Retention: Implications for School Leaders

The term at-risk is used by educators and policymakers to describe a wide variety of students who struggle in schools (Kronholz, 2011). Factors associated with labeling students at-risk include minority status, poverty, language difficulties, low school attendance, and poor family support (Re~ Akpo-Sanni, Losike-Sedimo, 2012; Stockard, 2010). For many at-risk students, reading at a proficient level is a primary concern for school leaders and teachers (Allington, 2011; McAlenney & Coyne, 2011), especially with increased accountability including school sanctions for not closing reading achievement gaps (Chappell, Nunnery, Pribesh, & Hager, 2011). Although a plethora of interventions have been proposed to assist at-risk students, requiring students to repeat a grade continues to be used as a threat for students who are not proficient, despite evidence that suggests grade retention is detrimental to students on various outcomes (Battistin & Schizzerotto, 2012; Webley, 2012)

Efficiency and thoroughness trade-offs in high-volume organisational routines:an ethnographic study of prescribing safety in primary care

BackgroundPrescribing is a high-volume primary care routine where both speed and attention to detail are required. One approach to examining how organisations approach quality and safety in the face of high workloads is Hollnagel’s Efficiency and Thoroughness Trade-Off (ETTO). Hollnagel argues that safety is aligned with thoroughness and that a choice is required between efficiency and thoroughness as it is not usually possible to maximise both. This study aimed to ethnographically examine the efficiency and thoroughness trade-offs made by different UK general practices in the achievement of prescribing safety.MethodsNon-participant observation was conducted of prescribing routines across eight purposively sampled UK general practices. Sixty-two semistructured interviews were also conducted with key practice staff alongside the analysis of relevant practice documents.ResultsThe eight practices in this study adopted different context-specific approaches to safely handling prescription requests by variably prioritising speed of processing by receptionists (efficiency) or general practitioner (GP) clinical judgement (thoroughness). While it was not possible to maximise both at the same time, practices situated themselves at various points on an efficiency-thoroughness spectrum where one approach was prioritised at particular stages of the routine. Both approaches carried strengths and risks, with thoroughness-focused approaches considered safer but more challenging to implement in practice due to GP workload issues. Most practices adopting efficiency-focused approaches did so out of necessity as a result of their high workload due to their patient population (eg, older, socioeconomically deprived).ConclusionsHollnagel’s ETTO presents a useful way for healthcare organisations to optimise their own high-volume processes through reflection on where they currently prioritise efficiency and thoroughness, the stages that are particularly risky and improved ways of balancing competing priorities.</jats:sec

The Impact on Older People’s Wellbeing of Leaving Heritage Volunteering and the Challenges of Managing this Process

The benefits of volunteering for older volunteers and for the organisations who host them is well-documented. The impact of being obliged to leave volunteering due to age-related conditions, and any challenges that this creates for volunteer managers, are under-researched. This study explored how volunteers and volunteer managers experienced this point in the volunteering lifecycle and whether the topic warranted further research. Semi-structured interviews were carried out with fourteen older people, who were (or had been) volunteers at one of three cultural heritage organisations in the north-east of England alongside seven volunteer managers from those organisations. These represented the diversity of heritage organisations in the region. Volunteers discussed leaving volunteering in terms of loss but also indicated that forms of personal appraisal and agency were possible, ameliorating the impact of leaving. Volunteer managers discussed how organisational frameworks and the relationships they formed with volunteers shaped their practices. These relationships created a sense of organisational reciprocity which led some managers to exceed the rules in order to sustain people in their volunteering. The results suggest that supporting personal agency could ameliorate the impact of leaving volunteering but that organisations would benefit from articulating the extent and the limits of that support

Metastatic Breast Cancer or Multiple Myeloma? Camouflage by Lytic Lesions

We report a case of a female with stage I infiltrating ductal carcinoma who received adjuvant therapy including trastuzumab. One year later she developed lytic lesions and was retreated with trastuzumab that was held after she developed symptomatic heart failure. Lytic lesions were attributed to relapse of breast cancer, and cardiac failure attributed to prior trastuzumab therapy. After complications necessitated multiple hospitalizations, a further workup revealed that the lytic lesions were not metastatic breast cancer but multiple myeloma. Her advanced multiple myeloma was associated with systemic amyloidosis involving gut and heart, which ultimately led to her demise. This report addresses the pitfalls of overlapping symptoms and the question of which patients with suspected metastatic disease should undergo a biopsy

Using Video-Reflexive Ethnography on an Acute Medical Unit:Methodological Challenges, Solutions and Opportunities within a Complex and Busy Healthcare Setting

Video-Reflexive Ethnography (VRE) is an innovative and participatory research and improvement methodology that involves videoing in-situ work practices and collaboratively analysing this footage with participants during reflexive sessions. This involves participants ‘slowing down’, engaging reflexively with their everyday working practices, and taking time out to discuss issues collectively. VRE has increasingly been used across a range of different healthcare settings. However, one setting that has received less attention is the Acute Medical Unit (AMU). AMUs are busy short-stay hospital departments with very high patient throughput and large multidisciplinary teams where patients receive initial assessment, diagnosis and treatment before being moved to other wards or settings. The aim of this study was to examine how VRE as a research and improvement methodology can be applied, in the busy and complex setting of an AMU. In this paper we outline some of the methodological challenges encountered in this setting and discuss how these were transformed into opportunities and solutions. Then, we evaluate our work by using the four guiding principles at the heart of VRE (care, collaboration, reflexivity and exnovation) to test if, and how, the methodology can be used in such a complex and busy setting without losing its methodological rigor and impact. We show how it is possible to initiate and achieve the core principles of VRE in the complex and busy AMU setting through careful planning, constant revision of data collection methods, remaining highly flexible and adaptable to the spatial and temporal rhythms of the ward and being sensitive to hierarchical inter- and intra-professional relationships and vulnerabilities. Finally, we share recommendations for using VRE in other busy and complex settings

A Case Report of Successful Management of Clostridium Difficile Colitis with Antegrade Fidaxomicin Through A Mucous Fistula Obviating the Need for Subtotal Colectomy.

Introduction Clostridium difficile is the most common cause of healthcare-associated infections and can have devastating morbidity and mortality. Traditional treatment algorithms involve intravenous metronidazole and enteric metronidazole or vancomycin. Fidaxomicin (DificidR) targets “switch regions” within RNA polymerases and effectively kills clostridium difficile bacteria and is typically administered orally primarily or through a naso/oro-gastric conduit. Presentation of case 55-year-old with a recent elective surgical procedure was hospitalized with multifocal pneumonia and subsequently developed clostridium difficile colitis. This patient failed the standard medical therapy for clostridium difficile colitis, decompensated and required surgical exploration, partial colectomy and mucous fistula creation. Following her surgery, her clinical condition improved and her colitis resolved with the antegrade administration of fidaxomicin through her mucous fistula. Discussion Fidaxomicin is a newer to market therapeutic agent that has been shown to be effective in the treatment of clostridium difficile colitis. Previously studies have shown benefit of oral fidaxomicin therapy for fulminant clostridium difficile but our study case report describes the index case of topical fidaxomicin through a mucous fistula. Conclusion In our case of fulminant clostridium difficile colitis, Fidaxomicin administered in an antegrade fashion through a mucous fistula may have reduced the need for total colectomy in the treatment of fulminant clostridium difficile colitis