MEANING-MAKING: ISSUES OF ANALYSIS IN MEMORY-WORK

ABSTRACT At the core of memory-work is the making of meaning from a collective reading of the memories of individuals' lived experiences. Memory-work enables many voices to be heard in the understanding and theorising of the cross-woven threads of embodied experience. The methodology, however, confronts memory-workers with the complexity of moving between the subjectivity of their collective experiences, emotions and interpretations, and the more academic and distanced processes of theorising the meaning of those experiences. In that process, the particular voices of participants are often felt to be vulnerable or lost in the final analysis. This paper focuses on the challenges of making transparent and convincing processes of analysis, given the collectivity of the endeavour and the subjective nature of the methodology

Transitions to palliative care in acute hospitals in England: qualitative study

Objective To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England

Leap into... collaborative learning

Part of a collection of documents from Leap, formerly a University of Adelaide website providing information about learning and teaching initiatives at the University, archived in PDF format 26th April 2012.Includes 5 pp. questionnaire, developed by Ann Noble in 2000.This publication is designed for University of Adelaide staff who are interested in collaborative learning—what it is and how it can be put into practice to enhance learning and teaching.Christine Ingleton, Loene Doube and Tim Rogers for the University of Adelaide ACU

Nurturing a cross-institutional curriculum planning community of practice

This paper focuses on academic skill-building through using cross-institutional collaborative approaches in developing quality learning and assessment tasks for experiential placements. A curriculum planning template was used for the collaborative work, with materials developed being disseminated on a specially designed online repository website. Results, analyzed within a community of practice framework, indicate the activities. There is potential evident for building a more mature community of practice given the value of the collaborative learning process involved. This would need additional opportunities and leadership over an extended timeline. Some longer term changes in curriculum planning and impacts on wider networks are also evident. This case study provides a model which is relevant across all disciplines and which highlights professional learning occurring through collaborative academic work focused on relevant practice

Receiving end of life care at home: experiences of the bereaved carers of cancer patients cared for by health care assistants

First paragraph: Many terminally ill cancer patients and their families prefer for death to occur at home rather than in an institution where the majority of care falls to the patient’s family and friends. As death approaches caring can become an increasing burden for the patient’s informal carers. This issue has long been recognized by health care professionals and also in current policy for end of life care, with the End of Life Care Strategy for England (DH, 2008) highlighting the need for community services to enable home death by supporting both patient and their family carers. Basic nursing, social and respite home care has frequently been provided by basically trained, unqualified nursing staff, including auxiliary nurses and health care assistants (HCA). Whilst increasing research has been undertaken into the needs of family carers (Stajduhar et al, 2010; Funk et al 2010), relatively little has focused on the care HCAs deliver (Herber & Johnston 2012) and very few studies have explored the experience of bereaved family carers of patients who have received such services

Leap into... Student-centred learning

Part of a collection of documents from Leap, formerly a University of Adelaide website providing information about learning and teaching initiatives at the University, archived in PDF format 26th April 2012.This publication is designed for University of Adelaide staff who are interested in student-centred learning—what it is and how it can be put into practice to enhance learning and teaching. We've tried to create a picture of student-centred learning that is broad and general enough to be useful to teachers in many, if not all disciplines, and with an eye to the variety of teaching settings, from the lab to the large lecture theatre to the studio and more.Christine Ingleton, Margaret Kiley, Robert Cannon and Tim Rogers for the University of Adelaide ACU

Is intraprocedural intravenous aspirin safe for patients who require emergent extracranial stenting during mechanical thrombectomy?

Background: Intraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy (MT). Most patients undergoing MT are also given thrombolysis. Antiplatelet agents are contraindicated within 24 hours of thrombolysis. We evaluated outcomes and complications of patients stented with and without intravenous aspirin during MT. Methods: All patients who underwent emergent extracranial stenting during MT at the Royal Stoke University Hospital, UK between 2010 and 2020, were included. Patients were thrombolysed before MT, unless contraindicated. Aspirin 500 mg intravenously was given intraoperatively at the discretion of the operator. Symptomatic intracranial haemorrhage (sICH) and the National Institutes for Health Stroke Scale score (NIHSS) were recorded at 7 days, and mortality and functional recovery (modified Rankin Scale: mRS ≤2) at 90 days. Results: Out of 565 patients treated by MT 102 patients (median age 67 IQR 57-72 years, baseline median NIHSS 18 IQR 13-23, 76 (75%) thrombolysed) had a stent placed. Of these 49 (48%) were given aspirin and 53 (52%) were not. Patients treated with aspirin had greater NIHSS improvement (median 8 IQR 1-16 vs median 3 IQR -9-8 points, p=0.003), but there were no significant differences in sICH (2/49 (4%) vs 9/53 (17%)), mRS ≤2 (25/49 (51%) vs 19/53 (36%)) and mortality (10/49 (20%) vs 12/53 (23%)) with and without aspirin. NIHSS improvement (median 12 IQR 4-18 vs median 7 IQR -7-10, p=0.01) was greater, and mortality was lower (4/33 (12%) vs 6/15 (40%), p=0.05) when aspirin was combined with thrombolysis, than for aspirin alone, with no increase in bleeding. Conclusion: Our findings based on registry data derived from routine clinical care suggest that intraprocedural intravenous aspirin in patients undergoing emergent stenting during MT does not increase sICH and is associated with good clinical outcomes, even when combined with intravenous thrombolysis.</p

What cost components are relevant for economic evaluations of palliative care, and what approaches are used to measure these costs? A systematic review

BACKGROUND: It is important to understand the costs of palliative and end-of-life care in order to inform decisions regarding cost allocation. However, economic research in palliative care is very limited and little is known about the range and extent of the costs that are involved in palliative care provision. AIM: To undertake a systematic review of the health and social care literature to determine the range of financial costs related to a palliative care approach and explore approaches used to measure these costs. DESIGN: A systematic review of empirical literature with thematic synthesis. Study quality was evaluated using the Weight of Evidence Framework. DATA SOURCES: The databases CINAHL, Cochrane, PsycINFO and Medline were searched from 1995 to November 2015 for empirical studies which presented data on the financial costs associated with palliative care. RESULTS: A total of 38 papers met our inclusion criteria. Components of palliative care costs were incurred within four broad domains: hospital care, community or home-based care, hospice care and informal care. These costs could be considered from the economic viewpoint of three providers: state or government, insurers/third-party/not-for-profit organisations and patient and family and/or society. A wide variety of costing approaches were used to derive costs. CONCLUSION: The evidence base regarding the economics of palliative care is sparse, particularly relating to the full economic costs of palliative care. Our review provides a framework for considering these costs from a variety of economic viewpoints; however, further research is required to develop and refine methodologies

Stakeholder involvement throughout health technology assessment: an example from palliative care

Objectives: Internationally, funders require stakeholder involvement throughout health technology assessment (HTA). We report successes, challenges, and lessons learned from extensive stakeholder involvement throughout a palliative care case study that demonstrates new concepts and methods for HTA. Methods: A 5-step “INTEGRATE-HTA Model” developed within the INTEGRATE-HTA project guided the case study. Using convenience or purposive sampling or directly / indirectly identifying and approaching individuals / groups, stakeholders participated in qualitative research or consultation meetings. During scoping, 132 stakeholders, aged ≥ 18 years in seven countries (England, Italy, Germany, The Netherlands, Norway, Lithuania, and Poland), highlighted key issues in palliative care that assisted identification of the intervention and comparator. Subsequently stakeholders in four countries participated in face–face, telephone and / or video Skype meetings to inform evidence collection and / or review assessment results. An applicability assessment to identify contextual and implementation barriers and enablers for the case study findings involved twelve professionals in the three countries. Finally, thirteen stakeholders participated in a mock decision-making meeting in England. Results: Views about the best methods of stakeholder involvement vary internationally. Stakeholders make valuable contributions in all stages of HTA; assisting decision making about interventions, comparators, research questions; providing evidence and insights into findings, gap analyses and applicability assessments. Key challenges exist regarding inclusivity, time, and resource use. Conclusion: Stakeholder involvement is feasible and worthwhile throughout HTA, sometimes providing unique insights. Various methods can be used to include stakeholders, although challenges exist. Recognition of stakeholder expertise and further guidance about stakeholder consultation methods is needed

Lay and professional stakeholder involvement in scoping palliative care issues: Methods used in seven European countries

BACKGROUND: Stakeholders are people with an interest in a topic. Internationally, stakeholder involvement in palliative care research and health technology assessment requires development. Stakeholder involvement adds value throughout research (from prioritising topics to disseminating findings). Philosophies and understandings about the best ways to involve stakeholders in research differ internationally. Stakeholder involvement took place in seven countries (England, Germany, Italy, Lithuania, the Netherlands, Norway and Poland). Findings informed a project that developed concepts and methods for health technology assessment and applied these to evaluate models of palliative care service delivery. AIMS: To report on stakeholder involvement in the INTEGRATE-HTA project and how issues identified informed project development. DESIGN: Using stakeholder consultation or a qualitative research design, as appropriate locally, stakeholders in seven countries acted as 'advisors' to aid researchers' decision making. Thematic analysis was used to identify key issues across countries. SETTING/PARTICIPANTS: A total of 132 stakeholders (82 professionals and 50 'lay' people) aged ⩾18 participated in individual face-to-face or telephone interviews, consultation meetings or focus groups. RESULTS: Different stakeholder involvement methods were used successfully to identify key issues in palliative care. A total of 23 issues common to three or more countries informed decisions about the intervention and comparator of interest, sub questions and specific assessments within the health technology assessment. CONCLUSION: Stakeholders, including patients and families undergoing palliative care, can inform project decision making using various involvement methods according to the local context. Researchers should consider local understandings about stakeholder involvement as views of appropriate and feasible methods vary. Methods for stakeholder involvement, especially consultation, need further development