Exploring ways to enhance pain management for older people with dementia in acute care settings using a Participatory Action Research approach

BACKGROUND: Dementia is a progressive condition that leads to reduced cognition, deteriorating communication and is a risk factor for other acute and chronic health problems. The rise in the prevalence of dementia means untreated pain is becoming increasingly common with healthcare staff being challenged to provide optimal pain management. This negatively impacts the person living with dementia and their carers. There is minimal evidence that explores the pain management experience of patients as they move through acute care settings. OBJECTIVE: To understand the complexities of managing the pain of older people with dementia as they progress through acute care settings, with the view of assisting staff to improve practice. METHOD: A Participatory Action Research approach, guided by the Promoting Action Research in Health Services framework, was used. Three Action Cycles were completed comprising of an exploratory audit and two case studies (Action Cycle One), three focus groups with a total of 14 participants (Action Cycle Two) and the development and implementation of immediate and long‐term actions (Action Cycle Three). RESULTS: Thematic analysis identified four themes that affected pain management practices. These were not knowing the patient; balancing competing priorities; knowledge and understanding of pain and dementia and not assimilating available information. CONCLUSION: Pain management practices for patient living with dementia, across acute care settings, was influenced by shared ways of thinking and working. Not knowing the patient, fragmentation of information and having insufficient knowledge of the subtleties of dementia led participants to deliver task‐focused, target and policy‐driven care that was not person‐centred in its approach. Facilitated reflection enabled acute care teams to actively participate in identifying problems and finding solutions to enhance practice

Guns 'n' Roses: Australian Women Writers' Bold-And-Not-So-Bold Journeys into the Great War

A discussion of Australian women's writing about the Great War

An evaluation of the effectiveness of self-management interventions for people with type 2 diabetes after an acute coronary syndrome: a systematic review

${\bf Background:}$ Type 2 diabetes is highly prevalent in patients with acute coronary syndrome and impacts negatively on health outcome s and self-management. Both conditions shar e similar risk factor s. However, there is insufficient evidence on the effectiveness of combined interventions to promote self-management behaviour for people who with diabetes and cardiac problems. Identifying critical features of successful interventions will inform future integrated self-management programmes for patients with both conditions. ${\bf Objectives:}$ To assess the evidence on the effectiveness of existing interventions to promote self-management behaviour for patients presenting with acute coronary syndrome and type 2 diabetes in secondary care settings and post discharge . ${\bf Design:}$ We searched Medline, PubMed, CINAHL Plus, PsycInfo, Cochrane Library and AMED for randomised controlled trials published between January 2005 and December 2014. The search was performed using the following search terms of “acute coronary syndrome”, “type 2 diabetes” and “self-management intervention” and their substitutes combined . ${\bf Results:}$ Out of 4275 articles that were retrieved, only 4 trials met all the inclusion criteria (population, intervention, comparison and outcome) and were analysed. Overall, the results show that providing combined interventions for patients with both conditions including educational sessions supported by multimedia or telecommunication technologies were partially successful in promoting self-management behaviours. Implementation of these combined interventions during patient’s hospitalisation and post discharge was feasible. Intervention group subjects, reported a significant improvement in self-efficacy, level of knowledge, glycated haemoglobin, blood pressure and fasting glucose test. However, there are many threats have been noticed around internal validity of included studies that could compromise the conclusions drawn . ${\bf Conclusion:}$ With limited research in this area there was no final evidence to support effectiveness of combined intervention s to promote self-management behaviour for patient s with type 2 diabetes and acute coronary syndrome. Sufficiently powered, good quality, well conducted and reported randomised controlled trials are required.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/jocn.1348

Exploring variation in ambulance calls and conveyance rates for adults with diabetes mellitus who contact the Northern Ireland Ambulance Service: a retrospective database analysis

BACKGROUND: People with diabetes frequently contact the ambulance service about acute problems. Overall, treating diabetes and its associated complications costs the NHS 10% of the annual budget. Reducing unnecessary hospital admissions and ambulance attendances is a high priority policy for the NHS across the UK. This study aimed to determine the characteristics of emergency calls for people with diabetes who contact the ambulance service and are subsequently conveyed to hospital by the Northern Ireland Ambulance Service (NIAS). METHODS: A retrospective dataset from the NIAS was obtained from the NIAS Trust’s Command and Control system relating to calls where the final complaint group was ‘Diabetes’ for the period 1 January 2017 to 23 November 2019. RESULTS: Of a total 11,396 calls related to diabetes, 63.2% of callers to the NIAS were conveyed to hospital. Over half of the calls related to males, with 35.5% of callers aged 60–79. The more deprived areas had a higher frequency of calls and conveyance to hospital, with this decreasing as deprivation decreased. Calls were evenly distributed across the week, with the majority of calls originating outside of GP working hours, although callers were more likely to be conveyed to hospital during working hours. Calls from healthcare professionals were significantly more likely to be conveyed to hospital, despite accounting for the minority of calls. CONCLUSION: This research found that older males were more likely to contact the ambulance service but older females were more likely to be conveyed to hospital. The likelihood of conveyance increased if the call originated from an HCP or occurred during GP working hours. The availability of alternative care pathways has the potential to reduce conveyance to hospital, which has been particularly important during the COVID-19 pandemic. Integration of data is vitally important to produce high quality research and improve policy and practice in this area

Lets Talk about Race: Identity, Chatbots, and AI

Why is it so hard for chatbots to talk about race? This work explores how the biased contents of databases, the syntactic focus of natural language processing, and the opaque nature of deep learning algorithms cause chatbots difficulty in handling race-talk. In each of these areas, the tensions between race and chatbots create new opportunities for people and machines. By making the abstract and disparate qualities of this problem space tangible, we can develop chatbots that are more capable of handling race-talk in its many forms. Our goal is to provide the HCI community with ways to begin addressing the question, how can chatbots handle race-talk in new and improved ways

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Sharon Pollock : first woman of Canadian theatre

As playwright, actor, director, teacher, mentor, theatre administrator, and critic, Sharon Pollock has played an integral role in the shaping of Canada's national theatre tradition, and she continues to produce new works and to contribute to Canadian theatre as passionately as she has done over the past fifty years. Pollock is nationally and internationally respected for her work and support of the theatre community. She has also played a major role in informing Canadians about the "dark side" of their history and current events. This collection, comprised entirely of new and original assessments of her work and contribution to theatre, is both timely and long overdue.YesThe University of Calgary Press acknowledges the support of the Government of Alberta through the Alberta Media Fund for our publications. We acknowledge the financial support of the Government of Canada through the Canada Book Fund for our publishing activities. We acknowledge the financial support of the Canada Council for the Arts for our publishing program. This book has been published with the help of a grant from the Canadian Federation for the Humanities and Social Sciences, through the Awards to Scholarly Publications Program, using funds provided by the Social Sciences and Humanities Research Council of Canada

Myrmidons and insubordinates: Australian and Canadian women's fictional responses to the Great War

Bibliography: p. 261-275

Brenda Walker’s Challenge to the Anzac Legend in her Great War Novel \u3cem\u3eThe Wing of Night\u3c/em\u3e

Donna Coates is an Associate Professor in the English Department at the University of Calgary. With Sherrill Grace, she has co-edited two volumes of Canada and the Theatre of War: Eight Plays on World War One and Two (2009) and Canada and the Theatre of War: Six Contemporary Dramas (2010), and with George Melnyk, Wild Words: Essays on Alberta Literature (2008). She has also published numerous book chapters and articles in Canadian, Australian, British, and European journals primarily on women’s fictional responses to the First and Second World Wars and to the Vietnam War