Your place or mine? Issues of power, participation and partnership in an urban regeneration area

This study sets out to explore what is characterised as the partnership process in an urban regeneration area. Rather than examine formal processes or policy, the intention was to explore the interaction between the active residents in the study area and the agents of some of the organizations with whom they came into contact. The area (Yoker) is at the western periphery of the city, but is neither a 'peripheral estate' nor until recently an area of formal policy intervention. It is typical of similar small areas in its industrial history and its difficulty in adjusting to changed economic circumstances. Its response has, however, been vigorous and based significantly on its own endogenous resources. In understanding the processes involved, the study has taken two broad approaches: the theoretical and the empirical, and is an attempt to relate the two as they can be seen to 'interact' on the ground. The theoretical approach has three strands (l) to understand the local working of power, (2) to examine the notions of social capital and collaboration and (3) to understand the local partnership process. Power, explored in terms of capacity and legitimacy and developed through consideration of 'circuits of power and 'hidden discourses', is seen not as a discrete entity but as providing the base on which social capital and partnership working might be constructed and as a signifier of other social and economic relationships. Social capital is seen as grounded in local power relations and as providing a matrix within which local networks might be activated, and trust developed; the cognate notion of collaborative planning is seen as a mechanism for bringing 'government' and 'community' into a process of active cooperation. Finally, partnership working is seen as the ideal outcome of the interaction between local power and social capital, dependant not on formal processes or discourses but on the harnessing of local skills founded on capacity and need. The three Yokel' case-studies are intended broadly to illustrate (rather than 'prove') some of these theoretical concerns in the field, but principally to allow local voices to articulate their perceptions of the issues within a semi-structured series of interviews. A brief comparative study in Drumchapel is intended to explore some of the differences between an area with a long history of policy intervention and an area like Yoker with no such history. The study concludes that a structured partnership approach will succeed best if founded firmly on local strengths and perceptions

Implementing social health insurance in Ireland: Report of a meeting and workshop held in Dublin, on December 6th 2010

We considered two basic questions, 'Is it possible to implement Social Health Insurance in Ireland?', and 'How can this be done?'. Can Social Health Insurance be implemented in Ireland? Our answer is a very definite yes. Furthermore, there would be many opportunities, while working towards this end, to improve the performance of our health care system. How can it be implemented? This process will need to be actively managed. There are many difficulties in the Irish health services, but also many opportunities. The greatest strengths are the talented, well-trained and very committed staff. Getting and keeping the support of these staff, for the necessary changes in service delivery, will be critical. Ireland has the capacity to make these changes, but without high quality management, a detailed focussed plan for change, and political support, little will happen. Each step in the change needs to be planned to maintain services, improve service delivery, improve service accountability, and improve service governance. Each sector of the service will need someone to lead the change, and mind that service during the change. Primary care remains under-developed. The HSE plan to develop primary care teams (PCT) has not succeeded. There are several established PCTs which work well. In other areas there are informal arrangements for collaboration, which work well. Overall, there are many useful lessons to learn from the experience so far. Future developments will need to place general practice at the centre of primary care. The mechanisms for doing this will vary from place to place, but need to be developed urgently. Acute hospitals face a crisis of governance. Maurice Hayes' (1) recent report on Tallaght hospital gives an idea of the scale of the changes needed. Tallaght is, we believe, not atypical, and is reputed to be by no means the worst governed hospital in the system. This, alone, should provide a pressing motive for change. Redesigning Irish hospitals to a new mission of supporting primary care, of supporting care in the community where possible can, and must, be done. Long-term care for older people is also a challenge. We advise moving to an integrated needs based system with smooth transitions between different degrees of support at home, and different degrees of support in specialized housing facilities including nursing homes. A similar model should apply to other forms of long-term care, for example for people with a substantial disability. Information systems and management processes both need a major overhaul. The health service remains strikingly under-managed, and fixing this will need a substantial culture change within the services. Wide use of standardized formal project management processes will be vital. There is a separate plan being developed to improve health service IT systems, and implementing this needs to be a high priority. We have not considered other key sectors, for example mental health, disability services, and social services. This does not mean that these are unimportant, merely that we had limited time, and a great deal to cover

Evaluation of bone marrow examinations performed by an advanced nurse practitioner: An extended role within a haematology service

Purpose: Traditionally, medical personnel have undertaken bone marrow (BM) examination. However, specially trained nurses in advanced practice roles are increasingly undertaking this role. This paper presents the findings from an audit of BM examinations undertaken by an advanced nurse practitioner (ANP) at a regional haematology specialist centre.Methods: The audit evaluated the quality of BM examinations performed by the ANP over the past two years (September 2007 September 2009). Over the two year period, 324 BM examinations were performed at the centre of which 156 (48.1%) were performed by the ANP A random sample of 30 BM examinations undertaken by the ANP were analysed by the consultant haematologist.Results: All 30 BM examinations undertaken by the ANP were sufficient for diagnosis.Conclusions: The ANP is capable and competent to obtain BM samples which are of a sufficient quality to permit diagnosis. (C) 2010 Elsevier Ltd. All rights reserved.peer-reviewe

Transcultural care and individuals with an intellectual disability

Healthcare delivery today reflects a history of change, which has responded to lifestyle changes, cultural diversity, population needs and expectations. In today’s health-care environment it is crucial for health-care professionals to be mindful of cultural factors that affect health. These factors include the intricate interdependent biological, intellectual, psychological, social and spiritual needs of the individuals they work with. However, challenges exists for those who provide healthcare to people with intellectual disability. This article presents the transcultural care challenges for people with intellectual disability, through highlighting the biomedical/sociocultural perspectives of healthcare, communication and inequality experienced by those with intellectual disability. As a population group, people with intellectual disability can often be considered part of a larger culture rather than a culture within itself, and this article endeavours to emphasize that intellectual disability is in itself a coterminous culture. By highlighting intellectual disability as a cultural community within a larger community, requiring a transcultural response to care on several levels health-care professionals can provide culturally compatible care to those with intellectual disability within a transcultural framework to augment a person-centred approach to care

Evaluation of bone marrow examinations performed by an advanced nurse practitioner: An extended role within a haematology service

Purpose: Traditionally, medical personnel have undertaken bone marrow (BM) examination. However, specially trained nurses in advanced practice roles are increasingly undertaking this role. This paper presents the findings from an audit of BM examinations undertaken by an advanced nurse practitioner (ANP) at a regional haematology specialist centre.Methods: The audit evaluated the quality of BM examinations performed by the ANP over the past two years (September 2007 September 2009). Over the two year period, 324 BM examinations were performed at the centre of which 156 (48.1%) were performed by the ANP A random sample of 30 BM examinations undertaken by the ANP were analysed by the consultant haematologist.Results: All 30 BM examinations undertaken by the ANP were sufficient for diagnosis.Conclusions: The ANP is capable and competent to obtain BM samples which are of a sufficient quality to permit diagnosis. (C) 2010 Elsevier Ltd. All rights reserved

Identifying the prevalence of aggressive behaviour reported by registered intellectual disability nurses in residential intellectual disability services: an Irish perspective

Purpose – Despite the high incidence of aggressive behaviours among some individuals with intellectual disability, Ireland has paid little attention to the prevalence of aggressive behaviours experienced by Registered Intellectual Disability Nurses (RNID). Within services the focus is mainly on intervention and management of such behaviours. Therefore a disparity occurs in that these interventions and management strategies have become the exclusive concern. Resulting in aggressive behaviour being seen as a sole entity, where similar interventions and management strategies are used for ambiguously contrasting aggressive behaviours. Consequently the ability to document and assess-specific behaviour typologies and their prevalence is fundamental not only to understand these behaviour types but also to orient and educate RNIDs in specific behaviour programme development. The paper aims to discuss these issues. Design/methodology/approach – This study reports on a survey of the prevalence of verbal aggression, aggression against property and aggression against others experienced by RNIDs’ within four residential settings across two health service executive regions in Ireland. A purposeful non-random convenience sampling method was employed. In total, 119 RNIDs responded to the survey which was an adaptation of Crocker et al. (2006) survey instrument Modified Overt Aggression Scale. Findings – The findings of this study showed the experienced prevalence rate of verbal aggression, aggression against property and aggression against others were 64, 48.9 and 50.7 per cent, respectively. Cross-tabulation of specific correlates identifies those with a mild and intellectual disability as displaying a greater prevalence of verbal aggression and aggression against property. While those with a moderate intellectual disability displayed a higher prevalence of aggression against others. Males were reported as more aggressive across all three typologies studied and those aged between 20 and 39 recorded the highest prevalence of aggression across all three typologies. The practice classification areas of challenging behaviour and low support reported the highest prevalence of aggression within all typologies. Originality/value – The health care of the person with intellectual disability and aggressive behaviour presents an enormous challenge for services. In-order to improve considerably the quality of life for clients, services need to take a careful considered pragmatic view of the issues for the person with intellectual disability and aggressive behaviour and develop realistic, proactive and responsive strategies. To do this, precise knowledge of the prevalence of aggressive behaviours needs to be obtained. This study is the first of its kind in the Republic of Ireland

Nonfamilial, MPL S505N-Mutated Essential Thrombocythaemia

Mutations of MPL are present in a significant proportion of patients with the myeloproliferative neoplasms (MPN), primary myelofibrosis (PMF), and essential thrombocythaemia (ET). The most frequent of these mutations, W515L and W515K, occur in exon 10 of MPL, which encodes the receptor for thrombopoietin. Another exon 10 mutation, MPL S505N, has been shown to be a founder mutation in several pedigrees with familial thrombocythaemia where it is associated with a high thrombotic risk, splenomegaly and progression to bone marrow fibrosis. Rare cases of sporadic, nonfamilial, MPL S505N MPN have been documented, but the presenting laboratory and clinical features have not been described in detail. The diagnosis and clinical course of a case of MPL S505N-positive MPN are presented with diagnostic features and treatment response resembling typical ET but with evidence of increasing bone marrow fibrosis. Further MPN cases possessing this genotype require reporting in order to ascertain whether any particular morphological or clinical features, if present, determine clinical course and aid the refinement of therapeutic options