Introducing consultant outpatient clinics to community settings to improve access to paediatrics:an observational impact study

Objectives - In line with a national policy to move care ‘closer to home’, a specialist children's hospital in the National Health Service in England introduced consultant-led ‘satellite’ clinics to two community settings for general paediatric outpatient services. Objectives were to reduce non-attendance at appointments by providing care in more accessible locations and to create new physical clinic capacity. This study evaluated these satellite clinics to inform further development and identify lessons for stakeholders. Methods - Impact of the satellite clinics was assessed by comparing community versus hospital-based clinics across the following measures: (1) non-attendance rates and associated factors (including patient characteristics and travel distance) using a logistic regression model; (2) percentage of appointments booked within local catchment area; (3) contribution to total clinic capacity; (4) time allocated to clinics and appointments; and (5) clinic efficiency, defined as the ratio of income to staff-related costs. Results - Satellite clinics did not increase attendance beyond their contribution to shorter travel distance, which was associated with higher attendance. Children living in the most-deprived areas were 1.8 times more likely to miss appointments compared with those from least-deprived areas. The satellite clinics’ contribution to activity in catchment areas and to total capacity was small. However, one of the two satellite clinics was efficient compared with most hospital-based clinics. Conclusions - Outpatient clinics were relocated in pragmatically chosen community settings using a ‘drag and drop’ service model. Such clinics have potential to improve access to specialist paediatric healthcare, but do not provide a panacea. Work is required to improve attendance as part of wider efforts to support vulnerable families. Satellite clinics highlight how improved management could contribute to better use of existing capacity

Factors associated with care-related Quality of Life of adults with Intellectual Disabilities in England: Implications for Policy and Practice

Over the last three decades, quality of life (QoL) has been advocated as an indicator of social care outcomes for adults with intellectual disabilities. In England, the Adult Social Care Survey (ASCS) is conducted annually by local authorities to contribute to the evidence base of the care-related QoL of people receiving publicly-funded adult social care. This study explores relationships between QoL and non-care related factors to identify relationships that could inform social care policy and practice. Cross-sectional data collected from 13,642 adults who participated in the 2011 and 2012 ASCS were analysed using regression to explore the factors associated with QoL measured using the Adult Social Care Outcomes Toolkit (ASCOT). Self-rated health, rating of the suitability of home design and anxiety/depression were all found to be significantly associated with ASCOT. Other individual and survey completion factors were also found to have weak significant relationships with ASCOT. The models also indicate that there was an increase in overall ASCOT-QoL and in five of the eight ASCOT domains (Personal comfort and cleanliness, Safety, Social participation, Occupation and Dignity) between 2011 and 2012. These findings demonstrate the potential value of QoL data for informing policy for people with intellectual disabilities by identifying key factors associated with QoL, the characteristics of those at risk of lower QoL, and QoL domains that could be targeted for improvement over time. Future research should establish causal relationships and explore the risk-adjustment of scores to account for variation outside of the control of social care support

Detection of Maternal Alcohol Use Problems in the Pediatric Emergency Department

Maternal alcohol use problems may impact the health and well-being of children, but often remain unrecognized. Mothers of young children seldom seek outpatient care for themselves; thus, pediatric settings may present an opportunity for the detection of maternal alcohol use problems. This study examines the feasibility of screening for and prevalence of alcohol use problems in mothers of young children in the context of seeking pediatric emergency care. We also examined the relationship of maternal alcohol use problems with use of pediatric emergency care. Methods : A total of 361 English-speaking mothers of children aged 7 and younger completed screening measures during their child's emergency care visit. TWEAK was used to screen for alcohol use problems. The screening survey also included information on children's health status and health care use, demographics, and the Center for Epidemiological Studies Depression Scale. Results : Of the women approached, 90% agreed to complete the screening measure. On the basis of cutoff score of 2 or more, 7% of women had elevated TWEAK scores. Those women with a TWEAK score >2 reported greater use of the pediatric emergency department (PED) than women scoring below the cutoff. On the basis of multivariate analyses, significant predictors of recent PED use included the presence of child chronic illness, younger maternal age, and TWEAK score. Conclusions : Screening for alcohol use problems among mothers of young children using the TWEAK appears to be feasible in a busy PED setting. The PED setting is promising for identifying risk drinking among women who may be less likely to be otherwise detected and for whom alcohol use may be impacting child outcomes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66222/1/j.1530-0277.2006.00132.x.pd

Formulation Development, Evaluation and Comparative Study of Effects of Super Disintegrants in Cefixime Oral Disintegrating Tablets

The present work was aimed at formulation development, evaluation and comparative study of the effects of superdisintegrants in Cefixime 50 mg oral disintegrating tablets. The superdisintegrants used for the present study were sodium starch glycolate and crosscarmellose sodium. The formulated tablets were evaluated for various tableting properties, like hardness, thickness, friability, weight variation, disintegration time and dissolution rate. Comparative evaluation of the above-mentioned parameters established the superiority of the tablets formulated with crosscarmellose sodium to those formulated with sodium starch glycolate

Using the theory of planned behavior to explore environmental behavioral intentions in the workplace

This paper presents a study using the theory of planned behavior (TPB) to explore environmental behavioral intentions in a workplace setting. The first stage of the research process was the development of a questionnaire covering TPB constructs, their antecedent beliefs, and environmental behavioral intentions across three scenarios (switching off PCs every time employees left their desks for an hour or more; using video-conferencing for meetings that would otherwise require travel; and recycling as much waste as possible), using best practice guidelines to ensure that it was specific and precisely defined for the target population. This was then administered to N = 449 participants, with the resulting dataset used to test hypotheses relating antecedent beliefs to behavioral intentions via the potentially mediating effect of TPB constructs. TPB constructs were found to explain between 46% and 61% of the variance in employee intentions to engage in three environmental behaviors, and to mediate the effects of specific antecedent beliefs upon employee intentions to engage in these behaviors. The results form a basis upon which interventions could be developed within the host organization, and are discussed in relation to their implications, in terms of theory, practice and future research

‘‘What matters to me’’ and ‘service users’, carers’, and clinicians’ needs’ and experiences of therapeutic engagement on acute mental health wards

Nurse–patient therapeutic engagement on acute mental health wards is beneficial to service users’ outcomes and nurses’ job satisfaction. However, engagement is not always fulfilled in practice and interventions to improve engagement are sparse and ineffective. We explored the experiences of service users, carers, and clinicians drawing from 80 hours of non-participant observations in an acute mental health ward and semi-structured interviews with 14 service users, two carers, and 12 clinicians. Analysis of these data resulted in 28 touchpoints (emotionally significant moments) and eight overarching themes. Service users, carers, and clinicians identified a lack of high-quality, person-centred, collaborative engagement and recognized and supported efforts to improve engagement in practice. Potential solutions to inform future intervention development were identified. Our findings align with previous research highlighting negative experiences and support the need to develop multicomponent interventions through participatory methods

Balancing Autonomy Rights and Protection:Children’s Involvement in a Child Safety Online Project

Researchers who involve children in their research are faced with the challenge of choosing between differing theoretical approaches which can prioritise children’s autonomy rights or their ‘vulnerability’ and their need to be protected. Somewhat confusingly, ethical guidelines seem to reflect a combination of these approaches. Even when researchers have settled on their preferred approach, they may find that this then has to be modified in accordance with gatekeeper requirements. In the context of children’s involvement in a child safety online project, this paper highlights the difficulties encountered because of a tension between children’s autonomy rights, educational norms in a school setting and child protection concerns, and considers whether an appropriate balance was achieved

Characteristics of the stickwork structure during snare drumming(HUMAN ENVIRONMENT)

Five skilled and 5 unskilled subjects played a snare drum at a rate of 480 bpm after sitting at rest for 6 minutes, then snare drum dynamics were changed from pianissimo, mezzo forte, to fortissimo successively every 3 minutes. The motions were recorded by 2 high-speed video cameras, and 3-dimensional coordinates were calculated using a 3-dimensional DLT method. At the same time, the EMG of the extensor and flexor of the radiocarpal joint, and the acceleration of the mid finger were recorded. Expired gas was simultaneously analyzed to calculate energy expenditure. Accordingly, as the feature was more remarkable at a high sound level, fortissimo was examined in detail by comparing the movement of the skilled group with that of the unskilled group. Although the vertical displacement range of the stick, the speed of the stick tip, and the equivalent sound level did not significantly differ in both groups, the displacement ranges of the hand, forearm, and mid arm, and the energy demand were significantly smaller in the skilled group than in the unskilled group. According to the acceleration data, finger shot was utilized in the skilled group. Furthermore, EMG and video images indicated that the movement of the skilled group was in general earlier and that they utilized the rebound of the stick more effectively

Pursuing concordance: moving away from paternalism

In the second of two articles exploring the value and application of concordance across nursing practice the discussion is aimed at clinical settings and patient groups where concordance may have been viewed as impractical. The author harnesses Cribb and Entwhistle's broader conception of shared decision making and the notion of decision-making capacity as a continuum to argue that concordance can be pursued effectively in challenging settings such as childcare practice, mental health and the care of older people. As in the first paper (McKinnon, 2013) the discussion is not limited to medicines management but remains engaged with all aspects of nursing practice. Legal and ethical frameworks, social participation theory and research across healthcare practice are sourced to argue for concordant approaches in the care of patients who may at times have compromised decision-making capacity. Ideas of direct and indirect concordance are explored. © 2014 MA Healthcare Ltd