Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative

Background: despite major policy initiatives in the United Kingdom to enhance women's experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought. Methods: a Continuous Quality Improvement (CQI) approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset. Results: questionnaires were received from 68 (46%) of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women's physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required. Conclusions: this was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their feedback on whether revisions were pragmatic and achieved anticipated improvements in care quality. Their initial involvement ensured priority areas for change were identified and implemented. Their subsequent feedback highlighted further important areas to address as part of CQI to ensure best quality care continues to be implemented. Our findings could support other maternity service organisations to optimise in-patient postnatal services

Can Low-Severity Fire Reverse Compositional Change in Montane Forests of the Sierra Nevada, California, USA?

Throughout the Sierra Nevada, nearly a century of fire suppression has altered the tree species composition, forest structure, and fire regimes that were previously characteristic of montane forests. Species composition is fundamentally important because species differ in their tolerances to fire and environmental stressors, and these differences dictate future forest structure and influence fire regime attributes. In some lower montane stands, shade-tolerant, fire-sensitive species have driven a threefold increase in tree density that may intensify the risk of high-severity fire. In upper montane forests, which were historically characterized by longer fire return intervals, the effects of fire exclusion are both less apparent and less studied. Although land managers have been reintroducing fire to lower and upper montane forests for \u3e4 decades, the potentially restorative effects of these actions on species composition remain largely unassessed. We used tree diameter and species data from 51 recently burned and 46 unburned plots located throughout lower and upper montane forests in Yosemite National Park and Sequoia & Kings Canyon National Parks to examine the effects of low-to moderate-severity (hereafter, lower-severity)fire on the demography of seven prevalent tree species. The density of Abies concolor concolor 30–45 cm dbh, A. magnifica Calocedrus decurrens concolor but not for C. decurrens, and (2) variability in tree density among plots that burned at lower severity exceeded the range of tree densities reported in historical data sets. High proportions of shade-tolerant species in some postfire stands may increase the prevalence of shade-tolerant species in the future, a potential concern for managers who seek to minimize ladder fuels and promote forest structure that is less prone to high-severity fire

Population policies and education: exploring the contradictions of neo-liberal globalisation

The world is increasingly characterised by profound income, health and social inequalities (Appadurai, 2000). In recent decades development initiatives aimed at reducing these inequalities have been situated in a context of increasing globalisation with a dominant neo-liberal economic orthodoxy. This paper argues that neo-liberal globalisation contains inherent contradictions regarding choice and uniformity. This is illustrated in this paper through an exploration of the impact of neo-liberal globalisation on population policies and programmes. The dominant neo-liberal economic ideology that has influenced development over the last few decades has often led to alternative global visions being overlooked. Many current population and development debates are characterised by polarised arguments with strongly opposing aims and views. This raises the challenge of finding alternatives situated in more middle ground that both identify and promote the socially positive elements of neo-liberalism and state intervention, but also to limit their worst excesses within the population field and more broadly. This paper concludes with a discussion outling the positive nature of middle ground and other possible alternatives

Facilitation skills: the catalyst for increased effectiveness in consultant practice and clinical systems leadership

Consultant practitioner is the pinnacle of the clinical career ladder for all health care disciplines in the United Kingdom. Consultant nurse, midwife and health visitor roles build on the clinical credibility and expertise characteristic of advanced level practice, but also possess expertise in: clinical systems leadership and the facilitation of culture change, learning and development; advanced consultancy approaches, and research and evaluation to prioritise person-centred, safe and effective care across patient pathways. This project aimed to help new and emerging consultants to become more effective in their role through a programme of support to develop their expertise. Emancipatory action research, supported by claims, concerns and issues tool, derived from Stakeholder Evaluation, and other methods (active learning, action learning, collaborative workshops and individual tools e.g. qualitative 360 degree feedback and reflective reviews) comprised the supportive intervention which enabled participants to research their own practice. The programme’s methodology and methods helped participants to: research their own practice; theorise from practice; grow the facilitation skills needed to develop and demonstrate their own effectiveness; foster the effectiveness of others and; transform practice culture. Greater effectiveness in their multiple roles was demonstrated, as was the impact of this on others, services and organisations. The study concludes that the support programme augmented by the methodology, facilitation skills and the 10 principles derived from a concept analysis of work-based learning is central to achieving improved effectiveness and transformation of others, services and organisations. Theoretical insights at collective/community levels also resulted. Key recommendations are identified for commissioners, higher education and research

Cardiopoietic cell therapy for advanced ischemic heart failure: results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial

Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort

Wild jackdaws can selectively adjust their social associations while preserving valuable long-term relationships

Abstract Influential theories of the evolution of cognition and cooperation posit that tracking information about others allows individuals to adjust their social associations strategically, re-shaping social networks to favour connections between compatible partners. Crucially, to our knowledge, this has yet to be tested experimentally in natural populations, where the need to maintain long-term, fitness-enhancing relationships may limit social plasticity. Using a social-network-manipulation experiment, we show that wild jackdaws (Corvus monedula) learned to favour social associations with compatible group members (individuals that provided greater returns from social foraging interactions), but resultant change in network structure was constrained by the preservation of valuable pre-existing relationships. Our findings provide insights into the cognitive basis of social plasticity and the interplay between individual decision-making and social-network structure