Bringing Down the Barriers of Maggot Debridement Therapy

The purpose of this paper is to describe the rationale for Maggot Debridement Therapy (MDT) and the development of a practice model. Chronic wounds are a growing problem in health care. Debridement of a wound is an essential component of wound healing as the presence of devitalized tissue can impede the healing process. Even with today\u27s high-tech medicine there are still times we need to resort back to the basic and simple principles from nature that may help combat medical problems. The use of maggot larvae for wound debridement has made resurgence into wound management in the last 15 years. This paper outlines and follows the development of a maggot debridement and implementation program at large medical center in Middle America

Technology-Based Literacy Instruction For English Language Learners

There is a growing need to implement an alternative and viable solution in U.S. K-12 schools that will address the ever-growing gap that the rapidly growing English language learner (ELL) population presents.  This article examines various technology-based solutions, and their potential impact.  The systematic implementation of these technology-based solutions could aid in alleviating an already taxed educational workforce, as well as significantly aid in promoting English language acquisition among the nation’s K-12 ELL population

The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study.

OBJECTIVE: To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. DESIGN: A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). SETTING: Six acute NHS hospital trusts in England. METHODS: Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. RESULTS: Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. CONCLUSIONS: The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers. Further research is recommended that describes and quantifies the most frequently needed reasonable adjustments within the hospital pathways of vulnerable patient groups, and the most effective organisational infrastructure required to guarantee their use, together with resource implications

Secure and equal access to land for all: Lessons on land governance and climate resilience from Dar es Salaam, Tanzania

Secure land and property rights are essential for improving the livelihoods of the poor and ending poverty. Effective and equitable land governance can also contribute to economic development, domestic resource mobilisation and climate change resilience. Promoting fair and transparent land tenure systems should therefore be a priority for national governments

Hopf solitons in the Nicole model

The Nicole model is a conformal field theory in a three-dimensional space. It has topological soliton solutions classified by the integer-valued Hopf charge, and all currently known solitons are axially symmetric. A volume-preserving flow is used to construct soliton solutions numerically for all Hopf charges from 1 to 8. It is found that the known axially symmetric solutions are unstable for Hopf charges greater than 2 and new lower energy solutions are obtained that include knots and links. A comparison with the Skyrme–Faddeev model suggests many universal features, though there are some differences in the link types obtained in the two theories

Informing the development of services supporting self-care for long term mental health conditions: A mixed method study of community based mental health initiatives in England

Background Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems. Methods A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together. Results Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health. Conclusions Service delivery components – e.g. peer support groups, personal planning – advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings

EFFIP (E-support for Families & Friends of Individuals affected by Psychosis) – developing and evaluating an eHealth complex intervention for family carers

Abstract of Speaker presentation, delivered at European Academy of Nursing Science Summer Conference 2018: Leadership in Nursing: challenges for the future, Ghent, Belgium, 11-12 July 2018.Background - Participatory action research (PAR) is active, collaborative and seeks to develop knowledge from everyday occurrences (Reason and Bradbury 2013). A creative movement workshop developed from the Lydia Osteoporosis PAR Project 2 (LOP 2) and enabled volunteer local research collaborators and participants to articulate new practice knowledge.Lydia Osteoporosis PAR Project 2 (LOP 2)17pubpubSuppl

What is the impact of psychiatric decision units on mental health crisis care pathways? Protocol for an interrupted time series analysis with a synthetic control study

Background: The UK mental health system is stretched to breaking point. Individuals presenting with mental health problems wait longer at the ED than those presenting with physical concerns and finding a bed when needed is difficult – 91% of psychiatric wards are operating at above the recommended occupancy rate. To address the pressure, a new type of facility – psychiatric decision units (also known as mental health decision units) – have been introduced in some areas. These are short-stay facilities, available upon referral, targeted to help individuals who may be able to avoid an inpatient admission or lengthy ED visit. To advance knowledge about the effectiveness of this service for this purpose, we will examine the effect of the service on the mental health crisis care pathway over a 4-year time period; the 2 years proceeding and following the introduction of the service. We use aggregate service level data of key indicators of the performance of this pathway. Methods: Data from four mental health Trusts in England will be analysed using an interrupted time series (ITS) design with the primary outcomes of the rate of (i) ED psychiatric presentations and (ii) voluntary admissions to mental health wards. This will be supplemented with a synthetic control study with the same primary outcomes, in which a comparable control group is generated for each outcome using a donor pool of suitable National Health Service Trusts in England. The methods are well suited to an evaluation of an intervention at a service delivery level targeting population-level health outcome and the randomisation or ‘trialability’ of the intervention is limited. The synthetic control study controls for national trends over time, increasing our confidence in the results. The study has been designed and will be carried out with the involvement of service users and carers. Discussion: This will be the first formal evaluation of psychiatric decision units in England. The analysis will provide estimates of the effect of the decision units on a number of important service use indicators, providing much needed information for those designing service pathways