Conceptualising quality of life for older people with aphasia

Background: There is an increasing need in speech and language therapy for clinicians to provide intervention in the context of the broader life quality issues for people with aphasia. However, there is no descriptive research that is explicitly focused on quality of life (QoL) from the perspectives of older people with aphasia. Aims: The current study explores how older people with chronic aphasia who are living in the community describe their QoL in terms of what contributes to and detracts from the quality in their current and future lives. The study is descriptive in nature, and the purpose is to conceptualize the factors that influence QoL. Methods & Procedures: Thirty older participants (16 women, 14 men) with mild to moderate aphasic impairment took part. All participants had adequate communication skills to participate: demonstrating reliable yes/no response and moderate auditory comprehension ability. Participants were interviewed in their own homes using six brief unprompted open questions about QoL, in a structured interview. The first five questions were drawn from previous gerontological research (Farquhar, 1995), and a sixth question specifically targeting communication was added. Content analysis was used, identifying discrete units of data and then coding these into concepts and factors. Additional demographic information was collected, and participants’ mood on day of interviewing was assessed using the Geriatric Depression Scale (Sheikh & Yesavage, 1986). Outcomes & Results: Activities, verbal communication, people, and body functioning were the core factors in QoL for these participants, and they described how these factors both contributed quality in life as well as detracted from life quality. Other factors that influenced QoL included stroke, mobility, positive personal outlook, in/dependence, home and health. Whilst the findings are limited by the lack of probing of participants’ responses, the study does present preliminary evidence for what is important in QoL to older people with aphasia. Conclusions: Quality of life for older people with predominantly mild to moderate chronic aphasia who are living in the community is multifactorial in nature. Some factors lie within the remit of speech and language therapy, some lie beyond the professional role, but all are relevant for consideration in rehabilitation and community practice. Further qualitative research is implicated to better understand QoL with aphasia, using in-depth interviewing with a broader range of people with aphasia

‘What’s it like to have ME?’ The discursive construction of ME in computer-mediated communication and face-to-face interaction

ME/CFS (chronic fatigue syndrome) is a debilitating illness for which no cause or medical tests have been identified. Debates over its nature have generated interest from qualitative researchers. However, participants are difficult to recruit because of the nature of their condition. Therefore, this study explores the utility of the internet as a means of eliciting accounts. We analyse data from focus groups and the internet in order to ascertain the extent to which previous research findings apply to the internet domain. Interviews were conducted among 49 members of internet (38 chatline, 11 personal) and 7 members of two face-to-face support groups. Discourse analysis of descriptions and accounts of ME/CFS revealed similar devices and interactional concerns in both internet and face-to-face communication. Participants constructed their condition as serious, enigmatic and not psychological. These functioned to deflect problematic assumptions about ME/CFS and to manage their accountability for the illness and its effects

Assessment of highly distributed power systems using an integrated simulation approach

In a highly distributed power system (HDPS), micro renewable and low carbon technologies would make a significant contribution to the electricity supply. Further, controllable devices such as micro combined heat and power (CHP) could be used to assist in maintaining stability in addition to simply providing heat and power to dwellings. To analyse the behaviour of such a system requires the modelling of both the electrical distribution system and the coupled microgeneration devices in a realistic context. In this paper a pragmatic approach to HDPS modelling is presented: microgeneration devices are simulated using a building simulation tool to generate time-varying power output profiles, which are then replicated and processed statistically so that they can be used as boundary conditions for a load flow simulation; this is used to explore security issues such as under and over voltage, branch thermal overloading, and reverse power flow. Simulations of a section of real network are presented, featuring different penetrations of micro-renewables and micro-CHP within the ranges that are believed to be realistically possible by 2050. This analysis indicates that well-designed suburban networks are likely to be able to accommodate such levels of domestic-scale generation without problems emerging such as overloads or degradation to the quality of supply

Should left-handed midwives and midwifery students conform to the ‘norm’ or practise intuitively?

It has been suggested that the proportion of left-handed people, or more specifically, the greater acknowledgement of left-handedness over the past century may be due to fewer left-handed people being ‘forced’ to use their right hand to conform to the ‘norm’, rather than a greater incidence of left-handedness (McManus, 2002). There are approximately 27,000 midwives in the UK (Royal College of Midwives (RCM), 2015); however there is no official data as to the proportion of midwives who are left-handed, nor research into whether they practise with left-handed dominance. This article was inspired by hearing the experiences in practice of first year student midwives who are left-handed. It also documents the experiences of Julie, a left-handed Senior Lecturer in Midwifery who trained in the early 1980s. Questions raised by this article include whether the left-handed student midwives of today have different experiences in practice to those of 30 years ago?; should all student midwives be trained to practise with right-handed dominance or should student midwives be supported and encouraged to practise intuitively, according to their natural dominance

A study of the validity and the reliability of the Geriatric Anxiety Inventory in screening for anxiety after stroke in older inpatients

Objectives: To investigate the validity and reliability of the Geriatric Anxiety Inventory in screening for anxiety in older inpatients post-stroke. Design: Longitudinal. Subjects: A total of 81 inpatients with stroke aged 65 years or older were recruited at four centres in England. Main measures: At phase 1 the Geriatric Anxiety Inventory and the Hospital Anxiety and Depression Scale were administered and then the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 4th edition (phase 2). The Geriatric Anxiety Inventory was repeated a median of seven days later (phase 3). Results: Internal reliability of the Geriatric Anxiety Inventory was high (α = 0.95) and test-retest reliability acceptable (τB = 0.53). Construct validity of the Geriatric Anxiety Inventory was evident with respect to the Hospital Anxiety and Depression Scale -Anxiety subscale (τB = 0.61). At a cut off of 6/7, the sensitivity of the Geriatric Anxiety Inventory was 0.88 and specificity 0.84, with respect to Structured Clinical Interview diagnosis of anxiety. Hospital Anxiety and Depression Scale -Anxiety subscale sensitivity was 0.88, specificity 0.54 at the optimum cut off of 5/6. A comparison the areas under the curve of the Receiver Operating Characteristics for the two instruments indicated that the area under the curve of the Geriatric Anxiety Inventory was significantly larger than that of the Hospital Anxiety and Depression Scale –Anxiety subscale, supporting its superiority. Conclusions: The Geriatric Anxiety Inventory is an internally consistent, reliable (stable) and valid instrument with acceptable sensitivity and specificity to screen for anxiety in older inpatients with stroke

Experiences of living with chronic back pain: The physical disabilities

Purpose. Back-related functional limitations are largely assessed using lists of activities, each scored on a yes/no basis and the scores then summed. This provides little information about how chronic back pain (CBP) patients live with their condition. This study describes the consequences of living day-to-day with CBP and documents the 'insider' accounts of its impact on daily life. Method. Unstructured interviews, using the 'Framework' approach with topic guide, were recorded and transcribed verbatim. Subjects were sampled for age, sex, ethnicity and occupation from new referrals with back pain to a rheumatology outpatient clinic. Eleven subjects (5 male, 6 female) were interviewed either in English (n = 9) or their preferred language (n = 2). Interviews were read in-depth twice to identify the topics. Data were extracted in phrases and sentences using thematic content analysis. Results. Four themes emerged: sleep/rest, mobility, independence and leisure. All subjects reported issues about sleep and rest, nine about mobility, seven about independence and six on leisure. Most descriptions concerned loss and limitation in daily life. Strategies for coping with sleep disruption and physical limitations were described. Conclusions. Subjects provided graphic 'in-depth' descriptions of experiences living with CBP every day; expressed regret at the loss of capabilities and distress at the functional consequences of those losses. Facilitating 'adjustment' to 'loss' may be more helpful than inferring the potential for a life free of pain as a result of therapeutic endeavours

Impact of a quality improvement project to reduce the rate of obstetric anal sphincter injury: a multicentre study with a stepped-wedge design

Objective To evaluate the impact of a care bundle (antenatal information to women, manual perineal protection and mediolateral episiotomy when indicated) on obstetric anal sphincter injury (OASI) rates. Design Multicentre stepped‐wedge cluster design. Setting Sixteen maternity units located in four regions across England, Scotland and Wales. Population Women with singleton live births between October 2016 and March 2018. Methods Stepwise region by region roll‐out every 3 months starting January 2017. The four maternity units in a region started at the same time. Multi‐level logistic regression was used to estimate the impact of the care bundle, adjusting for time trend and case‐mix factors (age, ethnicity, body mass index, parity, birthweight and mode of birth). Main outcome measures Obstetric anal sphincter injury in singleton live vaginal births. Results A total of 55 060 singleton live vaginal births were included (79% spontaneous and 21% operative). Median maternal age was 30 years (interquartile range 26–34 years) and 46% of women were primiparous. The OASI rate decreased from 3.3% before to 3.0% after care bundle implementation (adjusted odds ratio 0.80, 95% CI 0.65–0.98, P = 0.03). There was no evidence that the effect of the care bundle differed according to parity (P = 0.77) or mode of birth (P = 0.31). There were no significant changes in caesarean section (P = 0.19) or episiotomy rates (P = 0.16) during the study period. Conclusions The implementation of this care bundle reduced OASI rates without affecting caesarean section rates or episiotomy use. These findings demonstrate its potential for reducing perineal trauma during childbirth

Inclusive growth in English cities: mainstreamed or sidelined?

<p>The concept of inclusive growth is increasingly presented as offering prospects for more equitable social outcomes. However, inclusive growth is subject to a variety of interpretations and lacks definitional clarity. In England, via devolution, cities are taking on new powers for policy domains that can influence inclusive growth outcomes. This opens up opportunities for innovation to address central issues of low pay and poverty. This paper examines the extent to which inclusive growth concerns form a central or peripheral aspect in this new devolution through the content analysis of devolution agreements. It concludes that inclusive growth concerns appear to be largely sidelined.</p

A snapshot review of culturally competent compassion as addressed in selected mental health textbooks for undergraduate nursing students

Background The recent scandals involving poor healthcare put nurses under the spotlight in an attempt to understand how compassionate they are towards their patients. The aim of this article is to investigate how compassion is embedded in the textbooks of the undergraduate mental health nursing degree. Methods A snapshot review of key textbooks used, was conducted through the distribution of a list of textbooks and search terms to a panel of mental health teachers in four United Kingdom (UK) universities. They were asked to comment on the list’s completeness, and the terms’ suitability, comprehensiveness and sensitivity regarding culturally competent and compassionate care. Relevant data were extracted independently by each author followed by meetings to compare and discuss their findings and engage in deeper levels of analysis. Results The review found that despite the fact that few textbooks touched on a number of the search terms none of them directly addressed the issue of compassion or culturally competent compassion. This means that mental health undergraduate nurses may not be adequately prepared to provide culturally competent compassion. Conclusions Culturally competent compassion is not something we are born with. Imaginative teaching methods, good textbooks, good role models and opportunities to practice what one learns under supervision is required to nurture compassion in order to re-establish itself as the essence of nursing. Key textbooks need to be revised to reflect the virtue of culturally competent compassion