Addressing the needs of the children’s integrated workforce: A method for developing collaborative practice through joint learning

The delivery of welfare, health and educational provision to the majority of children aged 0–18 in England is primarily led by local authorities via their children’s integrated service. In 2004 the children’s integrated service model was launched and it promised the benefits of an integrated and collaborative system of working, regarding flexibility and responsiveness to national policy, local development and capacity building (Robinson et al, 2008). However, the implementation and emergence of this model has been characterised by competing local and national agendas, practitioner misunderstanding and lack of trust, a lack of strong leadership and also financial restrictions. It can therefore be contended that conceptually children’s integrated services are not operating fully with a collaborative and integrated workforce. As a possible solution to the current situation, it is proposed that joint learning, along with a combined continual professional development (CPD) framework, be made available as a valuable starting point for such organisations. Learning and working together has benefits for children and practitioners, and especially, as this article will argue, for playwork practitioners

Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review

Summary table and references for secondary search. (DOCX 204 kb

Factors of resilience in informal caregivers of people with dementia from integrative international data analysis

Background/Aims: Although caring for a person with dementia can be stressful, some caregivers appear to experience few negative consequences to their well-being. This study aimed to examine what proportion of caregivers demonstrates resilience under different challenging circumstances and to identify factors related to their resilience. Methods: Baseline data from 4 studies from the Netherlands and UK among informal caregivers of people with dementia were harmonized and integrated. Caregiver resilience was defined as high levels of psychological well-being despite different types of high caregiving demands. Multivariate regression analyses identified factors significantly related to caregiver resilience. Results: The integrated data set included 15 harmonized variables with data from 1,048 caregivers facing a high care demand. The prevalence of resilience varied between 35 and 43%, depending on the demand for high care. Being a male caregiver, caring for a female, living apart from your relative, and low caregiver burden were positively related to caregiver resilience. Conclusion: Caregivers have the capacity to demonstrate resilience despite significant challenges. This study demonstrates how harmonization of data from multiple existing studies can be used to increase power and explore the consistency of findings. This contributes to a better understanding of which factors are likely to facilitate caregiver resilience and offers insights for developing services

Location-specific cutaneous electrical stimulation of the footsole modulates corticospinal excitability to the plantarflexors and dorsiflexors during standing

Non-noxious electrical stimulation to distinct locations of the foot sole evokes location-specific cutaneous reflex responses in lower limb muscles. These reflexes occur at latencies that may enable them to be mediated via a transcortical pathway. Corticospinal excitability to the plantarflexors and dorsiflexors was measured in 16 participants using motor evoked potentials (MEPs). Spinal excitability was measured in eight of the original participants using cervicomedullary motor evoked potentials (CMEPs). Measurements were collected with and without preceding cutaneous stimulus to either the heel (HEEL) or metatarsal (MET) locations of the foot sole, and evoked potentials were elicited to coincide with the arrival of the cutaneous volley at either the motor cortex or spinal cord. Plantarflexor MEPs and CMEPs were facilitated with cutaneous stimulation to the HEEL for MEPs (soleus p = 0.04, medial gastrocnemius (MG) p = 0.017) and CMEPs (soleus p = 0.047 and MG p = 0.015), but they were unchanged following MET stimulation for MEPs or CMEPs. Dorsiflexor MEPs were unchanged with cutaneous stimulation at either location, but dorsiflexor CMEPs increased with cutaneous stimulation (p = 0.05). In general, the increase in CMEP amplitudes was larger than the increase in MEP amplitudes, indicating that an increase in spinal excitability likely explains most of the increase in corticospinal excitability. The larger change observed in the CMEP also indicates that excitability from supraspinal sources likely decreased, which could be due to a net change in the excitability of intracortical circuits. This study provides evidence that cutaneous reflexes from foot sole skin are likely influenced by a transcortical pathway

Difficulties in retrieving specific details of autobiographical memories and imagining positive future events in individuals with acute but not remitted anorexia nervosa

INTRODUCTION: The factors that contribute to the maintenance of anorexia nervosa (AN) are not fully understood, although it is generally accepted that depression is a core feature and contributes to poor prognosis. Individuals with depression tend to have difficulties in producing specific details of autobiographical memories and future episodes. Our aim was to investigate autobiographical memory and episodic future thinking (EFT) in individuals with AN (n = 46), people recovered from AN (recAN; n = 40), and non-affected controls (n = 35). METHOD: Using a remotely administered computerised version of the autobiographical memory test and episodic future thinking task, we measured six aspects of memory retrieval and EFT generation: specificity, detailedness, difficulty in remembering/imagining, positivity, vividness and realism. Memory and EFT cue valence was manipulated; cues were either positive, neutral, or disorder-related/negative. As the production of EFTs is theoretically linked to the ability to retrieve autobiographical memories, the relationship between autobiographical memory specificity and EFT specificity was explored. To investigate whether autobiographical memory and EFT performance were independent of performance on other forms of cognition, working memory, verbal fluency and cognitive flexibility were measured. RESULTS: People with AN had difficulties retrieving specific details of autobiographical memories and rated autobiographical memories as less positive overall, and less vivid when primed by positive cues. People with a lifetime diagnosis (currently ill or recovered) reported greater difficulty in retrieving memories. The AN group generated less positive EFTs, particularly to positive and neutral cues. Comorbid depressive symptoms had some contribution to the observed findings. Lastly, in all groups autobiographical memory specificity predicted EFT specificity. DISCUSSION: Problems with retrieving specific details of autobiographical memories and simulating positive EFTs may be a state feature of AN. Treatments targeted at alleviating depressive symptoms, as well those targeted towards facilitating memory retrieval or reconsolidation, and the construction of positive EFTs, may contribute to hope for recovery and strengthen the sense of self beyond the disorder. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40337-022-00684-w

'A hard-won capability': the experiences of parents managing their babies' medicines after discharge from a neonatal unit.:'A hard-won capability'

IntroductionParents of babies who required neonatal care are responsible for managing their medicines after they are discharged home. There is wide variation in the information and amount of preparation given to parents prior to assuming this challenging task. The aim of the Parent co-Designed Drug Information for parents and Guardians Taking Neonates home (PADDINGToN) study was to explore parents' experiences of managing their babies' medicines post discharge from a neonatal unit and to use this information to develop suitable resources for future families.MethodsA qualitative participatory interpretative approach using a mixture of remote and face-to-face small group interviews or one-to-one interviews was used. Parents were recruited using social media advertisements and convenience sampling from five study sites (four neonatal units in England and one in Ireland). Parents from other neonatal units were invited to take part through social media advertisement. The interviews were audio-recorded and inductive reflexive thematic analysis was used to analyze the data.Results17 parents (14 mothers, 3 fathers) participated. One over-arching theme, 'A hard won capability', and four major interpretive themes were generated from the analysis of the data: Being in NICU and the prospect of going home: emotional and practical challenges; Living the reality of being at home: the uncertainty associated with giving medicines; Being at home: battling the system and a lack of support/knowledge; and Suggesting ways forward: parents' lived insights into improving information and resources.ConclusionDespite the challenges they faced, parents developed strategies for safely and reliably managing medicines administration and they assimilated knowledge, built their confidence and achieved a capability in medicines administration. Their experiences have been used to build a suite of medicines administration resources to support future parents.</jats:sec

Developing a CPD Framework in a time of organizational cultural conflict

The need for continual organisational improvement is of critical importance for organisations like that of children’s integrated services where there is both a legal and moral authority to safeguard and promote the welfare of all children. However, the implementation of children’s integrated services since 2004 has produced a series of challenges in the forms of contextual barriers, changing political climates, organisational change and cultural issues (Robinson et al., 2008). A perennial challenge for children’s services has been the ability to meet the CPD needs of the various professions that constitute its workforce without seemingly destabilising the wider organisational norms and beliefs. This paper specifically focuses on the current development of a CPD framework for an entire children’s integrated workforce, and the impact the organisational culture, as well as the professional sub-cultures are having. Reference will be made to members of the workforce being cultural carriers and the role of leaders in relation to organisational change (Schein, 1993 and Lucas and Kline, 2008). In seeking to answer the real world problem of developing a CPD framework for multiple professions within a single organisation, the paper will identify the factors that need to be taken into account

Taking advantage of dissonance: a CPD framework

Purpose: To communicate the findings of an empirical research project based on a real world problem that involved the development of a Continuous Professional Development (CPD) framework for a children’s integrated service workforce. In addition, to give attention to the notion that children’s integrated services have not necessarily been viewed from the perspective of conflict management and that this has meant ensuing conflicts that characterise such organisations are more often than not ignored. Design/Methodology/Approach: A case study approach involving a mixed methodology consisting of semi-structured interviews for senior managers and service leads; a quantitative survey for frontline practitioners and focus groups for service users, carers and children. Findings: Rather than the service being fully integrated, services were aligned, and this was reflected in the conflict between professional cultures, reinforcing an ‘us and them’ culture. This culture had seemingly permeated all aspects of the organisation including the senior management team. It was also noted that certain systems and processes, as well as bureaucracy, within the service were seen as hindering integrated working and was in effect a catalyst for conflict. Originality/Value: Through the application of conflict management theory it will be illustrated how conflict could be used to effectively steer children integrated services towards creativity and productivity through an organisational wide framework that not only embraces dissonance, but also promotes a learning environment that takes advantage of such dissonance to incorporate a hybrid of professional practice and expertise

Operative and Radiographic Acetabular Component Orientation in Total Hip Replacement: Influence of Pelvic Orientation and Surgical Positioning Technique

Orthopaedic surgeons often experience a mismatch between perceived intra-operative and radiographic acetabular cup orientation. This research aimed to assess the impact of pelvic orientation and surgical positioning technique on operative and radiographic cup orientation. Radiographic orientations for two surgical approaches were computationally simulated: a mechanical alignment guide and a transverse acetabular ligament approach, both in combination with different pelvic orientations. Positional errors were defined as the difference between the target radiographic orientation and that achieved. The transverse acetabular ligament method demonstrated smaller positional errors for radiographic version; 4.0° ± 2.9° as compared to 9.4° ± 7.3° for the mechanical alignment guide method. However, both methods resulted in similar errors in radiographic inclination. Multiple regression analysis showed that intraoperative pelvic rotation about the anterior-posterior axis was a strong predictor for these errors (B TAL = −0.893, B MAG = −0.951, p &lt; 0.01). Application of the transverse acetabular ligament method can reduce errors in radiographic version. However, if the orthopaedic surgeon is referencing off the theatre floor to control inclination when operating in lateral decubitus, this is only reliable if the pelvic sagittal plane is horizontal. There is currently no readily available method for ensuring that this is the case during total hip replacement surgery. </p

Loss of Notch signalling induced by Dll4 causes arterial calibre reduction by increasing endothelial cell response to angiogenic stimuli

<p>Abstract</p> <p>Background</p> <p>In the vascular system, Notch receptors and ligands are expressed mainly on arteries, with Delta-like 4 (Dll4) being the only ligand known to be expressed early during the development of arterial endothelial cells and capillaries. <it>Dll4 </it>null embryos die very early in development with severely reduced arterial calibre and lumen and loss of arterial cell identity.</p> <p>Results</p> <p>The current detailed analysis of these mutants shows that the arterial defect precedes the initiation of blood flow and that the arterial <it>Dll4</it>^-/-endothelial cells proliferate and migrate more actively. <it>Dll4</it>^-/-mutants reveal a defective basement membrane around the forming aorta and increased endothelial cell migration from the dorsal aorta to peripheral regions, which constitute the main causes of arterial lumen reduction in these embryos. The increased proliferation and migration of <it>Dll4</it>^-/-endothelial cells was found to coincide with increased expression of the receptors VEGFR-2 and Robo4 and with downregulation of the TGF-β accessory receptor Endoglin.</p> <p>Conclusion</p> <p>Together, these results strongly suggest that Notch signalling can increase arterial stability and calibre by decreasing the response of arterial endothelial cells to local gradients of pro-angiogenic factors like VEGF.</p