Understanding the health and social care needs of people living with IBD: A meta-synthesis of the evidence

AIM: To undertake a metasynthesis of qualitative studies to understand the health and social needs of people living with inflammatory bowel disease (IBD). METHODS: A systematic search strategy identified qualitative studies exploring the phenomenon of living with inflammatory bowel disease. Databases included MEDLINE, PsychInfo, EMBASE, CINAHL and the British Nursing Index via the OVID platform. Qualitative search filters were adapted from Hedges database (http://www.urmc.rochester.edu/hslt/miner/digital_library/tip_sheets/Cinahl_eb_filters.pdf). Qualitative empirical studies exploring the health and social needs of people living with inflammatory bowel disease were selected. Study eligibility and data extraction were independently completed using the Critical Appraisal Skills Programme for qualitative studies. The studies were analysed and synthesised using metasynthesis methodology. The themes from the studies allowed for common translations into a new interpretation of the impact of living with inflammatory bowel disease. RESULTS: Of 1395 studies, six published studies and one unpublished thesis fulfilled the inclusion criteria. First iteration of synthesis identified 16 themes, 2nd iteration synthesised these into three main 2nd order constructs: “detained by the disease”; “living in a world of disease” and “wrestling with life”. “Detained by the disease” is the fear of incontinence, the behaviour the patients display due to the fear, and the impact this has on the individual, such as social isolation and missing out on life events. All of these serve to “pull” the patient back from normal living. “Living in a world of disease” is the long term effects of living with a long term condition and the fear of these effects. “Wrestling with life” is the continued fight to thrive, the “push” to continue normal living. CONCLUSION: The metasynthesis provides a comprehensive representation of living with IBD. The unmistakeable burden of incontinence is exposed and its ongoing effects are demonstrated. The combined overall impact of living with IBD is the tension these patients live with: “Pushed and pulled: a compromised life”, people living with IBD experience a constant conflict throughout their lives, they push to be normal but IBD pulls them back. The impact of the fear of incontinence and behaviour of the individual as a result, requires further qualitative enquiry

Forming Anglican Wayfinders in Aotearoa: A Contextual Approach to Ministerial Preparation

This dissertation begins with a Church in crisis and a story of vocation under pressure. It identifies the need for clergy who are resilient and adaptive in the face of change. Using the four phases of Appreciative Inquiry, Sections Two through Six build a picture of what New Zealand Anglican leaders need today.1 Discover: Section Two surveys bright spots in ministerial education, and exegetes the Rule of Benedict using a leadership lens. Dream: Section Three identifies key challenges, evaluates emerging models of leadership, and proposes a fresh approach to training. Design and Destiny phases (Sections Four through Six) present the St John’s College Diploma in Anglican Leadership as a historically grounded, contextually appropriate response to the ministry problem

Aligning oral mesalazine treatment to health service priorities:guidance for nurses

Oral mesalazine represents a crucial front-line agent for the treatment of active ulcerative colitis (UC) and the maintenance of remission. Clinical aspects of mesalazine therapy are guided by robust evidence-based guidelines, although there is a relative paucity of guidance examining the specific administrative and professional issues faced by inflammatory bowel disease (IBD) nurses. As IBD nurses frequently influence treatment decisions in UC, this article was written to provide a practical review of the key evidence and issues affecting mesalazine treatment. Therefore, it may act as an additional resource for IBD nurses, to enhance prescribing decisions. Using the UK's Quality, Innovation, Productivity and Prevention (QIPP) agenda as a framework, it considers clinical and health service priorities affecting treatment decisions. The quality of care perspective naturally focuses on efficacy; recent interest in specific aspects of efficacy, such as the speed of symptom resolution allows targeting of mesalazine treatment to individual needs. Furthermore, innovative adherence programmes build on the latest evidence to develop robust, integrated patient support approaches. In terms of productivity, nurse-led activities and more sophisticated management strategies may offer the best routes towards reducing the costs of care. Key opportunities for preventing ill health include improving adherence to maintenance therapy and achieving mucosal healing. The principles and approaches highlighted by the QIPP agenda emphasise that prescribing decisions for mesalazine in UC must take account of the full spectrum of clinical and health service needs, and cannot focus on any one element in isolation

Accessible and inclusive cyber security:a nuanced and complex challenge

It has been argued that human-centred security design needs to accommodate the considerations of three dimensions: (1) security, (2) usability and (3) accessibility. The latter has not yet received much attention. Now that governments and health services are increasingly requiring their citizens/patients to use online services, the need for accessible security and privacy has become far more pressing. The reality is that, for many, security measures are often exasperatingly inaccessible. Regardless of the outcome of the debate about the social acceptability of compelling people to access public services online, we still need to design accessibility into these systems, or risk excluding and marginalising swathes of the population who cannot use these systems in the same way as abled users. These users are particularly vulnerable to attack and online deception not only because security and privacy controls are inaccessible but also because they often struggle with depleted resources and capabilities together with less social, economic and political resilience. This conceptual paper contemplates the accessible dimension of human-centred security and its impact on the inclusivity of security technologies. We scope the range of vulnerabilities that can result from a lack of accessibility in security solutions and contemplate the nuances and complex challenges inherent in making security accessible. We conclude by suggesting a number of avenues for future work in this space.</p

Deep Haptic Model Predictive Control for Robot-Assisted Dressing

Robot-assisted dressing offers an opportunity to benefit the lives of many people with disabilities, such as some older adults. However, robots currently lack common sense about the physical implications of their actions on people. The physical implications of dressing are complicated by non-rigid garments, which can result in a robot indirectly applying high forces to a person's body. We present a deep recurrent model that, when given a proposed action by the robot, predicts the forces a garment will apply to a person's body. We also show that a robot can provide better dressing assistance by using this model with model predictive control. The predictions made by our model only use haptic and kinematic observations from the robot's end effector, which are readily attainable. Collecting training data from real world physical human-robot interaction can be time consuming, costly, and put people at risk. Instead, we train our predictive model using data collected in an entirely self-supervised fashion from a physics-based simulation. We evaluated our approach with a PR2 robot that attempted to pull a hospital gown onto the arms of 10 human participants. With a 0.2s prediction horizon, our controller succeeded at high rates and lowered applied force while navigating the garment around a persons fist and elbow without getting caught. Shorter prediction horizons resulted in significantly reduced performance with the sleeve catching on the participants' fists and elbows, demonstrating the value of our model's predictions. These behaviors of mitigating catches emerged from our deep predictive model and the controller objective function, which primarily penalizes high forces.Comment: 8 pages, 12 figures, 1 table, 2018 IEEE International Conference on Robotics and Automation (ICRA

Multidimensional Capacitive Sensing for Robot-Assisted Dressing and Bathing

Robotic assistance presents an opportunity to benefit the lives of many people with physical disabilities, yet accurately sensing the human body and tracking human motion remain difficult for robots. We present a multidimensional capacitive sensing technique that estimates the local pose of a human limb in real time. A key benefit of this sensing method is that it can sense the limb through opaque materials, including fabrics and wet cloth. Our method uses a multielectrode capacitive sensor mounted to a robot's end effector. A neural network model estimates the position of the closest point on a person's limb and the orientation of the limb's central axis relative to the sensor's frame of reference. These pose estimates enable the robot to move its end effector with respect to the limb using feedback control. We demonstrate that a PR2 robot can use this approach with a custom six electrode capacitive sensor to assist with two activities of daily living-dressing and bathing. The robot pulled the sleeve of a hospital gown onto able-bodied participants' right arms, while tracking human motion. When assisting with bathing, the robot moved a soft wet washcloth to follow the contours of able-bodied participants' limbs, cleaning their surfaces. Overall, we found that multidimensional capacitive sensing presents a promising approach for robots to sense and track the human body during assistive tasks that require physical human-robot interaction.Comment: 8 pages, 16 figures, International Conference on Rehabilitation Robotics 201

Transforming Congregational Conflict: An Integrated Framework for Understanding and Addressing conflict in Christian Faith Communities

Churches have traditionally turned to conflict resolution measures, such as mediation, arbitration, and litigation, rather than conflict transformation approaches, when addressing congregational discord. In so doing, they miss the opportunity for constructive change that conflict presents and set themselves up for cycles of conflict to recur in the future. At the same time they diminish their self-claimed identity as followers of Jesus Christ, whose recorded teaching gives striking priority to peacemaking and reconciliation. Chapter one introduces the context for this thesis. Much work has already been done to explore biblical understandings of conflict, forgiveness and reconciliation, on the one hand, and to apply current conflict resolution practices to congregational settings on the other. However, little has been done to develop a conceptual framework that seeks to integrate biblical understandings with the insights of modern conflict analysis in a practically useful way. Chapter two of this thesis focuses on Jesus' teaching in Matthew 18 and shows why this passage is a key biblical resource for understanding and addressing congregational conflict. Chapter three examines conflict resolution theory and practice and shows why a transformational approach is the most appropriate one for addressing congregational conflict. The fourth chapter brings Jesus' teaching in Matthew 18 into a dialogue with current conflict transformation theory and practice. This conversation integrates theology and practice and clarifies the ways in which Jesus' teaching and transformative approaches to conflict both complement and enrich each other in the quest for lasting answers to the problem of congregational conflict. This thesis concludes by proposing a framework in which the many resources available might be understood and utilised in an integrated way by congregations that seek not only to enhance their capacity to respond to conflict in healthier ways, but also to embody the teachings of Christ in their midst