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

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

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

British citizenship, gender and migration: the containment of cultural differences and the stratification of belonging

Debates about integration, British values and identity, who can belong and who can become a citizen, have been fuelled by concerns about growing cultural diversity in the United Kingdom. To promote a shared sense of national identity and claim a universal and normative citizen subject, the UK government, along with many other western nations, has introduced compulsory citizenship and language testing. This article traces and critiques the evolution of the British citizenship test since its introduction in 2005 and argues that the regime fails to recognise the gendered and segmented nature of migration, and functions as a silent and largely invisible mechanism of civic stratification and control. Drawing on Home Office data, it is argued that citizenship testing enables the government to cherry pick migrants who conform to an idealised citizen subject, while containing cultural difference by excluding others, particularly women, who are tolerated but remain symbolic non-citizens

Making space for co-produced research ‘impact’: learning from a participatory action research case study

There is growing emphasis in the UK on promoting research that creates a positive impact on society. Research Councils UK, the major national research funding agencies, have recently defined a framework for promoting and measuring this impact. This paper contributes to current debates about this developing agenda and, particularly, the problematic intersection of the impact agenda and co-production research approaches. I argue that processes of negotiating values, aims and power relations are essential to creating relevant, ethical impacts with research participants. In contrast to the emphasis placed on linear and top-down change by the impact agenda, my experience doing participatory action research with a UK community group shows that co-produced research produces different kinds of impacts: co-produced impacts are emergent and non-linear; responsive and relational; and empowering when rooted in reciprocal collaboration with research partners. This paper questions the implicit values the impact framework imposes on academic researchers and community partners, calling for continued critical engagement with the impact agenda to encourage the value-rational reflection, deliberation and collaboration needed for creating socially transformative research

Precarious lives and resistant possibilities: the labour of people with learning disabilities in times of austerity

This paper draws on feminist and queer philosophers? discussions of precarity and employment, too often absent from disability studies, to explore the working lives of people with learning disabilities in England in a time of austerity. Recent policy shifts from welfare to work welcome more disabled people into the job market. The reality is that disabled people remain under-represented in labour statistics and are conspicuously absent in cultures of work. We live in neoliberal-able times where we all find ourselves precarious. But, people with learning disabilities experience high levels of uncertainty in every aspect of their lives, including work, relationships and community living. Our research reveals an important analytical finding: that when people with learning disabilities are supported in imaginative and novel ways they are able to work effectively and cohesively participate in their local communities (even in a time of cuts to welfare). We conclude by acknowledging that we are witnessing a global politics of precarity and austerity. Our urgent task is to redress the unequal spread of precaritization across our society that risks leaving people with learning disabilities experiencing disproportionately perilous lives. One of our key recommendations is that it makes no economic sense (never mind moral sense) to pull funding from organisations that support people with intellectual disabilities to work

Multiple sclerosis outpatient future groups: improving the quality of participant interaction and ideation tools within service improvement activities

BackgroundImproving the patient experience is a key focus within the National Health Service. This has led us to consider how health services are experienced, from both staff and patient perspectives. Novel service improvement activities bring staff and patients together to use design-led methods to improve how health services are delivered. The Multiple Sclerosis Outpatient Future Group study aimed to explore how analogies and props can be used to facilitate rich interactions between staff and patients within these activities. This paper will consider how these interactions supported participants to share experiences, generate ideas and suggest service improvements. MethodQualitative explorative study using ‘future groups,’ a reinterpretation of the recognised focus groups method directed towards exploring future alternatives through employing analogies and physical props to engage participants to speculate about future service interactions and health experiences. Participants were people with multiple sclerosis (PwMS) and outpatient staff: staff nurses, nursing assistants, junior sisters and reception staff. ResultsUse of future groups, analogies and physical props enabled PwMS and outpatient staff to invest their own ideas and feelings in the service improvement activity and envisage alternative health care scenarios. The combination of participants in the groups with their diverse perspectives and knowledge of the service led to a collaborative approach in which staff highlighted potential practical problems and patients ensured ideas were holistic. Service improvements were prototyped and tested in the outpatient clinic. ConclusionDesign-led methods such as future groups using analogies and physical props can be used to facilitate interactions between staff and patients in service improvement activities, leading to the generation of meaningful ideas. It is hoped that improving the quality of ideation tools within design-led methods can contribute to developing successful service interventions in service improvement activities. <br/

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