Neglecting the Importance of the Decision Making and Care Regimes of Personal Support Workers: A Critique of Standardization of Care Planning Through the RAI/MDS

Purpose: The Resident Assessment Instrument–Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the decision making and care practices of personal support workers (PSWs) in relation to the RAI/MDS standardized process. Design and Methods: This qualitative study utilized focus groups and semi-structured interviews with PSWs (n = 26) and supervisors (n = 9) in two nursing homes in central Canada. Results: PSWs evidenced unique occupational contributions to assessment via proximal familiarity and biographical information as well as to individualizing care by empathetically linking their own bodily experiences and forging bonds of fictive kinship with residents. These contributions were neither captured by RAI/MDS categories nor relayed to the interdisciplinary team. Causal factors for PSW exclusion included computerized records, low status, and poor interprofessional collaboration. Intraprofessional collaboration by PSWs aimed to compensate for exclusion and to individualize care. Implications: Exclusive institutional reliance on the RAI/MDS undermines quality care because it fails to capture residents’ preferences and excludes input by PSWs. Recommendations include incorporating PSW knowledge in care planning and documentation and examining PSWs’ nascent occupational identity and their role as interprofessional brokers in long-term care

Source separation: Challenges & opportunities for transition in the swedish wastewater sector

A paradigm shift to waste reuse has started in the wastewater sector with many experts calling for greater resource recovery, often facilitated by alternative solutions such as source separation. Source separation has been shown to be advantageous for improving treatment capacity, food security, and efficiency; yet these systems are still immature, considered risky by professionals and scarcely implemented. This study attempts to answer the question of why source separation is still marginalized by examining the Swedish experience with source separated wastewater from the perspective of Technology Innovation Systems (TIS) in order to identify obstacles and policy recommendations. Considering that source-separation is still in a development phase, the study found that source separation works moderately well within the on-site niche and that blackwater systems in general perform better than urine diversion. Knowledge development is found to be the weakest function. A major blocking mechanism is the weakness of interchange between knowledge development and entrepreneurial activity. Policy recommendations include: increased R & D; building networks and communication platforms; and establishing guidelines for technologies, legislation interpretation and organizational models

Is the Swedish wastewater sector ready for a transition to source separation?

Source separation of urine for recycling has been applied in small-scale and decentralized wastewater systems in Sweden for the past 25 years and for blackwater for pollution control even longer. The Swedish experience with source separating nutrient recycling systems is relatively well documented; however, few reports have specifically studied the potential for expansion of this practice. The aim of this study is to fill this knowledge gap by assessing the status of source-separating technologies in Sweden based on transition theory. This study uses a multi-level perspective to determine how ready the Swedish wastewater sector is for transitioning to alternative systems. Given the stability of the existing sewage wastewater regime, it seems unlikely that changes within the regime will lead to a quick and large-scale transition to source separation. Instead, the initiative must come from the niche itself, exploiting institutional cracks in the regime and opportunities from shifting trends in the landscape. If source separation is to be mainstreamed in Sweden, it will need to break into markets within the wastewater jurisdictions. In order to do so, further knowledge needs to be developed that will overcome glitches with immature technologies, uncertain legal conditions/status, investigate potential risks, and clearly define complementary system advantages. This may require the use of new perspectives that focus on holistic sustainable use of resources, including other nutrients than phosphorous, and taking into account global issues such as planetary boundaries and effects from climate change, such as water scarcity. This knowledge can then be used to establish guidelines, norms, and standards, as well as clarify the legislative structures that can support such a transition. There is also a strong need to improve knowledge dissemination regarding best-practices for implementing source-separation technologies and supporting organizational structures. Similarly, support for entrepreneurial activities within the niche needs to increase, not least through strengthening social networks and communication platforms

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

International audienceBackground: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences.Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes.Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality.Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event