Thematic Research network for emergency and UnScheduled Treatment (TRUST): scoping the potential

<p>Abstract</p> <p>Background</p> <p>To identify the benefits of a network in emergency and unscheduled care research, a six week scoping study was undertaken. Objectives were to: draw together stakeholders; identify and prioritise research topics; identify sites for recruitment to studies; and agree a research strategy for a network.</p> <p>Methods</p> <p>A workshop was held to discuss and agree a research strategy based on results from four activities: visits to established research centres in emergency and unscheduled care; a literature overview; interviews with stakeholders in a GP out-of-hours service; and an exploration of the potential for routine data to support research in emergency care.</p> <p>Results</p> <p>Participants attended the workshop from user groups, primary care, the ambulance service, social care, the national telephone based health helpline, the Welsh Assembly Government and the academic sector. Site visits identified opportunities for collaboration. Gaps in knowledge were identified concerning the effectiveness of alternative models of emergency care delivery. Interview data highlighted a lack of evidence related to the quality of out-of-hours provision of primary care. The All Wales Injury Surveillance System (AWISS) was found to offer the potential to use routine data to support quantitative studies in emergency care. Three key issues emerged across all activities: working across boundaries; patient involvement; and triage.</p> <p>Conclusion</p> <p>The study included views from patient, provider, policy and academic perspectives and built the case for a research network in emergency care. Now funded, TRUST (Thematic Research network for emergency and UnScheduled Treatment) will allow the development of research proposals, building of research teams and recruitment of sites and patients both in Wales and across the UK. It aims to address the imbalance between investment and research in this area and help support provision of 'the right care to the right people at the right time'.</p

Comparing UK and 20 Western countries' efficiency in reducing adult (55-74) cancer and total mortality rates 1989-2010: Cause for cautious celebration? A population-based study.

OBJECTIVE: Every Western nation expends vast sums on health, especially for cancer; thus, the question is how efficient is the UK in reducing adult (55-74) cancer mortality rates and total mortality rates (TMR) compared to the other Western nations in the context of economic-input to health, the percentage of Gross-Domestic-Product-expenditure-on-Health. DESIGN: WHO mortality rates for baseline 3 years 1989-1991 and 2008-2010 were analysed, and confidence intervals determine any significant differences between the UK and other countries in reducing the mortalities. Efficiency ratios are calculated by dividing reduced mortality over the period by the average % of national income. SETTING: Twenty-one similar socio-economic Western countries. PARTICIPANTS: The 21 countries' general population. MAIN OUTCOME MEASURES: Cancer mortality rates, total mortality rates Gross Domestic Product and Efficiency Ratios. RESULTS: Economic Input: In 1980, UK national income was 5.6% and the European average was 7.1%. By 2010, UK national income was 9.4% being equal 17th of 21 averaging 7.1% over the period. Europe's 1980-2010 average of 8.4% yields a UK to Europe ratio of 1:1.18. Clinical output 1989-2010: UK Cancer Mortality Rates was the sixth highest, but equal sixth biggest fall, significantly greater than 14 other countries. UK Total Mortality Rates was the fifth highest but third biggest decline, significantly greater than 17 countries. UK's cancer Efficiency Ratios is largest at 1:301 and second biggest for Total Mortality Rates at 1.1341; the USA ratios were 1:152 and 1:525, respectively. CONCLUSIONS: UK reduced mortalities indicate that the NHS achieves proportionally more with relatively less, but UK needs to match European average Gross-Domestic-Product-expenditure-on-Health to meet future challenges

Dietary quality may enhance survival related to cognitive impairment in Taiwanese elderly

Impaired cognition increases mortality in the aged. It is unclear how dietary quality might affect this relationship.To examine how dietary diversity and cognition might interact to determine survival.In a Nutrition and Health Survey in Taiwan (NAHSIT 1999&#x2013;2000), 1,839 representative elderly were followed for mortality up to 10 years. The dietary quality measure was a dietary diversity score (DDS, range: 0&#x2013;6) to present six food groups (dairy, meat, rice and grains, fruit, vegetable,fat and oil) derived from a 24-h dietary recall. Cognitive function was evaluated by the validated Short Portable Mental Status Questionnaire (SPMSQ).Those with cognitive impairment (SPMSQ&#x200A;&#x2265;&#x200A;3 errors) had 2.56 (95% confidence intervals (CI), 1.99&#x2013;3.28) times the all-cause-mortality risk of those with intact cognition. After control for potential confounders, the adjusted hazard ratio (HR) remained significant (1.46, 95% CI: 1.06&#x2013;2.02). Significant interactions for DDS and cognition were found (p&#60;0.001). Jointly, compared to normal-SPMSQ-highest DDS, the greatest HR is where impaired cognition is combined with the lowest DDS (HR 2.24, 95% CI: 1.19&#x2013;4.24). Increased DDS was associated with improvement in survival that is especially evident in those with 1&#x2013;2 errors where the greatest HR reduction was found, and for fruit. Attributability for mortality amounted to 18% for impaired cognition and 33% for least diverse diet.Dietary diversity may improve survival in relation to impaired cognitive function

Effect of Dried Sewage Sludge on Compressive Strength of Concrete

Sewage sludge is a waste product generated from the wastewater treatment process at the treatment plant. The amount of sewage sludge produced is increases every year as the population increased. Poor management of sewage sludge will give negative impact to the environment. Replacing cement with sewage sludge ash is more significant to reduce the amount of waste material from sewage treatment plants. In this study, the various percentage of dried sewage sludge (DSS) has been added to replace the cement. Sewage sludge was dried in the oven with 100°C for 24 hours, then sieve through the sieve size 300 µm. Then, DSS was used in the concrete instead of cement with the replacement percentage of 0%, 5%, 10%, and 15% by weight. The compressive strength of concrete cube specimens was investigated after 7 and 28 days of curing. The results showed that the compressive strength of concrete specimens increased with the replacement of cement in concrete with 5 % to 10 % DSS, but the achieved maximum strength still lower compared to the control sample. However, the compressive strength of concrete specimens decreased when the DSS replacement of cement is more than 10 % by weight. The result of XRF test also showed that DSS has good potential to replace cement in concrete

Indication des cesariennes a la maternite du CHU de Yaounde de 2000 A 2004

Il s.agit d.une étude rétrospective réalisée à la maternité du Centre Hospitalier et Universitaire (CHU) de Yaoundé (Cameroun) du 1er janvier 2000 au 31 décembre 2004. Les dossiers médicaux des patientes ont été examinés et certaines données analysées. Nous avons eu un total de 1167 césariennes sur 9164 accouchements soit un taux de césarienne de 12,7 %.La moyenne d.âge de nos patientes est de 27,8 ans. La césarienne a été réalisée dans 43,6 % chez les primipares. Les césariennes en urgence ont été les plus pratiquées (81,9 %). Les principales indications étaient la disproportion cephalo-pelvienne (DCP) (24 %), l.utérus cicatriciel associé à un ou plusieurs autres facteurs de risque (15,4%), la souffrance f.tale aiguë (12,1%), le placenta praevia (9,5 %) et les anomalies de présentation (7%). Nous avons eu 74 décès f.taux (6,3% de décès f.tal) au cours ou au décours de la césarienne, et 3 décès maternels, soit 0,25%). Le taux de césarienne a augmenté, principalement à cause de l.évacuation des parturientes à partir des autres formations sanitaires, la principale indication était la DFP retrouvée surtout chez les primipares. La mortalité néo-natale est en baisse probablement grâce à l.amélioration des soins obstétriques et pédiatriques. Clinics in Mother and Child Health Vol. 3(1) 2006: 453-45

The Double Bind: Care Transition Experiences of Ageing Informal Carers and People with Disability in Minority Migrant Communities

An important milestone in social care and social policy since the late 1990s is the continued opportunity for persons with disability and their parents and/or family caregivers to have longer, enjoyable quality of life. However, as family carers, informal supporters and persons with disabilities age, their needs and expectations also change. Ageing family carers, usually parents, increasingly can no longer provide the quality and intensity of support and care required for their family members with disabilities. This puts additional pressure on informal long-term care and support relationships. It also threatens the future of care, especially for ageing carers from multicultural communities –who historically and continually find access to disability and other support services challenging in Australia. The intersection of migration and ageing in Australia presents a multifaceted challenge. The phenomenon of migration has led to a growing number of older Australians from multicultural backgrounds. The combination of the demographic shift, the trend of people living longer, as well as the evolving dynamics of informal caregiving for people with disabilities resulting from the ageing process means it is now imperative to gain insights into the experiences of ageing informal disability carers (hereinafter referred to as ‘AIDC’) from multicultural backgrounds, and their family member with disabilities. Understanding their perspectives on and preparations for this significant transition into the latter years of life is of the utmost importance. This project, therefore, aimed to work with multicultural communities in collaboration with the New South Wales (NSW) peak multicultural disabled people’s organisation, the Multicultural Disability Advocacy Association (MDAA), which advocates for people with disability, their families and carers in order to understand the care transition planning experiences of AIDC and their adult family members with disability. The overall goal is to use the findings of this pilot study to inform the design of an innovative multicultural care transition toolkit to support the care transition planning processes of multicultural families who provide informal disability care. There are profound uncertainties for the future of care and support for ageing carers and their adult children with disabilities in multicultural communities. The long-held assumption that these communities rely on an informal family support system is no longer tenable in the face of weakening intergenerational solidarity and the effect of acculturation into the Australian way of life of second and third-generation migrants. It is, therefore, imperative that stakeholders in multicultural disability support and care and aged care acknowledge the role of AIDC and the evolving context in which they provide care by designing tailored household interventions that support the care transition planning process for all concerned – the care and support providers within the family, and the person with disabilities who relies upon them. More importantly, there is the need for a deliberate multicultural policy response that recognises the voices, concerns, aspirations, and expectations of disability and aged caregiving in multicultural communities when designing tailored care transition services. The research recommends that disability advocacy and carer support organisations work towards strengthening and empowering ADIC and persons with disabilities to negotiate the care transition process, considering their personal cultural values, beliefs, gender, ethnoreligious, and family norms

Mort foetal intrapartum au Cameroun: Une analyse de deux hôpitaux de référence de Yaoundé, Cameroun.

Selon le rapport de l’organisation mondiale de la santé sur l’Afrique, 4.1% de nouveau nés meurent avant d’être nés, 37% de ces décès surviennent pendant le travail. Nous avons engagé ce travail afin d’identifier les facteurs de risque de mortalité intrapartum dans notre milieu. Dans une étude cas- témoins réalisée du 1er octobre 2000 au 31 septembre 2001 au centre hospitalier universitaire de Yaoundé (CHUY) et à l’hôpital central de Yaoundé (HCY) L’analyse des données a été faite avec le logiciel EPI-info 6. Nous avons utilisé le rapport de cote pour apprécier l’impact des différentes variables sur le risque de décès intrapartum. Quatre vingt six décès foetaux intrapartum ont été observés dans les deux hôpitaux durant la période de l’étude, soit une prévalence de 1,8 pour 100 naissances. Nous avons identifié 5 principaux facteurs de risque de mortalité foetale intrapartale : les hémorragies antépartum (OR=15,14, IC à 95%. [1.96 -322.72]; P=0.00081), la preéclampsie /éclampsie (OR=13,78, IC à 95%. [1.77 - 295.41] ; P= 0.0015); le travail stationnaire (OR=6,21 IC à 95%. [1.86- 22.91]; P= 0.00043); la souffrance foetale (OR=5,53, IC à 95%. [1.07-38.31].IC à 95% P= 0.0166) ; patiente référée d’une autre formation sanitaire (OR=4,81[IC à 95%. [2.39-9.91]; P= 0.0000015). Des actions spécifiques sont nécessaires pour permettre de reconnaître rapidement les facteurs de risque de mort foetale intrapartum et assurer une prise en charge rapide et efficace.MOTS CLES: Foetus - Mort intrapartum - Yaoundé - Cameroun

Reflections on a 'virtual' practice development unit: changing practice through identity development

Aims. This paper draws together the personal thoughts and critical reflections of key people involved in the establishment of a ‘virtual’ practice development unit of clinical nurse specialists in the south of England. Background. This practice development unit is ‘virtual’ in that it is not constrained by physical or specialty boundaries. It became the first group of Trust-wide clinical nurse specialists to be accredited in the UK as a practice development unit in 2004. Design and methods. The local university was asked to facilitate the accreditation process via 11 two-hour audio-recorded learning sessions. Critical reflections from practice development unit members, leaders and university staff were written 12 months after successful accreditation, and the framework of their content analysed. Findings and discussion. Practice development was seen as a way for the clinical nurse specialists to realize their potential for improving patient care by transforming care practice in a collaborative, interprofessional and evolutionary manner. The practice development unit provided a means for these nurses to analyse their role and function within the Trust. Roberts’ identity development model for nursing serves as a useful theoretical underpinning for the reflections contained in this paper. Conclusions. These narratives provide another example of nurses making the effort to shape and contribute to patient care through organizational redesign. This group of nurses began to realize that the structure of the practice development unit process provided them with the means to analyse their role and function within the organization and, as they reflected on this structure, their behaviour began to change. Relevance to clinical practice. Evidence from these reflections supports the view that practice development unit participants have secured a positive and professional identity and are, therefore, better able to improve the patient experience