Investigating staff knowledge of safeguarding and pressure ulcers in care homes

Objective: To investigate whether nursing/care home staff regard pressure ulceration as a safeguarding issue; and to explore reporting mechanisms for pressure ulcers in nursing/care homes. Methods: Sixty five staff members from 50 homes within one clinical commissioning group completed a questionnaire assessing their experiences of avoidable and unavoidable pressure ulcers, grading systems, and systems in place for referral to safeguarding teams. Understanding of safeguarding was assessed in depth by interviews with 11 staff members. Results: Staff observed an average of 2.72 pressure ulcers in their workplaces over the last 12 months; judging 45.6% to be avoidable. Only a minority of respondents reported knowledge of a grading system (mostly the EPUAP/NPUAP system). Most respondents would refer pressure ulcers to the safeguarding team: the existence of a grading system, or guidance, appeared to increase that likelihood. Safeguarding was considered a priority in most homes; interviewees were familiar with the term safeguarding, but some confusion over its meaning was apparent. Quality of written documentation and verbal communication received prior to residents returning from hospital was highlighted. However, respondents expressed concern over lack of information regarding skin integrity. Most staff had received education regarding ulcer prevention or wound management during training, but none reported post-registration training or formal education programmes; with reliance placed on advice of district nurses or tissue viability specialists. Conclusion: Staff within nursing/care homes understand the fundamentals of managing skin integrity and the importance of reporting skin damage; however, national education programmes are needed to develop knowledge and skills to promote patient health-related quality of life, and to reduce the healthcare costs of pressure damage. Further research to investigate understanding, knowledge and skills of nursing/care home staff concerning pressure ulcer development and safeguarding will become increasingly necessary, as levels of the older population who may require assisted living continue to rise

Pressure ulcers: are they are a safeguarding issue in care and nursing homes?

The impact of the Care Act (Department of Health [DH], 2014) and adult legislation such as the Mental Capacity Act (Deprivation of Liberty Safeguards, 2009) has resulted in closer scrutiny of care provision and outcomes for those living in residential and nursing homes

Exploring the value of reading lists to academic communities: an analysis of potential and perceived value to partners in reading list provision

This research investigated the evolving value of recommended reading lists to academic libraries and the communities that they serve. It examined the possibility of extending Library use of reading lists through new information extracted from associating online reading list data with Library circulation data in a Reading List Collection Use database. Potential information that can be generated on the utility of Library provision for targeted sectors of the Library’s taught-course market was identified. Possible collection management and academic support uses were suggested for such information generated from data already held on university computer systems. Factors that influence the use of materials on reading lists were further explored. Recognising that availability of recommended reading system data is wholly dependent on lecturer participation in online reading list provision, research was conducted on the perceived value of the Library/lecturer partnership for this purpose. Focus groups were conducted exploring the use and barriers to use of reading lists in the community. Analysis of focus group data indicated some lecturer perception that the Library/lecturer partnership for online reading list provision was imbalanced to favour Library objectives at lecturer expense. Problems of information and communication shortfalls were identified, and suggestions made for possible Library approaches in overcoming barriers to cooperative reading list provision and use

Engaging the disengaged indefinitely, and with no budget: creating a sustainable model for student library ambassadors

University Libraries offer a wide range of services and facilities to help enhance the student learning experience and to aid the transition into learning at University. Often, too few Science and Engineering students fully engage with the services and facilities on offer and therefore do not benefit from the opportunities available to them. Drawing on research highlighting the value of peer support, and the fact that students are far more likely to use their peers as an information source than ‘experts’, Loughborough University Library obtained small project funding in 2010 to employ four Student Ambassadors in a pilot project to improve student engagement with the Library. The successful project demonstrated the potency of the idea in engaging with students, particularly non-users, a large proportion of which are based in the Science and Engineering Faculties. In the absence of continued funding, the challenge, addressed here, is how to make such posts sustainable. Past experience at both Nottingham and Loughborough Universities has proven how difficult it is to recruit students on a voluntary basis to engage with University Libraries. In this paper, an innovative and creative method of recruiting and supporting “Learning Resource Leaders” (LRLs) at Nottingham and Loughborough Universities is discussed. The strategies employed have resulted in the recruitment of four LRLs – two at each institution – supported by an industrial sponsor who provides a package of non-monetary incentives. The paper also describes the techniques used by the LRLs to disseminate information about the resources offered by the University Libraries and to engage with the student cohort

“Just challenge those high-ability learners and they’ll be all right!” The impact of social context and challenging instruction on the affective development of high-ability students

This study provided a voice to gifted elementary children attending three very different schools that endeavoured to meet their atypical academic needs. While educators have theorised that special programs for gifted students benefit gifted children academically and contribute positively to their social and emotional development, there is limited research to support this belief. The phenomenological framework used in this study allowed 27 gifted elementary students to present their perceptions of the advantages and disadvantages of extension class environments. The results demonstrate that while challenging instruction was clearly important for the emotional wellbeing of the advanced learners, it went hand in hand with the schools’ ethoi in relation to the social and emotional development of their student populations. The schools’ objectives clearly influenced students’ perceptions of emotional safety, acceptance of diversity, and teacher-student and peer relations in the schools. This finding differs to previous research results, which suggest that if a gifted child’s cognitive abilities are catered for, her or his social and emotional needs will automatically be met. While this study found that the social context of the school played an important role in the talent process, a strong relationship was also found between program type and sociaffective outcomes

Expression of Escherichia coli F-18 Type 1 Fimbriae in the Streptomycin-Treated Mouse Large Intestine

Escherichia coli F-18, isolated from the feces of a healthy human, makes type 1 fimbriae and is an excellent colonizer of the streptomycin-treated mouse large intestine. Recently, it was shown that the inability to produce type 1 fimbriae had no effect on the ability of E. coli F-18 to colonize the streptomycin-treated mouse large intestine, suggesting the possibility that E. coli F-18 does not express type 1 fimbriae in vivo. However, we show here that E. coli F-18 does express type 1 fimbriae in mouse cecal mucus in vivo and, in fact, appears to express substantially more type 1 fimbriae in cecal mucus in vivo than in L broth in vitro

The effect of Massachusetts health reform on 30 day hospital readmissions: retrospective analysis of hospital episode statistics

Objectives: To analyse changes in overall readmission rates and disparities in such rates, among patients aged 18-64 (those most likely to have been affected by reform), using all payer inpatient discharge databases (hospital episode statistics) from Massachusetts and two control states (New York and New Jersey). Design: Difference in differences analysis to identify the post-reform change, adjusted for secular changes unrelated to reform. Setting: US hospitals in Massachusetts, New York, and New Jersey. Participants: Adults aged 18-64 admitted for any cause, excluding obstetrical. Main outcome measure Readmissions at 30 days after an index admission. Results: After adjustment for known confounders, including age, sex, comorbidity, hospital ownership, teaching hospital status, and nurse to census ratio, the odds of all cause readmission in Massachusetts was slightly increased compared with control states post-reform (odds ratio 1.02, 95% confidence interval 1.01 to 1.04, P<0.05). Racial and ethnic disparities in all cause readmission rates did not change in Massachusetts compared with control states. In analyses limited to Massachusetts only, there were minimal overall differences in changes in readmission rates between counties with differing baseline uninsurance rates, but black people in counties with the highest uninsurance rates had decreased odds of readmission (0.91, 0.84 to 1.00) compared with black people in counties with lower uninsurance rates. Similarly, white people in counties with the highest uninsurance rates had decreased odds of readmission (0.96, 0.94 to 0.99) compared with white people in counties with lower uninsurance rates. Conclusions: In the United States, and in Massachusetts in particular, extending health insurance coverage alone seems insufficient to improve readmission rates. Additional efforts are needed to reduce hospital readmissions and disparities in this outcome

The 5-Phosphatase SHIP2 Promotes Neutrophil Chemotaxis and Recruitment

Neutrophils, the most abundant circulating leukocytes in humans have key roles in host defense and in the inflammatory response. Agonist-activated phosphoinositide 3-kinases (PI3Ks) are important regulators of many facets of neutrophil biology. PIP3 is subject to dephosphorylation by several 5' phosphatases, including SHIP family phosphatases, which convert the PI3K product and lipid second messenger phosphatidylinositol 3,4,5-trisphosphate (PIP3) into PI(3,4)P2, a lipid second messenger in its own right. In addition to the leukocyte restricted SHIP1, neutrophils express the ubiquitous SHIP2. This study analyzed mice and isolated neutrophils carrying a catalytically inactive SHIP2, identifying an important regulatory function in neutrophil chemotaxis and directionality in vitro and in neutrophil recruitment to sites of sterile inflammation in vivo, in the absence of major defects of any other neutrophil functions analyzed, including, phagocytosis and the formation of reactive oxygen species. Mechanistically, this is explained by a subtle effect on global 3-phosphorylated phosphoinositide species. This work identifies a non-redundant role for the hitherto overlooked SHIP2 in the regulation of neutrophils, and specifically, neutrophil chemotaxis/trafficking. It completes an emerging wider understanding of the complexity of PI3K signaling in the neutrophil, and the roles played by individual kinases and phosphatases within