ISBAR+ a communication tool to advocate for patients

IntroductionRecognising the importance of social determinants of health is a key part of the curriculum for health practitioners. The ability to advocate on behalf of patients is a competency that demonstrates enacting this understanding in practice. Communication frameworks are used to structure difficult conversations in multiple settings, notably handover. There is no commonly accepted communication framework to structure a patient advocacy conversation.ApproachWe assembled a team with skills in patient advocacy, healthcare communication, community advocacy, education and business negotiation to identify the knowledge, skills and attitudes required and to develop a framework suitable for this purpose. We chose to adapt the ISBAR framework as an existing communication framework commonly used for handover.OutcomesISBAR+ is a framework that is based on a person-centred approach and ‘integrated negotiation’. ‘Intention and Inquiry’ involves a compassionate understanding of the patient’s position. ‘Situation’ is a succinct framing of the problem. ‘Background’ is the information required for the decision-maker to make a person-centred decision. The next step is ‘alignment’ of the priorities of the patient, practitioner and decision-maker. ‘Response’ is the proposed solution, and ‘+’ (‘plus’) is the actions taken for implementation.ConclusionsISBAR+ provides a framework for conversations advocating on behalf of patients that draws from the literature around advocacy inside and outside health. A communication framework allows the development and evaluation of interventions to teach and promote this critical function to promote person-centred care

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

Christianity and sustainable consumption : a social psychological investigation

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Christianity and Sustainable Consumption: A Social Psychological Investigation.

Evidence increasingly indicates that consumerism is deeply problematic. It exerts excessive pressure on the natural world, is characterised by social inequalities and injustices, and may even undermine the well-being of its participants. Shifts in consumption patterns are therefore required. Religious traditions may possess substantial, if unrealised, resources to counter the problems of consumerism. This thesis presents three studies which investigate the ways in which Christianity may or may not facilitate sustainable living (specifically, ecologically conscious, socially conscious and frugal consumer behaviours) on the part of its adherents. An initial discussion groups study framed the investigation of consumer behaviour within churchgoers’ discourses and narratives. Resources that might be brought to bear in fostering sustainable living were identified, such as environmental stewardship, justice for the marginalised, fulfilment through vocation and a relationship with God, as well as community support. Complex moral discussions about what addressing poverty and guarding against idolatry requires of Christians in terms of their consumption practices were also observed. In the second discussion groups study, Bible texts facilitated a more detailed examination of these latter themes. While addressing poverty and guarding against idolatry had implications for churchgoers’ consumption and earning choices, the Bible texts were understood primarily in an individualistic framework that does little to structurally address the ecological and social justice issues associated with consumerism. In the third study, a questionnaire survey of churchgoers and the general public which used value and discrepancy theories, the influence of Christianity on frugal and (especially) socially conscious consumer behaviours was found to be positive but small. In contrast, the religion variables related more strongly to values, and some relationships tentatively suggest a shift among churchgoers away from conservative values in the era of post-Christendom. Socially conscious consumer behaviour was found to be an expression of altruism that is compatible with rising consumption. In contrast, frugality is primarily about income constraints and low personal materialistic values, rather than about altruism. As such, frugality has not been widely adopted as a fully developed moral challenge to consumerism. Overall, the findings suggest that churches’ potential contributions to sustainable living remain largely unrealised. Collective efforts that integrate Christian values, narratives, symbols and practices in ways that counter the problems of consumerism and provide alternatives at the local level may provide a way forward. Research on Christian and other networks and communities which are already mobilised in this regard is therefore warranted, as is action research that would attempt to move other communities onto such a path

Consumerism as theodicy: Religious and secular meaning functions in modern society

On Monday 24 March 1851, a young girl named Annie, not yet ten years old, clings tearfully to her mother on a sofa in a house in Kent. For some months she has been suffering from stomach cramps, headaches, dizziness and difficulties in breathing. It is clear to her parents that her health is deteriorating. So on this day in late March, her father Charles prises Annie from her mother Emma’s reluctant farewell and together with her sister Henrietta and their nurse, Fanny, they set off for Dr James Gully’s famous water cure establishment in Malvern

Domestic and Family Violence: Responses and Approaches across the Australian Churches

Domestic and family violence (DFV) is a serious and widespread problem in Australia and across the world, including in faith communities. There are calls for research to assist churches to better recognize, respond to and prevent violence. This study draws on data from the 2016 Australian National Church Life Survey (n = 883 senior local church leaders, n = 1270 churchgoers) to provide the first Australia-wide cross-denominational statistics on Christian clergy responses to DFV. Two-thirds of leaders had previously dealt with DFV situations in their ministry, primarily responding to victims of abuse by referring them to specialist support services and by counselling them. The findings suggest a particular depth of experience with DFV situations and strength of awareness of the needs of victims for safety and specialist support among Salvationist leaders. While, overall, a substantial majority of churchgoers felt that they could approach their church for help if they were experiencing DFV, just half of Catholics felt that they could do so. Future research should explore responses to DFV in specific denominations and culturally and linguistic diverse contexts in more detail and seek to understand the practices used by the large minority of clergy who are dealing with perpetrators