'Moving on and feeling good' : a feasibility study to explore the lifestyle behaviours of young adults with intellectual disabilities as they transition from school to adulthood—a study protocol

Background: The transition from adolescence to adulthood is a ‘high-risk’ period for weight gain in the general population. There is speculation that this may also be a risk period for adults with intellectual disabilities; however, there has been no research which has monitored change in health indicators. Since adults with intellectual disabilities have higher rates of obesity and engage in more sedentary behaviour and less physical activity than the general population, there is a need to understand more about the lifestyle behaviours of this population during the transition to adulthood. This protocol paper will provide details of the moving on and feeling good feasibility study, designed for young people with intellectual disabilities. Methods/design: A multi-point recruitment strategy will be used to recruit 30 participants with a mild-moderate level of intellectual disability. The aim of the feasibility study is to examine the feasibility of recruitment, participant retention and the measurement of relevant health behaviour outcomes. The study will assess the feasibility of monitoring weight, diet and physical activity levels in adolescents over a 12-month transitional period from school to adult life. This mixed method study will provide insight into the lives of young people with intellectual disabilities and will examine the use of Walker et al.’s social-ecological approach to promote self-determination specific to lifestyle behaviours, during this transition period. Baseline data will be collected during the final year of school, with follow-up data collection at 6 and 12 months. Anthropometric (weight, height, waist and hip circumference), objective physical activity measures (7-day accelerometer wear) and dietary and choice measures will be collected at each time point to assess the feasibility of measuring diet patterns, food frequency, physical activity and BMI. Furthermore, ten participants will be selected for short semi-structured scoping interviews at baseline and 12-month follow-up, to gain information on psychological, social and environmental factors which might affect behaviour change. Discussion: The outcomes from the feasibility study will aid the development and piloting of a sufficiently powered randomised controlled trial. This would allow us to evaluate the effectiveness and sustainability of a lifestyle behaviour intervention, over a 5-year transition period

The Role of the Solicitor in the Children's Hearings System : A Study Commissioned by the Scottish Legal Aid Board

In 2015, the Scottish Legal Aid Board (SLAB) commissioned the Centre for Excellence for Looked After Children in Scotland (CELCIS) to carry out a piece of research looking at the role of solicitors in the children’s hearings system. This research took place between July and December 2015, and was designed to address the following five topics: • Defining the ethos of the children’s hearings system and applying this to solicitors • The role and impact of solicitors in the modernised children’s hearings system • How to achieve a fair and consistent approach to monitoring compliance • How best to get feedback from professional and non-professional stakeholders • Training of solicitors on children’s hearings The role of solicitors in the children’s hearings system has taken on greater importance over the last five years, as the number of solicitors attending hearings proceedings is perceived to have increased since Part 19 of the Children’s Hearings (Scotland) Act 2011 (The Scottish Executive, 2011) enabled the provision of legal aid to both children and relevant others. In order to gather information, the study included nationwide surveys with solicitors, social workers, reporters, and panel members, followed by focus groups with these same groups. In addition, the study included key informant interviews with various professional stakeholders and interviews with three young people with experience of solicitors in the children’s hearing system

TIPCU Engagement Program in Rural Hospitals and Non-Acute Settings

Introduction: In 2012 the Tasmanian Infection Prevention and Control Unit (TIPCU) implemented an Infection Control Assessment (ICA) program in rural hospitals and non-acute settings (RHANAS). The three main aims of the ICA program are: Build clinician capacity in RHANAS Have the ability to assess and manage infection control risks Foster local ownership of infection prevention and control by individual service providers and clinicians. The project implementation and evaluation is ongoing. Methods: The ICA consists of a range of location and process specific audits, designed specifically for RHANS. Each rural hospital in Tasmania participated in the ICA program during 2012. The program was undertaken collaboratively by a TIPCU CNC, regional infection prevention and control clinical nurse educator and either the DON of the hospital or a designated representative. The majority of the assessments were done on site at each rural hospital in conjunction with a short education program which was tailored on requests from each facility. Results: Consistent themes emerged from the results of each rural hospital ICA. These included the following set of challenges relating to infection prevention and control: No management plan including no regular or structured auditing program No consistent orientation messages Limited direction for site portfolio holders Limited or no healthcare associated infection surveillance programs No ongoing education for staff Outdated policies and procedures Conclusion: The TIPCU in conjunction with the regional Tasmanian Health Organisations (THO) are working collaboratively to address the challenges identified by the ICA program. The TIPCU have produced a template for an infection prevention and control management plan, a portfolio position description and tools for undertaking surveillance in RHANS. The additional challenges identified by the ICA are being addressed at the local THO level

Development and Trial of An Environmental Cleaning Assessment Program

Background: The Tasmanian Infection Prevention and Control Unit (TIPCU) reviewed methods of evaluating environmental cleanliness in healthcare in July 2012. At a subsequent State wide multidisciplinary forum, there was consensus for the TIPCU to develop a standardised method of assessing environmental cleanliness within Tasmanian healthcare using a combination of both visual and ultraviolet (UV) gel applicator assessments. Methods: The TIPCU developed a protocol outlining methodology for performing both visual and UV gel cleanliness assessments. An on-line tool was used to develop secure web based data collection and reporting. We developed a training program which could be used for face to face or web based education and provided training of key personnel across the Tasmanian Health Organisations (THOs) in the use of the environmental cleaning assessment tools and accompanying data collection and reporting tools. The sites were provided with IPads for data entry, UV sensitive gel and UV lights for a 6 week trial and consultation period. We sought feedback from participants via an on-line survey. Results: A trial period to test the programs functionality was held in the four Tasmanian larger acute public hospitals during April and May 2013. Over 80% of respondents were positive about the protocol, on-line tools and training. On qualitative feedback, the major themes that emerged were around the number of UV gel sites and the limitations in using the UV gel in some specialist areas. We have addressed each of these in the revised protocol. Conclusion: The consultation phase of this project highlighted a number of modifications that were required in the protocol and on-line tools and was an important phase that allowed us to evaluate aspects of the program prior to finalisation of the protocol and tools

Evaluating Environment Cleanliness Using Two Approaches: A Multi-centred Australian Study

Introduction: A standardised approach to evaluating environmental cleanliness is important to ensure consistency of assessor training, allow benchmarking of results between facilities, ensure consistency of the assessment of the environment and assist in meeting national accreditation standards. This paper describes the development process and the findings of the first 12 months of data following the introduction of a standardised program for evaluating environmental cleanliness within Tasmanian healthcare facilities using two different evaluation methods. Methods: Evaluation of environmental cleanliness was undertaken as part of a structured program and involved the use of an ultraviolet solution and fluorescent light in addition to a visual assessment. Twelve Tasmanian hospitals participated in this study. Results: A total of 290 fluorescent light assessments and 232 visual inspections were conducted. Using the fluorescent light assessment, the percentage of correctly cleaned items increased from a baseline of 82.3% to 85.4% over the 12-month study period. Using the visual assessment, 92.5% of items were deemed acceptable during the study period. Conclusions: Our multi-centred study identified a high baseline level of cleanliness using a fluorescent light. We identified that objects were frequently deemed to be visually acceptable, yet may not have been cleaned. The project was supported by a range of online tools for data submission, training tools and a formal assessment of auditors

Evaluating Environmental Cleanliness Using Two Approaches: A Multi-Centred Australian Study

A standardised approach to evaluating environmental cleanliness is important to ensure consistency of assessor training, allow benchmarking of results between facilities, ensure consistency of the assessment of the environment and assist in meeting national accreditation standards

Changes in experiences and engagement of adolescent girls in Physical Education classes, during a school-based physical activity programme : a qualitative longitudinal study.

There is a growing body of literature investigating age-related declines in physical activity (PA) participation among young people and especially girls, who have lower rates of PA than boys throughout the teenage years. Low PA is particularly apparent within the context of the school physical education classes – termed here as the Physical Education (PE) environment. My PhD thesis aims to explore the reasons for some girls disengagement in PE classes. Using a longitudinal qualitative approach the study tracks the experiences of a sample of ‘disengaged girls’ from four case study schools in Scotland taking part in a school-based physical activity programme, Fit for Girls (FfG). My research investigates the impact of the programme on their engagement through recording and analysis of the changes that take place in their attitudes and behaviour over the course of two years. The study involved the design of a questionnaire to identify a cohort of disengaged girls for baseline focus groups. Twelve focus groups (n=41 girls) were carried out during 2008/09 (three in each case study school) to capture girls’ opinions, perceptions and experiences of PE classes. Twenty disengaged girls were then selected across the four schools, based on their willingness to participate and self-disclose PE experiences. The girls were recruited for three phases of longitudinal in-depth interviews, over a one year period. The aim of these was to track changes in girls’ engagement and experiences in the PE environment. My theoretical framework is based on Welks (1999) Youth Physical Activity Promotion model (YPAP), a socioecological approach which divides the influential correlates of physical activity into 1) individual-level predisposing factors, 2) enabling factors, including personal attributes and environmental variables and 3) reinforcing (social) factors. The results indicate that individual predisposing factors, such as perceptions of competence and identity in the PE class along with the social context (peers and teachers) contribute to girls’ disengagement in PE. This suggests that aspects of the wider psychosocial environment in which PE takes place may be more important than the physical activity itself, impacting on levels of participation and enjoyment. There were subtle, as well as clear changes in engagement among many of the girls. However, for others no change was evident. Individual girls’ experiences across time or ‘journeys’ illustrate the importance of the relationships between the individual, social and PE environment in facilitating and sustaining positive change

Understanding students’ experiences in a PE, health and well-being context:a self-determination theory perspective

Framed by Self-Determination Theory, this investigation explored student experience as they engaged in their physical education (PE), health and well-being (HWB) curriculum in Scotland for the first time. We aimed to uncover the features of various learning environments that appeared to impact upon student motivation in PE over the period one academic year. We carried out focus group interviews with students from one state secondary school (secondary 1 and 2; ages 12–14) and its feeder primary schools (primary 7; age 11 years) immediately after a selection of PE lessons throughout the year. Furthermore, to provide some additional context for our analysis, the students in each year completed a questionnaire (pre–post) to identify and understand their motivation for PE over time. The results from the interviews indicated that students had a number of positive and negative PE experiences. However, the results from the questionnaire demonstrate that the students’ experiences during the first year of this ‘new’ curriculum had little impact on their motivation for PE. The findings highlight the importance of mixed methods research to provide context-specific account of student experience. This detail may be critical for the development of informed and effective pedagogy that supports student learning, health and well-being

Debridement for surgical wounds

Background: Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue will expedite wound healing. There are numerous methods available but no consensus on which one is most effective for surgical wounds. Objectives: To determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds. Search methods: In March 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. Selection criteria: We included randomised controlled trials (RCTs) with outcomes including at least one of the following: time to complete debridement or time to complete healing. Data collection and analysis: Two review authors independently reviewed the abstracts and titles obtained from the search, extracted data independently using a standardised extraction sheet and independently assessed methodological quality. One review author was involved in all stages of the data collection and extraction process, thus ensuring continuity. Main results: Five RCTs (159 participants) were eligible for inclusion; all compared treatments for infected surgical wounds and reported time required to achieve a clean wound bed (complete debridement). One trial compared an enzymatic agent (streptokinase/streptodornase) with saline-soaked dressings. Four trials compared the effectiveness of dextranomer beads or paste with other products (different comparator in each trial) to achieve complete debridement. Meta-analysis was not possible due to the unique comparisons within each trial. One trial reported that dextranomer achieved a clean wound bed significantly more quickly than Eusol, and one trial comparing enzymatic debridement with saline-soaked dressings reported that the enzyme-treated wounds were cleaned more quickly. However, methodological quality was poor in these two trials. Authors' conclusions: There is a lack of large, high-quality published RCTs evaluating debridement per se, or comparing different methods of debridement for surgical wounds, to guide clinical decision-making