Being perceived as a 'visitor' in the nursing staff's working arena--the involvement of relatives in daily caring activities in nursing homes in an urban community in Sweden

It is both complex and difficult for relatives when a loved one moves into a nursing home and many relatives are not prepared for the realities these new situations entail. Little attention has been paid to scrutinising the involvement of relatives in patient care, particularly in relation to the structures and routines of nursing homes or to the staff's reasoning concerning their involvement

Staff’s views on delivering patient-led therapy during inpatient stroke rehabilitation: a focus group study with lessons for trial fidelity

Background; Fidelity to the treatment protocol is key to successful trials but often problematic. This article reports the staff’s views on delivering a complex rehabilitation intervention: patient-led therapy during inpatient stroke care. Methods; An exploratory qualitative study using focus groups with staff involved in a multicenter (n = 12) feasibility trial of patient-led therapy (the MAESTRO trial) was undertaken as part of the evaluation process. Purposive sampling ensured that participants represented all recruiting sites, relevant professions and levels of seniority. Data analysis used a Framework Approach. Results; Five focus groups were held involving 30 participants. Five main themes emerged: the effect of the interventions, practical problems, patient-related factors, professional dilemmas, and skills. Staff felt the main effect of the therapies was on patients’ autonomy and occupation; the main practical problems were the patients’ difficulties in achieving the correct position and a lack of space. Staff clearly identified characteristics that made patient-led therapy unsuitable for some patients. Most staff experienced dilemmas over how to prioritize the trial interventions compared to their usual therapy and other clinical demands. Staff also lacked confidence about how to deliver the interventions, particularly when adapting the interventions to individual needs. For each barrier to implementation, possible solutions were identified. Of these, involving other people and establishing a routine were the most common. Conclusions; Delivering rehabilitation interventions within a trial is complex. Staff require time and support to develop the skills, strategies and confidence to identify suitable patients, deliver new treatments, adapt the new treatments to individuals’ needs and balance the demands of delivering the trial intervention according to the treatment protocol with other clinical and professional priorities

Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care

<p>Abstract</p> <p>Background</p> <p>Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people.</p> <p>Methods</p> <p>The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity.</p> <p>Results</p> <p>A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity.</p> <p>Discussion</p> <p>The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time.</p> <p>Trial registration</p> <p>ClinicalTrials.gov, <a href="http://www.clinicaltrials.gov/ct2/show/NCT01260493">NCT01260493</a>.</p

On The Shore Dimly Seen: Review

A new wave of understanding and agreement with all sorts of secret service methods which pretend to protect us against terrorism makes Whitehead’s radio performance, On The Shore Dimly Seen, even more precious and important than at the time of its production. Because it is the voice of a radical believer in democracy and human rights: today a lonely voice in the chorus of fear. We hear Gregory Whitehead’s voice chanting the interrogation log of Guantanamo Bay detainee 063 (prisoners in Guantanamo do not have names, they are only numbers), interwoven with the voices of vocalist Gelsey Bell and actress Anne Undeland. Often interweaving documentary and fictive materials into playfully unresolved narratives, Whitehead’s aesthetic is distinguished by a deep philosophical commitment to radio as a medium for poetic navigation and free association. In his voice and text-sound works, he explores the tension between a continuous pulse and the eruption of sudden discontinuities, as well as linguistic entropy and decay. We smell the fear. Whitehead forces us to be ‘there’ as a listener, feeling more and more uncomfortable – he won\u27t let us escape as distant and objective spectators. Unwillingly we become witnesses, become ‘guilty’. ‘Non-touch-torture’, ‘enhanced investigation\u27 - doesn’t that sound human, legal and progressive? Those who use euphemisms have something to hide or to cover. In Whitehead’s work we are confronted with the fact that the government of the proudest democracy of the world hides its actions behind such cynical euphemisms. ‘On the shore dimly seen’ is the first line of the second verse of the US-American national anthem; I interpret the use of this line as title of the Radio Performance as the J’accuse of a brave and upright American artist, who feels shame and anger when the symbol of freedom and democracy is misused against human rights. On The Shore Dimly Seen, a ‘boneyard cantata’ enquiry into no-touch torture, was short-listed for a Prix Italia

Spectroscopic analyzes of human whole blood to analyze the influence of temperature on age-correlating features

Nach derzeitigem Wissensstand existiert in der Forensik aktuell keine einheitlich verwendete Methodik eine in der Vergangenheit liegende Tatzeit zurück rechnen zu können. Einzelne zum Einsatz kommende Verfahren sind sehr kosten- oder zeitaufwendig und darüber hinaus zum Teil sehr unzuverlässig bzw. ungenau. Als Alternative zu diesen Verfahren existiert die Idee den Tatzeitpunkt anhand der Alterung vom am Tatort sichergestellten Blutspuren zu bestimmen. Die Herausforderung hierbei ist allerdings, dass noch nicht ausreichend erforscht wurde, inwiefern die Blutalterung durch Umwelteinflüsse, wie Luftfeuchtigkeit oder Raumtemperatur, beeinflusst wird. Um einen Beitrag zu dieser Fragestellung zu leisten, wird im Rahmen dieser Arbeit die Alterung von Blut in einem Zeitraum von drei Wochen und unter konstanten Umweltbedingungen spektroskopisch untersucht und verglichen. Dabei wird sich verstärkt auf die Umsetzung von Oxyhämoglobin zu Methämoglobin, sowie auf die Verschiebung der Soret-Bande als alterskorrelierende Feature konzentriert. Nach Auswertung der vorliegenden Datensätze kann gezeigt werden, dass beide Features signifikant durch die Temperatur beeinflusst werden. Aufbauend auf diese Ergebnisse kann in Zukunft weiter an der Untersuchung unterschiedlicher Wetterverhältnisse- und Kombinationen in Bezug auf die Blutalterung gearbeitet werden. Auch der Einfluss von Blutverdünnern und ähnlichen Substanzen sollte bei zukünftigen Versuchen nicht vernachlässigt werden.At the present state of knowledge, there is no uniformly used forensic methodology to calculate a time of crime in the past. Oft he few known processes, most are very expensive or time-consuming and, in addition, in some cases also very unreliable or inaccurate. As an alternative to these methods, the ideato determine the time of the crime based on the aging of blood traces at the crime scene exists. The challenge here is that there has not yet been sufficient research into how aging is influenced by environmental influences, such as humidity or room temperature. In order to contribute to this question, this work examines and compares the aging of blood under constant environmental conditions over a period of three weeks. The focus lies on the conversion from oxyhaemoglobin to methaemoglobin, as well as on the the soret band shifting as age-correlated features. After evaluating the existing data sets, it can be shown that both features are significantly influenced by the used temperatures. Based on these results, further work can be carried out to investigate different weather conditions and combinations in relation to the blood aging process. Also, the influence of blood thinners and similar substances should not be neglected in future experiment