Volunteer contributions in the emergency department: A scoping review

The objective of this scoping review was to identify published and unpublished reports that described volunteer programs in the emergency department (ED) and determine how these programs impacted patient experiences or outcomes. Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were conducted and reference lists were hand-searched. A grey literature search was also conducted. Two reviewers independently screened titles and abstracts, reviewed full text articles, and extracted data. The search strategy yielded 4,589 potentially relevant citations; 87 reports were included in the review. Volunteer activities were categorized as non-clinical tasks (e.g., provision of meals/snacks, comfort items and mobility assistance), navigation, emotional support/communication, and administrative duties. 52 (59.8%) programs had general volunteers in the ED and 35 (40.2%) had volunteers targeting a specific patient population, including pediatrics, geriatrics, patients with mental health and addiction issues and other vulnerable populations. 18 (20.6%) programs included an evaluative component describing how ED volunteers affected patient experiences and outcomes. Patient satisfaction, follow-up and referral rates, ED hospital costs and length of stay, subsequent ED visits, medical complications, and malnutrition in the hospital were all reported to be positively affected by volunteers in the ED. These findings demonstrate the important role volunteers play in enhancing patient and caregiver experience in the ED. Future volunteer engagement programs should be formally described and evaluated to share their success and experience with others interested in implementing similar programs in the ED. Experience Framework This article is associated with the Infrastructure & Governance lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Application of the Ultra-Poverty Graduation Model in understanding community health volunteers’ preferences for socio-economic empowerment strategies to enhance retention: a qualitative study in Kilifi, Kenya

Background: A significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare cover- age, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area in Kenya. Methods: This study adopted an exploratory qualitative approach. Using a semi-structured questionnaire, we conducted 10 Focus Group Discussions with the CHVs and 10 Key Informant Interviews with County and Sub-county Ministry of Health and Ministry of Agriculture officials including multi-lateral stakeholders’ representatives from two sub-counties in the area. Data were audio-recorded and transcribed verbatim and transcripts analysed in NVivo. Researcher triangulation supported the first round of analysis. Findings were mapped and interpreted using a theory- driven analysis based on the six-step Ultra-Poverty Graduation Model. Results: We mapped the UPG Model’s six steps onto the results of our analyses as follows: (1) initial asset transfer of in-kind goods like poultry or livestock, mentioned by the CHVs as a necessary step; (2) weekly stipends with consump- tion support to stabilise consumption; (3) hands-on training on how to care for assets, start and run a business based on the assets transferred; (4) training on and facilitation for savings and financial support to build assets and instil financial discipline; (5) healthcare provision and access and finally (6) social integration. These strategies were pro- posed by the CHVs to enhance economic empowerment and aligned with the UPG Model. Conclusion: These results provide a user-defined approach to identify and assess strategic needs of and approaches to CHVs’ socio-economic empowerment using the UPG model. This model was useful in mapping the findings of our qualitative study and in enhancing our understanding on how these needs can be addressed in order to economically empower CHVs and enhance their retention in our setting

Prognostic Biomarkers for Acute Graft-versus-Host Disease Risk after Cyclophosphamide–Fludarabine Nonmyeloablative Allotransplantation

AbstractFive candidate plasma biomarkers (suppression of tumorogenesis 2 [ST2], regenerating islet-derived-3α [REG3α], elafin, tumor necrosis factor receptor 1 [TNFR1], and soluble IL-2 receptor-alpha [sIL2Rα]) were measured at specific time points after cyclophosphamide/fludarabine-based nonmyeloablative allotransplantation (NMAT) in patients who did or did not develop acute graft-versus-host disease (aGVHD). Plasma samples from 34 patients were analyzed at days +7, +14, +21, and +30. At a median follow-up of 358 days, 17 patients had experienced aGVHD with a median time to onset at day +36. Risk of aGVHD was associated with elevated plasma ST2 concentrations at day +7 (c-statistic = .72, P = .03), day +14 (c-statistic = .74, P = .02), and day +21 (c-statistic = .75, P = .02); elevated plasma REG3α concentrations at day +14 (c-statistic = .73, P = .03), day +21 (c-statistic = .76, P = .01), and day +30 (c-statistic = .73, P = .03); and elevated elafin at day +14 (c-statistic = .71, P = .04). Plasma concentrations of TNFR1 and sIL2Rα were not associated with aGVHD risk at any of the time points studied. This study identified ST2, REG3α, and elafin as prognostic biomarkers to evaluate risk of aGVHD after cyclophosphamide/fludarabine-based NMAT. These results need to be confirmed in an independent validation cohort

Adjusting bone mass for differences in projected bone area and other confounding variables: an allometric perspective.

The traditional method of assessing bone mineral density (BMD; given by bone mineral content [BMC] divided by projected bone area [Ap], BMD = BMC/Ap) has come under strong criticism by various authors. Their criticism being that the projected bone "area" (Ap) will systematically underestimate the skeletal bone "volume" of taller subjects. To reduce the confounding effects of bone size, an alternative ratio has been proposed called bone mineral apparent density [BMAD = BMC/(Ap)3/2]. However, bone size is not the only confounding variable associated with BMC. Others include age, sex, body size, and maturation. To assess the dimensional relationship between BMC and projected bone area, independent of other confounding variables, we proposed and fitted a proportional allometric model to the BMC data of the L2-L4 vertebrae from a previously published study. The projected bone area exponents were greater than unity for both boys (1.43) and girls (1.02), but only the boy's fitted exponent was not different from that predicted by geometric similarity (1.5). Based on these exponents, it is not clear whether bone mass acquisition increases in proportion to the projected bone area (Ap) or an estimate of projected bone volume (Ap)3/2. However, by adopting the proposed methods, the analysis will automatically adjust BMC for differences in projected bone size and other confounding variables for the particular population being studied. Hence, the necessity to speculate as to the theoretical value of the exponent of Ap, although interesting, becomes redundant

A working theology: an evaluation of the popular beliefs of Roman Catholic Filipino seafarers

The article explores in detail the popular theological beliefs of Roman Catholic Filipino seafarers. It argues that they organise their beliefs and practices to ensure they enjoy God‘s protection in their dangerous work place. The keeping of religious artefacts, the practice of rituals such as signing the sign of the cross before work shifts, visiting important churches before voyages and asking priests to say mass after accidents or tragic events are all explained as means by which to guarantee God’s protection. The question is then asked whether these beliefs and practices might be called a theology. It is argued that what makes them a theology is not any critical or evaluative reflective task but instead the capacity of the theologian describing the beliefs and practices as theology to convince others that the categories utilised can and should be called theology

‘Here today, gone tomorrow’: the risks and rewards of port chaplaincy

This paper documents the findings of an ESRC-funded project about religion in the context of the international global shipping industry, with particular focus on the work of port chaplains. We describe the physical, emotional, spiritual and financial risks involved in port chaplaincy work, and the way this form of religious employment is distinctly gendered. But the risks and challenges of port chaplaincy are considered alongside its intrinsic rewards and potential for professional fulfilment, most especially through the traffic of material goods and the sharing of hospitality that enable relationships between chaplains and seafarers. Our work contributes to the scholarly field of workplace chaplaincy by providing an empirical case study of port chaplains who typically operate as ‘lone workers’ as they minister to seafarers whose labours are so vital to the global economy. We consider the fact that lone workers can be vulnerable to exclusion from effective management practices which otherwise assume face-to-face interaction

Climate change mitigation beyond agriculture: A review of food system opportunities and implications

A large body of research has explored opportunities to mitigate climate change in agricultural systems; however, less research has explored opportunities across the food system. Here we expand the existing research with a review of potential mitigation opportunities across the entire food system, including in pre-production, production, processing, transport, consumption and loss and waste. We detail and synthesize recent research on the topic, and explore the applicability of different climate mitigation strategies in varying country contexts with different economic and agricultural systems. Further, we highlight some potential adaptation co-benefits of food system mitigation strategies and explore the potential implications of such strategies on food systems as a whole. We suggest that a food systems research approach is greatly needed to capture such potential synergies, and highlight key areas of additional research including a greater focus on low- and middle-income countries in particular. We conclude by discussing the policy and finance opportunities needed to advance mitigation strategies in food systems

Relying on the kindness of strangers: Welfare-providers to seafarers and the symbolic construction of community

Seafarers who call into ports usually hope for, or anticipate, a visit from people who provide them with welfare services—from SIM cards and mobile top-up vouchers to religious or nonreligious reading materials, and free transport to the nearest seafarers’ center or shopping mall. In seafarers’ centers, seafarers can normally use free internet facilities, enjoy drinks from the bar, avail themselves of remittance services, and if they wish, practice their faith in rooms/chapels dedicated to religious observance. While port chaplains are usually the people that seafarers associate with welfare services, port chaplains are not alone in providing these services—there are also paid staff and volunteers working in seafarers’ centers. This worldwide community of welfare providers displays the patina of a homogeneous bloc, sharing the same functions, activities, and end-goals in their everyday pursuits in ports and seafarers’ centers. However, this belies a more complex and sometimes fractured community of welfare providers in ports. While their services could be described with one coherent narrative of kindness to strangers, members of this community come from different backgrounds and are employed by different welfare organizations, and in the case of port chaplains, by different religious maritime charities with varying theologies. As a result of this, and the challenges to and changing contexts of maritime welfare services, in ports worldwide, this community is riven with contestation and everyday politics, which may be associated with a symbolically constructed community. This article expands on these issues. It is underpinned by research into welfare provision in two UK ports and in five other countries. It highlights narratives of unity and conflict, opening the doors to a community of people rarely noticed by social scientists