Health-related quality of life in a PD-First programme in South Africa

Groote Schuur Hospital in Cape Town, South Africa, offers a PD-First policy as a result of haemodialysis (HD) restrictions and resource limitations. This study aimed to compare health-related quality of life (HRQOL) between HD and peritoneal dialysis (PD) patients, given the lack of autonomy in modality choice and the socio-economic challenges. This single-centre, cross-sectional study was performed between July 2015 and December 2016. Demographic, socio-economic variables and perceptions of safety were collected. HRQOL was assessed using the Kidney Disease Quality of Life-Short Form (KDQOL-SFTM) version 1.3. All data were compared between the two dialysis modalities; 77 HD and 33 PD patients were included in the study and there were no significant differences in demographics. Median age was 42.5 years (IQR: 32.4–48.6) and 57.3% were female. HD patients had less pain (P = 0.036), better emotional well-being (P = 0.020) and a better energy/fatigue score (P = 0.015). Both cohorts experienced role-limitations due to physical health with PD being more affected overall (P = 0.05). The only significant symptom in the kidney domain was that PD patients experienced more shortness of breath (P < 0.001). Patients in both groups had very poor socio-economic circumstances, and safety within their communities was a major concern. The patients in our dialysis service have very challenging social circumstances. Those on PD scored worse in four HRQOL domains, possibly due to a lack of autonomy in dialysis modality choice and less frequent contact with dialysis staff. Additional psychological and social support needs to be instituted to help improve our patients’ well-being on PD

Low-dose intensive insulin therapy in patients with acute coronary syndrome accompanied by left ventricular failure: Audit of two UK hospitals

Aims & Objectives: To determine whether a low-dose intravenous insulin regimen reduces blood glucose levels at a timely rate and associated side effects among patients with Acute Coronary Syndrome and Left Ventricular Failure. Background: Induced hypoglycaemia and the associated risks have questioned the benefits of intensive insulin therapy in patients presenting with raised blood glucose levels and Acute Coronary Syndromes. Local audit data identified that patients with Acute Coronary Syndrome and Left Ventricular Failure experienced more hypoglycaemic episodes than those with Acute Coronary Syndrome alone. Consequently, a new regimen of low-dose insulin for this group was implemented and audited over 12 months.Design: AuditMethods: 36 consecutive patient notes with a diagnosis of Acute Coronary Syndrome and blood glucose of ≥10 mmol/L treated with a new insulin therapy regimen were analysed. Data were extracted using a standardised form and entered into Excel spreadsheet for analysis.Results: The mean age of the sample was 70 years with 66% of subjects being men and 50% presenting with Acute Coronary Syndrome and Left Ventricular Failure. The low dose regimen was effective in achieving normoglycaemia, (range 4-8mmol/L) for a consecutive six hour period. This was achieved in 72% of patients and within a median time of 13 hours. Conclusion: The audit suggests that a low-dose insulin regimen can effectively stabilise blood glucose in patients presenting with both Acute Coronary Syndrome and Left Ventricular Failure. The importance of regularly monitoring blood sugar levels is vital and highlights the role of nurses in minimising patient risk and promoting safety.Relevance to practice: Nurses are instrumental in the safe implementation of intensive insulin guidelines. Close monitoring of patients is essential, enabling timely adjustments to treatments and ensuring patient safety. Regular audits allow nurses to evaluate care provision and continue to drive practice forward

Testbeam studies of pre-prototype silicon strip sensors for the LHCb UT upgrade project

The LHCb experiment is preparing for a major upgrade in 2018-2019. One of the key components in the upgrade is a new silicon tracker situated upstream of the analysis magnet of the experiment. The Upstream Tracker (UT) will consist of four planes of silicon strip detectors, with each plane covering an area of about 2 m$^2$. An important consideration of these detectors is their performance after they have been exposed to a large radiation dose. In this article we present test beam results of pre-prototype n-in-p and p-in-n sensors that have been irradiated with fluences up to $4.0\times10^{14}$ $n_{\rm eq}$ cm$^{-2}$.Comment: 25 pages, 20 figure

Effects of digging by a native and introduced ecosystem engineer on soil physical and chemical properties in temperate grassy woodland

Temperate grasslands and woodlands are the focus of extensive restoration efforts worldwide. Reintroduction of locally extinct soil-foraging and burrowing animals has been suggested as a means to restore soil function in these ecosystems. Yet little is known about the physical and chemical effects of digging on soil over time and how these effects differ between species of digging animal, vegetation types or ecosystems. We compared foraging pits of a native reintroduced marsupial, the eastern bettong (Bettongia gaimardi) and that of the exotic European rabbit (Oryctolagus cuniculus). We simulated pits of these animals and measured pit dimensions and soil chemical properties over a period of 2 years. We showed that bettong and rabbit pits differed in their morphology and longevity, and that pits had a strong moderating effect on soil surface temperatures. Over 75% of the simulated pits were still visible after 2 years, and bettong pits infilled faster than rabbit pits. Bettong pits reduced diurnal temperature range by up to 25 C compared to the soil surface. We did not find any effects of digging on soil chemistry that were consistent across vegetation types, between bettong and rabbit pits, and with time since digging, which is contrary to studies conducted in arid biomes. Our findings show that animal foraging pits in temperate ecosystems cause physical alteration of the soil surface and microclimatic conditions rather than nutrient changes often observed in arid areas.This work was supported by an Australian Research Council Linkage Grant (LP0561817, LP110100126, LP140100209). Catherine Ross was supported by an Australian Government Research Training Program (RTP) Scholarship, and an additional scholarship top-up from the ARC (LP140100209)

Reducing failure to rescue rates in a paediatric in‐patient setting: A 9‐year quality improvement study

Aim: To identify and quantify Failure to Rescue (FtR) episodes from emergency events at a large children’s hospital and understand the impact of targeted interventions on reducing FtR. Methods: A quality improvement approach was adopted. From 2011 – 2019 all emergency event calls were systematically reviewed prospectively to identify FtR episodes. Root-cause analysis was performed to identify practice deficiencies. The Plan-Do-Study-Act fundamentals were used. Results: A total of 520 (100%) emergency events were reviewed, with yearly mean of 58 events (SD 13, range 41- 81). Cardiac arrest events were the most common 132 (25.8%). Out of the total 132 (100%) cardiac arrest events, 116 (88%) occurred in paediatric critical care unit and only 16 (12%) occurred in general paediatric wards. Three hundred and twelve (60%) of the events were observed in children who had been inpatient for > 48 hours. Observed FtR figures over the nine years was characterised by high rate of 23.6% in 2011 when the project commenced followed subsequently by a sharp decrease after interventions and remained at 2.5% or below for the last six years.Conclusion: Identifying rates of FtR events from routinely collected emergency events data can be used as a patient safety measure to identify emergency concerns. This enables progressive dynamic problem solving through delivery of strategic targeted interventions. The proposed interventions outlined in this quality improvement study have application to critical care nursing as mechanisms for reducing in-hospital unplanned admissions to paediatric critical care

Systematic mapping of food safety outbreaks in the hospitality sector in the Dominican Republic

Purpose: The hospitality sector underpins the Dominican Republic’s (DR) economy but may be a setting where foodborne disease outbreaks (FBDOs) can occur. The purpose of this research is to conduct a systematic mapping exercise on the available scientific literature related to FBDOs in hospitality in the DR and their link to reported food safety and hygienic practices. Design/methodology/approach: A predefined search protocol applied the principles of PRISMA guidance. Publications (n= 2,793) from databases (e.g. Web of Science, PubMed) were identified, and systematically selected for relevance. A full-text assessment based on the inclusion criteria led to the identification of a refined list of studies and academic publications (n=22) included in this review. The descriptive analysis of the collated data is then presented graphically. Findings: A low rate of reporting highlights a knowledge gap on FBDOs, the related food safety hazards and how they are mitigated by stakeholders and local health authorities in the DR. Improving government and other stakeholder capacity to report, investigate and understand FBDOs and the practices involved is essential. Research limitations/implications: The research has implications for Government, businesses and public health officials and managers in the hospitality sector in the DR. A potential research limitation is that the search strategies could miss some relevant articles. Originality/value: To the best of our knowledge this is the first systematic mapping research assessing evidence of FBDOs affecting hospitality in the DR. Practical implications: The findings provide a framing for improved risk analysis in implementing food safety management strategies for FBDOs

Understanding the co-construction of safety in the paediatric intensive care unit: a meta- ethnography of parents' experiences

BackgroundChildren experiencing critical illness or injury may require admission to a paediatric intensive care unit (PICU) to receive life-sustaining or life-saving treatment. Studies have explored the experience of parents with a child in PICU but tend to focus on subgroups of children or specific healthcare systems. Therefore, we aimed to undertake a meta-ethnography to draw together the published research.MethodsA systematic search strategy was developed to identify qualitative studies, which had explored the experiences of parents with a critically ill child treated in a PICU. A meta-ethnography was undertaken following the structured steps of identifying the topic; undertaking a systematic search; reading the research; determining how the studies relate and translate into each other; and synthesising and expressing the results.ResultsWe identified 2989 articles from our search and after a systematic series of exclusions, 15 papers remaining for inclusion. We explored the original parent voices (first order) and the interpretation of the study authors (second order) to identify three third-order concepts (our interpretation of the findings), which related to technical, relational and temporal factors. These factors influenced parents' experiences, providing both barriers and facilitators to how parents and caregivers experienced the time their child was in the PICU. The dynamic and co-constructed nature of safety provided an analytical overarching frame of reference.ConclusionThis synthesis demonstrates novel ways in which parents and caregivers can contribute to the vital role of ensuring a co-created safe healthcare environment for their child when receiving life-saving care within the PICU

Evaluating the effectiveness and cost effectiveness of the 'strengthening families, strengthening communities' group-based parenting programme: study protocol and initial insights.

Funder: Public Health Research Programme; Grant(s): NIHR-PHR: 16/122/35BACKGROUND: Up to 20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children's well-being exist. Supporting parents to develop effective parenting skills is an important preventive strategy in reducing inequalities. Parenting interventions have been developed, which aim to reduce the severity and impact of these difficulties. However, most parenting interventions in the UK focus on early childhood (0-10 years) and often fail to engage families from ethnic minority groups and those living in poverty. Strengthening Families, Strengthening Communities (SFSC) is a parenting programme designed by the Race Equality Foundation, which aims to address this gap. Evidence from preliminary studies is encouraging, but no randomised controlled trials have been undertaken so far. METHODS/DESIGN: The TOGETHER study is a multi-centre, waiting list controlled, randomised trial, which aims to test the effectiveness of SFSC in families with children aged 3-18 across seven urban areas in England with ethnically and socially diverse populations. The primary outcome is parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes include child socio-emotional well-being, parenting practices, family relationships, self-efficacy, quality of life, and community engagement. Outcomes are assessed at baseline, post intervention, three- and six-months post intervention. Cost effectiveness will be estimated using a cost-utility analysis and cost-consequences analysis. The study is conducted in two stages. Stage 1 comprised a 6-month internal pilot to determine the feasibility of the trial. A set of progression criteria were developed to determine whether the stage 2 main trial should proceed. An embedded process evaluation will assess the fidelity and acceptability of the intervention. DISCUSSION: In this paper we provide details of the study protocol for this trial. We also describe challenges to implementing the protocol and how these were addressed. Once completed, if beneficial effects on both parental and child outcomes are found, the impact, both immediate and longer term, are potentially significant. As the intervention focuses on supporting families living in poverty and those from minority ethnic communities, the intervention should also ultimately have a beneficial impact on reducing health inequalities. TRIAL REGISTRATION: Prospectively registered Randomised Controlled Trial ISRCTN15194500

Returning a lost process by reintroducing a locally extinct digging marsupial

The eastern bettong (Bettongia gaimardi), a medium-sized digging marsupial, was reintroduced to a predator-free reserve after 100 years of absence from the Australian mainland. The bettong may have the potential to restore temperate woodlands degraded by a history of livestock grazing, by creating numerous small disturbances by digging. We investigated the digging capacity of the bettong and compared this to extant fauna, to answer the first key question of whether this species could be considered an ecosystem engineer, and ultimately if it has the capacity to restore lost ecological processes. We found that eastern bettongs were frequent diggers and, at a density of 0.3–0.4 animals ha−1, accounted for over half the total foraging pits observed (55%), with echidnas (Tachyglossus aculeatus), birds and feral rabbits (Oryctolagus cuniculus) accounting for the rest. We estimated that the population of bettongs present dug 985 kg of soil per ha per year in our study area. Bettongs dug more where available phosphorus was higher, where there was greater basal area of Acacia spp. and where kangaroo grazing was less. There was no effect on digging of eucalypt stem density or volume of logs on the ground. While bettong digging activity was more frequent under trees, digging also occurred in open grassland, and bettongs were the only species observed to dig in scalds (areas where topsoil has eroded to the B Horizon). These results highlight the potential for bettongs to enhance soil processes in a way not demonstrated by the existing fauna (native birds and echidna), and introduced rabbit