APPALACHIAN BRIDGES TO THE BACCALAUREATE: THE INFLUENCE OF MULTIPLE ROLES AND CULTURAL NORMS ON THE BACCALAUREATE PERSISTENCE OF LOCATION-BOUND APPALACHIAN WOMEN

Too few Kentucky community college students transfer and persist to earn baccalaureate degrees. This is particularly true in Appalachia Kentucky which has a high rate of poverty and a low rate of baccalaureate attainment. Scholars and economists agree that the fastest way to decrease poverty within a geographical region is to increase the educational level of the citizens. Policy makers in the Commonwealth have established a goal of doubling the number of baccalaureate holders within the state by 2020. This study is framed by a collaborative study which examined the ways in which institutional and student characteristics impact the pathway to the baccalaureate degree for Appalachian community college students in Kentucky. Quantitative analysis was conducted for the student populations who graduated in the summer and spring 2009 from four Appalachian community colleges. A framework was developed that identified two of the colleges as high-impact. The graduates of these colleges were twice as likely to transfer as the students from the two low-impact institutions. The two high performing colleges had partnership arrangements with baccalaureate-granting institutions that offered multiple degree options in or near the community college campus. Four companion studies that examined institutional and student characteristics were conducted. The purpose of this qualitative study was to examine the ways in which nontraditional-aged Appalachian women attending college as location-bound adults perceive the supports and challenges to baccalaureate attainment. Twenty-four women were interviewed to explore the ways in which they balance their multiple life roles with the demands of their postsecondary studies, to understand their perceptions how Appalachian culture impacts them as students, and their perceptions of the ways in which educational institutions provide them with baccalaureate access. Narrative was used both as the method of inquiry and the object of interpretation. Major themes that emerged from this study included: (1) Adult Appalachian female students are both challenged and supported by their major life roles and (2) Postsecondary institutions provide both support and challenges to this population

Benzo-pyrones for reducing and controlling lymphoedema of the limbs.

Background Lymphoedema is the accumulation of excess fluid in the body caused by obstruction of the lymphatic drainage mechanisms. Treatment with Benzo-pyrones is thought to reduce fluid forming in the subcutaneous tissues and reduce pain and discomfort of the affected area. Objectives To assess the effectiveness of benzo-pyrones compared to placebo in the management of lymphoedema. Search strategy We searched the Cochrane Breast Cancer Group register (September 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4,2003), MEDLINE, EMBASE, CINAHL, UnCover, PASCAL, SIGLE, reference lists produced by The British Lymphology Society, the National Research Register (NRR) and The International Society of Lymphology congress proceedings. Selection criteria Randomised controlled trials comparing Benzo-pyrones with placebo. Data collection and analysis Trials were selected for eligibility and tested for quality by two blinded reviewers who independently extracted data. Meta-analysis was not performed due to the poor quality of the trials. Main results Fifteen trials were included. Three oxerutin trials tested the same dose over 6 months against placebo and included a total of 127 participants (data were available for 81). There were insufficient data from these to calculate the per cent reduction or increase in baseline excess limb volume. One trial testing Cyclo 3 Fort (approved name) was found (57 participants) but insufficient data was provided to allow a proper analysis of its findings. A single trial of Daflon (approved name) was found (104 participants) but this also provided insufficient information to reach a conclusion about the effectiveness of the drug. Three trials of coumarin combined with troxerutin were found which tested two different doses of the drug against each other with no placebo, however participant numbers and baseline data were not provided. Eight trials of coumarin were identified. Two of these reported the same trial and the other potentially also referred to the same trial but this could not be confirmed. A further two papers also appeared to refer to the same trial but again this was unconfirmed. Five studies added anti-filarial drugs to the interventions tested. Participant data could not be extracted and the reporting of outcome measures in most was unclear. Loprinzi's 1999 trial was reported in more detail but its conclusions were very much at odds with other findings. Authors' conclusions It is not possible to draw conclusions about the effectiveness of Benzopyrones in the management of lymphoedema from the current available trials

Improving living and dying for people with advanced dementia living in care homes: a realist review of Namaste Care and other multisensory interventions

© The Author(s). 2018Background: Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances. Methods: This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops. Results: We included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia. Conclusions: This realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.Peer reviewe

Perceptions of outcomes of speech therapy among individuals with Parkinson’s disease: Examining a critical area of evidence-based practice

Parkinson’s disease (PD) is a progressive neurological disease that affects 60,000 Americans each year and over 10 million people worldwide. 1 Speech impairments are present in 49-70% of people with PD, often characterized by hypokinetic dysarthria and its symptoms include variable rate, monotonous, soft, and breathy speech, and quiet volume. 2 An overall aim of treatment in PD is to lower the negative impact of the disease on the functioning and quality of life (QoL) of patients in this population. Similar to other treatment approaches for PD, speech therapy for people with PD is aimed to improve their QoL. Some of the past research in speech therapy has focused on measuring QoL in patients with PD subsequent to their speech deficits. While these studies help us to understand the general lifestyle of patients with PD, it does not inform us about their perspectives on speech therapy. Relying on prior QoL studies presents us with a significant limitation to understanding whether speech therapy is considered beneficial for patients with PD. The term “evidence-based practice” (EBP) refers to using the best, research-proven assessment and treatment techniques to deliver the most effective services to patients. 3 EBP is the integration of clinical expertise, external and internal evidence, and client perspective. While there is published information on expert opinions and outcomes for different lines of speech treatment for people with PD, there is very limited information on how clients perceive the value of these treatments as consumers. To address this limitation, the current study aimed to survey patients with PD on their perspectives on speech therapy

“We could do better”: the nature and meaning of information-giving in end-stage COPD

Background: End of life in Chronic Obstructive Pulmonary Disease (COPD) is typically difficult to predict, and although palliative care initiatives are developing, active treatment in the acute hospital setting often continues up to death. Staff delivering care but who may not be part of the treatment decision-making process express frustration at the lack of a palliative approach in end-stage disease and cite part of their role is to give information to assist decision-making for those in their care. Overall study aim: To understand the meaning and experiences of information-giving of staff caring for acute severe COPD within the social context of the acute hospital setting. Methods: In this exploratory, qualitative study, interviews and focus groups were undertaken with nurses and physiotherapists (n=10) who care for people with severe COPD in acute hospital settings in the North of England. A grounded theory approach to analysis was aided by the software NVivo. Results: Although staff can act as information-givers to support their patients, time constraints lead to hesitancy on their part, and they often wait for the patient to express concerns for their future before intervening. Once the conversation is initiated, staff express a sense of responsibility to do the job well, and this is often difficult. More experienced staff feel better equipped to give information and discuss decisions on behalf of their patients, but the success of this is rooted in inter-disciplinary relationships and the nature of the ward hierarchy. Conclusion: Inter-disciplinary relationships, professional experience and time constraints all create a challenge to effective information-giving in clinical practice when considering treatment decision-making for people with acute severe COPD

Refractory pruritus from malignant cholestasis:Management

This case report deals with a patient managed in a tertiary-care cancer hospital who suffered pruritus associated with malignant cholestasis. His symptoms were resistant to conventional treatment with ursodeoxycholic acid, chlorpheniramine and cholestyramine. Hence, the multifactorial origin of malignancy-associated pruritus was considered. Correctable factors were corrected and generally the treatment was aimed at possible aetiologies. There were barriers related to insufficient resources available for symptom palliation in this particular setting, which could potentially reduce optimum symptom control. However, various pharmacotherapies and non-pharmacological measures which could potentially have helped relieve pruritus are described and future scope for research in this area discussed

What are the views of hospital-based generalist palliative care professionals on what facilitates or hinders collaboration with in-patient specialist palliative care teams?:a systematically constructed narrative synthesis

Background: Hospital-based specialist palliative care services are common, yet existing evidence of inpatient generalist providers’ perceptions of collaborating with hospital-based specialist palliative care teams has never been systematically assessed. Aim: To assess the existing evidence of inpatient generalist palliative care providers’ perceptions of what facilitates or hinders collaboration with hospital-based specialist palliative care teams. Design: Narrative literature synthesis with systematically constructed search. Data sources: PsycINFO, PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature and ProQuest Social Services databases were searched up to December 2014. Individual journal, citation and reference searching were also conducted. Papers with the views of generalist inpatient professional caregivers who utilised hospital-based specialist palliative care team services were included in the narrative synthesis. Hawker’s criteria were used to assess the quality of the included studies. Results: Studies included (n = 23) represented a variety of inpatient generalist palliative care professionals’ experiences of collaborating with specialist palliative care. Effective collaboration is experienced by many generalist professionals. Five themes were identified as improving or decreasing effective collaboration: model of care (integrated vs linear), professional onus, expertise and trust, skill building versus deskilling and specialist palliative care operations. Collaboration is fostered when specialist palliative care teams practice proactive communication, role negotiation and shared problem-solving and recognise generalists’ expertise. Conclusion: Fuller integration of specialist palliative care services, timely sharing of information and mutual respect increase generalists’ perceptions of effective collaboration. Further research is needed regarding the experiences of non-physician and non-nursing professionals as their views were either not included or not explicitly reported

Frontline direct care workers experiences of providing domiciliary care towards the end of life:a systematic literature review and narrative synthesis

Background An ageing population heralds a greater demand for palliative and end of life care. Many people approaching the end of life rely on domiciliary care services provided by a para-professional workforce. Despite low pay and status, these workers provide personal and social care to people at a difficult time in their lives. Little is known about the impact of this work on the workers themselves or how they are trained, supervised and supported. Methods A systematic search was conducted in six databases. All study designs were included. Titles and abstracts of retrieved papers were screened by two researchers working independently. Findings were analysed using a narrative synthesis approach. Results Of 747 retrieved references, 12 papers from six countries in four continents were selected for inclusion in the review. Few studies dealt directly with the experiences of direct care workers themselves. Most considered them as part of multi-professional care networks with many focusing on issues relating to the professionals involved in the teams under consideration. Internationally and within nations, workers job titles varied and in some cases obscured job role. Where this role was clear, there was much overlap between domestic, personal, social and health related tasks. There was little evidence of a consistent approach to training and supporting staff involved in care towards the end of life and a paucity of ‘voice’ for these workers in published studies. Conclusion The experiences of direct care workers in palliative homecare is poorly studied. There is considerable variability in how workers are named, the work they do, and who they report to. More research that privileges the voice of these workers and identifies the impact on them of caring for those approaching the end of life is required so that employing agencies may consider how to improve the training, supervision and support of this essential frontline workforce