The perceived and observed needs of patients with dementia admitted to acute medical wards

It is acknowledged that the needs of persons living with dementia admitted in acute hospitals are not always met. Previous studies have focused on the perceived needs of professional caregivers or family members whilst the voices of patients with dementia in acute hospitals has not been extensively reported. This may have contributed to the under-recognition of the needs of persons living with dementia. The aim of this study was to categorize the perceived and observed needs of persons with dementia admitted in acute medical wards and to explore whether these needs are being or have been met. Thirteen people with dementia in three medical wards who could verbally communicate with the researcher, were purposively selected as research participants. Semi-structured interviews were conducted to elicit each participant’s experiences of their hospital stay and whether their needs were perceived to have been/are being met. Moreover, routine care with the same participants was observed using Dementia Care Mapping. Maslow’s Hierarchy of Needs, was used as a framework to categorize care needs. Our findings demonstrate that basic needs such as toileting, feeding, drinking, continence and comfort were not always met. Moreover, the largest gap between met and unmet needs was found in patients who were either under constant observation or unable to communicate. Too much emphasis was perceived and observed to be given on what staff considered as safety needs at the expense of other needs. The patients’ need for social contact and self-esteem such as dignity and respect were often ignored and this led to patients feeling devalued. Hospital staff have to be more aware of the holistic needs of patients with dementia in acute settings and the way care is delivered in order to make up for these unmet needs thus facilitating person-centred care

Dementia training programmes for staff working in general hospital settings – a systematic review of the literature

Objectives: There has been an increased interest in dementia training programmes directed to general hospitals, partly due to the reported lack of staff training that may be contributing to poor quality of care. Although literature describing and evaluating training programmes in hospital settings increased in recent years, there are no reviews that summarise these programmes. This review sought to address this, by collecting the current evidence on dementia training programmes directed to staff working in general hospitals. Method: Literature from five databases (PubMed, Academic Search Complete, PsychInfo, CINAHL and AgeLine) were searched, based on a number of inclusion criteria. The selected studies were summarised and data was extracted and compared using narrative synthesis based on a set of pre-defined categories. Methodological quality was assessed using Kmet, Lee & Cook (2004) criteria. Results: Fourteen peer-reviewed studies were identified with the majority being pre-test post-test investigations. No randomised controlled trials were found. Methodological quality was variable with selection bias being the major limitation. There was a great variability in the development and mode of delivery although, interdisciplinary ward based, tailor-made, short sessions using experiential and active learning, were the most utilized approaches. The majority of the studies mainly evaluated learning, with few studies evaluating changes in staff behaviour/practices and patients’ outcomes. Conclusion: This review indicates that high quality studies are needed that especially evaluate staff behaviours and patient outcomes and their sustainability over time. This review also highlights measures that could be used to develop and deliver training programmes in hospital settings

Coarse-graining in retrodictive quantum state tomography

Quantum state tomography often operates in the highly idealised scenario of assuming perfect measurements. The errors implied by such an approach are entwined with other imperfections relating to the information processing protocol or application of interest. We consider the problem of retrodicting the quantum state of a system, existing prior to the application of random but known phase errors, allowing those errors to be separated and removed. The continuously random nature of the errors implies that there is only one click per measurement outcome -- a feature having a drastically adverse effect on data-processing times. We provide a thorough analysis of coarse-graining under various reconstruction algorithms, finding dramatic increases in speed for only modest sacrifices in fidelity

Dementia care in acute hospitals – a qualitative study on nurse managers’ perceived challenges and solutions

Aim - The aim of this study was to explore the perceived challenges of nurse managers when caring for patients with dementia in acute hospitals and identify possible solutions to address these challenges. Background - Although dementia care in acute hospitals is suboptimal, few solutions have been identified. Multilevel factors need to be considered to promote changes in practice. Method - Two focus groups were held with sixteen nurse managers responsible for eleven acute medical wards in Malta. Deductive qualitative analysis using an adapted version of McKinsey 7-S model was used as an a priori framework to categorise the perceived challenges and solutions. Results – The nursing managers identified a number of organisational challenges that have a direct impact on the quality of care of patients with dementia. They also suggested a number of solutions such as realigning the hospital strategy, improving training and care coordination, redesigning the ward environment and changing leadership styles. Conclusion - This study highlight the complexity of improving dementia care in hospitals and continues to show that a systems-wide approach is needed. Implications for Nursing Management – Understanding the challenges and identifying possible solutions can help hospital staff provide better person-centred dementia care

Asynchronous displays for multi-UV search tasks

Synchronous video has long been the preferred mode for controlling remote robots with other modes such as asynchronous control only used when unavoidable as in the case of interplanetary robotics. We identify two basic problems for controlling multiple robots using synchronous displays: operator overload and information fusion. Synchronous displays from multiple robots can easily overwhelm an operator who must search video for targets. If targets are plentiful, the operator will likely miss targets that enter and leave unattended views while dealing with others that were noticed. The related fusion problem arises because robots' multiple fields of view may overlap forcing the operator to reconcile different views from different perspectives and form an awareness of the environment by "piecing them together". We have conducted a series of experiments investigating the suitability of asynchronous displays for multi-UV search. Our first experiments involved static panoramas in which operators selected locations at which robots halted and panned their camera to capture a record of what could be seen from that location. A subsequent experiment investigated the hypothesis that the relative performance of the panoramic display would improve as the number of robots was increased causing greater overload and fusion problems. In a subsequent Image Queue system we used automated path planning and also automated the selection of imagery for presentation by choosing a greedy selection of non-overlapping views. A fourth set of experiments used the SUAVE display, an asynchronous variant of the picture-in-picture technique for video from multiple UAVs. The panoramic displays which addressed only the overload problem led to performance similar to synchronous video while the Image Queue and SUAVE displays which addressed fusion as well led to improved performance on a number of measures. In this paper we will review our experiences in designing and testing asynchronous displays and discuss challenges to their use including tracking dynamic targets. © 2012 by the American Institute of Aeronautics and Astronautics, Inc

Using appreciative inquiry to implement person-centred dementia care in hospital wards

The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an Appreciative Inquiry (AI) approach to implement person-centred dementia care in two hospital wards. Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using AI approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in AI workshops, during which they are listened to and appreciated for what they can contribute

Sustainability of innovations in healthcare: A systematic review and conceptual framework for professional pharmacy services.

BACKGROUND: Implementation science emerged to address the challenges associated with the incorporation of evidence-based innovations into practice. Once the challenge is overcome, the ultimate goal is to achieve the sustainability of innovations to promote their continuity and long-term integration. Assessment tools and measures have been designed to assess the sustainability of innovations in research and practice environments. However, the variability of assessment tools available becomes a challenge for policy makers, researchers and practitioners, particularly when deciding how to evaluate the sustainability of innovations. OBJECTIVES: to identify conceptual approaches and assessment tools for the sustainability of healthcare innovations and to develop a specific discipline-based framework for the sustainability of professional pharmacy services. METHODS: A systematic literature review was conducted in January of 2019 using PubMed, Scopus, and Web of Science. General information regarding the conceptual approaches (based on Nilsen's classification), assessment tools and the factors affecting the sustainability of the healthcare innovations was retrieved. RESULTS: From 3123 articles screened, 132 articles were selected from which 106 conceptual approaches and 26 assessment tools were identified. Several key factors moderating the sustainability of the innovations in healthcare were identified (e.g. funding, adaptation). A framework for the sustainability of professional pharmacy services is proposed based on these factors. It presents three performance domains influencing the service sustainability (i.e. environment, social and economic). CONCLUSIONS: The identified approaches in different healthcare settings have allowed the adaptation and design of a specific framework for pharmacy. The core factors included in the proposed framework are moderators of the sustainability process and should be considered in sustainability studies and evaluations. This framework will guide pharmacy practice researchers and practitioners to measure and achieve the sustainability of professional pharmacy services. Furthermore, the adaptation of this framework will allow its application to other healthcare settings. (Registration number CRD42018092160)

Ghajn Klieb, (Rabat, Malta)

Between October and December 1999 a team of local and foreign undergraduates from the University of Malta carried out a survey of the site at Ghajn Klieb outside Rabat. The exercise constituted the practical part of a unit on the Principles of Archaeological Surveying directed by Dr Nicholas Vella of the Department of Classics & Archaeology. For the survey the team was joined by Hanna Stager, a graduate of the same department, who also researched some of the references used in this article. Initial reconnaissance of the site was carried out on 15 October 1999 with Nathaniel Cutajar and Michelle B uhagiar, Curator and Assistant Curator respectively at the National Museum of Archaeology. The scatter of surface ceramics and the existence of previously known and unknown features revealed the extent and potential of the site. It was decided that the locality of Ghajn Klieb warranted systematic study that could be carried out in various stages, with the longterm aim being an assessment of human activity and cultural behaviour at the site. The Museums Department gave the go-ahead for this project, and permission to collect the surface ceramics was granted. This short report is intended to give an outline of the work undertaken to date. Emphasis is placed on the field methods adopted and on the presentation of what we believe to be worth talking about at this stage. An effort is here made by the senior author to unravel the collaborative nature of the exercise by lending weight to individual thoughts and interpretations that arose while work progressed in the field.peer-reviewe