128 research outputs found

    Patient and community nurse perspectives on recruitment to a randomized controlled trial of urinary catheter washout solutions

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    Aims To provide evidence around the acceptability of a proposed randomised controlled trial (RCT) of catheter washout solutions. Design: A sample of senior community nursing staff (n=7) were interviewed and four focus groups with a sample of community nurses were conducted. Eleven semi-structured face-to-face interviews were undertaken with patients using a long-term catheter. Methods: An in-depth qualitative study using a phenomenological approach was employed. This approach was suitable to explore the lived experiences of subjects and gain their viewpoints and experiences. Results: Nurse participants raised concerns regarding the removal of treatment or increased risk of infection in relation to which arm of the trial patients were randomised to. There was concern that patients could get used to the increased contact with nursing staff. Six patients who agreed to participate cited personal benefit, benefiting others, and a sense of indifference. Four patients were unsure about taking part and one declined

    Space matters: incorporating mechanistically determined spatial patterns into projected impacts of climate change on stream temperature

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    River temperatures are increasing as a results of climate change, and combined with decreased summertime flows, coldwater species are becoming increasingly stressed. In order to conserve sensitive species, managers need an estimate of how the availability of summertime thermal refuges in rivers will change in the future. Here, we applied the DHSVM-RBM, an existing process-based water temperature model that has been shown to accurately represent temporal variance in water temperature over hours to years. We calibrated this model to empirical data for two case study watersheds (Siletz River, Oregon and Snoqualmie River, Washington) to also ensure representation of observed spatial heterogeneity during summer. We used the model to predict future spatiotemporal patterns in water temperature that may arise as a result of climate change and to assess Pacific salmon vulnerability. We then compared our predictions to those made by statistical models to assess the unique benefits and constraints of a process-based approach. We found that a substantial decrease of snowmelt, and subsequently summer flow, will drive increases in water temperature and spatial variability in future summers. Our vulnerability analysis suggested that for salmon and steelhead exposed to warm August temperatures, conditions are already stressful in lower portions of the case study watersheds, and unlikely to become better in the future. All models predicted generally similar spatial patterns of water temperature in the future; across models, future cool patches will be reduced in number and located farther upstream. However, projected increases in water temperature were strikingly different among models, ranging from about +5 oC in the Snoqualmie River as predicted by DHSVM-RBM, to a negligible change in both watersheds as predicted by statistical methods. This information can be used to identify locations where protection and restoration of coolwater habitats may be most important into the future

    Estimating river flows across basins using water isotopes

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    Global warming is expected to dramatically alter the timing and quantity of water within the nation’s river systems; however, these impacts will be heterogeneous both within river basins and across regions. A detailed understanding of the spatial and temporal dynamics of water sources across river networks is therefore central to managing the impacts of climate change. Stable isotopes of water (2H:1H & 18O:16O) provide an emerging method for elucidating the contributions of varying water sources to rivers. Because the stable isotope composition of precipitation varies geographically, variation in the stable isotope composition of river water indicates the volume-weighted integration of source water within the watershed. During September 2017, we collected stable isotope samples across five river networks in the Pacific Northwest and SE Alaska that span a range of hydraulic and climatic conditions: the Snoqualmie, Green, Wenatchee, and Skagit Rivers as well as Cowee Creek. For each basin we regressed isotope values against computed spatial covariates such as elevation, mean annual precipitation, and geology to determine which covariates explained the greatest proportion of isotopic variation. We compared best-fit models for each basin to examine how major correlates of isotopic variation differed among river networks. Results indicate that rivers on the west side of the Cascades display a far stronger relationship to elevation than the Wenatchee. We then built spatial stream network models to display and communicate spatial patterns of isotopic variation within the Snoqualmie and Wenatchee basins. We also employed a mixing-model approach to determine where sources of water in the mainstems of each river originated (e.g. snow zone, rain-on-snow zone, or rain) during summer low flow conditions. Our results can be used by managers and watershed groups to estimate how river flows may shift in a changing climate

    Domestic abuse and safeguarding children : critical issues for multiagency work

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    This paper reports upon the learning that emerged from a development project which aimed to facilitate improvements in multiagency work in domestic abuse and safeguarding children. The two-year project (2011–13), funded by the Department for Education and led by WomenCentre, a specialist voluntary sector organisation based in West Yorkshire, was undertaken in nine local authorities in the north of England. Activities undertaken during the project included case mapping, service user and professional engagement exercises, observation of local multiagency meetings and provision of training. An evaluative research study examined the work of the project and the learning that emerged. Drawing upon data from telephone interviews with project participants, analysis of case mapping and project reports, this paper discusses some critical issues which emerged from this project. The paper draws attention to the different understandings and priorities which shape interprofessional practice in relation to safeguarding children and domestic abuse, and the complexities of the wider interagency environment including coordination, resources and expertise. Recommendations for improving multiagency work to achieve better outcomes for women and children experiencing domestic abuse are discussed

    Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT.

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    Background Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption. Objectives To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment. Design A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment. Setting The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England. Participants Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual. Interventions The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15–20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy. Main outcome measures Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data. Results The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment. Conclusions The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted. Trial registration Current Controlled Trials ISRCTN36257982. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information
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