Enhancing Care Transitions for Older People through Interprofessional Simulation: A Mixed Method Evaluation

Introduction: The educational needs of the health and social care workforce for delivering effective integrated care are important. This paper reports on the development, pilot and evaluation of an interprofessional simulation course, which aimed to support integrated care models for care transitions for older people from hospital to home. Theory and methods: The course development was informed by a literature review and a scoping exercise with the health and social care workforce. The course ran six times and was attended by health and social care professionals from hospital and community (n=49). The evaluation aimed to elicit staff perceptions of their learning about care transfers of older people and to explore application of learning into practice and perceived outcomes. The study used a sequential mixed method design with questionnaires completed pre (n=44) and post (n=47) course and interviews (n=9) 2-5 months later. Results:Participants evaluated interprofessional simulation as a successful strategy. Post-course, participants identified learning points and at the interviews, similar themes with examples of application in practice were: Understanding individual needs and empathy; Communicating with patients and families; Interprofessional working; Working across settings to achieve effective care transitions. Conclusions and discussion:An interprofessional simulation course successfully brought together health and social care professionals across settings to develop integrated care skills and improve care transitions for older people with complex needs from hospital to home

Personal information documents for people with dementia: healthcare staff’s perceptions and experiences

Person-centred care is internationally recognised as best practice for the care of people with dementia. Personal information documents for people with dementia are proposed as a way to support person-centred care in healthcare settings. However, there is little research about how they are used in practice. The aim of this study was to analyse healthcare staff’s perceptions and experiences of using personal information documents, mainly Alzheimer’s Society’s ‘This is me’, for people with dementia in healthcare settings. The method comprised a secondary thematic analysis of data from a qualitative study, of how a dementia awareness initiative affected care for people with dementia in one healthcare organisation. The data were collected through 12 focus groups (n=58 participants) and 1 individual interview, conducted with a range of healthcare staff, both clinical and non-clinical. There are four themes presented: Understanding the rationale for personal information documents; Completing personal information documents; Location for personal information documents and transfer between settings; Impact of personal information documents in practice. The findings illuminated how healthcare staff use personal information documents in practice in ways that support person-centred care. Practical issues about the use of personal information documents were revealed and these may affect the optimal use of the documents in practice. The study indicated the need to complete personal information documents at an early stage following diagnosis of dementia, and the importance of embedding their use across care settings, to support communication and integrated car

How does the length of day shift affect patient care on older people's wards? A mixed method study

Background: Internationally, studies have focused on whether shift length impacts on patient care. There are also ongoing concerns about patient care for older people in hospital. The study aim was to investigate how length of day shift affects patient care in older people’s hospital wards. Objectives: 1) To explore how length of day shift affects patient care in older people’s wards; 2) To explore how length of day shift affects the quality of communication between nursing staff and patients/families on older people’s wards Design: A mixed method case study. Settings: The study was based on two older people’s wards in an acute hospital in England. One ward was piloting two, overlapping 8 hour day shifts for 6 months while the other ward continued with 12 hour day shifts. Participants and Methods: Qualitative interviews were conducted with 22 purposively recruited nursing staff (17 registered nurses; 5 nursing assistants). An analysis of patient discharge survey data was conducted (n=279). Twenty hours of observation of nursing staff’s interactions with patients and families was conducted, using an adapted version of the Quality of Interaction Schedule (301 interactions observed), with open fieldnotes recorded, to contextualise the observations. Results: There were no statistically significant differences in patient survey results, or quality of interactions, between the two wards. There were three overall themes: Effects of day shift length on patient care; Effects of day shift length on continuity of care and relationships; Effects of day shift length on communication with patients and families. Nursing staff believed that tiredness could affect care and communication but had varied views about which shift pattern was most tiring. They considered continuity of care was important, especially for older people, but had mixed views about which shift pattern best promoted care continuity. The difficulties in staffing a ward with an 8 hour day shift pattern, in a hospital that had a 12 hour day shift pattern were highlighted. Other factors that could affect patient care were noted including: ward leadership, ward acuity, use of temporary staff and their characteristics, number of consecutive shifts, skillmix and staff experience. Conclusions There was no conclusive evidence that length of day shift affected patient care or nursing staff communication with patients and families. Nursing staff held varied views about the effects of day shift length on patient care. There were many other factors identified that could affect patient care in older people’s wards

Barriers to women in the UK construction industry

Purpose – This paper aims to identify the main barriers that lead to the under-representation of women in the UK construction industry. The study, funded by ConstructionSkills, seeks to explore the issues that women face and investigate the potential positive impact that continuous professional development (CPD) may have upon improving the retention and career progression of women. Design/methodology/approach – The study uses an open-ended grounded theory (GT) approach, including 231 semi-structured questionnaires and nine focus groups with women from a range of professional occupations. All the findings were analysed using keyword analysis to identify the top two barriers that women face, alongside a series of cross-cutting key themes and issues. Findings – The findings reveal that male-dominated organisational cultures and inflexible working practices are the main barriers to women in the UK construction industry, irrespective of job role or profession. This paper concludes by arguing for a sea-change in the expansion of CPD opportunities for women in managerial, confidence and communication based skills, with accompanying networking and support systems to facilitate the retention and advancement of women in the industry sector. Research limitations/implications – Due to the research approach, the data are not generalisable. Therefore, researchers are advised to research and test the findings with a larger group. Researchers are also recommended to investigate the impact of expanded CPD opportunities for both men and women. Originality/value – The paper puts forward a business case for the advancement of specific CPD training for women, to facilitate the expansion of equality and diversity in the workforce in the UK construction industry

The CCD and readout electronics for the OMC instrument on Integral

The Optical Monitoring Camera (OMC) on ESA's Integral gamma-ray astronomy satellite is devoted to optical wavelength observations simultaneously covering the same field-of-view as the gamma-ray and X-ray instruments. The OMC consists of a refracting telescope with a CCD as the imaging device in the focal plane. Here we describe the CCD and its associated readout electronics, in particular pointing out features of interest to users of the OMC instrument and its data

Fan-In analysis of a leaky integrator circuit using charge transfer synapses

It is shown that a simple leaky integrator (LI) circuit operating in a dynamic mode can allow spatial and temporal summation of weighted synaptic outputs. The circuit incorporates a current mirror configuration to sum charge packets released from charge transfer synapses and an n-channel MOSFET, operating in subthreshold, serves to implement a leakage capability, which sets the decay time for the postsynaptic response. The focus of the paper is to develop an analytical model for fan-in and validate the model against simulation and experimental results obtained from a prototype chip fabricated in the AMS 0.35 μm mixed signal CMOS technology. We show that the model predicts the theoretical limit on fan-in, relates the magnitude of the postsynaptic response to weighted synaptic inputs and captures the transient response of the LI when stimulated with spike inputs

Oscillation modes of dc microdischarges with parallel-plate geometry

Two different oscillation modes in microdischarge with parallel-plate geometry has been observed: relaxation oscillations with frequency range between 1.23 and 2.1 kHz and free-running oscillations with 7 kHz frequency. The oscillation modes are induced by increasing power supply voltage or discharge current. For a given power supply voltage, there is a spontaneous transition from one to other oscillation mode and vice versa. Before the transition from relaxation to free-running oscillations, the spontaneous increase of oscillation frequency of relaxation oscillations form 1.3 kHz to 2.1 kHz is measured. Fourier Transform Spectra of relaxation oscillations reveal chaotic behaviour of microdischarge. Volt-Ampere characteristics associated with relaxation oscillations describes periodical transition between low current, diffuse discharge and normal glow. However, free-running oscillations appear in subnormal glow only.Comment: Submitted to: New Journal of Physic

Alterations in mosquito behaviour by malaria parasites: potential impact on force of infection

BACKGROUND: A variety of studies have reported that malaria parasites alter the behaviour of mosquitoes. These behavioural alterations likely increase transmission because they reduce the risk of vector death during parasite development and increase biting after parasites become infectious. METHODS: A mathematical model is used to investigate the potential impact of these behavioural alterations on the lifetime number of infectious bites delivered. The model is used to explore the importance of assumptions about the magnitude and distribution of mortality as well as the importance of extrinsic incubation period and gonotrophic cycle length. Additionally, the model is applied to four datasets taken from actual transmission settings. RESULTS: The impact of behavioural changes on the relative number of lifetime bites is highly dependent on assumptions about the distribution of mortality over the mosquito-feeding cycle. Even using fairly conservative estimates of these parameters and field collected data, the model outputs suggest that altered feeding could easily cause a doubling in the force of infection. CONCLUSIONS: Infection-induced behavioural alterations have their greatest impact on the lifetime number of infectious bites in environments with high feeding-related adult mortality and many pre-infectious feeding cycles. Interventions that increase feeding-associated mortality are predicted to amplify the relative fitness benefits and hence enhance the strength of selection for behavioural alteration.This study was supported by the NIH-NIAID ICEMR award (#U19AI089676-01)

Antinuclear antibodies (ANA) in chronic hepatitis C virus infection: correlates of positivity and clinical relevance.

We examined correlates of antinuclear antibody (ANA) positivity (ANA+) in individuals with chronic hepatitis C virus (HCV) infection and the effect of positivity on clinical outcome of HCV. Pretreatment sera from 645 patients from three centres in Sweden (n = 225), the UK (n = 207) and Italy (n = 213) were evaluated by indirect immunofluorescence on Hep-2 cells for ANA pattern and titre by a single laboratory. Liver biopsies were all scored by one pathologist. A total of 258 patients were subsequently treated with interferon monotherapy. There was a significant difference in the prevalence of ANA (1:40) by geographic location: Lund 4.4%, London 8.7%, Padova 10.3% [odds ratio (OR) = 0.66; 95% CI: 0.46-0.94; P = 0.023]. Duration of HCV infection, age at infection, current age, route of infection, viral genotype, alcohol consumption, fibrosis stage and inflammatory score were not correlated with ANA+ or ANA pattern. Female gender was correlated with ANA+ and this association persisted in multivariable analyses (OR = 3.0; P = 0.002). Increased plasma cells were observed in the liver biopsies of ANA-positive individuals compared with ANA-negative individuals, while a trend towards decreased lymphoid aggregates was observed [hazard ratio (HR) = 9.0, P = 0.037; HR = 0.291, P = 0.118, respectively]. No correlations were observed between ANA positivity and nonresponse to therapy (OR = 1.4; P = 0.513), although ANA+ was correlated with faster rates of liver fibrosis, this was not statistically significant (OR = 1.8; P = 0.1452). Low titre ANA+ should not be a contraindication for interferon treatment. Our observation of increased plasma cells in ANA+ biopsies might suggest B-cell polyclonal activity with a secondary clinical manifestation of increased serum immunoglobulins

In-line near infrared spectroscopy during freeze-drying as a tool to measure efficiency of hydrogen bond formation between protein and sugar, predictive of protein storage stability

Sugars are often used as stabilizers of protein formulations during freeze-drying. However, not all sugars are equally suitable for this purpose. Using in-line near-infrared spectroscopy during freeze-drying, it is shown here that hydrogen bond formation during freeze-drying, under secondary drying conditions in particular, can be related to the preservation of the functionality and structure of proteins during storage. The disaccharide trehalose was best capable of forming hydrogen bonds with the model protein, lactate dehydrogenase, thereby stabilizing it, followed by the molecularly flexible oligosaccharide inulin 4kDa. The molecularly rigid oligo- and polysaccharides dextran 5kDa and 70kDa, respectively, formed the least amount of hydrogen bonds and provided least stabilization of the protein. It is concluded that smaller and molecularly more flexible sugars are less affected by steric hindrance, allowing them to form more hydrogen bonds with the protein, thereby stabilizing it better