Hospital-based social workers’ perceptions of generalist- and specialist-level palliative social work activities

Summary: A social work advisory group recently proposed 41 generalist-level palliative social work activities applicable to any venue, including hospital-based social work, but this applicability has not been empirically tested. Therefore, we used critical realist grounded theory analysis of qualitative interviews to explore whether the activities proposed by the advisory group reflect inpatient social workers’ perceptions of their generalist-level palliative activities when caring for patients alongside specialist-level palliative social workers. Fourteen Masters educated social workers from six hospitals in the Midwest United States participated. Corresponding concepts from interview data of hospital-based social workers’ perceptions of what facilitates or hinders collaboration with specialist-level palliative social workers were identified and mapped onto the 41 generalist-level palliative social work activities. We used NVivo to organize and track data. Findings: Inpatient social workers find it challenging to engage in specific generalist-level palliative social work activities; provision of generalist-level palliative services is shaped by discharge planning duties, the consultation model, and the concentrated role of specialist-level palliative social workers. Competency in cultural and spiritual aspects of care could be lacking. Applications: Most of the 41 generalist-level palliative social work activities are present in hospital-based social workers’ clinical practice. However, not all activities may be applicable or realizable in the inpatient venue. In the hospital, an emphasis on discharge planning and related time-barriers can mean seriously ill patients and their families lack access to generalist-level palliative social work services. Clarification is needed about which of the 41 activities are relevant to and actionable within the inpatient venue

Protocol for a longitudinal qualitative interview study: maintaining psychological well-being in advanced cancer - what can we learn from patients' and carers' own coping strategies?

IntroductionPeople with advanced cancer and their carers experience stress and uncertainty which affects the quality of life and physical and mental health. This study aims to understand how patients and carers recover or maintain psychological well-being by exploring the strategies employed to self-manage stress and uncertainty.Methods and analysisA longitudinal qualitative interview approach with 30 patients with advanced cancer and 30 associated family or informal carers allows the exploration of contexts, mechanisms and outcomes at an individual level. Two interviews, 4–12?weeks apart, will not only enable the exploration of individuals’ evolving coping strategies in response to changing contexts but also how patients’ and carers’ strategies inter-relate. Patient and Carer focus groups will then consider how the findings may be used in developing an intervention. Recruiting through two major tertiary cancer centres in the North West and using deliberately broad and inclusive criteria will enable the sample to capture demographic and experiential breadth.Ethics and disseminationThe research team will draw on their considerable experience to ensure that the study is sensitive to a patient and carer group, which may be considered vulnerable but still values being able to contribute its views. Public and patient involvement (PPI) is integral to the design and is evidenced by: a research advisory group incorporating patient and carers, prestudy consultations with the PPI group at one of the study sites and a user as the named applicant. The study team will use multiple methods to disseminate the findings to clinical, policy and academic audiences. A key element will be engaging health professionals in patient and carer ideas for promoting self-management of psychological well-being. The study has ethical approval from the North West Research Ethics Committee and the appropriate NHS governance clearance.RegistrationNational Institute for Health Research (NIHR) Clinical Studies Portfolio, UK Clinical Research Network (UKCRN) Study number 11725

Reducing the nitrate content of protected lettuce.

End of Project ReportA research project was carried out jointly between Teagasc, Kinsealy Research Centre and University College Dublin, Department of Crop Science, Horticulture and Forestry which studied the effects of cultivar, nitrogen fertilisation and light intensity on the nitrate content of protected butterhead lettuce. In a series of cultivar trials of winter and summer butterhead lettuce, significant differences in the nitrate content of the lettuce between cultivars were found only in one experiment. In this instance, the differences were not consistent between successive harvests. It was concluded that screening lettuce cultivars for tissue nitrate level is unlikely to contribute to an overall reduction of nitrate levels. The application of N in a liquid feed throughout the cropping period resulted in higher nitrate levels in lettuce plants grown in soil filled containers compared with a similar amount of N applied to the soil before planting. Withdrawing N for the final 10 days of the cropping period did not affect the nitrate content of the lettuce. In an experiment studying nitrogen source and rate on lettuce grown in containers, the use of calcium cyanamide as a N source resulted in lower nitrate levels in the lettuce and gave a reduced head weight compared with calcium ammonium nitrate (CAN) or ammonium sulphate. Increasing the rate of CAN or ammonium sulphate gave higher lettuce nitrate levels. A nitrification inhibitor reduced the soil nitrate levels especially with sulphate of ammonia as the N source but did not affect the plant nitrate levels significantly. The addition of chloride to the soil reduced nitrate levels in the lettuce. In a further fertilisation study using containers, calcium cyanamide again resulted in lower plant nitrate levels than CAN. Increasing the rate of CAN increased soil nitrate levels, lettuce head weight and plant nitrate levels. The relationship between soil nitrate levels, lettuce head weight and plant nitrate level indicates that the level of 100-150 mg·L-1 of nitrate N in the soil, advocated in the Code of Good Practice, is a compromise between maximising plant growth and minimising lettuce nitrate content. A comparison between CAN and calcium cyanamide in a border soil experiment again showed that the latter N source resulted in lower lettuce nitrate levels. In this experiment the addition of chloride to the soil did not affect plant nitrate levels. Lettuce was grown, in late summer, in small tunnels using a range of polyethylene cladding materials. Head weight correlated well with the overall light transmission of the materials. In one of the materials that had a low light transmission, lettuce nitrate content was doubled compared with those grown under the materials with high light transmission. Under both winter and summer conditions, the nitrate content of lettuce heads was not influenced by the time of day at which harvest took place. In experiments in which multiple harvests were carried out there was no consistent trend in nitrate content as the heads developed and matured. Within individual heads of lettuce there was a steep concentration gradient with the older outer leaves having much higher concentrations of nitrate than the younger inner leaves. Herbicides commonly used in protected lettuce production did not influence the nitrate content of the lettuce

Caribou nursery site habitat characteristics in two northern Ontario parks

To prevent further range recession, habitat features essential to the life-history requisites of woodland caribou (Rangifer tarandus caribou) such as calving and nursery sites need to be protected for the persistence of the species. Woodland caribou may minimize predation risk during calving by either spacing out or spacing away from predators in the forest to calve on islands, wetlands, or shorelines. Our objective was to determine the characteristics of shoreline habitats used as calving and nursery sites by female woodland caribou in northern Ontario. Detailed vegetation and other site characteristics were measured at nursery sites used by cow-calf pairs in Wabakimi and Woodland Caribou Provincial Parks for comparison with shoreline sites that were not used by caribou within each park. Differences in habitat variables selected by female caribou in the two study areas reflect broad ecoregional differences in vegetation and topography. In Wabakimi Provincial Park, understorey tree density and ground detection distance played key roles in distinguishing nursery sites from sites that were not used. In Woodland Caribou Provincial Park, groundcover vegetation and shrub density were important in the selection of nursery sites by female caribou. Generally, female caribou in both parks selected nursery sites with greater slope, lower shrub density but thicker groundcover vegetation, including greater lichen abundance, and higher densities of mature trees than shoreline sites that were not used. The identification of these important features for caribou nursery sites provides a basis for improving their protection in future management policies and legislation

How do I sound to me? Perceived changes in communication in Parkinson's disease

Objective: To examine self and carer perceived changes in communication associated with Parkinson's disease and relate these to speech intelligibility, gender, age and other disease measures. Design: Cross-sectional survey of a hospital- and community-based sample of 176 people with Parkinson's disease and their carers using a questionnaire based on semantic differential techniques. Participants: One hundred and four people with Parkinson's disease with no history of communication difficulties prior to onset of their Parkinson's disease and 45 primary carers who returned completed questionnaires. Main outcome measures: Differences in ratings for `before' the onset of Parkinson's disease versus present status. Results: There was a strong perception of negative impact on communication between `before' and `now', irrespective of age and gender and largely independent of disease severity and duration, intelligibility and cognitive status. Activities of daily living (assessed by Unified Parkinson's Disease Rating Scale (UPDRS) II) and depression rating scale scores had the strongest association with change (adjusted R 2 0.27). There was a significant correlation between the rank order of perceived change in features examined in people with Parkinson's disease versus their carers, though in general carers rated change as having less impact. Conclusions: Parkinson's disease exercises a strong influence on communication even before apparent alterations to intelligibility or motor status

Learning from MARQuIS: future direction of quality and safety in hospital care in the European Union

This article summarises the significant lessons to be drawn from, and the policy implications of, the findings of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project—a part of the suite of research projects intended to support policy established by the European Commission through its Sixth Framework Programme. The article first reviews the findings of MARQuIS and their implications for healthcare providers (and particularly for hospitals), and then addresses the broader policy implications for member states of the European Union (EU) and for the commission itself. Against the background of the European Commission’s Seventh Framework Programme, it then outlines a number of future areas for research to inform policy and practice in quality and safety in Europe. The article concludes that at this stage, a unique EU-wide quality improvement system for hospitals does not seem to be feasible or effective. Because of possible future community action in this field, attention should focus on the use of existing research on quality and safety strategies in healthcare, with the aim of combining soft measures to accelerate mutual learning. Concrete measures should be considered only in areas for which there is substantial evidence and effective implementation can be ensured

Prospects for seascape repair: Three case studies from eastern Australia

Three case studies spanning tropical, subtropical and temperate environments highlight the minimum potential benefits of investing in repair of coastal seascapes. Fisheries, a market benefit indicator readily understood by a range of stakeholders from policymakers to community advocates, were used as a surrogate for ecosystem services generated through seascape habitat restoration. For each case study, while recognising that biological information will always remain imperfect, the prospects for seascape repair are compelling