Understanding the role of peer involvement in UK harm reduction interventions

Aims: In recent decades British drug policy has shifted from a harm reduction approach to an abstinence-based recovery approach, changing the landscape of support available to people who continue to use drugs. People who use drugs (PWUD) are a highly stigmatised and marginalised population with high levels of mental health need, who often face barriers to accessing services. In other countries, peer work has provided opportunities for PWUD to deliver harm reduction interventions to their peers with a number of beneficial outcomes, but there is an absence of research on the experiences of peer workers in the UK. This study sought to understand the experiences of PWUD engaged as peer workers offering harm reduction interventions to fellow drug users in the UK. Method: Semi-structured interviews were conducted with eight peer workers with living experience of drug use, recruited through a harm reduction organisation. Thematic analysis was used to interpret the data. Results: Data analysis discovered four main themes: (1) Changing and Enhancing Perceptions of People Who Use Drugs, which referred to changes in the ways peer workers were perceived by others, allowing them to embrace a more positive perception of themselves; (2) A Unique and Valuable Role, which demonstrated the ways in which peer workers recognised their skills and, which made them feel valued and useful; (3) Positive Impact of Peer Work, which highlighted the changes that had occurred following involvement in peer work, including a reduction in drug use and improved mental health; (4) Fragility of Peer Work, which demonstrated the more challenging aspects of the work, including anxiety regarding the precariousness of the peer work role. Conclusion: The study highlighted a variety of experiences of peer work, including positive experiences and more challenging aspects of the role. The findings have implications for both harm reduction organisations seeking to develop peer work programmes and mental health services that seek to support PWUD. Suggestions for future policy development and research that builds on this emerging approach have also been discussed

Improving the identification and management of aspiration after stroke

Dysphagia, a common clinical corollary following stroke, may contribute to aspiration pneumonia, malnutrition, and dehydration which may significantly impair patient rehabilitation. Survey Aim: Establish current clinical practice regarding nurse dysphagia screening. Method: A cross-sectional regional postal survey was undertaken with 60 nurses and 45 Speech and Language Therapists. Results: Nurses were taught to use water swallow screening tools but, in reality, used a variety of testing materials. Conclusion: This demonstrated the need for a clinically useful bedside swallow screening tool. Pilot Study Aim: Develop and evaluate the diagnostic accuracy of a new BEdside Swallow Screening Tool (BESST), for use by nurses with acute stroke patients. Method: A literature search was undertaken to inform the BESST. Face validity was established using an iterative process of semi-structured interviews with eight specialist SLTs and eight nurses. The tool was piloted on 12 purposefully selected stroke patients by comparing the management options chosen by two nurses using the BESST with those of the Specialist SLT using their bedside assessment (gold standard). Results: The BESST demonstrated excellent sensitivity (100%) but specificity demonstrated by both nurses was poor (< 45% for both). Conclusion: A larger validation study of a modified BEEST would be appropriate. Main Study Aim: Establish the diagnostic accuracy and utility of the BESST. Method: Ratings by nurses using the BESST were compared with experienced SLT bedside assessment in 124 consecutively admitted stroke patients. Results: The BESST demonstrated good agreement between nurses (81%) and within nurses (87% nurse 1, 86% nurse 2), 93% sensitivity, 82% specificity; 71% positive iii predictive value, 95% negative predictive value; and overall efficiency was 84%. The BESST dictated the same management as the SLT in 75% of cases, and safely allowed 92% of patients modified oral intake when compared to the water swallow screening tool. Conclusion: The BESST has potential use in clinical practice, but further research is needed

Looking west: Three Essays on Swedish-American Life

Excerpt from preface: This book contains three essays on Swedish and Swedish-American topics by Jules Mauritzson, professor of Swedish language and literature at Augustana College from 1901 until his untimely death in 1930. Table of Contents: Preface / Dag Blanck, Ann Boaden -- Introduction / Dag Blanck -- The Swedish-American: at Work and Play, at Home and Away (Svensk-amerikanen i helg och söcken, hemma och borta) -- Chicago: From Open Prairie To a City of One Million in Fifty Years (Chicago: från öde prairie till million-stad på femtio år) -- Christmas Customs, Old and New (Julseder: gamla och nya)https://digitalcommons.augustana.edu/ahsbooks/1014/thumbnail.jp

Patient, carer and public involvement in major system change in acute stroke services: The construction of value

BACKGROUND: Patient and public involvement is required where changes to care provided by the UK National Health Service are proposed. Yet involvement is characterized by ambiguity about its rationales, methods and impact. AIMS: To understand how patients and carers were involved in major system changes (MSCs) to the delivery of acute stroke care in 2 English cities, and what kinds of effects involvement was thought to produce. METHODS: Analysis of documents from both MSC projects, and retrospective in-depth interviews with 45 purposively selected individuals (providers, commissioners, third-sector employees) involved in the MSC. RESULTS: Involvement was enacted through consultation exercises; lay membership of governance structures; and elicitation of patient perspectives. Interviewees' views of involvement in these MSCs varied, reflecting different views of involvement per se, and of implicit quality criteria. The value of involvement lay not in its contribution to acute service redesign but in its facilitation of the changes developed by professionals. We propose 3 conceptual categories-agitation management, verification and substantiation-to identify types of process through which involvement was seen to facilitate system change. DISCUSSION: Involvement was seen to have strategic and intrinsic value. Its strategic value lay in facilitating the implementation of a model of care that aimed to deliver evidence-based care to all; its intrinsic value was in the idea of citizen participation in change processes as an end in its own right. The concept of value, rather than impact, may provide greater traction in analyses of contemporary involvement practices