Maternal critical care: what can we learn from patient experience? A qualitative study.

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Partner Experiences of “Near-Miss” Events in Pregnancy and Childbirth in the UK : A Qualitative Study

Funding: This article presents independent research funded by the National Institute for Health Research (NIHR) under the “Beyond maternal death: Improving the quality of maternity care through national studies of ‘near-miss’ maternal morbidity” programme (Programme Grant RP-PG-0608-10038). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Acknowledgments The authors are grateful to all the women and men who contributed to the study, and the reviewers’ comments on the previous version of this article.Peer reviewedPublisher PD

Non-invasive techniques for predicting soft tissue during pressure induced ishaemia.

PhDSoft tissue breakdown occurs in association with biochemical changes that can be attributed to a reduction in blood and lymph flow to a localised tissue area in response to applied pressure. The resulting ischaemia can lead to a reduction in available oxygen and accumulation of waste products. Tissue breakdown leading to the development of pressure sores afflicts patients who are already debilitated, although not all patients appear to be equally susceptible. Measurement of sweat biochemistry and blood gas tensions may reflect the biochemical process in the underlying tissues and provide a simple and non-invasive method of investigating the status of soft tissues. The potential of specific sweat metabolites to act as markers of soft tissue status during and following loading has been investigated at a clinically relevant site in healthy volunteers, and in two clinically relevant patient groups. A range of validation procedures were undertaken and a series of parameters derived to investigate the temporal profile of sweat biochemistry, and identify various modes of gas tension response. Investigations at the loaded sacrum of healthy individuals showed a statistically significant increase in sweat lactate, urea, urate and chloride concentrations which were dependent upon the level of externally applied pressure. Mean increases of between 10%-60% were demonstrated for sweat metabolite concentrations at the loaded site compared to the control site for applied pressures in the range 40-120 mmHg. Similar increases were demonstrated in sweat collected from highly loaded tissue areas within the stump socket of lower limb amputees. A threshold value for P02 tension was identified, amounting to a 60% reduction from the unloaded value, which was associated with elevated tissue carbon dioxide levels as well as increased sweat metabolite concentrations in the loaded phase. This finding may provide a useful predictor of soft tissue status during prolonged loading. No pessimist ever discovered the secrets of the stars, or sailed to an uncharted land, or opened a new heaven to the human spirit. Helen Adam

Institutional work at field-configuring events:shaping industry change within sustainable transitions

Adopting an institutional approach from organization studies, this paper explores the role of key actors on “purposeful governance for sustainability” (Smith, Voss et al. 2010: 444) through the case of smart metering in the UK. Institutions are enduring patterns in social life, reflected in identities, routines, rules, shared meanings and social relations, which enable, and constrain, the beliefs and behaviours of individual and collective actors within a field (Thornton and Ocasio 2008). Large-scale external initiatives designed to drive regime-level change prompt ‘institutional entrepreneurs’ to perform ‘institutional work’ – “purposive action aimed at creating, maintaining and disrupting institutions” (Lawrence and Suddaby, 2006). Organization scholars are giving increasing attention to ‘field-configuring events’ (FCEs) which provide social spaces for diverse organizational actors to come together to collectively shape socio-technical pathways (Lampel and Meyer 2008). Our starting point for this exploratory study is that FCEs can offer important insights to the dynamics, politics and governance of sustainability transitions. Methodologically, FCEs allow us to observe and “link field evolution at the macro-level with individual action at the micro-level” (Lampel and Meyer, 2008: 1025). We examine the work of actors during a series of smart metering industry forums over a three-year period (industry presentations [n= 77] and panel discussions [n= 16]). The findings reveal new insights about how institutional change unfolds, alongside technological transitions, in ways that are partial and aligned with the interests of powerful incumbents whose voices are frequently heard at FCEs. The paper offers three contributions. First, the study responds to calls for more research examining FCEs and the role they play in transforming institutional fields. Second, the emergent findings extend research on institutional work by advancing our understanding of a specific site of institutional work, namely a face-to-face inter-organizational arena. Finally, in line with the research agenda for innovation studies and sustainability transitions elaborated by Smith et al (2010), the paper illustrates how actors in a social system respond to, translate, and enact interventions designed to promote industrial transformation, ultimately shaping the sustainability transition pathway

Achieving continuous improvement through self-assessment

In 2007 the UK Office of Government Commerce was mandated to carry out Procurement Capability Reviews (PCR) across the 16 top spending UK Government Departments. Since then, this programme has evolved into a self assessment based approach which is markedly different from the original approach. Will the move from a centre-led strategic review of procurement capability to a department-led model based on self assessment continue to strengthen and improve procurement capability across Central Civil Government? OGC is currently working with UK Government Departments to carry out their PCRs using a self-assessment tool which incorporates qualitative and quantitative measures. Results are generated based on a capability maturity model. The results are assured independently. OGC expectations are that tangible and measurable capability improvements will be realised when departments embed the self-assessment model and implement the findings as part of a continuous improvement regime. This paper is a case study, using some relevant literature to reflect on past and possible future development of the PCR self assessment scheme