Barriers and facilitators to pressure ulcer prevention behaviours by older people living in their own homes and their lay carers: a qualitative study

OBJECTIVE

To identify barriers and facilitators to pressure ulcer prevention behaviours in community-dwelling older people and their lay carers.

DESIGN

Theoretically informed qualitative interviews with two-phase, deductive then inductive, thematic analysis.

SETTING

The study was conducted in one geographical region in the UK, spanning several community National Health Service Trusts.

PARTICIPANTS

Community-dwelling older patients at risk of pressure ulcer development (n=10) and their lay carers (n=10).

RESULTS

Six themes and subthemes were identified: (1) knowledge and beliefs about consequences (nature, source, timing and taboo); (2) social and professional role and influences (who does what, conflicting advice and disagreements); (3) motivation and priorities (competing self-care needs and carer physical ability); (4) memory; (5) emotion (carer exhaustion and isolation, carergiver role conflict and patient feelings) and (6) environment (human resource shortage and equipment).

CONCLUSIONS

There is minimal research in pressure ulcer prevention in community-dwelling older people. This study has robustly applied the theoretical domains framework to understanding barriers and facilitators to pressure ulcer prevention behaviours. Our findings will support co-design of strategies to promote preventative behaviours and are likely to be transferable to comparable healthcare systems nationally and internationally.

Understanding the Five-Year Outcomes of Abusive Head Trauma in Children: A Retrospective Cohort Study

Understanding the long-term medical and developmental outcomes for children who survive abusive head trauma (AHT) is important to ensure necessary supports and services are available. This study examined the retrospective global and specific medical and developmental outcomes of 55 children with AHT who were treated at The Children's Hospital at Westmead. Global outcomes were assessed using the Kings Outcome Scale of Childhood Head Injury (KOSCHI). Five years post-injury, one child had died and two had made a complete recovery. Forty-five children (81.8%) had a moderate or severe disability, an increase from 64.5% at acute discharge. At follow-up, the main impairments were behavioral problems (53%), vision impairment (44%), fine motor difficulties (26%), gross motor problems (26%), communication problems (24%) and 16% had seizures. A Spearman's Rank correlation revealed that only 41% of variance in KOSCHI scores five years post-injury could be accounted for KOSCHI scores at the time of acute discharge (rs(55) = 0.638, p < .001), and many children's presentation was worse at follow-up. Therefore, all children presenting with AHT need long term follow up regardless of early indications of good recovery.

Short term outcomes of children with abusive head trauma two years post injury: A retrospective study

PURPOSE

Abusive head trauma (AHT) can have debilitating sequelae for children who survive. A retrospective medical record review was used to describe short-term developmental outcomes of children with AHT and identify predictors of poorer outcomes.

METHOD

Children with AHT who received follow up by the hospital's rehabilitation department for 12 to 24 months post-injury were included in this review. Data for 85 children were collected on hearing, vision, gross motor, fine motor, speech and language, cognition, play, adaptive functioning, behaviour and personal-social skills.

RESULTS

Global assessment found 42% of children had a good recovery, 34% had a moderate disability and 24% had a severe disability. For whom there was data, more than half had abnormal cognition, behaviour and personal-social skills, whilst more than a third had abnormal speech and language, neurological signs on last assessment, vision, play skills, and gross and fine motor skills. Factors that predicted poorer prognosis across all developmental domains included paediatric intensive care unit admission, longer length of hospital stay, breathing difficulty and lower Glasgow Coma Scale on presentation.

CONCLUSION

This study highlights the substantial number of children who have abnormal development in the short-term post-AHT and assists in identifying those who require extensive long-term follow up.

Social determinants of psychological wellness for children and adolescents in rural NSW

Background

The mental wellness of children and adolescents in rural Australia is under researched and key to understanding the long-term mental health outcomes for rural communities. This analysis used data from the Australian Rural Mental Health Study (ARMHS), particularly the parent report Strengths and Difficulties Questionnaire (SDQ) measure for children under 18 years old and their reporting parent’s demographic information to compare this sample’s mental wellness scores to the Australian norms and to identify what personal, family, community and rurality factors contribute to child mental wellness as pertaining to the SDQ total and subdomain scores.

Method

Five hundred thirty-nine children from 294 families from rural NSW were included. SDQ scores for each child as well as personal factors (sex and age), family factors (employment status, household income and sense of community of responding parent), community SES (IRSAD) and rurality (ASCG) were examined.

Results

Children and adolescents from rural areas had poorer mental wellness when compared to a normative Australian sample. Further, personal and family factors were significant predictors of the psychological wellness of children and adolescents, while after controlling for other factors, community SES and level of rurality did not contribute significantly.

Conclusions

Early intervention for children and families living in rural and remote communities is warranted particularly for low income families. There is a growing need for affordable, universal and accessible services provided in a timely way to balance the discrepancy of mental wellness scores between rural and urban communities.

Consumer participation in service evaluation and quality improvement: key ingredients for a system to deliver national indicators

OBJECTIVES

The aim of this paper is to describe the fundamental components of a system to ensure consumer participation in mental health service evaluation and quality improvement.

CONCLUSIONS

The seven fundamental components identified provide the basis for a system to deliver national indicators for consumer participation in quality improvement under the National Health Performance domain of "responsiveness to consumers". The MH-CoPES Framework satisfies these criteria and may be drawn upon as the basis for developing local systems for consumer participation in quality improvement within mental health services.

Building consumers in to service evaluation: development of the MH-CoPES Framework in New South Wales

OBJECTIVE

The aim of this paper is to present the Mental Health Consumer Perceptions and Experiences of Services (MH-CoPES) Framework and discuss its development. The Framework was developed to address the need for a consistent approach across New South Wales mental health services for consumer involvement in service evaluation and planning.

CONCLUSIONS

A four step Framework has been developed for implementation across adult public mental health services in NSW. The Framework focuses not only on collecting consumers' views of mental health services but on ensuring that procedures to report on and make changes based on this information are in place.

Erythropoietin in thyroid cancer

Erythropoietin (Epo) and the epo-receptor (EpoR) have been implicated in tumor growth, invasion and metastasis. We previously demonstrated Epo and EpoR expression in a small group of archived papillary thyroid cancers (PTC), but were unable to examine functional integrity using formalin-fixed tissues. In the present study, we examined the in vitro expression, induction and function of Epo and EpoR in papillary (NPA), follicular (WRO) and anaplastic (ARO-81) thyroid cancer cells. We found that all three cell lines expressed Epo and EpoR mRNA and that the hypoxia-mimetic cobalt induced Epo expression in all cell lines. None of the growth factors we examined (thyrotropin, vascular endothelial growth factor, IGF-I, or human Epo) altered Epo or EpoR gene expression. Importantly, however, administration of Epo to NPA but not WRO cells resulted in significant alterations in the expression of several mitogenic genes including cyclooxygenase-2 (COX-2), beta-casein (CSN2), wild type p53-induced gene-1 (WIG1) and cathepsin D (CTSD). Epo treated ARO-81 cells only had an increase in CSN2 expression. We conclude that Epo and EpoR are expressed by thyroid cancers and that stimulation of the Epo/EpoR signal pathway results in changes that could impact on the clinical behavior of thyroid cancers.

Making sense of universal precautions

Universal precautions are a way of reducing risks to patients, clients and health-care professionals from infection via body fluids. This paper outlines the principles underlying universal precautions, and looks at the practicalities of their implementation.

Anxiety and perception of risk of HIV and hepatitis B infection among health-care workers reporting accidental exposures to blood and other body fluids

We noticed considerable variation in anxiety among staff reporting blood exposure incidents and therefore undertook a study to investigate this. We studied 100 consecutive staff reporting blood or other body fluid exposures to the Occupational Health Unit. The nurse seeing the staff member administered a questionnaire about worries related to the incident, knowledge of HIV and hepatitis B transmission risks, perception of risk from the particular incident and predicted reaction of others that would be told. Level of anxiety was recorded on a visual analogue scale. Staff were then given information and counselling as usual, and asked to re-attend after a week, when the questionnaire was repeated. We found that the initial level of anxiety was not related to knowledge of HIV or hepatitis B transmission risks, but was related to perception of risk from the incident and to predicted reaction of others that would be told. The eight staff involved in exposures to known HIV-infected blood were not more anxious than the remainder. There was a reduction in anxiety between visits, which was significantly greater in women, in those who had a non-parental exposure and in those where the source patient was known. Knowledge of transmission risks also improved significantly between visits. This study underlines the importance of adequate counselling of staff who have suffered blood exposures.

Review of management of incidents involving exposure to blood in a London teaching hospital, 1989-91

OBJECTIVE

To review management of incidents involving exposure to blood reported to an occupational health unit.

DESIGN

Analysis of all reported incidents from January 1989 to June 1991.

SETTING

London teaching hospital.

SUBJECTS

447 health care workers and students.

MAIN OUTCOME MEASURES

Immunisation against hepatitis B virus before exposure, proportion of known source patients tested for hepatitis B surface antigen and HIV antibodies, and reasons for not testing known source patients.

RESULTS

447 incidents were reported: 337 sharps injuries and 110 other exposures. 310 staff reporting incidents (205 (82%) nurses) were already immune to hepatitis B virus, nearly always because of immunisation. 345 source patients were identified, 77 of whom had already been tested for hepatitis B surface antigen (28 positive results) and 58 for HIV antibodies (18 positive results). Of those not previously tested, 145 of 266 were subsequently tested for hepatitis B surface antigen (two positive) and 149 of 287 for HIV antibodies (none positive). The main reasons for not testing source patients were that the incident was not considered a risk, that the patient had gone home, and that the clinical team were unwilling to ask the patient. Specific hepatitis B immunoglobulin was given to 18 staff who were not immune and was avoided in 11 cases by a negative result for the patient. Prophylactic zidovudine was discussed but not given to any staff member.

CONCLUSIONS

Management of exposure to blood is improved by widespread immunisation against hepatitis B virus and by knowledge of source patients' hepatitis B virus and HIV status.

Analysis of ST-segment changes in normal subjects: implications for ambulatory monitoring in angina pectoris

Continuous monitoring of the electrocardiogram in patients with angina pectoris and coronary artery disease (CAD) has shown episodes of asymptomatic ST-segment depression, suggesting frequent silent myocardial ischemia during normal daily life. Interpretation of this new finding depends on whether similar changes occur in normal subjects. Frequency-modulated ambulatory electrocardiographic recordings were performed in 80 asymptomatic normal volunteers (20 from each decade between 20 and 50 years and, 20 more than 50 years old) and in 20 patients with noncardiac pain, negative exercise and provocative tests and angiographically normal coronary arteries. Treadmill exercise testing was performed in all subjects more than 40 years old. Episodes of T-wave change were identified in 53 subjects. Five subjects younger than 40 years had episodes of ST elevation that were prolonged; they usually occurred at night. In 3 patients they could be reproduced by postural change. Only 2 subjects, both older than 40 years had planar ST depression during tachycardia; one of these subjects had a positive exercise test response. No patient with normal coronary arteries had significant ST depression. Tachycardia was frequently associated with upsloping ST depression (36%), which was more common in younger subjects: Five subjects also showed isolated single complexes with ST depression during baseline instability. With use of frequency-modulated recordings, transient ST depression of 0.1 mV or greater that lasted 80 ms or longer and more than 30 seconds in duration, was rare in a normal population. This finding supports the use of this signal to follow the activity of CAD out of the hospital, specifically in patients with typical angina and proved CAD.