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A comparison of the performance of the Braden Q and the Glamorgan paediatric pressure ulcer risk assessment scales in general and intensive care paediatric and neonatal units
No full textAbstract
Aims
To compare the predictive ability of two risk asses
sment scales used in children.
Background
There are several risk assessment scales (RASs) emp
loyed in paediatric settings but most have been
modified from adult scales such as the Braden Q whe
reas the Glamorgan was an example of a scale
designed for children.
Methods
Using incidence data from 513 paediatric hospital a
dmissions, receiver operating characteristic
(ROC) was employed to compare the two scales. The a
rea under the curve (AUC) was the outcome of
interest.
Results
The two scales were similar in this population in t
erms of area under the curve. Neonatal and
paediatric intensive care were similar in terms of
AUC for both scales but in general paediatric wards
the Braden Q may be superior in predicting risk.
Conclusion
Either scale could be used if the predictive abilit
y was the outcome of interest. The scales appear to
work well with neonatal, paediatric intensive care
and general children’s wards. However the
Glamorgan scale is probably preferred by childrens’
nurses as it is easy to use and designed for use i
n
children. There is some suggestion that while the t
wo scales are similar in intensive care, for genera
l
paediatrics the Braden Q may be the better scale
Drop punt kicking induces eccentric knee flexor weakness associated with reductions in hamstring electromyographic activity
No full textObjectives: To examine the effect of 100 drop punt kicks on isokinetic knee flexor strength and surface electromyographic (sEMG) activity of bicep femoris (BF) and medial hamstrings (MH). Design: Randomised control study. Methods: Thirty-six recreational footballers were randomly assigned to kicking or control groups. Dynamometry was conducted immediately before and after the kicking or 10 minutes of sitting (control). Results: Eccentric strength declined more in the kicking than the control group (p < 0.001; d = 1.60), with greater reductions in eccentric than concentric strength after kicking (p = 0.001; d = 0.92). No significant between group differences in concentric strength change were observed (p = 0.089; d = 0.60). The decline in normalized eccentric hamstring sEMG (BF and MH combined) was greater in the kicking than the control group (p < 0.001; d =1.78), while changes in concentric hamstring sEMG did not differ between groups (p = 0.863; d = 0.04). Post-kicking reductions in sEMG were greater in eccentric than concentric actions for both BF (p = 0.008; d = 0.77) and MH (p < 0.001; d = 1.11). In contrast, the control group exhibited smaller reductions in eccentric than concentric hamstring sEMG for BF (p = 0.026; d = 0.64) and MH (p = 0.032; d = 0.53). Reductions in BF sEMG were correlated with eccentric strength decline (R = 0.645; p = 0.007). Conclusions: Reductions in knee flexor strength and hamstring sEMG are largely limited to eccentric contractions and this should be considered when planning training loads in Australian Football
Determining the kinematic properties of an advancing front using a decomposition method
No full textIn applications where partial differential equations are used to model populations, there is frequently a critical density
threshold below which the population cannot be detected in practice and the corresponding position is often termed the
leading edge of the distribution. Historically this position has been investigated for large time problems, but little attention has been afforded to understanding its short term dynamics. In this work we describe a novel approach, utilizing the Laplace decomposition method, that generates algebraic expressions for
the initial kinematic properties of the leading edge in terms of the initial data and model parameters. The method is demonstrated on two well-studied partial differential equations and two established systems of equations (representing the growth of fungal networks), all of which display travelling fronts. The kinematics of these advancing fronts are determined using our method and are shown to be in excellent agreement with both exact solutions and numerical approximations of the model equations
Wales and the German Democratic Republic: Expressions and perceptions of Welsh identity during the Cold War
No full textThis thesis examines relations between Wales and the German Democratic Republic (GDR) during the Cold War period of 1949 to 1990. Previous studies have investigated who in Britain interacted with the GDR and their motivations for doing so. The appeal of particular groups and demographics to the GDR authorities - in pursuit of foreign policy objectives - are also well documented. This study is driven by two research questions:
i) the identity and motivations of Welsh individuals or organisations approaching and engaging with the GDR and considering to what extent their ‘Welsh identity’ influenced their positioning vis-à-vis the GDR and the Cold War;
ii) the extent of Welsh acceptance of any overtures made by a socialist state, including the likely resonance of the GDR’s self-promotion as an anti-fascist, egalitarian state, which sought to protect and develop the rights of its own Sorbian minority culture. The research approach adopted for the thesis has considered how multiple projections of ‘Welshness’ influenced the expression of, and thus the GDR’s perception and understanding of Welsh identity. The findings from this research suggest that the most intriguing and recurrent interactions between Wales and the GDR occurred as a result of concerns for the status of the Welsh language during the Cold War period, encouraged by the GDR’s domestic policy for its own Sorbian minority. This study thus contributes a further category of Welsh-speakers to those identified in the existing scholarship as having interacted with the GDR. Notwithstanding Welsh-Sorbian interactions, this research also determines that other facets of Welsh life sought to engage with the GDR, including representatives of the friendship movement, the Welsh proletariat and left-leaning politicians who believed that establishing relations with the GDR would facilitate détente and peaceful co-existence. Existing assumptions in the field are further strengthened by this thesis’ findings, including the GDR’s methods and approaches for cultivating relationships with the West. Varying projections of Welsh identity prompted different (and often confused and inappropriate) responses from the GDR authorities. By evaluating a range of Welsh-GDR interactions throughout the Cold War period, the findings of this research contribute an alternative Welsh narrative to the field of British-GDR relations
Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England
No full textObjective: To implement parent-oriented discharge
planning (Train-to-Home) for preterm infants in
neonatal care.
Design: Before and after study, investigating the
effects of the intervention during two 11-month
periods before and after implementation.
Setting: Four local neonatal units (LNUs) in South
West England.
Participants: Infants without major anomalies born at
27–33 weeks’ gestation admitted to participating units,
and their parents.
Train-to-Home intervention: A family-centred
discharge package to increase parents’ involvement
and understanding of their baby’s needs, comprising a
train graphic and supporting care pathways to facilitate
parents’ understanding of their baby’s progress and
physiological maturation, combined with improved
estimation of the likely discharge date.
Main outcome measures: Perceived Maternal
Parenting Self-Efficacy (PMP S-E) scores, infant length
of stay (LOS) and healthcare utilisation for 8 weeks
following discharge.
Results: Parents reported that the Train-to-Home
improved understanding of their baby’s progress and
their preparedness for discharge. Despite a lack of
change in PMP S-E scores with the intervention, the
number of post-discharge visits to emergency
departments (EDs) fell from 31 to 20 ( p<0.05), with a
significant reduction in associated healthcare costs
(£3400 to £2200; p<0.05) after discharge. In both
study phases, over 50% of infants went home more
than 3 weeks before their estimated date of delivery
(EDD), though no reduction in LOS occurred.
Conclusions: Despite the lack of measurable effect on
the parental self-efficacy scores, the reduction in ED
attendances and associated costs supports the
potential value of this approach.This is the first study to measure the impact of a
neonatal family-centred care intervention on parental
self-efficacy or use of emergency department
(ED) post-discharge for moderately
preterm infants.
▪ Health economic data collection was available for
most families which facilitated a detailed analysis
of the costs of healthcare usage following
discharge.
▪ The lack of time for implementing the
Train-to-Home intervention meant that some
staff were not confident in using the familycentred
approach to discharge planning.
▪ The quasi-experimental study design (before and
after) was also a limitation in that the changes in
outcome measures were not randomised
between units, but there were no significant differences
in the infant or maternalThe project was funded by the National Institute for Health Research
(NIHR) Health Services and Delivery Research programme ( project number
11/1015/09)
The ManVan: a mobile cancer support service for men with prostate, testicular and penile cancer in Wales
No full textThe ManVan commenced service delivery on 1st April 2014 and is the United Kingdom’s first dedicated mobile support service for men
affected by prostate, testicular, and penile cancer. It is delivered in partnership with Prostate Cancer UK and Movember and fully funded by
the Movember Foundation. It brings nursing care, counselling for individuals and couples, group support and welfare rights advice, directly
to men living with prostate, testicular and penile cancer in communities across Wales. The ManVan has travelled extensively across Wales
during its first year, visiting 94 different locations, across all seven Local Health Board areas.
The first half of the year began with a Roadshow where we welcomed thousands of visitors on board, including men and women worried
by all sorts of cancer symptoms; their family and friends; health and social care professionals and politicians. The variety of venues the
ManVan has visited has included hospitals, supermarkets, social clubs, caravan fairs and rugby grounds to help raise awareness of the
ManVan service and identify potential clients. As expected the greatest proportion of visitors are male, particularly older men.
In the second half of the year, we focussed on our target audience – men diagnosed with prostate, testicular, or penile cancer and their
families. Using a targeted approach to urology clinics across NHS Wales, as well as community-based activity encouraging men from
ethnic minorities to visit, we have now taken on 161 clients, many of whom have received more than one ManVan service, and attended
on more than one occasion. Most of our clients have prostate cancer, are over the age of 55 years, and are married. Analysis of the
early data around the clinical and psychosocial benefits of the services offered on the ManVan is positive and the annualised value of
the benefits obtained for ManVan clients equates to more than £300,000 in this first year. There were 3,319 visitors to the ManVan in
total during the first year.The ManVan commenced service delivery on 1st April 2014 and is the United Kingdom’s first dedicated mobile support service for men
affected by prostate, testicular, and penile cancer. It is delivered in partnership with Prostate Cancer UK and Movember and fully funded by
the Movember Foundation. It brings nursing care, counselling for individuals and couples, group support and welfare rights advice, directly
to men living with prostate, testicular and penile cancer in communities across Wales. The ManVan has travelled extensively across Wales
during its first year, visiting 94 different locations, across all seven Local Health Board areas.
The first half of the year began with a Roadshow where we welcomed thousands of visitors on board, including men and women worried
by all sorts of cancer symptoms; their family and friends; health and social care professionals and politicians. The variety of venues the
ManVan has visited has included hospitals, supermarkets, social clubs, caravan fairs and rugby grounds to help raise awareness of the
ManVan service and identify potential clients. As expected the greatest proportion of visitors are male, particularly older men.
In the second half of the year, we focussed on our target audience – men diagnosed with prostate, testicular, or penile cancer and their
families. Using a targeted approach to urology clinics across NHS Wales, as well as community-based activity encouraging men from
ethnic minorities to visit, we have now taken on 161 clients, many of whom have received more than one ManVan service, and attended
on more than one occasion. Most of our clients have prostate cancer, are over the age of 55 years, and are married. Analysis of the
early data around the clinical and psychosocial benefits of the services offered on the ManVan is positive and the annualised value of
the benefits obtained for ManVan clients equates to more than £300,000 in this first year. There were 3,319 visitors to the ManVan in
total during the first year.The Movember Foundatio
Effect of high-speed running on hamstring strain injury risk
No full textBackground Hamstring strain injuries (HSIs) are common within the Australian Football League (AFL) with most occurring during high-speed running (HSR). Therefore, this study investigated possible relationships between mean session running distances, session ratings of perceived exertion (s-RPE) and HSIs within AFL footballers.
Methods Global positioning system (GPS)-derived running distances and s-RPE for all matches and training sessions over two AFL seasons were obtained from one AFL team. All HSIs were documented and each player's running distances and s-RPE were standardised to their 2-yearly session average, then compared between injured and uninjured players in the 4 weeks (weeks −1, −2, −3 and −4) preceding each injury.
Results Higher than ‘typical’ (ie, z=0) HSR session means were associated with a greater likelihood of HSI (week −1: OR=6.44, 95% CI=2.99 to 14.41, p<0.001; summed weeks −1 and −2: OR=3.06, 95% CI=2.03 to 4.75, p<0.001; summed weeks −1, −2 and −3: OR=2.22, 95% CI=1.66 to 3.04, p<0.001; and summed weeks −1, −2, −3 and −4: OR=1.96, 95% CI=1.54 to 2.51, p<0.001). However, trivial differences were observed between injured and uninjured groups for standardised s-RPE, total distance travelled and distances covered whilst accelerating and decelerating. Increasing AFL experience was associated with a decreased HSI risk (OR=0.77, 95% CI 0.57 to 0.97, p=0.02). Furthermore, HSR data modelling indicated that reducing mean distances in week −1 may decrease the probability of HSI.
Conclusions Exposing players to large and rapid increases in HSR distances above their 2-yearly session average increased the odds of HSI. However, reducing HSR in week −1 may offset HSI risk
The key features of effective drug, alcohol and tobacco education: The absence of craving
No full textSchools in England and Wales are required to teach a comprehensive drugs education programme in key stages 1 through to 4. A number of information sources are available to teachers covering the key features of effective drug, alcohol and tobacco education. A notable absence in the information available to teachers is the concept of ‘craving’. For many craving is central to drug use behaviour and will inevitably form apart of discussions concerning drug use and abuse. This article considers what craving is, what its importance in drug use behaviour is, and suggests that exclusion of specific reference to the term ‘craving’ is perhaps sensible given the uncertainty of it as a construct, but an appreciation of the complexity is necessary for appropriate drugs educatio
Knowledge acquisition through process mapping: Factors affecting the performance of work-based activity
No full textPurpose – Business improvement initiatives have benefit for both an organisation’s operational
effectiveness and its knowledge acquisition capabilities. These have a synergistic effect upon the
ability to gain and maintain competitive advantage. Among the multitude of approaches that can be
adopted process mapping (PMapping) is widely used. The purpose of this paper is to examine the
utilisation of PMapping for undertaking business process improvement and the resultant acquisition of
knowledge among those that are involved in its performance and the subsequent use of process
maps (PMaps).
Design/methodology/approach – Adopting the notion of "knowledge as knowing" and Activity
Theory as the research framework, a four-year Participatory Action Research study of three
organisations was conducted. Data were gathered through cyclically developed semi-structured
interviews, on-site observation and instantaneously sampled field notes.
Findings – It finds that PMapping is a useful technique for conducting business process
improvements and acquiring knowledge of organisations and their people. It also finds that PMaps are
useful knowledge repositories that have value beyond aiding the development of improved business
processes. Socialisation is a key determinant of knowledge coproduction and transfer. This study finds
that it occurs in formal and informal modes between individuals engaged in PMapping.
Research limitations/implications – The choice of PMapping technique may have significant
influence upon the knowledge that is acquired by individuals and organisations during business
process improvement initiatives. Future research should explore the relationship between PMapping
methods, their knowledge-generative potential and the usability of the resultant PMaps.
Practical implications – Organisations undertaking business process improvement initiatives
should take account of those factors that mediate its undertaking and its knowledge-generative
potential. The objectives of improvement initiatives and of specific activities such as PMapping need to
be carefully considered. Changes in objectives need clear communication and justification, and the
purpose and benefit of such changes must be weighed against the potential detrimental effect that they
may have upon the workforce. Inconsiderate goals setting and changing can lead to individuals
coming under significant psychological and sociological pressures.
Originality/value – This research furthers the understanding of knowledge acquisition and business
process improvement in non-manufacturing environments. It identifies the challenges involved in
adopting PMapping as a business improvement tool. It also provides insight into the use of the tool as a
technique for fostering knowledge acquisition in individuals
