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Taking a "care pathway/whole systems" approach to equality diversity inclusion (EDI) in organ donation and transplantation in relation to the needs of "ethnic/racial/migrant" minority communities: a statement and a call for action
Get PDFInternational evidence shows variation in organ donation and transplantation (ODT) based upon a range of patient characteristics. What is less well understood is the impact of patient "ethnicity/race/immigration background," as these terms are defined and intended differently across countries. We also know that these characteristics do not operate in isolation but intersect with a range of factors. In this paper, we propose a framework that seeks to clarify the definition of the key terms "ethnicity/race/migrant" and to review how these communities are operationalized across European studies about inequities in ODT. Further, patients and the public wish to see Equality Diversity Inclusion (EDI) approaches in their everyday lives, not just in relation to ODT. We propose a 'care pathway/whole-systems' approach to ODT encompassing culturally competent public health interventions for a) the prevention and management of chronic diseases, b) improvements in public engagement for the promotion of the culture of ODT and enhancements in end-of-life care, through to c) enhanced likelihood of successful transplant among migrant/ethnic minority communities. Our framework recognizes that if we truly wish to take an EDI approach to ODT, we need to adopt a more social, human and holistic approach to examining questions around patient ethnicity
The systematic development of guidance for parents on talking to children of primary school age about weight
Get PDFBackground: The prevalence of overweight and obesity in children is increasing, alongside increases in rates of children’s anxiety and worry about their weight. In many countries children’s weight is measured, and parents are made aware if a child has been classified as having overweight or obesity. However, many parents are concerned that raising their child’s awareness of their weight, and talking to children about their weight could harm their wellbeing. The aim of this project was to develop guidance for parents on constructive ways to talk to children of primary school age about weight when they need to. Methods: The project followed a mixed-methods design: Phase 1 involved the collation of evidence including (a) two previously published systematic literature reviews to identify the associations between parent-child weight talk, and broader health discussions, and children’s wellbeing, (b) interviews with children, and (c) development and refinement of narrative messaging (previously published). In Phase 2 we developed a conceptual model and mapped primary findings to techniques and content within a draft guidance document for parents on talking to children about weight. Phase 3 involved a modified Delphi process with 29 stakeholders to refine and agree a final version. Results: An acceptable draft guidance was agreed following two stages of feedback from Delphi participants. Key areas for debate and adaptation included: encouraging discussion about health and growth with lesser focus on weight; finding ways to reduce stigma and perceptions of blame; emphasising a whole-family approach; inclusive representation of diversity among children and families. Conclusions: Consensus on the content of guidance for parents on talking to children about weight was achieved through a process of evidence review and stakeholder and expert engagement. The next steps are to measure the impact of the resource on improving the experience of parents and children in communicating about weight
A systematic review and thematic synthesis of inpatient nursing staff experiences of working with high-risk patient behaviours
Get PDFIntroduction Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours.AimThe aim of the study was to examine nursing staff experiences of high-risk behaviours in inpatient mental health settings.MethodsFour electronic databases (CINAHL, Medline, PsycINFO, EMBASE) were searched. The protocol for this review was prospectively registered in PROSPERO (Ref: CRD42022334739). A meta-synthesis of nursing staff's experiences of high-risk behaviours in inpatient mental health settings was conducted.ResultsWe identified 30 eligible studies. Six themes were constructed from the meta-synthesis: the social contract of care; the function of risk behaviours; the expectation of risk; risk as a relational concept; navigating contradictions in care; the aftermath.DiscussionNursing staff conceptualize risk as a meaningful behaviour shaped by patient, staff and environmental factors. Managing risk is an ethical dilemma for nursing staff and they require more training and support in ethical risk decision-making.Implications for PracticeInpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours.Relevance StatementNursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. This systematic review offers insights into how high-risk behaviours are experienced by nursing staff and makes recommendations about how to improve the understanding and management of them. Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours
Training for the impossible? induction and identity formation among trainee teachers and psychoanalysts
Get PDFThis article explores the systems under which teachers and psychoanalysts are trained in England and how trainees in these professions are inducted into their respective cultures. Both of these were deemed as ‘impossible professions’ in Freud’s evocative phrase and the authors enquire whether the training and resulting process of identity formation make teaching and psychoanalysis particularly open to such notions of ‘impossibility’. The article acknowledges the complex and demanding routes offered to new entrants into these fields and how the person-centred aspects of both disciplines leave trainees susceptible to a certain professional and personal vulnerability. It is argued such vulnerability requires a particularly strong sense of belonging as part of the trainees’ formation of identity. Processes such as effective mentoring, supervision and peer support are critical to ensuring new entrants are able to complete the course of training relatively unscathed and with a balanced idea of who they are and where they stand within their respective areas of work
UE admittance and contention free resource allocation for interference mitigation in HetNet cognitive femtocells
Get PDFFemtocells are designed to co-exist alongside macrocells providing higher spectrum efficiency, spatial frequency reuse, to name a few. However, when deployed in the two-tier architecture with macrocells, interference is imminent thereby it is necessary to mitigate the inherent co-tier and cross-tier interference. The integration of cognitive radio (CR) in femtocells introduces the ability of femtocells to dynamically adapt to varying network conditions through learning, adapting, and reasoning leading to informed decisions. This paper proposes a joint threshold power based admittance and contention free resource allocation scheme (known as Proposed SA) for interference mitigation in HetNet cognitive femtocells (CF). In the proposed SA, a CF sets a threshold value on the mutual interference between itself and a close-by mobile user equipment (MUE). To mitigate cross-tier interference, a CF classifies MUEs which fall above this threshold value (high interference value) as Undesired MUEs (UMUEs), whereas MUEs which fall below this threshold are classified as Desired MUEs (DMUEs). To mitigate co-tier interference, proposed SA introduces a scheduling engine which employs matching policy attributes and assigns resource blocks (RBs) of unique DMUEs to CFs to avoid any possible contention problems, thus providing improved co-tier interference. System level simulations have been performed to demonstrate working and effectiveness of proposed SA. Key performance indicators including choice of maximum transmit power for MUE, co and cross tier interference mitigation, as well impact of MUE mobility has been investigated. Performance analysis of the Proposed SA has also found that the scheme performs much better in relation to a random spectrum assignment (Random SA) scheme. The proposed SA caters the mobility of the MUEs very well allowing more and more admittance thereby providing improved interference results and making it a viable candidate for Femtocell Access points (FAPs) implementation
Researching sensitive topics with children and young people: ethical practice and blurry boundaries
Get PDFDespite representing a vast and global concern, the narratives of children who experience child sexual exploitation (CSE) and access associated services are marginalised within research. As an outcome, relatively little is known about how children cope with the impact and consequences of their experiences. This paper draws together methodological insights from researchers reflecting upon three distinct pieces of qualitative fieldwork conducted with children and young people considered ‘vulnerable’ to, and ‘at risk of’, CSE. In doing so, we seek to recognise the challenges encountered when conducting research with vulnerable populations and explore the ‘blurry boundaries’ that researchers tread in order to balance competing power dynamics. This paper will discuss potential safeguarding concerns that arise when conducting sensitive research and will share our experiences of supporting young people to take part in research around child sexual exploitation. We will reflect upon the research process to highlight some of the strategies adopted to enable young people to engage in data collection safely. We consider the dynamic ethical practices that take place in the moment of research encounters, alongside the framework of procedural ethics, to conclude that both are fundamental to enable meaningful participation in research
Boosting smarter digital healthcare with 5G and beyond networks
Get PDFWith 5G and beyond on the horizon, ultra-fast and low latency data transmission on the cloud and via the Internet will enable more intelligent and interactive medical and health-care applications. This paper presents a review of 5G technologies and their related applications in the health-care sector. The introduction to 5G technology includes software defined network, 5G architecture and edge computing. The second part of the paper then presents the opportunities provided by 5G to the health-care sector and employs medical imaging applications as central examples to demonstrate the impacts of 5G and the cloud. Finally, this paper summarize the benefits brought by 5G and cloud computing to the health-care sector
Risk of low birthweight and late antenatal care initiation in an ethnically diverse maternal cohort
Get PDFBackground Babies born with low birthweight (LBW,< 2500 g) are vulnerable to infant mortality, restricted growth, poorer development, and long-term health complications. Antenatal care (ANC) can improve maternal and infant outcomes; women are recommended to have first antenatal visit by 10 weeks’ gestation. Ethnic minority women are significantly more likely to initiate ANC later than recommended gestational week compared to white women. This study examined associations between late ANC initiation (first appointment >10 weeks gestation) and LBW in an ethnically diverse maternal cohort in the UK. Methods A retrospective cross sectional study using routinely collected anonymous data of singleton births during April 2015 - October 2022 from a large UK National Health Service maternity unit in an ethnically diverse area. Logistic regression models were used to examine associations between late ANC initiation and prevalence of low (<2500 g); very low (VLBW, <1500 g) and extremely low (ELBW, <1000g) birth weight. Results Of 39,785 singleton births recorded, more than one third (34.6%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds. Birthweight was reported for 39,698 (99.78%) neonates; among them 8.9% had LBW, including 1.0% VLBW and 1.1% ELBW. More than one third (34.8%) of mothers had first appointment at > 10 weeks, including 26% during 11-19 weeks and 8.8% at > 20 weeks. Late ANC initiation was associated with increased risk of LBW for neonates: OR = 1.15 [95% CI: 1.07, 1.23] and 1.60 [1.44, 1.78] for ANC initiation at > 10 weeks and ≥20 weeks respectively (vs ≤ 10 weeks). Mothers who started care at ≥ 20 weeks were 5.37 times (95% CI: 4.31, 6.70) more likely to have a baby born with ELBW (vs ≤ 10 weeks). Conclusions Neonates born to mothers who started antenatal care late in ethnically diverse neighborhoods are more likely to have low birthweight, highlighting the need for targeted primary and secondary interventions
Strategies to improve the magnetic resonance imaging experience for autistic individuals:a cross-sectional study exploring parents and carers’ experiences
Get PDFBackground: Autistic individuals encounter numerous barriers in accessing healthcare, including communication difficulties, sensory sensitivities, and a lack of appropriate adjustments. These issues are particularly acute during MRI scans, which involve confined spaces, loud noises, and the necessity to remain still. There remains no unified approach to preparing autistic individuals for MRI procedures. Methods: A cross-sectional online survey was conducted with parents and carers of autistic individuals in the UK to explore their experiences, barriers, and recommendations concerning MRI scans. The survey collected demographic information and experiential accounts of previous MRI procedures. Quantitative data were analysed descriptively, while key themes were identified within the qualitative data through inductive thematic analysis. Results: Sixteen parents/carers participated. The majority reported difficulties with communication, inadequate pre-scan preparation, and insufficient adjustments during MRI scans for their autistic children. Key barriers included an overwhelming sensory environment, radiographers’ limited understanding of autism, and anxiety stemming from uncertainties about the procedure. Recommended improvements encompassed accessible communication, pre-visit familiarisation, noise-reduction and sensory adaptations, staff training on autism, and greater flexibility to meet individual needs. Conclusions: There is an urgent need to enhance MRI experiences for autistic individuals. This can be achieved through improved staff knowledge, effective communication strategies, thorough pre-scan preparation, and tailored reasonable adjustments. Co-producing clear MRI guidelines with the autism community could standardise sensitive practices. An individualised approach is crucial for reducing anxiety and facilitating participation. Empowering radiographers through autism-specific education and incorporating insights from autistic individuals and their families could transform MRI experiences and outcomes.</p
A horizon scan of issues affecting UK forest management within 50 years
Get PDFForests are in the spotlight: they are expected to play a pivotal role in our response to society's greatest challenges, such as the climate and biodiversity crises. Yet, the forests themselves, and the sector that manages them, face a range of interrelated threats and opportunities. Many of these are well understood, even if the solutions remain elusive. However, there are also emerging trends that are currently less widely appreciated. We report here the results of a horizon scan to identify developing issues likely to affect UK forest management within the next 50 years. These are issues that are presently under-recognized but have potential for significant impact across the sector and beyond. As the forest management sector naturally operates over long timescales, the importance of using good foresight is self-evident. We followed a tried-and-tested horizon scanning methodology involving a diverse Expert Panel to collate and prioritize a longlist of 180 issues. The top 15 issues identified are presented in the Graphical Abstract. The issues represent a diverse range of themes, within a spectrum of inf luences from environmental shocks and perturbations to changing political and socio-economic drivers, with complex emerging interactions between them. The most highly ranked issue was 'Catastrophic forest ecosystem collapse', ref lecting agreement that not only is such collapse a likely prospect but it would also have huge implications across the sector and wider society. These and many of the other issues are large scale, with far-reaching implications. We must be careful to avoid inaction through being overwhelmed, or indeed to merely focus on 'easy wins' without considering broader ramifications. Our responses to each of the challenges and opportunities highlighted must be synergistic and coherent, involving landscape-scale planning. A more adaptive approach to forest management will be essential, encouraging continual innovation and learning. The 15 horizon scan issues presented here are a starting point on which to build further research, prompt debate and action, and develop evidence-based policy and practice. We hope that this stimulates greater recognition of how our forests and sector may need to change to be fit for the future. In some cases, these changes will need to be fundamental and momentous.</p
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