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This commentary continues a dialogue which began among literacy teacher educators attending an alternative format session about mentoring in the academy at a national conference. Literacy teacher educators participated in an informal discussion centered on the nature of mentoring in the academy for doctoral students, untenured professors, and tenured professors. Doctoral students focused on their changing identities and roles in the academy, their concerns about navigating the political infrastructure of academia, and the importance of assuming a proactive stance towards obtaining mentoring, especially for part-time doctoral students. Untenured professors focused on the ways they were inventing and reinventing themselves within the power and politics of academia and their need for more holistic mentoring during these turbulent times. Tenured professors were able to embed mentoring experiences into their scholarly work and find ways to benefit or learn from mentoring experiences. These mentors also found comfort in more informal mentoring that included self-initiated endeavors centered on mutual interests. Our commentary draws on these discussions as well as the professional literature on mentoring to describe the importance of mutual trust and reciprocity in mentoring throughout all stages of academia with attention to cultural and linguistic diversity. (Contains 1 figure.)

Sociocultural theories provide a useful lens for interpreting behaviors as individuals enter contexts requiring social interactions. These theories help us understand that learning is stimulated and nourished by interactions with others, supporting a view that learning is essentially a socially inspired process. This emphasis on the social and cultural origins of knowledge, however, often minimizes dynamics related to individual development that influence how we respond to others and how others respond to us. Most relevant to this argument is information related to the influence of (a) the child's history of relationships, (b) the child's understanding of others and others' behavior, and (c) the child's cognitive perspective on the world. To account for these influences, the authors propose a model of collaborative literacy events (CLEs). The model merges understandings related to a sociocultural theory and individual development to broaden interpretations of children's behavior during socially mediated literacy events.

Summary This article highlights the need to improve care for older people dying in acute hospitals. It discusses the role that nurses have to play in promoting better care and [...]

Aims and objectives To explore, using the example of a project working with older people in an outpatient setting in a large UK NHS Teaching hospital, how the constructs of Person Centred Nursing are reflected in interviews from participants in a Co-design led service improvement project. Background Person Centred Care and Person Centred Nursing are recognised terms in healthcare. Co-design (sometimes called participatory design) is an approach that seeks to involve all stakeholders in a creative process to deliver the best result, be this a product, technology or in this case a service. Co-design practice shares some of the underpinning philosophy of Person Centred Nursing and potentially has methods to aid in Person Centred Nursing implementation. Research design The research design was a qualitative secondary Directed analysis. Methods Seven interview transcripts from nurses and older people who had participated in a Co-design led improvement project in a large teaching hospital were transcribed and analysed. Two researchers analysed the transcripts for codes derived from McCormack & McCance's Person Centred Nursing Framework. Results The four most expressed codes were as follows: from the pre-requisites: knowing self; from care processes, engagement, working with patient's beliefs and values and shared Decision-making; and from Expected outcomes, involvement in care. This study describes the Co-design theory and practice that the participants responded to in the interviews and look at how the co-design activity facilitated elements of the Person Centred Nursing framework. Conclusions This study adds to the rich literature about using emancipatory and transformational approaches to Person Centred Nursing development, and is the first study exploring explicitly the potential contribution of Co-design to this area. Implications for practice Methods from Co-design allow older people to contribute as equals in a practice development project, co-design methods can facilitate nursing staff to engage meaningfully with older participants and develop a shared understanding and goals. The co-produced outputs of Co-design projects embody and value the expressed beliefs and values of staff and older people. [ABSTRACT FROM AUTHOR]

Missed appointments are an avoidable cost and resource inefficiency which impact upon the health of the patient and treatment outcomes. Health care services are increasingly utilizing reminder systems to manage these negative effects. This study explores the effectiveness of reminder systems for promoting attendance, cancellations, and rescheduling of appointments across all health care settings and for particular patient groups and the contextual factors which indicate that reminders are being employed sub-optimally. We used three inter-related reviews of quantitative and qualitative evidence. Firstly, using pre-existing models and theories, we developed a conceptual framework to inform our understanding of the contexts and mechanisms which influence reminder effectiveness. Secondly, we performed a review following Centre for Reviews and Dissemination guidelines to investigate the effectiveness of different methods of reminding patients to attend health service appointments. Finally, to supplement the effectiveness information, we completed a review informed by realist principles to identify factors likely to influence non-attendance behaviors and the effectiveness of reminders. We found consistent evidence that all types of reminder systems are effective at improving appointment attendance across a range of health care settings and patient populations. Reminder systems may also increase cancellation and rescheduling of unwanted appointments. "Reminder plus", which provides additional information beyond the reminder function may be more effective than simple reminders (ie, date, time, place) at reducing non-attendance at appointments in particular circumstances. We identified six areas of inefficiency which indicate that reminder systems are being used sub-optimally. Unless otherwise indicated, all patients should receive a reminder to facilitate attendance at their health care appointment. The choice of reminder system should be tailored to the individual service. To optimize appointment and reminder systems, health care services need supportive administrative processes to enhance attendance, cancellation, rescheduling, and re-allocation of appointments to other patients. [ABSTRACT FROM AUTHOR]

Background: There is a lack of research into suffering and what it means to the individual patient with advanced cancer and its importance in end of life care. Aims: To explore the concept of suffering and distress by eliciting what individual patients with advanced cancer perceived as suffering and how they utilised their own resources to manage suffering. Method: A qualitative study design of focused narrative interviews analysed by thematic analysis was conducted with a heterogeneous sample of 49 palliative day care patients. Results: For those patients who perceived they were suffering, this study revealed a wide spectrum of definitions which could be described within the following areas; the unavoidable and avoidable suffering, physical and emotional suffering, suffering as loss and finally transformation through suffering. Conclusions: These findings provide important insight that broadens and enriches our understanding into the concept of suffering and how patients utilise their resources, which may have important implications for end of life care. [ABSTRACT FROM AUTHOR]

We report a patient with non-dermatomal radiating neck pain without focal neurologic deficit. Traditional workup could not identify an anatomic or biomechanical cause. Imaging showed a deep cervical vessel centered in the region of pain. Angiography later identified an aberrant anastomosis of this vessel with the occipital artery. Subsequent endovascular embolization of this arterial trunk resulted in complete pain relief. [ABSTRACT FROM AUTHOR]

The author reflects on the need to achieve the outcomes for professional health care chaplaincy as health care systems in industrialized countries such as Australia, Canada, and the U.S. are increasingly focused on outcomes. Topics discussed include focus on the unsustainable cost of health care, movement of chaplains in health care from being emissaries of local religious communities to integrated members of the health care team, and spiritual and religious needs in health care.

Improving co-design methods implies that we need to understand those methods, paying attention to not only the effect of method choices on design outcomes, but also how methods affect the people involved in co-design. In this article, we explore participants' experiences from a year-long participatory health service design project to develop ‘Better Outpatient Services for Older People’. The project followed a defined method called experience-based design (EBD), which represented the state of the art in participatory service design within the UK National Health Service. A sample of participants in the project took part in semi-structured interviews reflecting on their involvement in and their feelings about the project. Our findings suggest that the EBD method that we employed was successful in establishing positive working relationships among the different groups of stakeholders (staff, patients, carers, advocates and design researchers), although conflicts remained throughout the project. Participants' experiences highlighted issues of wider relevance in such participatory design: cost versus benefit, sense of project momentum, locus of control, and assumptions about how change takes place in a complex environment. We propose tactics for dealing with these issues that inform the future development of techniques in user-centred healthcare design. [ABSTRACT FROM AUTHOR]

Background: There is clear evidence that the full range of services required to support people dying at home are far from being implemented, either in England or elsewhere. No studies to date have attempted to identify the proportion of hospital admissions that could have been avoided amongst patients with palliative care needs, given existing and current local services. This study aimed to examine the extent of potentially avoidable admissions amongst hospital patients with palliative care needs. Methods: A cross sectional survey of palliative care needs was undertaken in two acute hospitals in England. Appropriateness of admission was assessed by two Palliative Medicine Consultants using the following data collected from case notes: reasons for admission; diagnosis and co-morbidities; age and living arrangements; time and route of admission; medical and nursing plan on admission; specialist palliative care involvement; and evidence of cognitive impairment. Results: A total of 1359 inpatients were present in the two hospitals at the time of the census. Of the 654 consenting patients/consultees, complete case note data were collected for 580 patients; the analysis in this paper relates to these 580 patients. Amongst 208 patients meeting diagnostic and prognostic criteria for palliative care need in two acute settings in England, only 6.7% were identified as 'potentially avoidable' hospitalisations. These patients had a median age of 84. Half of the patients lived in residential or nursing homes and it was concluded that most could have received care in this setting in place of hospital. Conclusion: Our findings challenge assumptions that, within the existing configuration of palliative and end of life health and social care services, patients with palliative care needs experience a high level of potentially avoidable hospitalisations. [ABSTRACT FROM AUTHOR]

Abstract: Context: Spirituality is a distinctive subject within palliative care practice and literature, but research to date is relatively undeveloped in this field and studies often throw more light on conceptual and methodological issues than producing reliable data for clinical practice. Objectives: To determine what is known about the spiritual needs of palliative care patients from the evidence presented in published research. Methods: Specialist online databases were interrogated for primary empirical studies of patients with a chronic disease unresponsive to curative treatment. Studies that only used a proxy for the patient or reported expert opinion were excluded. Each study was critically appraised for quality and the strength of its evidence to determine if any data could be pooled. Results: Thirty-five studies were identified, equating to a total of 1374 patients. Study populations were typically people with advanced-stage cancer, older than 60 years, who were English speaking, and with a Christian or Jewish religious affiliation, reflecting the predominance of Anglo-American studies. Studies fell into two groups: those that investigated the nature of spiritual experience and those that examined the relationship of spirituality with other phenomena. The evidence was insufficiently homogeneous to pool. Conclusion: Relevant accounts of what spirituality means for palliative care patients and evidence of how it operates in the lives of people with life-limiting disease can be derived from research. Studies to date are limited by reductive representations of spirituality and the conduct of research by health professionals within health care communities demarcated from disciplines and interpretive traditions of spirituality. [Copyright &y& Elsevier]

Conventional forms of healthcare are built on disciplinary thinking and practices that compartmentalize problems, treat delineated parts and dislocate the medical condition from the wider context of a person's life. In contrast, palliative care is founded upon a holistic philosophy that aims to understand and care for the whole person, and because this approach acknowledges that complex dynamic real-world problems cannot be addressed through a monocular view it works through the collaborative efforts of a multidisciplinary team. Transdisciplinary teams are strongly holistic through accommodating a breadth of perspectives, forging new interpretations and meanings, and developing coherent practices. In this study we discuss the value of transdisciplinary forms of palliative care and consider how this may apply to spiritual care. We consider spirituality as a complex, dynamic, and multidimensional field that can benefit from a transdisciplinary approach and outline the necessary conditions for spiritual care to be integrated into the practice of a transdisciplinary team. Finally, we consider the role of the chaplain in the team and the unique contribution of a chaplain's training and formation. We conclude that while transdisciplinary approaches to palliative care remain atypical it may be conceived as an expression of the most radical form of palliative care in all its dimensions. [ABSTRACT FROM AUTHOR]

Background The need to more fully understand the economics of palliative care provision is widely acknowledged; however, the evidence base regarding the extent of potentially avoidable admissions in the last year of life, and the link between reducing/redistributing overall costs of end-of-life care has not been previously evaluated. Aim A narrative review of the evidence relating to the potential economic impact of reducing avoidable admissions among palliative care patients in the UK. Methods Ten electronic bases were searched in 2010 using key terms to identify UK literature relating to the economic consequence of avoidable hospital admissions among palliative care patients. Results Five studies met the inclusion criteria. Two were randomized controlled trials comparing the addition of new services to support patients in the community at the end of life with the existing standard service provided; one was a descriptive analysis of the change in usage and costs of health care services following the introduction of two community-based services; two were retrospective analyses of patient records for patient who had died in hospital to estimate the proportion of final admissions that could be classified as avoidable. Conclusions The evidence base from the UK relating to the economic impact of avoidable admissions in palliative care is limited. Although two recent retrospective studies suggest that there are currently high levels of avoidable admissions, the feasibility of avoiding such admissions and the full economic consequences of such changes have not been clearly demonstrated. Further evidence is needed to provide a more robust estimate of the extent to which the additional costs of providing high-quality community support are offset by reduced inpatient usage by palliative care patients. Prospective studies are needed which seek to demonstrate the scale of admissions which can actually be avoided in clinical practice, when issues such as capacity constraints come into play. [ABSTRACT FROM AUTHOR]

This commentary continues a dialogue which began among literacy teacher educators attending an alternative format session about mentoring in the academy at a national conference. Literacy teacher educators participated in an informal discussion centered on the nature of mentoring in the academy for doctoral students, untenured professors, and tenured professors. Doctoral students focused on their changing identities and roles in the academy, their concerns about navigating the political infrastructure of academia, and the importance of assuming a proactive stance towards obtaining mentoring, especially for part‐time doctoral students. Untenured professors focused on the ways they were inventing and reinventing themselves within the power and politics of academia and their need for more holistic mentoring during these turbulent times. Tenured professors were able to embed mentoring experiences into their scholarly work and find ways to benefit or learn from mentoring experiences. These mentors also found comfort in more informal mentoring that included self‐initiated endeavors centered on mutual interests. Our commentary draws on these discussions as well as the professional literature on mentoring to describe the importance of mutual trust and reciprocity in mentoring throughout all stages of academia with attention to cultural and linguistic diversity. [ABSTRACT FROM AUTHOR]

Abstract: Although comparatively few people have regular contact with a church or spiritual leader, during times of terminal illness or bereavement, clergy are expected to be available and able to provide support. This study was carried out to determine the perceptions of clergy on the training they had received in supporting the dying patient and the bereaved. A sample of clergy working in the diocese of Sheffield was sent a questionnaire to assess what skills and knowledge clergy believed they had in this area, together with areas where they would wish for further training. The questionnaire was developed with input from hospital, hospice, and academic chaplains, and palliative care consultants. A subsidiary questionnaire was sent to clergy training colleges to evaluate the teaching offered. There was a trend across all denominations that those who had trained more recently were more likely to have received relevant training. Most clergy believed that they possessed adequate liturgical skills, but 13% felt they possessed none or little skill in pastoral care of the dying. Seventy-one percent indicated that they would like further training in pastoral care of the dying and 66.3% desired training in care of the bereaved. Of the 50% of training colleges that responded, the number of hours of training on pastoral care of the dying ranged from 6 to 36 hours (median 23 hours and mean 25 hours) and only 26% believed that their training in pastoral support skills was comprehensive. This study suggests that care of the dying and the bereaved is identified by clergy as an area in need of further training by the majority of clergy and should be part of the core curriculum within clergy training colleges and late training programs. [Copyright &y& Elsevier]

The article presents information on children's literacy development in the context of sociocultural views on learning. To have an accurate representation of the child in classroom interactions around literacy, the forces related to individual development along with tenets of sociocultural theories must also be considered. It is important that any discussion on learning must account for the critical role individuals play in their own construction of knowledge, as well as the contributions others make in that construction. According to the sociocultural perspective, learning is as an active process to solve practical problems, with members of a given cultural group developing shared understandings of common experiences. Young children, through their interactions with others, learn the values and ways of their home community. According to a study related to children's development of status hierarchies based on their perceptions of classmates, status influences participation in groups and the resultant decrease or increase in participation levels can influence achievement.

Spiritual care is an integral part of palliative care and if asked, most members of a palliative care team would state they address spiritual issues. The majority of hospices have support from a chaplain. This study was to determine the roles of chaplains within hospices and to look at their levels of stress. A questionnaire containing both open and closed questions was sent to chaplains working within hospices in the UK. The questionnaire enquired about number of sessions, specific roles of chaplain, whether they were members of the multidisciplinary team and their sources of internal support. Stress was measured on a 10-point Likert scale and the GHQ12. One hundred and fifteen questionnaires were returned, with a 72% response rate. The majority (62%) defined their denomination as Church of England and Free Church (24%); 71% of respondents had parish commitments in addition to their hospice role. Roles were predominantly defined as spiritual care of patients and staff (95%) and bereavement support of relatives (76%) and 75% regularly attended the multidisciplinary meetings. Senior medical and nursing staff and other chaplains were perceived as providing most support. Median Likert score for stressfulness was 5, and 23% scored at or above the threshold on the GHQ12 for identifiable psychological morbidity. Clear role definition was associated with less perceived stress whereas the provision of bereavement support was associated with statistically significant increased perceived stress. The role of a chaplain within a hospice is varied and this study suggests that the provision of training and formal support is to be recommended. [ABSTRACT FROM AUTHOR]

Spiritual care is an important aspect of holistic care. However, it is seldom the subject of audit, or included in quality standards. This article reports on the work of the Trent Hospice Audit Group (THAG) into the development of a quality standard for the assessment, delivery and evaluation of spiritual care. The standard was drafted by a multidisciplinary team and circulated among the THAG user group and other interested specialists, and subsequently revised. Three levels of assessment are defined and the different levels of expertise needed for these assessments identified. Education has been highlighted as a key issue in enable effective use of the standard package. Although acknowledging possible limitations and the importance of professional judgment, the standard should help provide a consistent approach to assessment, care planning and outcome review of spiritual care. [ABSTRACT FROM AUTHOR]

Mycobacterium fortuitum is a rapidly growing atypical mycobacterium frequently reported as a postsurgical wound complication from a major surgical procedure. We present a unique case of M. fortuitum infection occurring in a 4-year-old boy after a minor punch biopsy surgical procedure. As far as we know there has been no published case of M. fortuitum occurring after a punch biopsy procedure. [ABSTRACT FROM AUTHOR]

A review is presented of the book 'Spiritual Care at the End of Life: The Chaplain As a ‘Hopeful Presence,'' by Steve Nolan. [ABSTRACT FROM AUTHOR]

We report a patient with non-dermatomal radiating neck pain without focal neurologic deficit. Traditional workup could not identify an anatomic or biomechanical cause. Imaging showed a deep cervical vessel centered in the region of pain. Angiography later identified an aberrant anastomosis of this vessel with the occipital artery. Subsequent endovascular embolization of this arterial trunk resulted in complete pain relief., (2016 BMJ Publishing Group Ltd.)