Search

Introduction: The aim of this study was to gain consensus among young people with a stoma due to inflammatory bowel disease (IBD) on the priorities for the content of an intervention for the self‐management of stoma‐related distress. The current identification and management of distress in young people with a stoma is often suboptimal in clinical settings and there is a need for improved support resources. Methods: Two consensus group meetings were carried out via online video conferencing, using nominal group technique. Participants generated, rated on a Likert scale and discussed, topics for inclusion in a future self‐management intervention. Results: Nineteen young people, aged 19–33, with a stoma due to IBD took part in one of two group meetings. Participants were located across England, Scotland, and Northern Ireland. Twenty‐nine topics were generated by participants, seven of which reached consensus of ≥80%, that is, a mean of ≥5.6 on a 7‐point Likert scale. These were: receiving advice from young people with lived experience of stoma surgery; advice on/addressing concerns about romantic relationships, sex and intimacy; information about fertility and pregnancy related to stoma surgery; stoma 'hacks', for example, useful everyday tips regarding clothing, making bag changes easier and so forth; reflecting on and recognising own emotional response to surgery; tips on managing the stoma during the night; and processing trauma related to the illness and surgery journey. Conclusions: Findings extend previous research on young people's experiences of stoma surgery, by generating consensus on young people's priorities for managing distress related to surgery and living with a stoma. These priorities include topics not previously reported in the literature, including the need for information about fertility and pregnancy. Findings will inform the development of a self‐management resource for young people with an IBD stoma and have relevance for the clinical management of stoma‐related distress in this population. Patient or Public Contribution: Three patient contributors are co‐authors on this paper, having contributed to the study design, interpretation of results and writing of the manuscript. The study's Patient and Public Involvement and Engagement advisory group also had an integral role in the study. They met with the research team for four 2‐h virtual meetings, giving input on the aims and purpose of the study, recruitment methods, and interpretation of findings. The group also advised on the age range for participants. The views of young people with a stoma are the central component of the study reported in this paper, which aims to gain consensus among young people with an IBD stoma on their priorities for the content of a resource to self‐manage distress related to stoma surgery. [ABSTRACT FROM AUTHOR]

The use of standardized screening tools to identify trauma exposure and associated symptoms is commonly recommended as a key component in the development of trauma informed services and is seen as integral to facilitating access to evidence‐based therapies. However, there is limited evidence in the UK about the factors influencing the adoption of such tools into routine practice in children's social care. This paper presents the findings from a process evaluation of how practitioners implemented a screening tool for post‐traumatic stress disorder, anxiety and depression into their day‐to‐say practice and what worked or did not work during the process. The findings from this study highlight the potential benefits for both young people and practitioners, alongside some of the challenges involved. In particular, practitioners need to see the direct benefit for young people of being assessed. Additionally, practitioners value regular mentoring as they become more proficient in using standardized screening tools. [ABSTRACT FROM AUTHOR]

In recent years, social exclusion has gained the attention of governments around the world. This paper reports on a qualitative study involving 27 young men aged 14-19 years experiencing particular forms of exclusion in the context of Northern Irish society. The study used a focus group methodology to elicit their views with the aim of exploring both emotional and psychological needs and the structural factors that may contribute to their experiences of social exclusion. The findings reveal a range of unmet social and psychological needs, the impact of sectarianism and segregation, and a paucity of support systems in place. The paper concludes by making recommendations about how policy-makers and practitioners could find more imaginative ways of engaging such vulnerable young men to reduce social exclusion. [ABSTRACT FROM AUTHOR]

The gender-based nature of suicide-related behaviour is largely accepted. However, studies that report exclusively on female suicides are rare. Here we demonstrate how female suicide has effectively been 'othered' and appears incidental in studies which compare female and male behaviour. We highlight how recent studies of suicide have tended to be dominated by male-only approaches, which increasingly link issues of masculinity with male death by suicide. Drawing on data collected from the general practitioner and coroner's office, we then apply the sociological autopsy approach to a cohort of 78 deaths recorded as suicides in the UK between 2007 and 2009. By focusing on females in isolation from males, we demonstrate that, as in male-only suicide studies, it is similarly possible to draw out issues associated with the feminine identity, which can be linked to death by suicide. We find that bereavement, sexual violence and motherhood could all be linked to the lives and help-seeking of the females who died. In closing, we suggest that a reorientation towards sociological analytic approaches of female suicide may help to produce further reductions in the rate of female death by suicide. A Virtual Abstract of this paper can be found at: [ABSTRACT FROM AUTHOR]

Background This paper focuses on the relationships between health 'policy' as it is embodied in official documentation, and health 'practice' as reported and reflected on in the talk of policy-makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland - involving as they do a predominantly state funded (National Health Service) system in the north and a mixed health-care economy in the south. The key question is to determine how the detail of health policy as contained in policy documents connects to and gets translated into practice and action. Methods The data sources for the study include relevant health-care policy documents ( N = 5) and progress reports ( N = 6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers ( N = 28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents' contents and how they saw the impact of 'policy' on primary care practice. Results The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do. Conclusion To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements - specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required. [ABSTRACT FROM AUTHOR]

ABSTRACT Until recently, little was known about kinship care in the UK. Research has begun to illuminate the circumstances which lead to children being cared for by relatives, and the stresses and strains experienced by carers. However, most UK research has only considered 'looked-after' children placed with formal approved kinship foster carers, although this group forms the smallest proportion of children in kinship arrangements. In this paper, we use microdata from the 2001 UK Population Census to examine the characteristics of kinship carers and children, and demonstrate that most children in kinship care are growing up in informal unregulated arrangements. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Cognitive balance theory posits that a drive for cognitively consistent thoughts modulates interpersonal relations. We extended cognitive balance theory to intergroup relations and tested it in a real‐life setting where intergroup relations are under strain: Northern Ireland in the wake of the UK's withdrawal from the EU. We predicted that when the groups of Irish people and British people in Northern Ireland are perceived as more compatible, intergroup bias would be lower than when groups are perceived as less compatible. We collected data of residents of Northern Ireland before the UK's official withdrawal from the EU (N = 604) and after (N = 350). As hypothesized, attitudes towards British people positively related to attitudes towards Irish people when participants perceived the groups as more compatible. We found the opposite relationship at low levels of perceived compatibility. Exploratory cross‐lagged panel analyses did not show that these effects occurred longitudinally, suggesting that cognitive balance does not drive judgements over time possibly because people are less likely to notice inconsistent responses across different time points. The present research demonstrates that intergroup attitudes assessed at a certain point in time follow cognitive balance principles. [ABSTRACT FROM AUTHOR]

Background: The importance of good oral hygiene for patients in Intensive Care Units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. Aim: This study aimed to provide a national picture of oral care practices in adult ICUs in the United Kingdom (UK) to identify areas for improvement. Study Design: A national one‐day point prevalence study was undertaken in adult ICUs in the UK in the period from 30th September to 14th October 2021. Data were collected on all patients in the ICU on the date of data collection. Using a validated electronic data collection form, anonymised data were collected on methods and frequency of oral care provided, and the use of oral care protocols within the ICU. Data were analysed using descriptive analysis. Results: Data from 195 patients in 15 ICUs in England, Wales and Northern Ireland were collected. Written oral care protocols were available for use in the care of 65% (n = 127) of patients. 73% (n = 142) of patients received oral care within the 24‐h period. Oral care methods included toothbrushing 41% (n = 79), foam sticks 3% (n = 5), moisturizing the oral cavity 10% (n = 19) and mouth rinse with chlorhexidine 3% (n = 5) and other oral care methods not specified 12% (n = 23). 44% (n = 85) of patients had an oral assessment within the 24‐h period and variable assessment methods were used. Conclusion: There is large variability in oral care provision and methods for intubated ICU patients and a lack of consensus was revealed in the study. Oral assessment is conducted less frequently using multiple tools. Optimal oral care standards and further research into oral care provision is pivotal to address this important patient‐relevant practice. Relevance to Clinical Practice: Oral care is a fundamental part of care for ICU patients, however, there is a large degree of variability, and oral care is often not based upon oral assessment. The use of an oral care protocol and oral assessments would help to improve patient care, ease of use for staff and provide a tailored oral care plan for patients, improving efficiency and preventing wasted resources. [ABSTRACT FROM AUTHOR]

Aims: To evaluate whether adding financial incentives to usual care is cost‐effective in encouraging pregnant women to quit tobacco smoking, compared with usual care alone. Design: Cost‐effectiveness analysis (CEA) and cost–utility analysis (CUA) from a health‐care provider's perspective, embedded in the Smoking Cessation in Pregnancy Incentives Trial (CPIT III). Long‐term analyses were conducted from the same perspective, using an existing Markov model over a life‐time horizon. Setting: Seven maternity smoking cessation sites in Scotland, England and Northern Ireland in the United Kingdom. Participants: In the short‐term analysis, CPIT III participants were assessed: women 16 years or older, self‐reporting as smokers, fewer than 24 weeks pregnant and English‐speaking (n = 944). The same population was used for the life‐time analysis, plus their infants. Measurements Costs included financial incentive vouchers and postage, cessation support and nicotine replacement therapy and neonatal stays. The outcome measure was a biochemically verified quit rate for the CEA and quality‐adjusted life‐years (QALYs) for CUA. Costs are presented in 2020 GBP sterling (£). Data for the life‐time analysis came from the trial and were combined with data from published literature embedded in the model, reporting incremental cost per quitter and QALY. A 3.5% discount rate was applied. Findings The short‐term incremental cost per quitter was £4400 and cost per QALY was £150 000. Results of sensitivity analyses confirmed these results. The long‐term analysis combined costs and outcomes for mother and infants; results showed a cost saving of £37 [95% confidence interval (CI]) = £35–106] and increase in QALYs of 0.171 (95% CI = 0.124–0.229). These findings indicate that, over a life‐time, financial incentives are cost‐saving and improve health outcomes. Conclusions: In the United Kingdom, offering up to £400 financial incentives, in addition to usual care, to support pregnant women to stop smoking appears to be highly cost‐effective over a life‐time for mother and infants. [ABSTRACT FROM AUTHOR]

Objectives: Eating disorders (ED) are associated with significant morbidity and mortality rates and are most common in young people aged between 15 and 19 years. Large representative surveys on disordered eating in youth are lacking. The main aims were to estimate the prevalence of disordered eating in a representative sample of 11–19 year olds in Northern Ireland and investigate the associations between probable eating disorder and a range of risk factors. Designs and Methods: A large nationally representative household survey was conducted, and the bivariate and multivariate associations between demographic, familial, economic and psychological risk factors and probable eating disorder were assessed. Results: A total of 16.2% (n = 211) of the sample met the SCOFF screening criteria for disordered eating. Probable eating disorder was associated with being female (OR = 2.44), having a parent with mental health problems (OR = 1.68), suffering from certain psychological problems, such as mood or anxiety disorder (OR = 2.55), social media disorder (OR = 2.95), being the victim of physical bullying (OR = 1.71) and having smoked (OR = 2.46). Conclusions: This study provides the first prevalence estimates of probable eating disorder among youth in Northern Ireland. Furthermore, the study identifies unique risk factors for probable eating disorder among this representative sample. [ABSTRACT FROM AUTHOR]

Organisations funded by Sport England or UK Sport must work towards achieving standards for safeguarding and protecting children in sport as set by the National Society for the Prevention of Cruelty to Children's Child Protection in Sport Unit (CPSU) and encourage a culture of listening to children. The present research was commissioned by the NSPCC CPSU to understand the practices of UK sports clubs regarding this objective. An electronic questionnaire was distributed through the national governing bodies of sport working with the CPSU. Some 64 clubs/squads representing 6,000+ juniors (under 18 years) responded. Quantitative data were analysed using simple statistics and qualitative data were themed utilising Foucault's theory of power and following Braun and Clark's six‐phase guide. Discourse, hierarchical judgement and docility were considered with reference to formal management and cultural environments. Semantic and latent themes were explored. The themes identified were: expectation awareness, reframing voice and preserving discourse. Clubs recognise the value of listening to children. However, existing power relations valorise adult knowledge fields over the experiences of juniors. Technology could provide an effective solution as it is remote, potentially anonymous and culturally accessible. As power is a productive force, problematisation of organisational culture could centralise children's voices and limit/prevent abuse. [ABSTRACT FROM AUTHOR]

Background A large number of people who experience a stroke are affected by dysarthria. This may be in isolation or in association with aphasia and/or dysphagia. Despite evidence highlighting the psychological and social impact of having post-stroke dysarthria and a number of clinical guidelines that make recommendations for appropriate management, little is known currently about UK service delivery issues relating to speech and language therapy (SLT) assessment and treatment for this group. Such evidence is necessary in order to plan, develop and research services for people with post-stroke dysarthria. Aims To gain an overview of SLT practices in the management of people with dysarthria after stroke in the UK. Methods & Procedures SLTs in the UK were asked to complete an online survey addressing referral patterns, caseload profiles, and their assessment and intervention methods for post-stroke dysarthria. In the absence of a national register of clinicians working with people with acquired dysarthria, a snowballing method was used to facilitate participant recruitment. Results were analysed using descriptive statistics. Outcomes & Results A total of 146 SLTs responded. The majority were employed by the National Health Service (NHS). Most patients were referred within 1 week post-stroke. Almost half the respondents did not regularly use formal assessments and the use of instrumentation was rare, including the use of video recording. The focus of therapy for mild, moderate and severe dysarthria did not differ significantly for clinicians. A little under half the respondents endorsed non-verbal oral exercises in rehabilitation. The survey demonstrated some appreciation of the centrality of regular intensive practice to effect change, but this was in a minority. Conclusions & Implications Through this research it became clear that basic information regarding post-stroke dysarthria incidence, prevalence and core demographics is currently unavailable. More embedded NHS SLT reporting systems would make a significant contribution to this area. A more in-depth examination is required of the natural history of dysarthria over the months and years following stroke, of SLT practices in relation to post-stroke dysarthria, with investigations to understand more fully the choices SLTs make and how this relates to available evidence to support their clinical decision-making. [ABSTRACT FROM AUTHOR]

Compared to children in other placements, there is much less known about the characteristics and needs of children in the UK who are returned to their birth parents with a care order still in place. That is in spite of evidence to suggest they face more difficulties than young people in other placements. Based on a 2009 census of looked after children in Northern Ireland, just under 10% ( n = 193) were found to be living at home under a care order. Case file reviews were conducted for a quarter of these young people ( n = 47) to generate descriptive statistics showing a very diverse population. That was followed by semi-structured interviews with members of eight families (ten children and eight birth parent/s), providing transcripts for thematic analysis. Nearly half of the young people whose case files were reviewed had experienced at least one home placement breakdown, but nearly two thirds had a stable last home placement. Care orders appeared to serve two functions: to give legal authority to social services for the monitoring of placements, and to facilitate family access to family support services. Replacing some care orders with supervision orders might better align legal status and actual function. [ABSTRACT FROM AUTHOR]

Aims To estimate (1) the associations between parent-adolescent relationship, parental knowledge and subsequent adolescent drinking frequency and (2) the influence of alcohol use on parental knowledge. Design Path analysis of school based cohort study with annual surveys. Setting Post-primary schools from urban and intermediate/rural areas in Northern Ireland. Participants A total of 4937 post-primary school students aged approximately 11 years in 2000 followed until approximately age 16 years in 2005. Measurements Pupil-reported measures of: frequency of alcohol use; parent-child relationship quality; subdimensions of parental monitoring: parental control, parental solicitation, child disclosure and child secrecy. Findings Higher levels of parental control [ordinal logistic odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.78, 0.95] and lower levels of child secrecy (OR = 0.83, 95% CI = 0.75, 0.92) were associated subsequently with less frequent alcohol use. Parental solicitation and parent-child relationship quality were not associated with drinking frequency. Weekly alcohol drinking was associated with higher subsequent secrecy (beta −0.42, 95% CI = -0.53, −0.32) and lower parental control (beta −0.15, 95% CI = -0.26, −0.04). Secrecy was more strongly predictive of alcohol use at younger compared with older ages ( P = 0.02), and alcohol use was associated less strongly with parental control among families with poorer relationships ( P = 0.04). Conclusions Adolescent alcohol use appears to increase as parental control decreases and child secrecy increases. Greater parental control is associated with less frequent adolescent drinking subsequently, while parent-child attachment and parental solicitation have little influence on alcohol use. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most common cancer in men in the UK accounting for 25% of all new cases of cancer. It is predicted to become the most common cancer overall by 2030. A national survey of the specialist nursing workforce caring for men with prostate cancer was completed across the four countries of the UK during June and July 2014. In total 302 specialist nurses completed the survey and data from 285 was used in the analysis. This is the biggest whole population survey of this workforce in recent years. The most common job title was clinical nurse specialist (185) and the most common band was agenda for change band 7 (174). However in Scotland 50% of the respondents stated that they were paid on band 6. Over half the group (158) had worked in prostate cancer care for more than 10 years. Few (48) had come into specialist posts from a specific specialist nurse development role. There is wide geographic variation in the provision of specialist nursing for men with prostate cancer. This is reflected in available hours and caseload sizes. The respondents reported frozen and vacant posts across the UK. This equated to 58·3 full time equivalents. The work of specialist nurses caring for men with prostate cancer is clinically complex and appears to cover most key times in the cancer journey. However workload appears to be limiting the care that the nurses are able to provide with over half the respondents (163) saying that they left work undone for patients. [ABSTRACT FROM AUTHOR]

Objectives This study sought to investigate the psychometric properties of the Posttraumatic Cognitions Inventory ( PTCI; Foa et al., 1999, Psychol. Assess., 11, 303) among a cohort of older adolescents and to determine the relationship between post-traumatic cognitions and a variety of psychological outcomes including depression, anxiety, stress, and loneliness. Methods The PTCI was investigated among a large sample ( N = 785) of Northern Irish adolescents. Confirmatory factor analysis and composite reliability analysis were conducted to assess the psychometric properties of the scale. Results The familiar three-factor solution of negative cognitions of self, negative cognitions of the world and others, and self-blame was supported; however, it was necessary to remove eight items from the original 33-item scale. The three-factor structure was subsequently demonstrated to be factorially invariant across gender and to possess satisfactory internal reliability. The three PTCI factors were found to correlate with depression, anxiety, stress, and three dimensions of loneliness. Conclusion These results provide the first piece of evidence that older adolescents cognitively respond to trauma in a similar manner to adults, that the PTCI is factorially invariant between genders, and that trauma cognitions are correlated with feelings of loneliness. The contextual dependent nature of the structure of the PTCI factors is discussed in relation to future research efforts. Practitioner points The PTCI is a valid and reliable measure of trauma-related cognitions among adolescents and works equally well for male adolescents and female adolescents., Trauma cognitions are associated with a range of mental health problems beyond post-traumatic stress disorder including depression, anxiety, stress, and various aspects of loneliness., Reductions in trauma cognitions in survivors of trauma will have wide-scale clinical benefits to patient well-being., The exact structure and make-up of items in the PTCI may well be dependent on culture, context, and the nature of the trauma., The study is limited due to the fact that the authors could not assess the severity of the trauma experienced by the adolescent sample. [ABSTRACT FROM AUTHOR]

Objective Previous research has identified an association between traumatic experiences and psychotic symptoms. Few studies, however, have explored the underlying mechanisms and contingent nature of these associations in an integrated model. This study aimed to test a moderated mediation model of negative childhood experiences, associated cognitive processes, and psychotic experiences within a context of adolescent loneliness. Design Cross-sectional survey. Methods A total of 785 Northern Irish secondary school adolescents completed the survey. A moderated mediation model was specified and tested. Results Childhood experiences of threat and subordination were directly associated with psychotic experiences. Analyses indicated that peer victimization was a mediator of this effect and that loneliness moderated this mediated effect. Conclusion A new model is proposed to provide an alternative framework for assessing the association between trauma and psychotic experience in adolescence that recognizes loneliness as a significant contextual moderator that can potentially strengthen the trauma-psychosis relationship. Practitioner points Moderated mediation analyses poses an alternative framework to the understanding of trauma-psychosis associations, Adolescent loneliness is a vulnerability factor within this association, Data are based on a Northern Irish sample with relatively low levels of loneliness, Cross-sectional data cannot explore the developmental course of these experiences in adolescence. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives This study aimed to determine the value of using a mix of clinical pharmacy data and routine hospital admission spell data in the development of predictive algorithms. Exploration of risk factors in hospitalized patients, together with the targeting strategies devised, will enable the prioritization of clinical pharmacy services to optimize patient outcomes. Methods Predictive algorithms were developed using a number of detailed steps using a 75% sample of integrated medicines management ( IMM) patients, and validated using the remaining 25%. IMM patients receive targeted clinical pharmacy input throughout their hospital stay. The algorithms were applied to the validation sample, and predicted risk probability was generated for each patient from the coefficients. Risk threshold for the algorithms were determined by identifying the cut-off points of risk scores at which the algorithm would have the highest discriminative performance. Clinical pharmacy staffing levels were obtained from the pharmacy department staffing database. Results Numbers of previous emergency admissions and admission medicines together with age-adjusted co-morbidity and diuretic receipt formed a 12-month post-discharge and/or readmission risk algorithm. Age-adjusted co-morbidity proved to be the best index to predict mortality. Increased numbers of clinical pharmacy staff at ward level was correlated with a reduction in risk-adjusted mortality index ( RAMI). Conclusions Algorithms created were valid in predicting risk of in-hospital and post-discharge mortality and risk of hospital readmission 3, 6 and 12 months post-discharge. The provision of ward-based clinical pharmacy services is a key component to reducing RAMI and enabling the full benefits of pharmacy input to patient care to be realized. [ABSTRACT FROM AUTHOR]

Negative (vs positive) intergroup contact may have a disproportionately large impact on intergroup relations because of valence-salience effects, whereby negative contact causes higher category salience (Paolini, Harwood, & Rubin, 2010). One correlational and three experimental studies in three conflict areas (Northern Ireland, Arizona's border area, and Cyprus; Ns = 405, 83, 76, and 91) tested the moderation of these valence-salience effects by individuals' histories of outgroup contact. Consistent with a perceived fit principle valence-salience effects of face-to-face, television-mediated, and imagined contact held among individuals with negative or limited histories of outgroup contact; these effects were significantly reduced or nonsignificant among individuals with positive or extensive past outgroup contact. These moderation effects suggest that positive and diverse intergroup contact in the past buffers against the harmful effects of negative contact experiences in the present, thus limiting the potential for negative spiralling of intergroup relations. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Secondary transfer effects ( STEs) of intergroup contact refer to the generalization of contact effects from a primary encountered outgroup to attitudes towards secondary outgroups (Pettigrew, 2009). Using two large, cross-sectional data sets from Germany ( N = 1,381) and Northern Ireland ( N = 1,948), this article examined the extent to which STEs of intergroup contact on attitudes towards a range of secondary outgroups occur via a previously unexplored psychological construct, social identity complexity (operationalized as similarity complexity and overlap complexity). Study 1 found primary outgroup contact to be associated with greater similarity complexity, but no indirect effects on secondary outgroup attitudes via complexity emerged. Study 2, however, revealed indirect positive relationships between primary outgroup contact and secondary outgroup attitudes via increased similarity complexity and overlap complexity. These relationships were obtained while controlling for two previously tested mediating mechanisms, attitude generalization (operationalized as primary outgroup attitude) and deprovincialization (operationalized as ingroup attitude and identification). We discuss the theoretical implications of these findings and the contribution of social identity complexity to understanding processes underlying STEs of contact. [ABSTRACT FROM AUTHOR]

Background People with intellectual disabilities ( ID) are at a higher risk of developing diabetes compared with the non-intellectually disabled population, as a consequence of genetic syndromes and because this cohort are more exposed to many of the identified risk factors. However, little is known about the management of diabetes in this population. The aim of this study was to examine the demographics, health and the diabetes quality of care indicators used with people with ID in one region of the UK. Methodology This was a quantitative study using a postal survey design. An anonymised questionnaire was posted to all community ID teams and supported living/residential facilities requesting information on the demographics, health and quality of care indicators for people with ID who have diabetes on their caseloads. Results In total 186 questionnaires were returned. Results showed that 125 people with ID had Type 2 diabetes (67%) and 61 people had Type 1 (33%). Significantly more people with Down syndrome and Autistic Spectrum Disorder had Type 1 diabetes. This study found that 6% had glycossylated glucose levels ( HbA1c) greater than 9.5% and for 52% the levels were between 6.5% and 9.4%. Individuals reported to have poor glycaemic control were statistically more likely to have Type 1 diabetes and be younger, live with parents or independently and be obese. Results also illustrate that the national standards for good diabetes management were only partially met. Discussion Because of their enhanced predisposition for the development of diabetes this population merits particular attention with regards to screening for the onset of diabetes. The extent to which the quality of diabetes care indicators were achieved was variable but results suggest that for many people the indices were not met, that glycaemic control was poor, that only a quarter were of normal weight, that many were hypertensive and that almost a quarter had no record of their lipid levels. These findings provoke two important questions: first, who should be responsible for promoting diabetes management in this client group and second, how can service provision be tailored to better meet their needs? Greater collaborative working and education is required between ID services, primary healthcare and diabetes clinicians in order to promote the health and meet the quality indicators of diabetes care among this population. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To profile the characteristics and outcomes of adult haematology patients admitted to the intensive care unit ( ICU). Background The role of intensive care support for haematology patients is contentious due to high mortality rates thus generating debate regarding the inappropriate use of limited resources versus denial of effective care. Methods Medical notes, laboratory records and Intensive Care National Audit and Research Centre ( ICNARC) data for all adult haematology patients admitted to Belfast City Hospital ICU in 2009 were analysed. Results Twenty one patients were admitted to the ICU; mean age was 56 years ( SD 12·5), 52% were male and 82% ( n = 19) had a malignant diagnosis. The main indication for admission was neutropenic sepsis with associated organ impairment ( n = 18, 85%). ICU mortality was 43%. Three-month and six-month mortality rates were 62% and 67%, respectively. ICU survivors had lower acute physiology and chronic health evaluation ( APACHE II) scores, and decreased requirements for invasive ventilation and inotropic support. Of the post-six-month survivors, one had a relapse, one had responding disease and five remained in remission. Two patients have subsequently undergone a reduced intensity conditioning transplant. Conclusion One third of patients survived for >6 months indicating that critically ill haematology patients can benefit from ICU admission, allowing progression to potentially curative therapies. Relevance to clinical practice This study highlights the necessity of individualized assessment regarding patient suitability for admission to a critical care facility, incorporating the perspective of both the haematologist and the intensivist. [ABSTRACT FROM AUTHOR]

Objective Previous research has identified an association between loneliness and psychiatric morbidity, but many of the studies have been based on small convenience samples and have not always used standardized measures. Aims and Methods This study aimed to assess the association between standardized measures of loneliness and psychiatric morbidity using data from a large sample of adolescents from Northern Ireland (Young Life and Times Survey, 2011). A total of 1,434 participants completed the survey. Results The prevalence of loneliness and psychiatric morbidity was 15.6% and 28.4% respectively. A multivariate binary logistic regression was used to identify the significant correlates of psychiatric morbidity. Demographic and loneliness variables were entered as covariates and female gender and perceptions of familial poverty were significantly associated with GHQ caseness. Loneliness increased the likelihood of GHQ caseness by more than five times. Conclusions Adolescent loneliness is significantly associated with psychiatric morbidity for Northern Irish adolescents. School-based screening and interventions to reduce loneliness may reduce the prevalence of loneliness. Practitioner Points Adolescent loneliness is a possible indirect indicator for mental health problems., Standardized measures of loneliness, with population norms, are widely available., There is no clear profile of a 'lonely adolescent' based on demographic variables. [ABSTRACT FROM AUTHOR]

Rational, aims and objective The aim of the present study was to compare the ease of use and the capability of four approaches [Medication Appropriateness Index (MAI), the Beers' criteria 2003, the Improved Prescribing in the Elderly Tool (IPET) and Health Plan Employer Data and Information Set (HEDIS)] in assessing changes in medication appropriateness in elderly patients over a period of hospitalization. Methods A retrospective observational study in two hospitals in Northern Ireland using the four measures was undertaken, involving a cohort of 192 patients (aged > 65 years). Medication appropriateness assessments were made at three stages during the patients' hospital 'journey', that is, at admission, during their inpatient stay and at discharge. The identifying rates of inappropriate prescribing in elderly patients in hospital used validated screening tools: MAI, the Beers' criteria 2003, the IPET and HEDIS. Results The MAI was the most comprehensive approach but was also the most time consuming to apply. Data derived using the MAI indicated clearly that there was improved medication appropriateness over the three hospital stay stages ( P < 0.001). Although this trend was also significant for the Beers' criteria 2003 ( P < 0.05) and the IPET ( P < 0.05) approaches, the HEDIS was unable to differentiate changes in appropriateness over time. There was a good correlation between data derived using the MAI and the Beers' criteria 2003 and the IPET approaches; this correlation was not evident for the HEDIS. Conclusions The MAI is the most convincing tool in evaluating medication appropriateness, but is very time consuming to apply. Beers' criteria 2003 and the IPET perform to an acceptable standard within the clinical setting and are more practical in their application. The HEDIS, although simplest to apply, does not have the sensitivity to measure change in appropriateness over time. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 766-776 Context The effects of assessment practice on students' learning are unclear, particularly regarding professional development. Corralling in objective structured clinical examinations (OSCEs) is designed to reduce illicit passing of examination information. Candidates completing an examination are kept secluded until the next cohort of examinees has begun. We used the introduction of corralling as a context in which to explore social influences on examination misconduct, with the aims of improving understanding of the hidden effects of assessment, and evaluating the acceptability of corralling from the student perspective. Methods A questionnaire was administered to students corralled post-OSCE for the first time. Eleven semi-structured interviews were subsequently conducted. Questionnaire data were analysed for descriptive statistics and thematic analysis of interview transcripts was carried out. Results The questionnaire response rate was 95.4% (251/263). Before corralling, 80.9% (203/251) of students were aware of the sharing of information among peers and 78.5% (197/251) agreed that such misconduct was unprofessional. The majority were in favour of corralling (90.8%, 228/251). Four themes emerged from the semi-structured interviews: the student network versus the individual; assessment-driven culture; the deferring of professionalism, and the 'level playing field'. Students saw interaction within the student network, on a background of assessment-driven culture, as the key driver in examination misconduct. Conforming to the rules of the social network was prioritised over individual agency, although the mismatch between the rules of the network and the dominant professional discourse caused some conflict for individuals. Deferred professionalism (described as the practice of taking on the norms of professional behaviour only when qualified) was a rationalisation used to minimise this conflict. Corralling provided a 'level playing field' in which the influences of the network were minimised. Conclusions Examination misconduct is thus a complex social construction with implications for individual learners in terms of professional development. Corralling is one mechanism for addressing misconduct that is acceptable to students, but assessment processes have important hidden effects which educators should acknowledge. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Previous service development work in the area of integrated medicines management (IMM) has demonstrated clear quality improvements in a targeted group of patients within a hospital in Northern Ireland. In order to determine whether this programme could be transferable to routine practice and thereby assess its generalizability, research has been carried out to quantify the health care benefits of incorporating the concept of IMM as routine clinical practice. Method The IMM programme of care was delivered to all eligible patients (subject to inclusion criteria) across two hospital sites in Northern Ireland during normal pharmacy opening hours. All patients were followed up for a period of 12 months from their time of hospital admission. All patient data were collected using the custom-designed Electronic Pharmacist Intervention Clinical System at each stage of their hospital journey, that is, admission, inpatient stay and discharge. Results Patients who received the IMM service benefited from a reduced length of hospital stay on their reference admission (1.42 days; P = 0.020) as well as a reduced length of stay during the first rehospitalization (5.86 days; P = 0.013). There was also a trend of a reduced number of readmissions and a longer time to readmission during the 12-month follow-up period. Potential significant opportunity cost savings were demonstrated as well as a significant improvement in medication appropriateness (discharge vs. reference admission). Conclusions The IMM programme of care has proven to be transferable to routine hospital care within two hospitals in Northern Ireland. It is anticipated that this current research will further inform the development of IMM as routine clinical practice across Northern Ireland and beyond. [ABSTRACT FROM AUTHOR]

The initiation of complementary feeding (CF; introducing infants to food/drink other than milk) is recommended close to 6 months and not before 4 months of age. Low socio‐economic status (SES) is a determinant of nonadherence to CF recommendations, but there is an evidence gap around reasons for nonadherence among these parents. This study investigated knowledge, attitudes, and practices of disadvantaged families (in terms of SES and social support) and use of guidance for CF, in the Republic of Ireland and Northern Ireland. Parents of infants aged 3–14 months were recruited via community groups. Semistructured focus groups aided by vignettes were used. Data were analysed using an inductive thematic approach. Nineteen focus groups took place with parents (n = 83). A range of factors influence parents when introducing solids. Sources of guidance extend to family, friends, the internet, and commercial resources. Parents experience uncertainty and anxiety during this time, driven by lack of knowledge and conflicting advice. Five major themes were identified: (a) more guidance that is accessible, timely, and respectfully needed; (b) the challenge of choosing safe, nutritious food; (c) "everybody has an opinion"; (d) feelings of inadequacy, embarrassment, and guilt; and (e) decisions are ultimately based on individual circumstances. CF advice should be culturally appropriate, practical, and empowering, emphasising the rationale behind updates to recommendations and consequences of nonadherence. Future training of health professionals for delivery of CF advice and guidance should consider these findings. Compliance with CF recommendations is influenced by health professionals, the wider family, and the commercial baby‐food sector. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 950-956 (2012) Abstract Aims To determine if an educational DVD increases knowledge and changes attitudes of women with diabetes towards preconception care. Methods Ninety-seven women with diabetes (Type 1, n = 89; Type 2, n = 8), aged 18-40 years, completed a pre-DVD and post-DVD intervention study by postal questionnaire. Beliefs and attitudes associated with preventing an unplanned pregnancy and seeking preconception care were assessed using a validated questionnaire; scales included benefits, barriers, personal attitudes and self-efficacy. Knowledge of pregnancy planning and pregnancy-related risks were assessed by a 22-item questionnaire. Results After viewing the DVD there was significant positive change in women's perceived benefits of, and their personal attitudes to, receiving preconception care and using contraception: change in score post-DVD viewing 0.7 (95% confidence interval 0.3, 1.2), P = 0.003, and 0.8 (0.3, 1.2), P = 0.001, respectively. The DVD significantly improved self-efficacy, that is, self-confidence to use contraception for prevention of an unplanned pregnancy and to access preconception care [3.3 (1.9, 4.7), P < 0.001], and significantly reduced perceived barriers to preconception care [−0.7 (−1.2, −0.2), P = 0.01]. Knowledge of pregnancy planning and pregnancy-related risks increased significantly after viewing the DVD: mean increase was 37.6 ± 20.0%, P < 0.001, and 16.9 ± 21.2%, P < 0.001, respectively. Conclusions This study demonstrates the effectiveness of a DVD in increasing knowledge and enhancing attitudes of women with diabetes to preconception care. This DVD could be used as a prepregnancy counselling resource to prepare women with diabetes for pregnancy. [ABSTRACT FROM AUTHOR]