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Patients are routinely advised to follow hip precautions following their total hip arthroplasty (THA) surgery. There is lack of evidence regarding compliance with these precautions and when patients return to activities of daily living following their surgery. We designed a new questionnaire to discover when patients return to their activities of daily living. Two hundred and ninety seven consecutive patients who attended 12 week follow up arthroplasty clinic following their primary elective THA were asked to complete the questionnaire. All patients who attended the follow up clinic at 12 weeks responded to the questionnaire. Only 6.3% (n = 19) of the patients reported that they restricted their daily activities, as prescribed for the full 12 week period, while 50% (n = 148) of patients stopped using prescribed adaptive equipment by 6 weeks after their operation. There were no dislocations recorded among the study group. We found that the majority of patients do not adhere to hip precautions advice. They return to their activities of daily living prior to the end of prescription period based on their pain and activity level. Lack of adherence to hip precautions do not predispose to hip dislocation in the immediate post-operative period.

BackgroundThe community hospital sector is characterised by high levels of upheaval, variation and dispute. Debates over the value and contribution of community hospitals are hampered by a lack of empirical assessment of the experience of patients using these services. This paper presents findings from a study of patient and family experiences in community hospitals in England.MethodsWe adopted a qualitative design involving nine case study hospitals, selected to represent a range of characteristics. Case study data collected included discovery interviews with patients (n=60) and semi-structured interviews with carers (n=28). We conducted thematic analysis of interview data.ResultsThe study confirms some of the distinctive functional and technical aspects of care associated with community hospitals, including: access to services facilities and equipment; the environment and atmosphere; information sharing; continuity, and; the potential for longer lengths of stay. The study also finds high reported levels of personalised care in community hospitals. Our study suggests the importance of additional social and psychological aspects of patient experience. Social aspects included having family and friends close, and the importance of being known and maintaining social connections during periods of hospital treatment. Psychological aspects included feeling less anonymous and frightened than they would in an acute setting, especially when coming to terms with loss and change. Conclusions Although the experiences uncovered in this study were not uniformly positive, patients and carers placed a high overall value on the distinctive qualities of the care provided by community hospitals. The study suggests the need to weigh the full range of these dimensions of patient experience – including functional, relational, social and psychological – when assessing the role and contribution of community hospitals.

Together and apart, we have adopted an auto/biographical approach to the work that we do and continue to engage with new (to us at least) and different ways to collect, present and archive data. Our relationship as close friends as well as colleagues is relevant here, in that not only do we support each other in our work, but we also provide each other with a safe space to make mistakes, to share ideas to experiment. In our chapter, we reflect on our individual and collective selves and focus on some of our projects—The Tattoo Project (Deborah), Doing Griefwork Through Fiction and Memoir (Gayle) and Stepford Academics (Deborah and Gayle)—to highlight our collective, creative approach and our challenge to rather than compliance with ‘expected’ approaches and practices within the academy.

We present findings of a qualitative study exploring what constitutes relevant health promotion initiatives for immigrant mothers of children with developmental disabilities. We apply a social ecological approach, with a focus on gender-specific and transformative health promotion, to examine factors impacting mothers' health and wellbeing. Twenty-eight semi-structured and open-ended interviews were conducted with immigrant mothers in the greater Toronto area, Canada. Mothers identified facilitators, challenges, and strategies for their health promotion, providing relevant insights for meaningful intervention. Our findings show that immigrant mothers' health is influenced by intersecting social determinants of health, including migration status, gender, and disability.

ObjectiveTo examine the forms, scale and role of community and voluntary support for community hospitals in England.DesignA multimethods study. Quantitative analysis of Charity Commission data on levels of volunteering and voluntary income for charities supporting community hospitals. Nine qualitative case studies of community hospitals and their surrounding communities, including interviews and focus groups.SettingCommunity hospitals in England and their surrounding communities.ParticipantsCharity Commission data for 245 community hospital Leagues of Friends. Interviews with staff (89), patients (60), carers (28), volunteers (35), community representatives (20), managers and commissioners (9). Focus groups with multidisciplinary teams (8 groups across nine sites, involving 43 respondents), volunteers (6 groups, 33 respondents) and community stakeholders (8 groups, 54 respondents).ResultsCommunities support community hospitals through: human resources (average=24 volunteers a year per hospital); financial resources (median voluntary income = £15 632); practical resources through services and activities provided by voluntary and community groups; and intellectual resources (eg, consultation and coproduction). Communities provide valuable supplementary resources to the National Health Service, enhancing community hospital services, patient experience, staff morale and volunteer well-being. Such resources, however, vary in level and form from hospital to hospital and over time: voluntary income is on the decline, as is membership of League of Friends, and it can be hard to recruit regular, active volunteers.ConclusionsCommunities can be a significant resource for healthcare services, in ways which can enhance patient experience and service quality. Harnessing that resource, however, is not straight forward and there is a perception that it might be becoming more difficult questioning the extent to which it can be considered sustainable or ‘renewable’.

BackgroundGPs were a key driving force for the development of a network of community hospitals across England, and have provided medical cover for most of them. However, during the past decade there has been a significant shift, with the dominant trend appearing to be one of declining GP involvement.AimTo explore how and why the role of GPs within community hospitals in England is changing.Design and settingQualitative study in a sample of nine diverse community hospitals in England.MethodQualitative interviews with community hospital clinical staff.ResultsIn all, 20 interviews were conducted and two models of medical care observed: GPs employed by a practice and trust-employed doctors. Interviewees confirmed the trend towards declining GP involvement, with the factors driving change identified as being GP workload and recruitment challenges, a change from ‘step-up’ admissions from the community to ‘step-down’ admissions from acute hospitals, fewer local patients being admitted, increased medical acuity of patients admitted, increased burden of medical support required, and inadequate remuneration. The majority of doctors viewed community hospital work in a positive light, welcoming the opportunities for personal development and to acquire new clinical skills. GPs viewed community hospital work as an extension of primary care, adding to job satisfaction.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital work.

BackgroundCommunity hospitals have been part of England’s health-care landscape since the mid-nineteenth century. Evidence on them has not kept pace with their development.AimTo provide a comprehensive analysis of the profile, characteristics, patient experience and community value of community hospitals.DesignA multimethod study with three phases. Phase 1 involved national mapping and the construction of a new database of community hospitals through data set reconciliation and verification. Phase 2 involved nine case studies, including interviews and focus groups with patients (n = 60), carers (n = 28), staff (n = 132), volunteers (n = 68), community stakeholders (n = 74) and managers and commissioners (n = 9). Phase 3 involved analysis of Charity Commission data on voluntary support.SettingCommunity hospitals in England.ResultsThe study identified 296 community hospitals with beds in England. Typically, the hospitals were small (LimitationsThere were limitations to the secondary data available for mapping community hospitals and tracking charitable funds and to the sample of case study respondents, which concentrated on people with a connection to the hospitals.ConclusionsCommunity hospitals are diverse but are united by a set of common characteristics. Patients and carers experience community hospitals as qualitatively different from other settings. Their accounts highlight the importance of considering the functional, interpersonal, social and psychological dimensions of experience. Community hospitals are highly valued by their local communities, as demonstrated through their active involvement as volunteers and donors. Community hospitals enable the provision of local intermediate care services, delivered through an embedded, relational model of care, which generates deep feelings of reassurance. However, current developments may undermine this, including the withdrawal of GPs, shifts towards step-down care for non-local patients and changing configurations of services, providers and ownership.Future workComparative studies of patient experience in different settings; longitudinal studies of community support and value; studies into the implications of changes in community hospital function, GP involvement, provider-mix and ownership; and international comparative studies could all be undertaken.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.

This paper describes an action research study which focused on an exploration of the aspirations for and initial achievements of Stratham Mental Health NHS and Social Care Trust. Local leaders perceived that Stratham had a good history of health and social care partnership working and as such, adopted an integrationist view of culture to help shape the context of the new structural form. In doing so, consistency remained a key message to staff throughout this organizational transition and the change did not appear to cause the distraction to core business which the literature suggests it would do so. However, this continuity may have come at a cost, at least initially. In the process of formalizing the previous partnership into a Care Trust, Stratham may not have produced all the beneficial effects of synergy which are usually (albeit eventually) associated with mergers in the private sector. Certainly, local actors could see opportunities that had been missed. By focusing on the structural manifestation of the relationship, the opportunities to broaden informal horizontal linkages may have been underexploited. The study of Stratham serves to confirm that the integrationist conception of culture is limited and that the differentiation of professional groupings and the ambiguity of individual experience will always make contested the meanings that are attributed to organizational change.

The authors describe what happened when feminist teaching came head to breast with mothering. The authors' attempt to impact student responses to feminist theorizing in a third‐year social psychology class met with transgressions when a colleague, who had been invited as a guest‐lecturer to speak about social structure and violence against women, brought her three‐year‐old and five‐month‐old sons with her. During her presentation, when her youngest child started to fuss she breastfed him while she lectured. What followed in later class discussions informed the students about their own contradictory investments in dominant discourses, and informed the authors that a breastfeeding feminist university teacher represents transgressions in the academy. The authors discovered through a reflective and layered analysis of the incident that the breastfeeding feminist university teacher is subjected, not merely to a ‘chilly climate’ or an intellectualized ‘symbolic violence’, but, tersely—to violence—because she is...

Objectives: To determine whether offspring of centenarians acquired protection from age-related diseases. Design: Case-control study. Setting: The study was part of the Longevity Genes Project at Albert Einstein College of Medicine. Participants: Centenarians (n=145), offspring of centenarians (n=180), and spouses of the offspring of centenarians (n=75) as a control group. Two additional groups served as controls: age-matched Ashkenazi Jews, and an age-matched control group from the Third National Health and Nutrition Examination Survey. Measurements: Self-reported family history of longevity; prevalence of hypertension, diabetes mellitus, heart attacks, and strokes; and objective measurements of body mass index and fat mass. Results: Parents of centenarians (born in approximately 1870) had a markedly greater (∼sevenfold) “risk” for longevity (reaching ages 90–99), supporting the notion that genetics contributed to longevity in these families. The offspring of long-lived parents had significantly lower prevalence of hypertension (by 23%), diabetes mellitus (by 50%), heart attacks (by 60%), and strokes (no events reported) than several age-matched control groups. Conclusion: Offspring of centenarians may inherit significantly better health. The authors suggest that a cohort of these subjects and their spouses is ideal to study the phenotype and genotype of longevity and its interaction with the environment.

BACKGROUND Families of centenarians have high levels of plasma high-density lipoprotein (HDL) cholesterol, which may have neurological as well as cardiovascular protective effects during aging. Because plasma HDL level declines progressively with aging, we examined whether centenarians with higher plasma HDL levels have better cognitive function. METHODS Total plasma cholesterol, low-density lipoprotein (LDL) cholesterol, HDL, triglycerides, and apolipoprotein levels were measured in a group of centenarians (N = 139; older than 95 years) and were correlated with their cognitive function (measured by Mini-Mental State Examination [MMSE]). RESULTS Plasma HDL levels correlated significantly with MMSE (r =.32; p

he growth of the service user/survivor movement over the last 20 years has provided an opportunity for people to speak openly about their experiences of mental health services and to be involved in local health and social care organisations, regional and national initiatives, and to influence Government policy. The Government’s mental health strategy (Department of Health, 1998) and National Service Framework for Mental Health (Department of Health, 1999) emphasise a more user-centred service and state that their commitment to a modern, decent and inclusive society provides the context for mental health services. The first of the guiding values and principles of the National Service Framework states that: ‘People with mental health problems can expect that services will involve service users and their carers in planning and delivery of care.’ This principle is further echoed in the NHS Plan (Department of Health, 2000) and in the Mental Health Policy Implementation Guide (Department of Health, 2001, p6) which states that: ‘Above all, mental health services must place the needs of ... service users at the centre of their planning and their practice.’ Despite government intentions to put the service user at the centre, there is little evidence of this in the application of policy and practice at a local level. The IAHSP’s work with approximately 50 local implementation teams in the South East, North West, South West and Trent regions of England shows that 90% of their plans and actions do not include user involvement. There are pockets of good practice but T in the main this is limited to involvement on the local implementation teams in commissioning services and, in a few cases, on the boards of trusts. There has also been little action on other stated aims of the National Service Framework – promoting mental health, tackling stigma and discrimination, person-centred planning or promoting independence – and no targeted action in relation to a key issue that service users want; that is, involvement in care planning and treatment provision.

This article describes and reflects on the standards set out in the new National Service Framework for Mental Health, as they relate to policy development in mental health and social inclusion. It highlights both positive contributions and missed opportunities.

Purpose: High grade prostatic intraepithelial neoplasia is considered the most likely precursor of prostatic adenocarcinoma. However, the natural history and predictive value of prostatic i...

Background Gaps between research knowledge and practice have been consistently reported. Traditional ways of communicating information have limited impact on practice changes. Strategies to disseminate information need to be more interactive and based on techniques reported in systematic reviews of implementation of changes. There is a need for clarification as to which dissemination strategies work best to translate evidence into practice in neonatal units across England. The objective of this trial is to assess whether an innovative active strategy for the dissemination of neonatal research findings, recommendations, and national neonatal guidelines is more likely to lead to changes in policy and practice than the traditional (more passive) forms of dissemination in England. Methods/design Cluster randomised controlled trial of all neonatal units in England (randomised by hospital, n = 182 and stratified by neonatal regional networks and neonatal units level of care) to assess the relative effectiveness of active dissemination strategies on changes in local policies and practices. Participants will be mainly consultant lead clinicians in each unit. The intervention will be multifaceted using: audit and feedback; educational meetings for local staff (evidence-based lectures on selected topics, interactive workshop to examine current practice and draw up plans for change); and quality improvement and organisational changes methods. Policies and practice outcomes for the babies involved will be collected before and after the intervention. Outcomes will assess all premature babies born in England during a three month period for timing of surfactant administration at birth, temperature control at birth, and resuscitation team (qualification and numbers) present at birth. Trial registration Current controlled trials ISRCTN89683698

Between August 1980, when dialysate solution in appropriate volumes for pediatric patients became available in the United States, and February 1984, 68 patients, aged 1 to 21 years, were trained for CAPD/CCPD at UCLA. This report reviews the clinical experience with these home dialytic modalities during the past 31/2 years.