Search

Domestic/family violence is a widespread major public health and human rights violation issue that runs across ethno-cultural affiliations and economic status. Relative to the actual incidence of family violence, use of services is low, and delayed for years after onset, within the broader Victorian and Australian community. Utilization is even lower for women from immigrant and refugee communities. It has been noted that family violence service utilization by Indian women immigrants in particular was especially low, relative to the size of the Indian population in Victoria. With the Indian culture understood to be traditionally a strongly male-dominated culture, it was deemed important to explore the nature of family violence experience of Indian women living in Australia, and culturally determined barriers to use of services. A partnership was formed to explore this issue through a participatory community theatre approach. Forum Theatre is a powerful tool that uses theatre for generating community understanding around hard to address issues such as domestic violence. Using such theatre-based ethnography, we aimed to identify the key issues, challenges and needs of Indian immigrant families when accessing and using services that could assist in situations of domestic/family violence.

Background Our existing hospice was over 30 years old and no longer fit for purpose, refurbishment costs were estimated at £3.4 million and we would have had to close for a year. Aims To build a new hospice which incorporated the good design we had seen in other new hospices but also to use the knowledge of our own staff to design a hospice which would really work for our patients and their families. Method Communication, communication, communication! During the tendering process to select the architect and the builders, we ensured that we chose professionals who would become partners and who would embrace a collaborative approach. We also wanted our staff, volunteers, patients and their families to participate in the design process. We visited many other hospices, undertook desk research on good hospice design and we used different activities to ensure that the building worked for everyone. Results Our 23-bedded hospice was finished two weeks early, and on budget. We have won the local award for Social Entrepreneurs of the Year, the Royal Institute of Chartered Surveyors’ (RICS) Awards for best new community building and the best overall new building in the East of England. We now go through to the finals of the RICS Awards. Our patients, their families and staff love the building and the building works just the way we hoped. Conclusion In 2013, after having commissioned a feasibility study, we decided to build a new hospice. We moved our patients in, in November 2016. We have been overwhelmed by the enthusiastic response from everyone. It has been a smooth, collaborative process. Many hospices teams have visited for support and advice. All the professionals involved have advised us that this has been a ‘model’ project for them and would like to share our experience further.

OBJECTIVE: The objective of this study was to determine whether suture placement through the bladder during closure of the vaginal cuff at the time of transabdominal hysterectomy is associated with formation of postoperative vesicovaginal fistula. STUDY DESIGN: Virgin female New Zealand White rabbits were used to perform this study. The study protocol was approved by the institutional Animal Use and Care Committee. Animals were housed and maintained in the animal facilities at the University of Mississippi Medical Center according to appropriate guidelines. Thirty-two animals were randomized into two groups at a 2:1 ratio. All animals underwent transabdominal hysterectomy. Animals in group 1 ( n = 21) had a figure-of-eight suture placed through the anterior vaginal cuff and intentionally into the bladder. Animals in group 2 ( n = 11) were treated in an identical manner but care was taken to exclude the bladder when the suture was placed into the anterior vaginal cuff. Animals were put to death, and necropsy was performed 28 days after surgery. The bladder and vagina of each animal were harvested en bloc. Evidence of a fistula between the bladder and vagina was then determined in three distinct ways. Infant formula was infused into the bladder through a urethral catheter, and the vagina was inspected for leakage. Saline solution tinted with methylene blue was used in the same manner. Last, air was injected through the catheter into the bladder with the en bloc vagina and bladder preparation submerged in water. The vagina was observed for air leakage manifest by bubble formation. RESULTS: The two groups were comparable in regard to weight gain, intraoperative complications, and postoperative complications. One animal in each group died. Neither had a surgical complication directly related to the suture placement. During inspection of the vagina and bladder no animal was noted to have a vesicovaginal fistula. CONCLUSIONS: A suture placed through the bladder during closure of the vaginal cuff after transabdominal hysterectomy, as an isolated event, does not appear to be associated with formation of postoperative vesicovaginal fistula.(Am J Obstet Gynecol 1997;177:304)

For the last 32 years the Arthur Rank Hospice has been an NHS hospice supported by the Arthur Rank Hospice Charity. The charity and the NHS teams have worked very well together. However both teams, and the charity’s trustees, have been cognisant of the fact that NHS rules and regulations have on occasions created additional layers of regulation and process which has not been conducive to providing a flexible and responsive service fully utilising charity support. Furthermore the charity, although funding approximately 40%+ of patient services has not been able to access most grant funding available to hospices, because the way the charity works is perceived to be ‘giving the NHS’ funds and some individual donors also baulk at what they interpret as ‘propping up the NHS’. In addition to the service arrangements there was a real need to address the physical environment of the hospice. The hospice was built 32 years ago, largely with charitable funds, and then gifted to the NHS. It has now become outdated in the facilities it can offer, it is on an unattractive, overcrowded site and does not offer the serenity and comfort to which we would all aspire for our end of life patients. Following a feasibility study which stated that it would cost £3.5 million to upgrade, but not extend, the facilities the charity decided to embark on a fundraising campaign and build a new hospice. However the trustees were adamant that this time it would not be handed to the NHS and therefore the charity would need to be in charge. Our journey has been long and difficult, but work has started on our beautiful new hospice and we become independent within the next two months. Our paper would be an exploration of the journey.

Objective To determine whether the method used to expand the uterine incision for caesarean delivery affects the incidence of intra-operative haemorrhage. Design A prospective randomised study of women undergoing a low segment transverse caesarean delivery. Participants were assigned to have their uterine incision either sharply or bluntly expanded. Participants Between June 1998 and June 2000, 470 women drew assignments to the sharp expansion group and 475 to the blunt group. Results The maternal demographics of age, race, nulliparity, and body mass index as well as pre-operative haematocrit were similar between groups. Compared with the blunt group, the estimated blood loss (886 versus 843mL, P = 0.001), change in the mean haematocrit (6.1% versus 5.5%, P = 0.003), incidence of postpartum haemorrhage (13% versus 9%; relative risk = 1.23, 95% CI 1.03, 1.46) and need for a transfusion (2% versus 0.4%; relative risk = 1.65, 95% CI 1.25, 2.21) were significantly greater in the sharp group. Conclusion In caesarean delivery, sharply expanding the uterine incision significantly increases intra-operative blood loss and the need for subsequent transfusion.

Issue addressed: The increase in mental health disorders worldwide makes it important to recognise health promotion interventions that are effective, accessible and affordable. Although natural spaces are coming to be recognised as health-promoting settings for general populations, little is understood about the use of naturecontact in treatment and care for individuals experiencing ill-health. Methods: This paper provides a summary of key research findings and presents a case study examining the selfreported health and well-being benefits of nature contact for a small clinical sample. The ‘Spectrum of Interventions for Mental Health Problems and Mental Disorders’ provides a conceptual framework for ordering current and future information relating to nature-based interventions. Results: Evidence demonstrates that separately, physical activity, social connection, and contact with nature enhance human health and well-being. The case example illustrates how ‘active’, ‘social’ and ‘adventurous’ contact with nature may be combined within a treatment intervention to protect and enhance the health of individuals experiencing chronic mental, emotional and physical health difficulties. Conclusions: ‘Contact with nature’ constitutes a health promotion strategy with potential application in prevention, early intervention, treatment and care. Recommendations include further research to investigate the benefits of nature contact within existing interventions, and the impacts of ‘active’ and ‘social’ nature contact within tailored interventions for targeted individuals and communities.