Demelza Hospice Care for Children, Sittingbourne, Kent, UKThe United Kingdom is one of the most prominent destination countries for people to be trafficked to in Europe. An estimated 20 000 people are trafficked into (and throughout) the UK every year, with the majority of victims coming from, arguably, the poorest countries. This presentation outlines the case of a baby (aged two days) who was referred to a children’s hospice for end of life care. Within the context of the direct work, it became apparent that the mother had been trafficked into the UK and had experienced periods of homelessness. The children’s hospice social work team worked intensively to seek support for this mother, but due to high service demand, and the mother’s questionable residency status, no statutory organisation was willing to engage. The NSPCC helpline recommended the Salvation Army, a Christian church and registered charity and this partner charity offered an assessment visit by their Anti-Human Trafficking Team’s First Responder Co-ordinator and plans were subsequently put in place for the team to take on the supporting role after the baby’s death. As well as focusing on safeguarding this extremely vulnerable family unit, it was essential that this mother had the opportunity to bond with her baby and to, albeit briefly, positively experience motherhood. The baby died peacefully, aged seven weeks. Pre-death planning had clarified the family’s customs and rituals, which dictated that the parents did not attend the funeral and therefore, two members of the children’s hospice team, together with two representatives from the Salvation Army were present, as a mark of respect. A year on, the mother continues to receive concerted support from the partnership charity, enabling her to preserve her dignity, reflect, recover and rebuild her life.
Objective: To determine characteristics, precipitating circumstances, clinical care, outcome and disposition of patients brought to the ED under section 351 (s351, police detention and transport) powers of the Mental Health Act 2014 (Vic) (MHAV). Methods: This is an observational cohort study conducted in two metropolitan teaching hospitals in Victoria. Participants were adult patients brought to ED under s351 of the MHAV. Data collected included demographics, event circumstances, pre-hospital and ED interventions and outcome. Analyses are descriptive. Results: The present study included 438 patient encounters. Median age was 34 years. In 84% of encounters (368/438) patients were co-transported with ambulance. The most common primary reason for detainment was suicide risk/intent (296/438, 67.6%) followed by abnormal behaviour without threat to self or others (92/438, 21%). In ED, parenteral sedation was administered in 11% (48/438). Physical restraint was applied in 17.6% (77/438). Psychiatric admission was required in 23.5% (103/438). In 63 cases, psychiatric admission was involuntary (14.4%). Most patients (297/438, 67.8%) were discharged home. A subset of patients had recurrent s351 presentations. Eighteen (5.6%) patients accounted for 22% (96/438) of all events. Conclusion: Most patients brought to ED under s351 of the MHAV had expressed intention to self-harm, did not require medical intervention and were discharged home. It could be questioned whether the current application of s351 is consistent with the least restrictive principles of the MHAV, especially as there is no apparent monitoring or reporting of the use of these powers. There were a concerning number of patients with multiple s351 events over a short period.
Background Antimicrobial resistance (AMR) is a global public health concern currently mitigated by antimicrobial stewardship (AMS). Pharmacists are strategically placed to lead AMS actions that contribute to responsible use of antimicrobials; however, this is undermined by an acknowledged health leadership skills deficit. Learning from the UK’s Chief Pharmaceutical Officer's Global Health (ChPOGH) Fellowship programme, the Commonwealth Pharmacists Association (CPA) is focused to develop a health leadership training program for pharmacists in eight sub-Saharan African countries. This study thus explores need-based leadership training needs for pharmacists to provide effective AMS and inform the CPA’s development of a focused leadership training programme, the ‘Commonwealth Partnerships in AMS, Health Leadership Programme’ (CwPAMS/LP). Methods A mixed methods approach was undertaken. Quantitative data were collected via a survey across 8 sub-Saharan African countries and descriptively analysed. Qualitative data were collected through 5 virtual focus group discussions, held between February and July 2021, involving stakeholder pharmacists from different sectors in the 8 countries and were analysed thematically. Data were triangulated to determine priority areas for the training programme. Results The quantitative phase produced 484 survey responses. Focus groups had 40 participants from the 8 countries. Data analysis revealed a clear need for a health leadership programme, with 61% of respondents finding previous leadership training programmes highly beneficial or beneficial. A proportion of survey participants (37%) and the focus groups highlighted poor access to leadership training opportunities in their countries. Clinical pharmacy (34%) and health leadership (31%) were ranked as the two highest priority areas for further training of pharmacists. Within these priority areas, strategic thinking (65%), clinical knowledge (57%), coaching and mentoring (51%), and project management (58%) were selected as the most important. Conclusions The study highlights the training needs of pharmacists and priority focus areas for health leadership to advance AMS within the African context. Context-specific identification of priority areas supports a needs-based approach to programme development, maximising African pharmacists’ contribution to AMS for improved and sustainable patient outcomes. This study recommends incorporating conflict management, behaviour change techniques, and advocacy, amongst others, as areas of focus to train pharmacist leaders to contribute to AMS effectively.
This article explores setting up a research group and outlines how we work together. The goal of the research group is to work collaboratively to conduct research on aspects of life for young disabled LGBT+ people that we think need more research. We hope to outline the aim of the group and what we want to achieve. It will also discuss our research principles and how we have conducted research together. We hope that the article provides insight on how to set up collaborative groups, how to work together, and what such groups can achieve. This article has been written collaboratively and this is reflected throughout.
Novel data sources and analyses of statutory data are highlighting challenges and opportunities for the children's palliative care sector. Such services have a growing evidence base for their work which includes some of the most robust demographic data to date (Fraser et al . 2011, 2013). Articulating how to channel the knowledge gained into effective service developments is a key challenge for children's hospices.One example of using data to challenge existing thinking and evolve evidence based services concerns post death care. Child Death Overview Processes [CDOP] facilitate annual reporting of child mortality. Of the child deaths reviewed in 2014, over 80% had ongoing health problems and 70% had a known life-limiting or life-threatening condition (DfE 2014). Children's hospices provide end of life care. Post death care may also be offered, providing an alternative to mortuary or funeral home for the child's body and facilitating immediate bereavement support forextended family. Not all children's hospices provide this service. Of those that do, practice varies with respect to service provision for families whose child has not accessed the hospice in life and who may not fulfil hospice access criteria.Not extending the service to such families may reflect anxiety among children's hospices that their bereavement services will be overwhelmed by numbers of families requiring the service. This paper seeks to address those concerns and contextualise appropriate service development utilising local and national data sources.Local CDOP data are reviewed for a number of children's hospices and compared to bed availability for end of life care and post death care services, alongside a review of the evidence of the impact of provision or not of provision of such services upon family grieving and morbidity.
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beth@arl.army.mil I. IntroductionEmphasis in hybrid electric technology development has typically been focused on automotive performance and benefits. However, as this technology crosses over into the military arena, vulnerability becomes important. Army combat vehicles must be capable of surviving the full spectrum of threats and environments. The U.S. Army Research Laboratory (ARL) is responsible for assessing this capability when military systems are exposed to ballistic, nuclear, biological, chemical, and directed energy threats; information operations and electronic warfare; flame and incendiary attacks; as well as the influence of the electromagnetic (EM) environment, obscurants, weather, and secondary weapon effects. By performing vulnerability analyses, ARL supports all phases of Army acquisition to include design, development, test, and evaluation. A vulnerability analysis performed early in a system design program can result in more survivable systems through the implementation of good design practices. The purpose of this paper is to present the ARL analysis process structure for combat vehicles and to indicate how design practices of a hybrid electric drive (HED) can affect survivability.
(1) Background: Pharmacists play a pivotal role in tackling Antimicrobial resistance through antimicrobial stewardship (AMS) and are well placed to lead behaviour change interventions across the healthcare system; (2) Methods: A cross-sector AMS training initiative for pharmacists was implemented across England, with three cohorts between 2019–2021. Each cohort took part in an introductory workshop, followed- by a workplace-based quality improvement project supported by peer-assisted learning sessions. Completion of training was determined by an end of training assessment after three to four months. Outcome data and learner survey results were collated, anonymised, and analysed by the training provider. (3) Results: In total, 118 pharmacists participated in the introductory workshop, 70% of these subsequently undertook an improvement project, and 48% engaged workplace stakeholders in the process. Interventions were designed by 57% of learners and 18% completed a at least one Plan-Do-Study-Act cycle. Approximately a quarter of learners met the requirements for a Certificate of Completion. Knowledge quiz scores were obtained from 115 learners pre-training and 28 learners post-training. Paired t-tests conducted for 28 learners showed a statistically significant improvement in mean score from 67.7% to 81.1% (p < 0.0001). Sixty-two learner survey responses were received during the training and 21 follow-up survey responses 6 to 12 months post training. Of the 21 responses to the follow-up survey, ongoing quality improvement work and improvement outcomes were reported by nine and six learners, respectively. (4) Conclusions: The delivery of workplace-based training at scale can be challenging, however this study demonstrates that coupling learning with workplace implementation and peer support can promote behaviour change in learners. Further study into the impact of providing pharmacists across sectors and geographies with access to this type of training will help inform ongoing workforce development interventions.
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