No / The recently published ‘Burden of Wounds’ study (Guest et al, 2015a) not only highlighted the cost of delivering wound care in the UK but also revealed a number of shortcomings in the method of care delivery, many of which could potentially have adversely affected patient outcome. This paper looks more closely at some of the clinical and service issues raised by the published data from the study and combines this with observations made by the research team when reviewing the patient records to generate a number of recommendations for improvements in staff engagement, documentation, clinical management and service delivery. By implementing these recommendations variations in care standards should be reduced, delayed and non- healing be recognised earlier and as a result cost savings generated.

The National Health Service (NHS) in England is changing, not only in terms of the technical aspects of care (such as that afforded by new technology), but also in the way in which care is delivered to patients. For example, due to the increasing pressures being placed upon health services, hospitals need to develop innovative ways to reduce the length of time patients actually spend in hospital. Whilst this improves capacity planning, bed management and patient flow, it also seeks to ensure improved patient safety by delivering care and ongoing treatment in the most appropriate setting. However, discharging patients from hospital can be challenging and fraught with complexities. Therefore, the efficient and effective management of this process can have a considerable impact on subsequent clinical outcomes and readmission rates. As such, effective discharge planning and practice has become an integral part of health service policy and, in recent years, there has been an increased emphasis placed on the contribution nurses make to this process (Department of Health, 2002; 2005a; 2005b). New recommendations from the Kings Fund (Seale, 2016) suggest that a collaborative relationship between patients, carers, third sector parties and communities is central to the future of the NHS. This is because these perspectives are fundamental; indeed, patients are the reason the NHS exists. Since 2010, this has been the aim of my doctoral research ― to explore a shared leadership approach in determining the principles of care. The purpose of this study is to gain an insight into (and a greater understanding of) patient experiences during the discharge process following percutaneous coronary intervention (PCI) after myocardial infarction (MI) ― commonly known as a heart attack. PCI is a relatively new procedure; since its implementation it has resulted in patients staying in hospital for less than three days. Previous management would regularly result in patients remaining in hospital for longer than seven days. However, reducing the length of stay has potentially impacted how information and communication are both provided and understood by patients on discharge from acute hospital care. Previous research such as Hainsworth (2006), Department of Health (DoH) (2004) and Picker (2010) suggests that whilst there has been a great deal of emphasis placed on policy, there still remains scope for improvement in practice. As qualitative research is a form of social enquiry that focuses on the way people make sense of their experiences and the world in which they live, this research focuses on individuals who have had a heart attack and have then undergone the same treatment. The aim is to understand, describe and interpret their experiences, behaviour and feelings by looking at social processes and interactions. This was based on undertaking three separate focus groups involving patients, clinicians and members of the management team from a local NHS acute hospital in West London. Furthermore, in-depth, semi-structured interviews with eight patients were conducted. The idea behind surveying patients', clinical staff and managers narratives/opinions, was to establish a holistic view of discharge planning and practice. Recommendations for change could then be made dependant on these findings, in order to improve the effectiveness and efficiency of this process, in addition to patients’ experiences. Following the completion of the focus groups and semi-structured interviews, analysis was undertaken to identify whether any common themes emerged across the three different groups. Although the narratives identified varying views, the most significant of the emerging themes was that of communication and the attitude of staff. Indeed, further analysis confirmed that communication was a prevalent issue in all three focus groups. The findings suggest patients have specific individual needs; this would not be surprising given the treatment and care received. Communication was also noted to be a major theme for patients; whilst clearly the majority of patients were relatively happy with the care received, they remained keen to make suggestions for improvement. The attitude of staff also featured strongly; patients were keen to suggest the changes they required and their rationale for these suggestions. The clinicians' themes mirrored the patients' themes, whilst also incorporating resource and innovation. The managers' themes commonly focused on service and proposed new ways of working, which included 'joined-up' working across acute and community services. Furthermore, the clinicians' and managers’ themes recognised that the attitudes of all groups of staff remained a challenge. In conclusion, this study has demonstrated the requirement for and the importance of effective communication throughout the entire discharge process. The aims are as follows: to ensure that post-procedure patients are discharged home or into a community setting safely; that they receive the right care, treatment and information in the most appropriate setting; and that they find and use ways to facilitate their recovery. Furthermore, this study has validated the importance of empowering patients to live with their diagnosed condition/disease by enabling the provision of support post-discharge. To this end, there is a need to ensure that positive values (such as empathy and compassion) remain a core part of the discharge planning process. This can be achieved by recognising each patient as an individual who is trying to make sense of a daunting life-changing experience whilst maintaining their own core belief and value systems. As a result, recommendations for improvements and change within this study have been based upon these findings. Further research needs to be defined to ensure that discharging patients from an acute hospital to their home or community setting remains both safe and effective, whilst also being informative and empowering.

Philosophiae Doctor - PhD (Physiotherapy) / Stroke is the third leading cause of death and disability worldwide. Eighty five per cent of strokes occur in developing countries, and it is estimated that the prevalence will increase in future. Evidence based rehabilitation programs inherent in clinical practice guidelines has the potential to improves functional activities, and participation. However Kenya does not have this guideline. Most clinical guidelines are developed in the western world, and reflect developed world healthcare systems and resources that are not always appropriate to developing nations. Likewise, guidelines are costly to produce. Kenya lacks the resources and the expertise for de novo guideline development. It is therefore appropriate and cost effective to contextualise the available high quality recommendations.

BACKGROUND: Over the past 10 years, molecular-based and targeted therapies in oral forms have emerged and continue to change the landscape of cancer care and care delivery. While cancer treatments traditionally have been administered at the hospital, oral anti-cancer medications (OAM) can be taken by patients at the comfort and convenience of their homes. However, this also creates implications for ensuring that patients take their oral chemotherapies correctly, timely, and safely, all of which can impact outcomes and tolerance. Studies have shown concerning gaps in patients’ knowledge of taking and handling their OAM, including lower rates of adherence. Interventions have largely consisted of a combination of nurse- and pharmacist-led approaches along with the use of various educational and reminder tools. However, few studies have examined the potential of an intervention led by a pharmacist and a medication (patient) navigator. OBJECTIVE: This ongoing pilot study aims to assess the feasibility of the intervention, the impact on patients’ understanding and adherence to their oral anti-cancer medications, and the patient perceptions of the helpfulness of the intervention. METHODS: Patients who were initiating oral chemotherapy were enrolled at Tufts Medical Center Cancer Center, which was the study site for this pilot intervention. Study participants met with the Specialty Pharmacist and Medication Navigator for their initial education session and teach-back using the Oral Agent Teaching Tool (MOATT). They were also given Information Sheets and individualized Calendars for their OAM. The Pharmacist and/or Navigator subsequently followed up with the participants for three more check-ins and educational boosters. Participants completed study measures including the self-reported Adherence Measure, MD Anderson Symptom Inventory, and study evaluation. RESULTS: A total of 37 patients have so far been enrolled in the study and completed their initial education session with the Pharmacist and 33 of those patients completed the Navigator-led booster check-in approximately one week later. These patients are receiving ongoing follow-up for their two remaining check-ins in the study. After the first teach-back with the Pharmacist, patients largely showed sufficient understanding of how to take and handle their medication. This level of understanding was sustained a week later at the Navigator booster. Despite high levels of self-reported adherence, patients showed insufficient understanding of refill logistics. Patients were highly satisfied with the intervention and had found both the check-ins and the educational tools provided useful. CONCLUSION: This Pharmacist- and Navigator-led intervention was found to be feasible to deliver, capable in enhancing patient understanding and adherence to their medications, and helpful to the patients throughout taking their OAM.

Purpose: A systematic review and meta-analysis tested the 'paranoia as a defence' model's original prediction that those experiencing persecutory delusions would take excessive credit for positive events as part of an attributional style that protects them from low self-esteem. The empirical project explored forensic mental health nurses' experiences of a Cognitive Analytic Therapy (CAT) training programme with an emphasis on complex case conceptualisation and implications for clinical practice. Methods: In relation to the systematic review and meta-analysis, those experiencing persecutory delusions were compared to those with non-paranoid psychosis, depression, and healthy controls, in terms of the magnitude of internalising attributional bias (IAB) for positive events. Correlation analysis also examined the association between magnitude of IAB and paranoia severity. In the empirical study, 10 forensic mental health nurses took part in semi-structured interviews to qualitatively explore their experiences and applications of CAT training. Results: Consistent with the model, an internalising attributional bias was present for those experiencing paranoid delusions when compared to individuals with depression. Contrary to the model, there were no differences between the other control groups and there was no significant correlation between IAB and paranoia severity. Internal attributions for positive events appear to be associated with depression, rather than paranoia. Analysis of the empirical data provided a rich account of nurses' experiences of the CAT training and how this helped them to conceptualise complex patients and promoted more positive ways of working. Conclusions: The findings from the systematic review and meta-analysis do not support the original model, but are consistent with the modified 'paranoia as a defence' model of persecutory delusions. Other cognitive models also help explain paranoia suggesting that refining the existing models further could be useful. The empirical findings suggest that CAT could be a valuable model of psychologically informed practice for nurses working in a forensic setting. Specifically, training appeared to help nurses develop a better understanding of their patients, greater self-reflection skills, and improved clinical care approaches.

With the prosperity of information technology, the hospital introduces the high-tech equipment and information systems to improve patient-centered clinical care capability and efficiency. Because of structural changes in the medical environment, the traditional modes of care have many impacts. This study combines the enterprise architecture (EA) theory with evidences and experiences of clinical care, including suggestions of supervisors and colleagues. Our purpose is to find out a description tool for patient-centered clinical care, and to improve communication and interaction among personnel, equipment, and system, leading to the development of architecture-oriented clinical care model (AOCCM). This study uses structure-behavior coalescence architecture description language (SBC-ADL) to construct a multiple view integrated AOCCM. AOCCM is a patient-centered blueprint which includes architecture hierarchy diagram, framework diagram, component operation diagram, component connection diagram, structure-behavior coalescence diagram, and interaction flow diagram. Comparing with existing clinical care model from various kinds of views, all logical results demonstrate that AOCCM is superior to the existing model. The methodology of architecture-oriented covers the organizational structure, caring behavior, and the relationship between patients and hospitals, to systematically show the face of clinical care. Accordingly, AOCCM helps a great deal care staffs achieve effective consensus in corporate communications and new staffs accomplish systematical learning in clinical studies.

No description available.

This study using a quantitative, descriptive design with a questionnaire investigated cultural, religious and social factors that might impact on ARV treatment in HIV/AIDS-infected women in Botswana. The study found that the majority never missed any doses, a few missed doses once or twice, and a small minority missed more than three times. The respondents’ perception of cultural influence on treatment of HIV/AIDS in women revealed that the majority (70%) believe culture has an influence on the treatment. Social factors also impacted on ARV adherence. A few of the respondents indicated that side effects and the number of pills prevented ARV medication adherence. The main reason for non-adherence, however, was forgetfulness. There had been an improvement in the majority of the respondents’ health status and quality of life. Maximizing adherence is essential. Providers and patients both have responsibilities in this regard. / Health Studies / M.A.(Health Studies)

This study using a quantitative, descriptive design with a questionnaire investigated cultural, religious and social factors that might impact on ARV treatment in HIV/AIDS-infected women in Botswana. The study found that the majority never missed any doses, a few missed doses once or twice, and a small minority missed more than three times. The respondents’ perception of cultural influence on treatment of HIV/AIDS in women revealed that the majority (70%) believe culture has an influence on the treatment. Social factors also impacted on ARV adherence. A few of the respondents indicated that side effects and the number of pills prevented ARV medication adherence. The main reason for non-adherence, however, was forgetfulness. There had been an improvement in the majority of the respondents’ health status and quality of life. Maximizing adherence is essential. Providers and patients both have responsibilities in this regard. / Health Studies / M.A.(Health Studies)

AI is entering clinical care and the healthcare sector in a big way, at the same time, a growing number of scholars are concerned that this technology cannot adhere to current bioethical principles. In particular, there are increasing concerns that AI poses a threat to the autonomy of patients by being irreconcilable with the practice of informed consent. In this essay, I shall defend the thesis that some applications of AI can be reconciled with a revised version of informed consent – what I call AI Adapted Informed Consent. This solution shall not rest on the idea of making black box AI more transparent or explicable. Instead, I shall argue that black box AI does not necessarily withhold the kind of information necessary for informed consent. Rather, patients can be given epistemic access to the kind of information necessary to make an informed decision, as well as being informed as to how the AI is used in the medical decision-making and in the assessment of their medical situation. Hence, this solution offers a re-interpretation of informed consent as information about contextual functioning and role of AI in medical decision-making. Drawing on republican interpretations of freedom as nondomination, I argue that demands for informed consent can only be restrained if it preserves the voluntariness of our decisions. Hence, I shall conclude that my adapted informed consent thesis allows for the possibility that some applications of black box AI in clinical care can be reconciled with informed consent and due respect for patient autonomy – if three specific conditions can be met.