Coman W.,Northern Health and Social Care Trust |
Devaney J.,Queens University of Belfast
Child Care in Practice | Year: 2011
Despite huge investment over the past 10 years, improving outcomes for looked-after children remains elusive. A challenge for practitioners, researchers and policy-makers alike has been the absence of a shared conceptual framework for considering and responding to the needs of looked-after children. A second challenge relates to the measurement of outcomes. In this article the authors reflect on the multiple factors that contribute to outcomes for looked-after children and, drawing upon the work of Cronen and Pearce, propose an organising framework. In as much as it facilitates reflection on the complex interplay between looked-after children and their environments, the ecological perspective outlined in this article holds some promise as an aid to targeting interventions more effectively and efficiently. © 2011 The Child Care in Practice Group.
Harrington C.,Northern Health and Social Care Trust |
Rodgers C.,Antrim Area Hospital
BMJ Case Reports | Year: 2014
An underweight 15-year-old boy had a video capsule endoscopy (VCE) to investigate iron deficient anaemia associated with elevated platelet and white cell counts. The suspicion was of subclinical small bowel Crohn's disease after the findings of a radiolabelled white cell scan. The VCE in May 2007 found patchy inflammation and superficial ulcers in the terminal ileum consistent with Crohn's disease. By March 2008, the patient remained asymptomatic but the capsule had not passed. He was treated with steroids to improve the inflammation and allow the capsule to pass. This was unsuccessful. Abdominal X-rays appeared to show that it was in the rectum. CT of the abdomen and pelvis in July 2012 showed that it was actually in the mid-distal ileum within a mass of inflamed and matted small bowel loops. He was last reviewed in March 2014. He has now retained the capsule asymptomatically for 6 years and 10 months. Copyright 2014 BMJ Publishing Group. All rights reserved.
Tinkler M.,Northern Health and Social Care Trust |
Hoy L.,Queens University of Belfast |
Martin D.,Queens University of Belfast
British Journal of Community Nursing | Year: 2014
Northern Irish (and all UK-based) health care is facing major challenges. This article uses a specific theory to recommend and construct a framework to address challenges faced by the author, such as deficits in compression bandaging techniques in healing venous leg ulcers and resistance found when using evidence-based research within this practice. The article investigates the challenges faced by a newly formed community nursing team. It explores how specialist knowledge and skills are employed in tissue viability and how they enhance the management of venous leg ulceration by the community nursing team. To address these challenges and following a process of reflection, Lewin's forcefield analysis model of change management can be used as a framework for some recommendations made. © 2014 MA Healthcare Ltd.
Aldeyab M.A.,Queens University of Belfast |
Aldeyab M.A.,Pharmacy and Medicines Management Center |
Harbarth S.,University of Geneva |
Vernaz N.,University of Geneva |
And 5 more authors.
British Journal of Clinical Pharmacology | Year: 2012
Aims: The objective of the present study was to study the relationship between hospital antibiotic use, community antibiotic use and the incidence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in hospitals, while assessing the impact of a fluoroquinolone restriction policy on ESBL-producing bacteria incidence rates. METHODS: The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (ARIMA) model was built to relate antibiotic use to ESB-producing bacteria incidence rates and resistance patterns over a 5 year period (January 2005-December 2009). Results: Analysis showed that the hospital incidence of ESBLs had a positive relationship with the use of fluoroquinolones in the hospital (coefficient = 0.174, P= 0.02), amoxicillin-clavulanic acid in the community (coefficient = 1.03, P= 0.03) and mean co-morbidity scores for hospitalized patients (coefficient = 2.15, P= 0.03) with various time lags. The fluoroquinolone restriction policy was implemented successfully with the mean use of fluoroquinolones (mainly ciprofloxacin) being reduced from 133 to 17 defined daily doses (DDDs)/1000 bed days (P < 0.001) and from 0.65 to 0.54 DDDs/1000 inhabitants/day (P= 0.0007), in both the hospital and its surrounding community, respectively. This was associated with an improved ciprofloxacin susceptibility in both settings [ciprofloxacin susceptibility being improved from 16% to 28% in the community (P < 0.001)] and with a statistically significant reduction in ESBL-producing bacteria incidence rates. Discussion: This study supports the value of restricting the use of certain antimicrobial classes to control ESBL, and demonstrates the feasibility of reversing resistance patterns post successful antibiotic restriction. The study also highlights the potential value of the time-series analysis in designing efficient antibiotic stewardship. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.
Williams M.A.,Queens University of Belfast |
Silvestri V.,Institute of Clinical Science A |
Craig D.,Northern Health and Social Care Trust |
Passmore A.P.,Queens University of Belfast |
Silvestri G.,Queens University of Belfast
Journal of Alzheimer's Disease | Year: 2014
Background: Age-related macular degeneration (AMD) and Alzheimer's disease (AD) share several features, including the presence of extracellular abnormal deposits associated with neuronal degeneration, drusen, and plaques, respectively. Investigation of any association of AMD and specifically AD is worthwhile but has rarely been done. Objectives: The aim of this study was to determine the prevalence of AMD in subjects with AD in comparison with an age-matched cognitively normal cohort. Methods: Cases were defined as those diagnosed with AD using standardized criteria as part of their clinical care, while controls were cognitively intact individuals aged 65 years or more. Dilated retinal photographs were taken, and a range of potentially confounding factors measured including APOE genotype. AMD features were recorded and AMD grades given. Results: Data was collected on 322 controls and 258 cases. While AMD was associated with AD, and the proportion of cases of advanced AMD in AD cases was twice that of controls, when corrected the association was lost. AD was associated with age, the presence of an APOE allele, and smoking, while being 'generally unwell recently' was associated with a reduced risk of AD. Conclusion: AD and AMD are both associated with age, but our study does not find evidence they are associated with each other. However the retina offers an opportunity to non-invasively image neuronal tissue, and more sophisticated imaging techniques may shed light on ocular biomarkers of AD. © 2014-IOS Press.