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Northumbria, United Kingdom

Emmett C.,Northumbria University | Poole M.,Northumbria University | Bond J.,Northumbria University | Hughes J.C.,Northumbria Healthcare NHS Trust
International Journal of Law and Psychiatry | Year: 2013

Background: This article stems from a larger project which considers ways of improving assessments of capacity and judgements about best interests in connection with people with dementia admitted to acute hospitals with respect to decisions about place of residence. Aims: Our aim is to comment on how assessments of residence capacity are actually performed on general hospital wards compared with legal standards for the assessment of capacity set out in the Mental Capacity Act, 2005 (MCA). Method: Our findings are grounded in ethnographic ward-based observations and in-depth interviews conducted in three hospital wards, in two hospitals (acute and rehabilitation), within two NHS healthcare trusts in the North of England over a period of nine months between 2008 and 2009. Twenty-nine patient cases were recruited to the study. We also draw from broader conceptions of capacity found in domestic and international legal, medical, ethical and social science literature. Results: Our findings suggest that whilst professionals profess to be familiar with broad legal standards governing the assessment of capacity under the MCA, these standards are not routinely applied in practice in general hospital settings when assessing capacity to decide place of residence on discharge from hospital. We discuss whether the criteria set out in the MCA and the guidance in its Code of Practice are sufficient when assessing residence capacity, given the particular ambiguities and complexities of this capacity. Conclusions: We conclude by suggesting that more specific legal standards are required when assessing capacity in this particular context. © 2012 Elsevier Ltd.

Reed M.,Northumbria Healthcare NHS Trust | Kimberger O.,Medical University of Vienna | McGovern P.D.,Medway Maritime Hospital | Albrecht M.C.,Augustine Temperature Management
AANA Journal | Year: 2013

Forced-air warming devices are effective for the prevention of surgical hypothermia. However, these devices intake nonsterile floor-level air, and it is unknown whether they have adequate filtration measures to prevent the internal buildup or emission of microbial contaminants. We rated the intake filtration efficiency of a popular current-generation forced-air warming device (Bair Hugger model 750, Arizant Healthcare) using a monodisperse sodium chloride aerosol in the laboratory. We further sampled 23 forced-air warming devices (same model) in daily hospital use for internal microbial buildup and airborne-contamination emissions via swabbingand particle counting. Laboratory testing found the intake filter to be 63.8% efficient. Swabbing detected microorganisms within 100% of the forcedair warming blowers sampled, with isolates of coagulase- negative staphylococci, mold, and micrococci identified. Particle counting showed 96% of forced-air warming blowers to be emitting significant levels of internally generated airborne contaminants out of thehose end. These findings highlight the need for upgraded intake filtration, preferably high-efficiency particulate air filtration (99.97% efficient), on currentgeneration forced-air warming devices to reduce contamination buildup and emission risks.

Poole M.,Northumbria University | Bond J.,Northumbria University | Emmett C.,Northumbria University | Greener H.,Gateshead Health NHS Foundation Trust | And 4 more authors.
BMC Geriatrics | Year: 2014

Background: A significant proportion of patients in an acute hospital is made up of older people, many of whom have cognitive impairment or dementia. Rightly or wrongly, if a degree of confusion is apparent, it is often questioned whether the person is able to return to the previous place of residence. We wished to understand how, on medical wards, judgements about capacity and best interests with respect to going home are made for people with dementia and how decision-making around hospital discharge for people with dementia and their families might be improved. Our research reflects the jurisdiction in which we work, but the importance of residence capacity rests on its implications for basic human rights. Methods. The research employed a ward-based ethnography. Observational data were captured through detailed fieldnotes, in-depth interviews, medical-record review and focus groups. Themes and key issues were identified using constant comparative analysis of 29 cases. Theoretical sampling of key stakeholders was undertaken, including patients with dementia (with and without residence capacity), their relatives and a range of practitioners. The research was carried out in three hospital wards (acute and rehabilitation) in two hospitals within two National Health Service (NHS) healthcare trusts in the North of England over a period of nine months between 2008 and 2009. Results: Our analysis highlights the complexity of judgements about capacity and best interests in relation to decisions about place of residence for people with dementia facing discharge from hospital. Five key themes emerged from data: the complexity of borderline decisions; the requirement for better understanding of assessment approaches in relation to residence capacity; the need for better documentation; the importance of narrative; and the crucial relevance of time and timing in making these decisions. Conclusions: We need: more support and training for practitioners, as well as support for patients and families; clarity about the information to be imparted to the person with dementia; more advocacy for people with dementia; appropriate assessments embedded in routine clinical practice; the patient with dementia to be centre-stage; and properly resourced step-down or rehabilitation units to facilitate timely and good decision-making about place of residence. © 2014 Poole et al.; licensee BioMed Central Ltd.

Lie M.L.S.,Northumbria University | Hayes L.,Northumbria University | Lewis-Barned N.J.,Northumbria Healthcare NHS Trust | May C.,University of Southampton | And 2 more authors.
Diabetic Medicine | Year: 2013

Aims: To explore factors influencing post-natal health behaviours following the experience of gestational diabetes, and to elicit women's views about the feasibility of lifestyle intervention to prevent diabetes during the first 2 years after childbirth. Methods: Qualitative study using semi-structured interviews with women who had gestational diabetes. In phase 1 (31 women), interviews explored the experience of gestational diabetes, ideas about future risk of diabetes and factors influencing post-natal health-related behaviours. Statements were developed summarizing women's views of lifestyle change to prevent diabetes. In phase 2 (14 women), interviews explored how the passage of time had contributed to changes in health behaviour, and the statements were used to develop views about diabetes interventions. Results: Women were aware of their risk of developing diabetes, but did not always act on such knowledge. Pregnancy motivated behaviour changes to benefit the unborn child, but after delivery these changes were often not maintained. Tiredness, maternal attachment and childcare demands were prominent barriers in the early post-natal months. Later, work, family and child development became more significant barriers. Many women became more receptive to healthy eating messages around the time of weaning. Women were positive about long-term support for self-management to reduce their diabetes risk. Conclusions: There is potential to reduce the risk of Type 2 diabetes post-natally among women with gestational diabetes. Interventions need to be developed that take into account contextual factors and competing demands, are flexible and respond to women's individual circumstances. Randomized trials of such interventions are warranted. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

Bates D.,Royal Infirmary | Bates C.,Northumbria Healthcare NHS Trust
Medicine (United Kingdom) | Year: 2013

Confusion and delirium are the most common behavioural disorders seen in an acute medical or surgical unit. Confusion can be regarded as a mild form of delirium and may give warning of the development of the more severe disorder. It causes an acute change of mental status, characterized by abnormal and fluctuating attention. It affects between 10 and 30% of medically ill patients, especially the elderly and often shortly after admission to hospital. It causes prolonged admission, increased morbidity and mortality, and delayed discharge, often culminating in long-term care. Its causation is reviewed and its prevention and management are described. © 2013 Elsevier B.V. All rights reserved.

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