Structural Changes in Silicon Rubber Peritoneal Dialysis Catheters in Patients using Mupirocin at the Exit Site

Structural damage to polyurethane PD (peritoneal dialysis) catheters in patients using mupirocin ointment is widely appreciated, but damage to silicon rubber PD catheters is less well described. Ten catheters (6.6%) out of 152 were found to have structural alterations such as opacification, ballooning, thinning, and rupture. The duration of PD in these 10 patients ranged from 23 months to 80 months (mean duration 51.1 months). The frequency of mupirocin application varied from daily (2 cases) to 2-3 times per week (7 cases). In eight catheters opacification occurred at the exit site whereas one catheter showed opacification midway between the exit site and the titanium adaptor. One catheter showed opacification, ballooning, and thinning at the exit site ruptured in the form of two slit-like openings. In conclusion, various structural changes such as opacification, ballooning or thinning were seen in 6.6% of silicon rubber PD catheters in patients using mupirocin at the exit site. Although the mechanism remains elusive, mupirocin or the antiseptic solution alone or in combination may be contributory. We believe that this is an under-reported complication and encourage other health care givers to incorporate a search for such changes during clinic visits.

Violent children: a framework for assessment

Violence by and towards young people has become a major public health issue. Increased lethality, more random violence and fewer safe places largely account for the high levels of fear experienced by both children and adults. In the field of child protection and domestic violence, where traditionally the child is referred as the victim not the perpetrator, child psychiatrists are well versed, practised and skilled in the assessment of children and families. However, young people are increasingly being referred to child and adolescent mental health teams for assessment because of violent acts that they have carried out. This is reflected in heavy case-loads of children with conduct disorder who have multi-morbidity and complex need. In England and Wales, health (including mental health), social care and education services are mandated to assist youth offending teams.

Young people, mental illness and stigmatisation

In a recent review of the literature, Hayward & Bright (1997) offer four possible answers to the question of “What is the root cause of an unfavourable view of ‘mental illness’?” First, dangerousness: people fear the mentally ill because they believe them to be prone to violence. Second, attribution of responsibility: sufferers of mental/behavioural problems are seen as more responsible for their condition, implying a belief that the mentally ill ‘choose’ to behave as they do. Third, conditions perceived as being chronic, difficult to treat and having a poor prognosis are more stigmatised, and fourth, the cause for stigma lies in the disruption of normal social interactions based on social role.

The effects of domestic violence and sexual abuse on mental health

The Department of Health and National Institute for Mental Health in England have undertaken a programme of research and policy development since spring 2004 in partnership with the Home Office which has important implications for the practice of psychiatry. This article looks at the Victims of Violence and Abuse Prevention Programme (VVAPP) guide ‘Tackling the Health and Mental Health Effects of Domestic and Sexual Violence and Abuse’ launched in 2006, supported by Department of Health and Home Office ministers and national clinical directors.

Minimal methylation classifier (MIMIC): A novel method for derivation and rapid diagnostic detection of disease-associated DNA methylation signatures

Rapid and reliable detection of disease-associated DNA methylation patterns has major potential to advance molecular diagnostics and underpin research investigations. We describe the development and validation of minimal methylation classifier (MIMIC), combining CpG signature design from genome-wide datasets, multiplex-PCR and detection by single-base extension and MALDI-TOF mass spectrometry, in a novel method to assess multi-locus DNA methylation profiles within routine clinically-applicable assays. We illustrate the application of MIMIC to successfully identify the methylation-dependent diagnostic molecular subgroups of medulloblastoma (the most common malignant childhood brain tumour), using scant/low-quality samples remaining from the most recently completed pan-European medulloblastoma clinical trial, refractory to analysis by conventional genome-wide DNA methylation analysis. Using this approach, we identify critical DNA methylation patterns from previously inaccessible cohorts, and reveal novel survival differences between the medulloblastoma disease subgroups with significant potential for clinical exploitation.

The potential of bike desks to reduce sedentary time in the office: a mixed-method study

OBJECTIVES

To investigate the use of bike desks in an office setting and office workers' experiences of bike desks.

STUDY DESIGN

Mixed-method study; quantitative data of cycling desk use in combination with qualitative data of users' experience were obtained via questionnaires.

METHODS

Bike desks were provided in an office setting during a five-month period. The amount of cycled time, distance and the cycling intensity were registered. At the end of the intervention period, participants filled out a questionnaire about their experiences of cycling desks in the office.

RESULTS

Participants cycled for approximately 98 min/week. Most participants were very positive about their bike desk experience and almost all of them would continue using them. About one third of the participants experienced a positive effect on attention and work performance and for about two thirds it positively influenced their motivation during work. Furthermore, about half of the participants felt more energetic, more self-confident and perceived a positive effect on their health and lifestyle.

CONCLUSIONS

Providing bike desks in an office reduces office workers sedentary time. Furthermore, people experienced positive effects on several personal and work-related parameters. Therefore, providing bike desks in office settings seems to be a promising means to reduce sedentary time.

Decision Making in Acute Care: A practical framework supporting the ‘best interests’ Principle

The best interests principle is commonly utilized in acute care settings to assist with decision making about life-saving and life-sustaining treatment. This ethical principle demands that the decision maker refers to some conception of quality of life that is relevant to the individual patient. The aim of this article is to describe the factors that are required to be incorporated into an account of quality of life that will provide a morally justifiable basis for making a judgement about the future quality of life, and therefore the best interests, of critically ill patients who are mentally incompetent. This account consists of three major components - pain and suffering, body functioning, and autonomy - and is applicable in situations where very limited information is available to guide decision making. This framework helps to make decisions about the provision of life-saving treatment that are as consistent as possible in all patient situations.

The Concept of Futility in Health Care Decision Making

Life saving or life sustaining treatment may not be instigated in the clinical setting when such treatment is deemed to be futile and therefore not in the patient’s best interests. The concept of futility, however, is related to many assumptions about quality and quantity of life, and may be relied upon in a manner that is ethically unjustifiable. It is argued that the concept of futility will remain of limited practical use in making decisions based on the best interests principle because it places such high demands on the individual responsible for decision making. This article provides a critical analysis of futility (in the context of the best interests decision-making principle), and proposes an ethically defensible notion of futility.

Sharing news of a lung cancer diagnosis with adult family members and friends: a qualitative study to inform a supportive intervention

OBJECTIVE

Extensive research exists on breaking bad news by clinicians. This study examines perspectives of patients and those accompanying them at diagnosis-giving of subsequently sharing news of lung cancer with adult family/friends, and views of healthcare professionals, to inform development of a supportive intervention.

METHODS

Qualitative interviews with 20 patients, 17 accompanying persons; focus groups and interviews with 27 healthcare professionals from four Thoracic Oncology Units. Intervention development workshops with 24 healthcare professionals and six service users with experience of sharing a cancer diagnosis. Framework thematic analysis.

RESULTS

Patients and accompanying persons shared news of lung cancer whilst coming to terms with the diagnosis. They recalled general support from healthcare professionals but not support with sharing bad news. Six elements were identified providing a framework for a potential intervention: 1-people to be told, 2-information to be shared, 3-timing of sharing, 4-responsibility for sharing, 5-methods of telling others and 6-reactions of those told.

CONCLUSION

This study identifies the challenge of sharing bad news and a potential framework to guide delivery of a supportive intervention tailored to individual needs of patients.

PRACTICE IMPLICATIONS

The identified framework could extend the portfolio of guidance on communication in cancer and potentially in other life-limiting conditions.

A C60-aryne building block: synthesis of a hybrid all-carbon nanostructure

Covalent all-carbon few layer graphene and [60]fullerene conjugates can be easily formed from a versatile [60]fullerene-benzyne building block.

Involving disabled children and young people as partners in research: a systematic review

Children and young people can be valuable partners in research, giving their unique perspectives on what and how research should be done. However, disabled children are less commonly involved in research than their non-disabled peers. This review investigated how disabled children have been involved as research partners; specifically how they have been recruited, the practicalities and challenges of involvement and how these have been overcome, and impacts of involvement for research, and disabled children and young people. The INVOLVE definition of involvement and the Equality and Human Rights Commission definition of disability were used. Relevant bibliographic databases were searched. Websites were searched for grey literature. Included studies had involved disabled children and young people aged 5-25 years in any study design. Reviews, guidelines, reports and other documents from the grey literature were eligible for inclusion. Twenty-two papers were included: seven reviews, eight original research papers, three reports, three guidelines and one webpage. Nine examples of involvement were identified. Recommendations included developing effective communication techniques, using flexible methods that can be adapted to needs and preferences, and ensuring that sufficient support and funding is available for researchers undertaking involvement. Positive impacts of involvement for disabled children included increased confidence, self-esteem and independence. Positive impacts for research were identified. Involving disabled children in research can present challenges; many of these can be overcome with sufficient time, planning and resources. More needs to be done to find ways to involve those with non-verbal communication. Generally, few details were reported about disabled children and young people's involvement in studies, and the quality of evidence was low. Although a range of positive impacts were identified, the majority of these were authors' opinions rather than data. There remains scope for methodological research to inform appropriate approaches to public and patient involvement in childhood disability research.

Peer support for parents of disabled children part 2: how organizational and process factors influenced shared experience in a one-to-one service, a qualitative study

BACKGROUND

Parents of disabled children often seek support from their peers. The shared experience between parents appears to be a crucial mediating factor. Understanding how a sense of shared experience is fostered can help to design and evaluate services that seek to provide peer support.

METHODS

We carried out a qualitative study involving semi-structured interviews and focus groups. Participants were 12 parents and 23 befrienders who had contact with the Face2Face one-to-one befriending service in Devon and Cornwall during a 12-month period, and 10 professionals from health, social care and education.

FINDINGS

Formal structures and processes in place such as training and ongoing supervision and support were highly valued as was the highly personalized, confidential, flexible, one-to-one at-home nature of the service. Crucial to establishing rapport was putting the right people together and ensuring a good match between befrienders and parents. Clearly, the befriending parent has to be emotionally prepared to provide help. However, if the parent being offered support was not ready to accept help at the time it was offered or the type of support was not right for them, they are less likely to engage with the service.

CONCLUSION

Organizational and process factors as well as characteristics of the parents offering and receiving support contribute to the sense of shared experience in one-to-one peer support. These factors interact to influence whether peer support is effective and should be explicitly considered when designing and evaluating services.

Peer support for parents of disabled children part 1: perceived outcomes of a one-to-one service, a qualitative study

BACKGROUND

Parents of disabled children are encouraged to seek peer support. Delivering one-to-one support requires resources; therefore, investigating how these services may impact on families and those providing the service is important when evaluating such services.

METHODS

We carried out a qualitative study involving semi-structured interviews and focus groups. Participants were 12 parents and 23 befrienders who had contact with the Face2Face one-to-one befriending service in Devon and Cornwall during a 12-month period, and 10 professionals from health, social care and education services.

FINDINGS

Shared experience was perceived central to successful peer support and was a catalyst for other elements of support, enabling parents to (i) learn from the experience of others; (ii) speak freely in a safe and non-judgemental environment; and (iii) receive support and encouragement from their befriender. These elements underpinned perceived outcomes for both parents providing and receiving support. Outcomes for parents receiving support centred on emotional stability, personal growth and reduced isolation. Supporting parents experienced positive outcomes through their training, mutual support and the feeling that they were helping others. Parents and befrienders appeared to benefit through expanding their social network. Nevertheless providing support was reported to create emotional burden and concerns for befrienders around their performance, and also required a substantial time commitment.

CONCLUSIONS

Befrienders as well as parents perceived positive outcomes from their involvement in peer support although there is also potential for less positive impact on those offering support.