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158 results

Page 1 of 8

  • Experience of financial challenges, retirement concerns, and planning: evidence from representative samples of workers in 16 countries

  • Stefania Innocenti, Gordon L. Clark, Sarah McGill
  • Journal:
    Journal of Pension Economics & Finance , First View
    Published online by Cambridge University Press:
    19 June 2023, pp. 1-19
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  • We examine whether an individual's inability to save in the last 12 months affects the extent to which they are concerned about their future financial security and their propensity to plan for retirement. We use an original survey based upon representative samples of working individuals in 16 countries. We show that individuals who were unable to save over the 12-month period prior to the survey are less likely to consider well-being in retirement as their major financial concern. They are also less likely to invest in supplementary pension funds than those who were able to accumulate savings. We provide evidence that these findings are robust under several specifications and are mediated by respondents' perceived income prospects and assessment of their current financial situations.

  • Implementation of the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme: an interdisciplinary, generalisable approach to inpatient neurodevelopmental care

  • Kelly R. Wolfe, Sherrill D. Caprarola, Caelah Clark, Jesse Davidson, Melanie D. Everitt, Laura Faul, Colton Hageman, Sarah L. Kelly, Emily Maloney, Hilary Patteson, Sarah Scott, Alyse Talbot, Suhong Tong, Kimberly L. DiMaria
  • Journal:
    Cardiology in the Young , First View
    Published online by Cambridge University Press:
    12 April 2023, pp. 1-8
  • Background:

    Children with CHD are at risk for neurodevelopmental delays, and length of hospitalisation is a predictor of poorer long-term outcomes. Multiple aspects of hospitalisation impact neurodevelopment, including sleep interruptions, limited holding, and reduced developmental stimulation. We aimed to address modifiable factors by creating and implementing an interdisciplinary inpatient neurodevelopmental care programme in our Heart Institute.

    Methods:

    In this quality improvement study, we developed an empirically supported approach to neurodevelopmental care across the continuum of hospitalisation for patients with CHD using three plan-do-study-act cycles. With input from multi-level stakeholders including parents/caregivers, we co-designed interventions that comprised the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme. These included medical/nursing orders for developmental care practices, developmental kits for patients, bedside developmental plans, caregiver education and support, developmental care rounds, and a specialised volunteer programme. We obtained data from the electronic health record for patients aged 0–2 years admitted for at least 7 days to track implementation.

    Results:

    There were 619 admissions in 18 months. Utilisation of CINCO interventions increased over time, particularly for the medical/nursing orders and caregiver handouts. The volunteer programme launch was delayed but grew rapidly and within six months, provided over 500 hours of developmental interaction with patients.

    Conclusions:

    We created and implemented a low-cost programme that systematised and expanded upon existing neurodevelopmental care practices in the cardiac inpatient units. Feasibility was demonstrated through increasing implementation rates over time. Key takeaways include the importance of multi-level stakeholder buy-in and embedding processes in existing clinical workflows.

  • Undue burden: Black faculty, COVID-19, and the racial justice movement

  • Tracy M. Layne, Uraina S. Clark, Nihal E. Mohamed, Sarah J. Miller, Jamilia R. Sly, Holden E. Kata, Varuna Astha, Steven A. Lawrence, Yvette Hutson, Kirk N. Campbell, Emma K.T. Benn
  • Journal:
    Journal of Clinical and Translational Science / Volume 7 / Issue 1 / 2023
    Published online by Cambridge University Press:
    13 September 2022, e14
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  • A crucial reckoning was initiated when the COVID-19 pandemic began to expose and intensify long-standing racial/ethnic health inequities, all while various sectors of society pursued racial justice reform. As a result, there has been a contextual shift towards broader recognition of systemic racism, and not race, as the shared foundational driver of both societal maladies. This confluence of issues is of particular relevance to Black populations disproportionately affected by the pandemic and racial injustice. In response, institutions have initiated diversity, equity, and inclusion (DEI) efforts as a way forward. This article considers how the dual pandemic climate of COVID-19-related health inequities and the racial justice movement could exacerbate the “time and effort tax” on Black faculty to engage in DEI efforts in academia and biomedicine. We discuss the impact of this “tax” on career advancement and well-being, and introduce an operational framework for considering the interconnected influence of systemic racism, the dual pandemics, and DEI work on the experience of Black faculty. If not meaningfully addressed, the “time and effort tax” could contribute to Black and other underrepresented minority faculty leaving academia and biomedicine – consequently, the very diversity, equity, and inclusion work meant to increase representation could decrease it.

  • Digital and virtual strategies to advance community stakeholder engagement in research during COVID-19 pandemic

  • Part of
  • Samuel Byiringiro, Cyd Lacanienta, Roger Clark, Crystal Evans, Sarah Stevens, Melanie Reese, Pamela Ouyang, Mia Terkowitz, Christine Weston, Panagis Galiatsatos, Monica Guerrero Vazquez, Frederick W. Luthardt, Cheryl R. Dennison Himmelfarb
  • Journal:
    Journal of Clinical and Translational Science / Volume 6 / Issue 1 / 2022
    Published online by Cambridge University Press:
    30 August 2022, e121
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  • Despite the adversity presented by COVID-19 pandemic, it also pushed for experimenting with innovative strategies for community engagement. The Community Research Advisory Council (C-RAC) at Johns Hopkins University (JHU), is an initiative to promote community engagement in research. COVID-19 rendered it impossible for C-RAC to conduct its meetings all of which have historically been in person. We describe the experience of advancing the work of the C-RAC during COVID-19 using digital and virtual strategies. Since March 2020, C-RAC transitioned from in person to virtual meetings. The needs assessment was conducted among C-RAC members, and individualized solutions provided for a successful virtual engagement. The usual working schedule was altered to respond to COVID-19 and promote community engaged research. Attendance to C-RAC meetings before and after the transition to virtual operation increased from 69% to 76% among C-RAC members from the community. In addition, the C-RAC launched new initiatives and in eighteen months since January 2020, it conducted 50 highly rated research reviews for 20 research teams. The experience of the C-RAC demonstrates that when community needs are assessed and addressed, and technical support is provided, digital strategies can lead to greater community collaborations.

  • Chapter 28 - Cardiac Disease in Pregnancy

  • from Section 4 - Maternal Medicine
  • Edited by Tahir Mahmood, Charles Savona Ventura, Ioannis Messinis, Sambit Mukhopadhyay
  • Book:
    The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
    Published online:
    20 November 2021
    Print publication:
    02 December 2021, pp 225-235

  • Summary

    Major physiological changes occur in the maternal cardiovascular system during pregnancy. In women with pre-existing or previously undiagnosed cardiac disease, these changes may precipitate cardiac decompensation. The number of women with heart disease embarking on a pregnancy is increasing. Heart disease is the commonest cause of maternal death in the UK where all maternal deaths are critically reviewed. In approximately half of the women who died from cardiac disease in the UK, suboptimal care was identified. In the Netherlands, the maternal mortality rate from cardiac disease (2004–2006) was 3 per 100 000 maternities. Multidisciplinary teams working and co-location of clinical services are critically important to ensure the best care possible for pregnant women with cardiac conditions (Figure 28.1).

  • 5 - Making and maintaining neighbourhood connections when living alone with dementia

  • Edited by Richard Ward, University of Stirling, Andrew Clark, University of Salford, Lyn Phillipson, University of Wollongong, Australia
  • Book:
    Dementia and Place
    Published by:
    Bristol University Press
    Published online:
    13 May 2022
    Print publication:
    24 September 2021, pp 67-89

  • Summary

    Introduction

    This chapter draws on qualitative research using participatory methods to explore the experience of people with dementia who live alone. Drawing on data gathered in Sweden and the UK, the chapter highlights the distinct challenges of living alone with dementia and explores the different ways that people remain connected to neighbourhood places. We argue that the invisibility of such experiences to dementia policy and strategies (which typically assume the presence of a cohabiting carer or household member to provide support) needs to be addressed if dementia-friendly initiatives are to be truly inclusive.

    Demographic projections show that the number of people living in single households will continue to increase steadily in many western and northern European countries and that older women are the fastest-growing section of the single householder population (Sundström et al, 2016; United Nations, 2017). The ageing population living alone in Europe also includes an increasing proportion of people with dementia (Prescop et al, 1999; Gaymu and Springer, 2010; Prince et al, 2015). In Canada, France, Germany, the UK and Sweden, between one third and one half of the population of people with dementia residing in a neighbourhood context live in single households (Ebly et al, 1999; Nourhashemi et al, 2005; Alzheimer's Society, 2013; Eichler et al, 2016; Odzakovic et al, 2019). Despite this increase in single householders with dementia, there is currently limited awareness of the particular challenges associated with living alone with dementia, even within emerging discourses and practices associated with dementia-friendly communities (Alzheimer's Society, 2013; Age UK, 2018; Odzakovic et al, 2018). As such, there is a danger that the creation of ‘dementia-friendly’ communities, and especially those based on communities of place, may rest upon a series of normative assumptions about dementia and about the relational context of people living with the condition.

    Evidence from service-oriented research shows that people with dementia who live alone are more prone to (unplanned) hospitalisation (Ennis et al, 2014); are at greater risk of malnutrition (Nourhashemi et al, 2005); are likely to be admitted to long-term care at an earlier point in their journey with dementia (Yaffe et al, 2002); are often less well connected to formal services (Webber et al, 1994); and lack the advocacy of a co-resident carer (Eichler et al, 2016).

  • 7 - Enabling the neighbourhood: a case for rethinking dementia-friendly communities

  • Edited by Richard Ward, University of Stirling, Andrew Clark, University of Salford, Lyn Phillipson, University of Wollongong, Australia
  • Book:
    Dementia and Place
    Published by:
    Bristol University Press
    Published online:
    13 May 2022
    Print publication:
    24 September 2021, pp 94-112

  • Summary

    Introduction

    Neighbourhoods have been integral to the rapid changes occurring within dementia care in recent years, although have not always been acknowledged as such. Dementia, like aged and mental health care before it has been absorbed into a project of deinstitutionalisation occurring within healthcare systems across much of the affluent west (Anttonen and Karsio, 2016). In the UK, deinstitutionalising dementia has involved large-scale reductions to hospital beds available to people with dementia and reduced duration of stay (Alzheimer's Society, 2009). In basic terms, it has meant the relocation of care and support from one type of material and social setting to another, and as such marks a changing geography of care. In many parts of Europe, this ‘re-placing’ of dementia care has not stalled at the shift to community-based support. The ongoing retrenchment of public services driven by a policy of fiscal consolidation (that is austerity) has led to widespread closures of traditional council-led day care services (Needham, 2014) alongside tightening of eligibility criteria for admission to care homes and for Continuing Health Care (RCN, 2012), resulting in significant reductions in collective forms of community-based provision. People with dementia are increasingly less likely to be clustered in designated care settings while segregated from the wider community. Instead, policy intentions have shifted to supporting people to age in place through a focus on Personalisation (DoH, 2019; Malbon et al, 2019; Manthorpe and Samsi, 2016). However, as with aged care before it, concerns have been raised over the extent of an existing neighbourhood infrastructure to adequately respond to such changes in dementia care (for example, Miranda-Castillo et al, 2010). The potential danger is that people living with the condition may become, in Rowles’ (1978) terms, ‘prisoners of space’; facing the prospect of social isolation and domestic confinement as their lifeworld constricts (Alzheimer's Society, 2013; Moyle at el, 2011).

    The advent of the ‘dementia-friendly community’ (DFC), following in the wake of the age-friendly cities movement (WHO, 2007), might be read as a vehicle for policy to address these concerns. Interestingly in the UK, the approach differs between countries. In Scotland, dementia is a devolved matter, with the Holyrood government setting policy which acknowledges the importance of DFCs through the National Dementia Strategy (Scottish Government, 2017).

  • 2 - Understanding the meaning of neighbourhoods for people living with dementia: the value of a relational lens

  • Edited by Richard Ward, University of Stirling, Andrew Clark, University of Salford, Lyn Phillipson, University of Wollongong, Australia
  • Book:
    Dementia and Place
    Published by:
    Bristol University Press
    Published online:
    13 May 2022
    Print publication:
    24 September 2021, pp 23-43

  • Summary

    Introduction

    This chapter explores what neighbourhoods mean for people living with dementia. While the built environment, and the economic and political apparatus they comprise of such as shops, services and localised campaigning, are certainly important, our attention focuses on how people living with dementia understand neighbourhoods as sites of relationally constituted ordinary or everyday social connection, engagement and interaction. The chapter outlines the nature of associations individuals have with the wider social sphere of their immediate locale and considers how these ostensibly geographical proximate (or local) social connections might support people to live as well as they might with dementia. In doing so, it considers why it matters to understand the socio-spatial dimensions of neighbourhoods as relational and interconnected phenomena and considers the importance of thinking about neighbourhoods as more than environments in need of intervention or modification in order to support people living with dementia.

    How are neighbourhoods understood in the dementia literature?

    In a review published in 2012, Keady and colleagues noted that a surprisingly small amount of literature has focused specifically on the importance of neighbourhoods for people living with dementia. The review identified three domains of activity: outdoor spaces, the built environment, and everyday technologies. The first examines how the outdoor environment can be better designed and/or modified to support people living with dementia. This includes work on the design of streetscapes and road layouts to better support mobility, as well as ongoing work to enable easier access to a range of different environments such as green and recreational spaces. A second attends to navigation and mobility of environments, such as shopping centres, hospitals, museums and grocery stores. The third investigates the use of technologies, including virtual realities, to support access to, or better develop, environments beyond the home (Keady et al, 2012). Since then, a considerable body of work has continued to investigate these areas (Sturge et al, 2021) and continues to provide evidence of the need to better understand why and how people living with dementia interact with their immediate environments outside of the home.

  • Impact of CLSI Break Point Changes Over the Past Decade on Antimicrobial Susceptibility in Gram-Negative Bacteria

  • Wesley Johnson, David Burgess, Donna Burgess, Sarah Cotner, Jeremy VanHoose, Justin Clark, Katie Wallace
  • Journal:
    Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
    Published online by Cambridge University Press:
    29 July 2021, p. s60
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  • Background: Over the past decade, the CLSI has updated susceptibility break points for several antimicrobial agents. The purpose of this study was to evaluate the impact of these changes against gram-negative bacteria at our academic medical center. Methods: In this retrospective, IRB-approved study, we collected consecutive, nonduplicate clinical isolates of Enterobacter cloacae, Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, and Pseudomonas aeruginosa for the past decade (2010–2019) at our academic medical center and 3 adult ICUs. Susceptibility testing was performed using the BD Phoenix automated system. For these isolates, susceptibilities for 7 β-lactams (aztreonam, ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, ertapenem, and meropenem) and 2 fluoroquinolones (levofloxacin, ciprofloxacin) were calculated based upon CLSI break points in 2010 and current CLSI break points in 2020. Any change >5% in susceptibility was deemed significant for this analysis. Results: In 17.5% of Enterobacteriales isolates tested, at least 1 antimicrobial demonstrated significant decline. Ertapenem was the most commonly affected antimicrobial (45% of the isolates) followed by ceftriaxone (35%) and cefepime (25%). Susceptibilities of aztreonam, ceftazidime, and meropenem were not affected for any of the Enterobacteriales. The most common organism demonstrating a significant impact on change in susceptibility among the Enterobacteriales was E. cloacae (41.7% of the time) followed by E. aerogenes (20.8%), K. oxytoca (12.5%), K. pneumoniae (8.3%) and E. coli (4.2%). Most of the impact was observed hospital-wide (33.3%), followed closely by the MICU (28.6%), the NSICU (23.8%) and the CVICU (14.3%). For P. aeruginosa, the impact of the antimicrobial break-point changes on susceptibility was more pronounced than the Enterobacteriales. Overall, 93.8% of the time there was a significant decline in antimicrobial susceptibility. Each antimicrobial (ciprofloxacin, levofloxacin, meropenem, and piperacillin/tazobactam) demonstrated a significant decline in susceptibility hospital-wide and in each ICU except for the susceptibility of meropenem in the NSICU. Conclusions: Changes in break points had a significant impact on the susceptibility of all antimicrobials for P. aeruginosa at our institution, both hospital-wide and in the adult ICUs. Although the impact was less for the Enterobacteriales, ertapenem, ceftriaxone, and cefepime demonstrated significant susceptibility changes, especially with E. cloacae. Understanding and evaluating the impact of the break-point changes may lead to changes in empiric therapy in other institutions.

    Funding: No

    Disclosures: None

  • Chapter 2 - Seventeenth-Century Women’s Poetry in Ireland

  • Edited by Ailbhe Darcy, Cardiff University, David Wheatley, University of Aberdeen
  • Book:
    A History of Irish Women's Poetry
    Published online:
    11 June 2021
    Print publication:
    01 July 2021, pp 57-73

  • Summary

    This essay surveys the small but compelling body of poetry written by women in Ireland, in English and Irish, in the seventeenth century. The Irish bardic tradition generally excluded women, but exceptions do occur, as when a bardic poem addressed to the teenaged Brighid Nic Gearailt elicits a response from its subject. The bardic poems of Caitlín Dubh are another exception again, memorialising an Irish-speaking Protestant loyalist, the Earl of Thomond. Women did, however, occupy a central role in the caoine/caoineadh traditions (the rituals of verse and oral lament). In the Anglophone tradition, poets such as Mary Sidney Herbert, Anne Southwell, and Katherine Philips explore their marginality from their positions as colonial Protestant writers, while still engaging sympathetically with Ireland as setting and subject matter. The network of connections between writers and readers is often complex, but the picture that emerges comprehensively deepens our understanding of Irish poetry from this period.

  • Supporting general adult psychiatry higher trainees to develop research competencies: a training improvement project

  • Annalie Clark, John Stevens, Sarah Abd El Sayed
  • Journal:
    BJPsych Open / Volume 7 / Issue S1 / June 2021
    Published online by Cambridge University Press:
    18 June 2021, pp. S131-S132
    • Article
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  • Aims

    Evidence shows that research-active trusts have better clinical patient outcomes. Psychiatric trainees are required to develop knowledge and skills in research techniques and critical appraisal to enable them to practice evidence-based medicine and be research-active clinicians. This project aimed to evaluate and improve the support for developing research competencies available to general adult psychiatry higher trainees (HT) in the North-West of England.

    Method

    General Adult HT in the North–West of England completed a baseline survey in November 2019 to ascertain trainee's experience of research training provision. The following interventions were implemented to address this feedback:

    A trainee research handbook was produced, containing exemplar activies for developing research competencies and available training opportunities, supervisors and active research studies.

    The trainee research representative circulated research and training opportunities between November 2019 – August 2020.

    Research representatives held a trainee Question and Answer session in September 2020.

    All General Adult HT were asked to complete an electronic survey in November 2020 to evaluate the effect of these interventions.

    Result

    18 General Adult HT completed the baseline survey in November 2019. 29.4% of trainees thought they received enough information on research competencies and 88.9% wanted more written guidance. 38.9% of trainees knew who to contact about research within their NHS Trust and 33.3% were aware of current research studies. Identified challenges for meeting research competencies included lack of time, difficulty identifying a mentor and topic and accessibility of projects.

    20 General Adult HT completed the repeat survey in November 2020. 50% of trainees wanted to be actively involved in research and 35% wanted to develop evidence-based medicine skills. A minority of trainees aimed to complete only the minimum ARCP requirements. All trainees thought the handbook was a useful resource for meeting research competencies and would recommend it to other trainees. In trainees who received the handbook, 94.7% thought they had received adequate support on meeting research competencies and 94.7% knew who to contact about research in their trust. 68.4% of trainees would like further written guidance on meeting research competencies. Trainees highlighted ongoing practical difficulties with engaging with research and concern about lacking required skills for research.

    Conclusion

    Trainees are motivated to engage with research on various different levels, not purely for ARCP purposes. Simple interventions can help trainees feel adequately supported with meeting research competencies. Further work to support trainee involvement in research and improve trainee confidence in engaging with research is required.

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