Psychological distress in mothers of children admitted to a nutritional rehabilitation unit in Malawi - a comparison with other paediatric wards

In a previous study we found a very high prevalence of psychological distress in mothers of children admitted to a nutritional rehabilitation unit (NRU) in Malawi, Africa. The objective of this study was to compare the prevalence and severity of maternal distress within the NRU with that in other paediatric wards. Given the known association between poor maternal psychological well-being and child undernutrition in low- and middle-income countries, we hypothesised that distress would be higher among NRU mothers. Mothers of consecutive paediatric inpatients in a NRU, a high-dependency (and research) unit and an oncology ward were assessed for psychological distress using the Self-Reporting Questionnaire (SRQ). Two hundred sixty-eight mothers were interviewed (90.3% of eligible). The prevalence of SRQ score ≥8 was 35/150 {23.3% [95% confidence interval (CI) 16.8- 30.9%]} on the NRU, 13/84 [15.5% (95% CI 8.5-25.0%)] on the high-dependency unit and 7/34 [20.6% (95% CI 8.7-37.9%)] on the oncology ward (χ(2)  = 2.04, P = 0.36). In linear regression analysis, the correlates of higher SRQ score were child diarrhoea on admission, child diagnosed with tuberculosis, and maternal experience of abuse by partner; child height-for-age z-score fell only just outside significance (P = 0.05). In summary, we found no evidence of greater maternal distress among the mothers of severely malnourished children within the NRU compared with mothers of paediatric inpatients with other severe illnesses. However, in support of previous research findings, we found some evidence that poor maternal psychological well-being is associated with child stunting and diarrhoea.

Early Implementation of BIM into a Cold-Formed Steel Design/ Fabricator and an Architectural/Planning Consultancy

There is a broad consensus surrounding the ability of building information modelling (BIM) to positively impact a project by enabling greater collaboration. This paper aims to examine the development of BIM and how it can contribute to the evermore present and growing cold-formed steel (CFS) industry. This is achieved thorough a comprehensive literature review and four exploratory interviews with industry experts. Work has been carried out, for the first time, alongside one of the UK’s largest CFS Designer/Fabricators in conjunction with Northern Ireland’s leading Architectural and Town Planning Consultants in the identification and dissemination of information. The capabilities of BIM have been investigated through modeling of simple CFS structures n consultation with the project partners. By scrutinising the literature and associated interviews, the primary opportunities, as well as barriers, of BIM implementation have been investigated in the context of these companies. It is essential to develop greater understanding of the flexibility, adaptability and interoperability of BIM software as the UK construction industry faces a daunting challenge; fully collaborative 3D BIM as required by the UK Government under the “Government Construction Strategy” by 2016 in all public sector projects. This paper, and the wider study that it stems from, approaches the problem from a new angle, from sections of the construction industry that have not yet fully embedded BIM.

Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews

Background Physical rehabilitation interventions aim to ameliorate the effects of critical illness-associated muscle dysfunction in survivors. We conducted an overview of systematic reviews (SR) evaluating the effect of these interventions across the continuum of recovery.

Methods Six electronic databases (Cochrane Library, CENTRAL, DARE, Medline, Embase, and Cinahl) were searched. Two review authors independently screened articles for eligibility and conducted data extraction and quality appraisal. Reporting quality was assessed and the Grading of Recommendations Assessment, Development and Evaluation approach applied to summarise overall quality of evidence.

Results Five eligible SR were included in this overview, of which three included meta-analyses. Reporting quality of the reviews was judged as medium to high. Two reviews reported moderate-to-high quality evidence of the beneficial effects of physical therapy commencing during intensive care unit (ICU) admission in improving critical illness polyneuropathy/myopathy, quality of life, mortality and healthcare utilisation. These interventions included early mobilisation, cycle ergometry and electrical muscle stimulation. Two reviews reported very low to low quality evidence of the beneficial effects of electrical muscle stimulation delivered in the ICU for improving muscle strength, muscle structure and critical illness polyneuropathy/myopathy. One review reported that due to a lack of good quality randomised controlled trials and inconsistency in measuring outcomes, there was insufficient evidence to support beneficial effects from physical rehabilitation delivered post-ICU discharge.

Conclusions Patients derive short-term benefits from physical rehabilitation delivered during ICU admission. Further robust trials of electrical muscle stimulation in the ICU and rehabilitation delivered following ICU discharge are needed to determine the long-term impact on patient care. This overview provides recommendations for design of future interventional trials and SR.

Investigating Fractured Flow from Orthopaedics to Rehabilitation

Patients often spend time as inpatients in hospitals outside their home area because of the need to access specialist services. If there is a need for ongoing care after the need for specialist care has passed, patients are transferred (or ‘repatriated’) back to the inpatient care of a hospital in their local Health and Social Care Trust. The need for bed space in specialist units means that there is pressure for this transition to occur in a timely way. We investigated the flow of patients through a trauma and orthopaedics unit using the 6M Design® framework and Vitals Charts® in order to investigate concerns about delayed repatriation. We found that repatriation was part of a complex system that had interdependent components. There was considerable variation in the number of discharges (to any destination) by day of week, with a reduction on Saturdays and Sundays. Understanding that the pressure for quicker repatriation was really due to high work-in-progress led us to model the effects of strategies to address the high work-in-progress. We found that, because only a small proportion of patients require repatriation, expediting the repatriation process by one day for each patient would only reduce WIP by an average of 1.6 patients. Reducing the average length of stay for all trauma and orthopaedics inpatients by one day would reduce the WIP by 10 patients, which would make a much greater impact on the problem of high bed occupancy. Though the smooth and timely repatriation of patients to rehabilitation units is desirable, it is unlikely that efforts to achieve this will have a substantial impact on the problem of high WIP, so other strategies will be required. We will model the effects of strategies to reduce variation in daily discharges by the day of week in a future essay.