An evaluation of palliative care services for cancer patients in the Southern Health and Social Services Board of Northern Ireland.

An interview study of 55 lay carers of people who died from cancer in the Southern Board of Northern Ireland was undertaken using a combination of closed-format and open-ended questions. The aim of the study was to evaluate palliative care services delivered in the last six months of their lives to cancer patients who died either at home or in hospital. Two-thirds of the deaths (36) occurred in the domestic home, 45 of the deceased were admitted as hospital inpatients, and the great majority were in receipt of community nursing (53) and general practitioner (54) services. Open-ended questions were used to allow respondents to give their views about services in some detail and their views about good and bad aspects of services were sought. While they were generally satisfied with services specific areas of difficulty were identified in each aspect of care addressed by the study. The most favourable assessments were made of community nursing with the greatest number of negative comments being made about inpatient hospital care. Differing interests between some of those who were dying and their lay carers were found in two areas: the receipt of help from nonfamily members and the information that the deceased received about their terminal status.

Outcomes and projected impact on vision restoration of the China million cataract surgeries program

Purpose: The recently completed Chinese "Million Cataract Surgeries Program" (MCSP) is among the largest such campaigns ever, providing 1.05 million operations. We report MCSP outcomes for the first time, in Jiangxi, the province with the greatest program output. Methods: Ten county hospitals participating in MCSP were selected in Jiangxi (range of gross domestic product per capita US$743-2998). Each hospital sought to enroll 75 consecutive MCSP patients aged ≥50 years. Data recorded included type of cataract procedure, bilateral uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), and refractive error pre- and ≥50 days postoperatively. Results: Among 715 patients (mean age 72.3±9.1 years, 55.5% female), preoperative UCVA was <3/60 (legally blind) bilaterally in 13.3% and unilaterally in the operated eye in 50.9%. No subjects had UCVA >6/18 preoperatively. Small incision cataract surgery was performed in 92.3% patients. Among 662 patients (92.6%) completing follow-up was ≥ 40 days after surgery, BCVA was ≥6/18 in 80.1%, UCVA was ≥6/18 in 57.1% and UCVA was <3/60 in 2.1%. Older age (p<0.001), female sex (p=0.04), worse refractive error (p=0.02) and presence of intra- (p=0.002) and postoperative surgical complications (p<0.001), were independently associated with worse postoperative UCVA. Based on these results, the MCSP cured an estimated 124,950 cases (13.3%×[100-2.1%]×1.05 million) of bilateral and 502,500 (50.9%×[100-2.1%]×1.05 million) of unilateral blindness. Conclusions: Due to relatively good outcomes and the large number of surgeries performed on blind persons, the sight-restoring impact of the MCSP was probably substantial. © Informa Healthcare USA, Inc.

Personal and Public Involvement and its impact - Monitoring, measuring and evaluating the impact of Personal and Public Involvement (PPI) in Health and Social Care in Northern Ireland.

Introduction
This report details the findings from research conducted across Northern Ireland’s Health and Social Care Trusts during 2015 which examines the current state of Personal and Public Involvement (PPI). This is about how service users, carers and patients engage with staff, management and directors of statutory health and social care organisations. Most statutory health and social care organisations must, under legislation, meet the requirements of PPI. PPI has been part of health and social care policy in Northern Ireland since 2007 and became law two years later with the introduction of the Health and Social Care Reform Act (2009). It is, therefore, timely that PPI is now assessed in this systematic way in order to both examine the aspects which are working well and to highlight those areas where improvements need to be made. As far as possible, this Summary Report is written in an accessible way, avoiding jargon and explaining key research terms, so as to ensure it is widely understood. This is in keeping with established good practice in service user involvement research. This summary, therefore, gives a picture of PPI in Northern Ireland currently. There is also a fuller report which gives a lot more details about the research and findings. Information on this is available from the Public Health Agency and/or the Patient and Client Council.

Predictable Pathways? Negotiating Risk in the Context of Marginalisation and Social Exclusion

This article is based on ethnographic research with young people living in an area of multiple deprivation in the North-east of England. The young people in this study experience many risk factors associated with social exclusion and future offending. Through in-depth examination of crime within the context of their lives, it will be argued that recent theorisations of youth crime and criminal careers do not fully capture the nature of their offending, the contextual circumstances surrounding it and the differential impact of similar risk factors on their lives. The article concludes by suggesting that not only do such theories detract from the situations of poverty and social exclusion in which young people live but that youth policies informed by them potentially add to their experiences of exclusion and marginalisation.

The `Chicken and Egg' of Subjective and Social Factors in Desistance from Crime

It is now widely acknowledged that progression from persistent offending to desistance from crime is the outcome of a complex interaction between subjective/ agency factors and social/environmental factors. A methodological challenge for desistance researchers is to unravel the differential impacts of these internal and external factors and the sequence in which they come into play. Towards this, the present investigation draws on a prospective study of 130 male property offenders, interviewed in the 1990s (the Oxford Recidivism Study), and followed up 10 years later. The analysis supports a `subjective—social model' in which subjective states measured before release have a direct effect on recidivism as well as indirect effects through their impact on social circumstances experienced after release from prison.

An Innovative Model for the Provision of Practice Learning Opportunities in Family and Child Care: Newry Student Unit, Southern Health and Social Care Trust.

This article describes the work of Newry Student Unit which operates in the Southern Health and Social Care Trust. The background to the unit is outlined and its development is discussed in the context of practice learning provision in Northern Ireland. The operation of the unit in providing Family and Child Care practice learning opportunities (PLOs) for student social workers is outlined and findings from evaluation questionnaires completed by students, college tutors and team leaders are presented. The paper highlights both the advantages and disadvantages of this model of PLO provision and concludes that it is a valuable resource for practice learning. Proposals for the development of the unit are discussed and it is suggested that the model has the potential be replicated in other areas of Northern Ireland.

Social exclusion and social capital: A comparison and critique

Social exclusion and social capital are widely used concepts with multiple and ambiguous definitions. Their meanings and indicators partially overlap, and thus they are sometimes used interchangeably to refer to the inter-relations of economy and society. Both ideas could benefit from further specification and differentiation. The causes of social exclusion and the consequences of social capital have received the fullest elaboration, to the relative neglect of the outcomes of social exclusion and the genesis of social capital. This article identifies the similarities and differences between social exclusion and social capital. We compare the intellectual histories and theoretical orientations of each term, their empirical manifestations and their place in public policy. The article then moves on to elucidate further each set of ideas. A central argument is that the conflation of these notions partly emerges from a shared theoretical tradition, but also from insufficient theorizing of the processes in which each phenomenon is implicated. A number of suggestions are made for sharpening their explanatory focus, in particular better differentiating between cause and consequence, contextualizing social relations and social networks, and subjecting the policy 'solutions' that follow from each perspective to critical scrutiny. Placing the two in dialogue is beneficial for the further development of each.

An Unkind Cut: Circumcision, Death and the Impact of Irish Health Policy on Asylum Seekers

Healthcare and the wider social determinants of health are the keystone of a number of complex progressive social justice issues that evoke complex emotions. As the demography of Ireland rapidly changes, the practices and expectations of some asylum seekers presents new opportunities for the providers of health service provision and reform. This paper looks at some of the emotions evoked in health care issues and draws on observations and interviews from empirical fieldwork carried out for the Health Research Board. The research was conducted both in the Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght and in a number of refugee reception centres in Ireland. At one level honouring faith choices within a healthcare setting is a societal acknowledgement made to people at their most vulnerable, that the potent and cathartic transformative rituals they value are significant in mediating and managing their emotions - at another level, it is a practical and a symbolic communication of a statutory commitment to inter-culturalism and community cohesion..

Are rural development programmes socially inclusive? Social inclusion, civic engagement, participation, and social capital: Exploring the differences

Considerable importance is attached to social exclusion/inclusion in recent EU rural development programmes. At the national/regional operation of these programmes groups of people who are not participating are often identified as ‘socially excluded groups’. This article contends that rural development programmes are misinterpreting the social processes of participation and consequently labelling some groups as socially excluded when they are not. This is partly because of the interchangeable and confused use of the concepts social inclusion, social capital and civic engagement, and partly because of the presumption that to participate is the default position. Three groups identified as socially excluded groups in Northern Ireland are considered. It is argued that a more careful analysis of what social inclusion means, what civic engagement means, and why participation is presumed to be the norm, leads to a different conclusion about who is excluded. This has both theoretical and policy relevance for the much used concept of social inclusion.

Healthcare professionals’ attitudes towards traumatic brain injury (TBI): The influence of profession, experience, aetiology and blame on prejudice towards survivors of brain injury

Primary objective: To investigate the attitudes of healthcare professionals towards individuals with traumatic brain injury (TBI) and their relationship to intended healthcare behaviour.

Research design: An independent groups design utilized four independent variables; aetiology, group, blame and gender to explore attitudes towards survivors of brain injury. The dependent variables were measured using the Prejudicial Evaluation and Social Interaction Scale (PESIS) and Helping Behaviour Scale (HBS).

Methods and procedures: A hypothetical vignette based methodology was used. Four hundred and sixty participants (131 trainee nurses, 94 qualified nurses, 174 trainee doctors, 61 qualified doctors) were randomly allocated to one of six possible conditions.

Main outcomes and results: Regardless of aetiology, if an individual is to blame for their injury, qualified healthcare professionals have more prejudicial attitudes than those entering the profession. There is a significant negative relationship between prejudice and helping behaviour for qualified healthcare professionals.

Conclusions: Increased prejudicial attitudes of qualified staff are related to a decrease in intended helping behaviour, which has the potential to impact negatively on an individual's recovery post-injury.