Bladder continence management in adult acquired brain injury

Purpose: Persistence of urinary incontinence post acquired brain injury (ABI) carries important prognostic significance. We undertook to document the incidence of urinary incontinence, its management and complications in rehabilitation inpatients following ABI and to assess adherence to post ABI bladder management guidelines. 

Method: A retrospective chart survey of a convenience sample of consecutive admissions to two adult neurorehabilitation units Forster Green Hospital, Belfast, and the Scottish Brain Injury Rehabilitation Service, Edinburgh (SBIRSE). Bladder continence and management on transfer to and discharge from rehabilitation, trial removal of catheter, use of bladder drill, ultrasound investigation, anticholinergic medication and complications were recorded. 

Results: One hundred and forty six patients were identified. Seventy-seven (52.7%) were independent and continent of urine at rehabilitation admission and 109 (74.7%) on discharge. In all, 13 patients had urinary tract infection, 7 had urethral stricture and 1 developed haematuria whilst catheterised. Ultrasound of renal tracts was underused. Trial removal of catheter after transfer to rehabilitation occurred at a median of 10 days. 

Conclusions: Urinary continence was achieved in almost half of incontinent ABI patients during rehabilitation. There is potential for increased use of investigation of the renal tracts. Rehabilitation physicians should consider urethral stricture in the management of continence post ABI. 

Implications for Rehabilitation:

- Persisting urinary incontinence post ABI is associated with increased morbidity.

- Urethral stricture is an under-recognised complication after ABI and should be considered as a potential cause of incontinence in this patient group.

- Gains in urinary continence are seen in patients post ABI, managed with various interventions.

- Goal setting offers an opportunity to focus on bladder management rather than simply continence and may allow improvement in rate of appropriate investigation

Survey of oral health behaviours of patients receiving methadone therapy at a drug rehabilitation centre

Background: This survey aimed to record the dietary habits and oral health behaviours of patients undergoing methadone maintenance therapy at a Scottish drug rehabilitation centre.The objectives were to obtain descriptive data for each of the participants on items including dietary habits, oral hygiene practices and dental health. The study also aimed to explore explanatory relationships between dietary habits, oral hygiene practices and dental health (DMFT) in methadone users.
Methods: A cross – sectional descriptive study using survey methodology was conducted of consecutive adult patients undergoing methadone maintenance therapy at a non-residential drug rehabilitation centre in Dundee, Scotland. A self-completion retrospective questionnaire was distributed to 66 consecutive patients.
Results: A response rate of 74.2% was achieved. Participants reported low daily intakes of fresh fruit and vegetables with diets high in fatty foods. Respondents reported regular snacking between meals and consumption of large amounts of sugared carbonated drinks. Oral hygiene practices were poorly adhered to and a high level of dental disease was observed amongst participants. Poisson regression analysis revealed that the amount of alcohol consumed per day (p=0.02), the length of time taking methadone (p=0.002) the amount of sugar added to hot drinks (p<0.0001) and regular dental attendance (p=0.0001) were all independently associated with poor dental health.
Conclusions: Dietary habits and adherence to oral hygiene practices amongst this group of patients were very poor. This study suggests that these behaviours were contributing to the high levels of dental disease observed in this group.

Are the differences in adulthood ill-health across the North-South divide and between Scotland and England also evident in early childhood health indicators?

Regional differences in adult morbidity and mortality within England (i.e., north-south divide or gradient) and between England and Scotland (i.e., Scottish effect) are only partly explained by adult levels of socioeconomic status or risk factors. This suggests variation in early life, and is supported by the fetal origins and life-course literature which posits that birth outcomes and subsequent, cumulative exposures influence adult health. However, no studies have examined the north-south gradient or Scottish effect in health in the earliest years of life. The aims of the study were: i) to examine health indicators in English and Scottish children at birth and age three to establish whether regional differences exist; and ii) to establish whether observed changes in child health at age three were attributable to birth and/or early life environmental exposures. Respondents included 10,639 biological Caucasian mothers of singleton children recruited to the Millennium Cohort Study (MCS) in the year 2000. Outcome variables were: gestational age and birth weight, and height, body mass index (BMI), and externalising behavioural problems at age three. Region/country was categorised as: South (reference), Midlands, North (England), and Scotland. Respondents provided information on child, maternal, household, and socioeconomic characteristics. Results indicated no significant regional variations for gestational age or birth weight. At age three there was a north-south gradient for externalising behaviour and a north-south divide in BMI which attenuated on adjustment. However, a north-south divide in height was not fully explained by adjustment. There was also evidence of a ‘Midlands effect’, with increased likelihood of shorter stature and behaviour problems. Results showed a Scottish effect for height and BMI in the unadjusted models, and height in the adjusted model, but a decreased likelihood of behaviour problems. Findings indicated no regional differences in health at birth, but some regional variation at age three supports the cumulative life-course model.

Chan ceist duit a bhás go bráth: 'An Lon Dubh Báite'

This article discusses an enigmatic poem by the 18th century Gaelic poet Séamas Mac Cuarta, and three subsequent translations into English. The poem is written in the 'Trí Rann agus Amhrán' form, reminiscent of the English sonnet.

Dangerous Liaisons:for tape

honourable mention, Bourges Festival France 1983
choreographed by Richard Alston for Ballet Rambert 1984
revived by Scottish Ballet (20th Century Classics) Festival Theatre Edinburgh 25/09/04

UK medical graduates’ preparedness for practice (P4P): A multi-site qualitative study

Introduction Previous research has demonstrated mixed findings in terms of graduates’ P4P in terms of their knowledge and skills, and interpersonal, systemic and technological aspects (Monrouxe et al. 2014). Few studies have included diverse stakeholders from multiple sites and employing longitudinal methods. We therefore aimed to understand the extent to which UK medical graduates are prepared for practice as Foundation doctors. Methods Cross-sectional qualitative narrative interview and longitudinal audio-diary (LAD) studies with participants from England, Scotland, Wales and Northern Ireland. Study 1 comprised 27 group and 84 individual interviews (n=185) with participants representing different stakeholders (F1s, fully registered trainees, clinical educators, undergraduate/postgraduate deans/foundation programme directors, other healthcare professionals, employers, policy makers, government representatives, and patient/public representatives). Study 2 comprised LADs with 26 F1s over 4-months. Results Participants found it hard initially to conceptualise the term ‘preparedness for practice’. We identified 2187 personal incident narratives (i.e. stories of P4P experiences) across our data: 506 (23%) were classed as ‘prepared’, 730 (33%) as ‘unprepared’ and 951 (44%) as ‘unspecified’. We identified factors that facilitated (e.g. supportive supervisors/colleagues, opportunities for shadowing) and hindered (e.g. unsupportive or disrespectful colleagues, poor organization, understaffing) transitions into and through the Foundation programme. The LADs suggested that trainees felt more confident and competent over time, but that such development was not always linear as challenging circumstances (e.g. new rotations) sometimes made trainees feel unprepared for situations where they had previously indicated preparedness. Conclusion Our findings add to the existing evidence on medical graduates’ P4P in the UK (e.g. Goldacre et al. 2008; Illing et al. 2013). Our findings support the role of assistantships and supportive supervisors for smoothing transitions from student to F1. Further longitudinal and action research studies are now needed to follow students through their final-year assistantships and into their F2 year.

A review of offshore wind power development in the United Kingdom

Currently wind power is dominated by onshore wind farms. However, as the demand for power grows driven by security of energy supply issues, dwindling fossil fuel supplies and greenhouse gas emissions reduction targets, offshore wind power will develop rapidly because of the decline of viable onshore sites. The United Kingdom has a target of 21% renewable electricity by 2020 and this is expected to come mostly from wind power. Britain is the most active internationally in terms of offshore wind farm development with almost 48GW in some stage of development. In addition the Scottish Government, the Northern Ireland Executive and the Government of Ireland undertook the 'Irish-Scottish Links on Energy Study' (ISLES), which examined the feasibility of creating an offshore interconnected transmission network and subsea electricity grid based on renewable energy sources off the coast of western Scotland and the Irish Sea. The aim of this paper is to provide an appraisal of offshore wind power development with a focus on the United Kingdom. © 2013 IEEE.

The Science of a Lost Medieval Graveyard: The Ballyhanna Research Project

he Science of Lost Medieval Gaelic Graveyard tells the story of the discovery in 2003 of a graveyard and the foundations of a small forgotten stone church at Ballyhanna, in Ballyshannon, Co. Donegal, as part of the N15 Bundoran–Ballyshannon Bypass archaeological works. This led to the excavation of one of the largest collections of medieval burials ever undertaken on this island. Over 1,200 individuals were excavated from the site at Ballyhanna during the winter of 2003–4, representing 1,000 years of burial through the entire Irish medieval period. The discovery led to the establishment of a cross-border research collaboration—the Ballyhanna Research Project—between Queen’s University Belfast and the Institute of Technology, Sligo, which has brought to life this lost Gaelic graveyard.

This book shows how cutting-edge scientific research may aid our understanding and interpretation of archaeology and reveal new insights into past societies. For example, the use of ancient DNA analysis represented the first biomolecular archaeological evaluation of a medieval population to date and provided evidence that cystic fibrosis was much less prevalent in the medieval period than today. The Science of Lost Medieval Gaelic Graveyard is about a community who lived in Gaelic Ireland, about their lifestyles, health and diet. It tells us of their deaths and of their burial traditions, and through examining all of these aspects, it reveals the ebb and flow of their lives.

The book is accompanied by a CD-ROM which includes supplementary information from the Ballyhanna Research Project and the original excavation and survey reports for all of the archaeological sites on the N15 Bundoran–Ballyshannon Bypass.

Sporting Justice: An Arbitrator's Perspective

Drawing on my experience of a number of sports dispute resolution tribunals in the UK and Ireland (such as Sports Resolutions UK; Just Sport Ireland; the Football Association of Ireland’s Disciplinary Panel and the Gaelic Athletic Association’s Dispute Resolution Authority) I intend to use this paper to review the legal arguments typically made in sports-related arbitrations. These points of interest can be summarised as a series of three questions: the fairness question; the liability question; the penalty question.

In answer to the fairness question, the aim is to give a brief outline on best practice in establishing a "fair" sports disciplinary tribunal. The answer, I believe, is always twofold in nature: first, and to paraphrase Lord Steyn in R v Secretary of State For The Home Department, Ex Parte Daly [2001] UKHL 26 at [28] "in law, context is everything" – translated into the present matter, this means that in sports disciplinary cases, the more serious the charges against the individual (in terms of reputational damage, economic impact and/or length of sanction); the more tightly wrapped the procedural safeguards surrounding any subsequent disciplinary hearing must be. A fair disciplinary system will be discussed in the context of the principles laid down in Article 8 of the World Anti-Doping Code which, in effect, acts as sport’s Article 6 of the ECHR on a right to a fair trial.

Following on from the above, in the 60 or so sports arbitrations that I have heard, there are two further points of interest. First, the claim before the arbitral panel will often be framed in an argument that, for various reasons of substantive and procedural irregularity, the sanction imposed on the appellant should be quashed ("the liability"). Second, and in alternative, that the sanction imposed was wholly disproportionate ("the penalty").

The liability issue usually breaks down into two further questions. First, what is the nature of the legal duty upon a sports body in exercising its disciplinary remit? Second, to what extent does a de novo hearing on appeal cure any apparent defects in a hearing of first instance? The first issue often results in an arbitral panel debating the contra preferentum approach to the interpretation of a contested rule i.e., the sports body’s rules in question are so ambiguous that they should be interpreted in a manner to the detriment of the rule maker and in favour of the appellant. On the second matter, it now appears to be a general principle of sports law, administrative law and even human rights law that even if a violation of the principles of natural justice takes place at the first instance stage of a disciplinary process, they may be cured on de novo appeal. Authority for this approach can be found at the Court of Arbitration for Sport and in particular in CAS 2009/A/1920 FK Pobeda, Aleksandar Zabrcanec, Nikolce Zdraveski v UEFA at para 87.

The question on proportionality asks what, aside from precedent found within the decisions of the sports body in question, are the general legal principles against which a sanction by a sports disciplinary body can be benchmarked in order to ascertain whether it is disproportionate in length or even irrational in nature?

On the matter of (dis)proportionality of sanction, the debate is usually guided by the authority in Bradley v the Jockey Club [2004] EWHC 2164 (QB) and affirmed at [2005] EWCA Civ 1056. The Bradley principles on proportionality of sports-specific sanctions, recently cited with approval at the Court of Arbitration for Sport, will be examined in this presentation.

Finally, an interesting application of many of the above principles (and others such as the appropriate standard of proof in sports disciplinary procedures) can be made to recent match-fixing or corruption related hearings held by the British Horse Racing Authority, the integrity units of snooker and tennis, and at the Court of Arbitration for Sport.

Academic selection and Northern Ireland

An overview of research and public policy debate on academic selection in Northern Ireland. The chapter examines the outcomes of the major investigation of the effects of the selective system of secondary education published in 2000, including a consideration of comparative evidence collected in Scotland. The paper outlines the debate which followed the publication of the Burns Report and presents the current state of play in policy and practice.

A Pilot Study of Reciprocal Peer Tutoring in Irish Medium Schools

A pilot study to investigate the effects of mathematics peer tutoring in Irish medium primary schools was undertaken. Five schools and 90 students took part in the pilot. Materials and resources that had previously been shown to work in English medium Scottish schools were translated into Irish by CCEA. Irish medium teachers attended three professional development days. Teachers implemented the peer tutoring techniques during mathematics lessons during a period of 16 weeks. Changes in attainment were measures with an Irish translation of the Scottish Survey of Achievement Mathematics Test. Results were positive. Student attainment was significantly raised during the 16-week implementation period by over one standard deviation. This equated to one-year’s worth of mathematics development during this time period. Results must be treated with caution. No control group was used in the pilot study. However, results are very promising and indicate that reciprocal role peer tutoring may be a useful pedagogy in Irish medium education. Further work would be required to establish this definitively.

Social Risk of Public Spending Cuts in Scotland: Local Authority Experiences

This paper relates to work supported by the Joseph Rowntree Foundation which examines the way Scottish Local Authorities have approached budget cuts (Asenova, et. al., 2013). Starting with a discussion of notions of social risk, we discuss the heightened challenges faced by local authorities. We note that the literature on public sector innovation predict such pressures would cause local authorities to engage in short term decision making and adopt a static coping approach to risk mitigation which is likely to stifle innovation and obstruct the creation of more coherent and resilient localities. Although we find this to have happened in some areas, we discuss two cases where these challenges have promoted innovative and inclusive approaches to service re-design and delivery.

What Have We Learned...

Presentation on the outworkings of the selective system of secondary education in Northern Ireland and a commentary on themes emerging on the conference held to mark the 50th anniversary of comprehensive schooling in Scotland. The two main challenges identified were: (1) how to deal with the consequence that not all children arrive in school with the same experiences or support, that is, dealing with the consequences of social disadvantage; and (2) not all post-school outcomes are seen to have the same value, so post-compulsory schooling risks becoming a selective mechanism for entry to more desirable outcomes