Escaping the Cage of Ethno-National Conflict in Northern Ireland: The Importance of Transnational Networks

co-author; Cathal McCall

Macro impacts on caseworker decision-making in child welfare: a cross-national comparison

This paper focuses on the factors impacting on decision-making in child and family social work through a cross-national comparison. In doing so, the larger arena of the political and social contexts of both the United States and Northern Ireland are examined. For each of the countries we describe the historical and political context of child welfare, particularly the tension between child safety and family support, and how children’s rights are attended to and interpreted in each country. This discussion also examines the extent to which decision-making in each jurisdiction is influenced by constitutional imperatives, with particular reference to the US Constitution and the European Convention on Human Rights. From this general comparison we conclude with observations about child welfare decision-making within the national context and offer suggestions for further theoretical development in this area whilst also examining where the practices in each jurisdiction may benefit from review.

A national survey of the mangement of delirium in UK intensive care units

Background: Delirium is an acute organ dysfunction common amongst patients treated in intensive care units. The associated morbidity and mortality are known to be substantial. Previous surveys have described which screening tools are used to diagnose delirium and which medications are used to treat delirium, but these data are not available for the United Kingdom. Aim: This survey aimed to describe the UK management of delirium by consultant intensivists. Additionally, knowledge and attitudes towards management of delirium were sought. The results will inform future research in this area. Methods: A national postal survey of members of the UK Intensive Care Society was performed. A concise two page questionnaire survey was sent, with a second round of surveys sent to non-respondents after 6 weeks. The questionnaire was in tick-box format. Results: Six hundred and eighty-one replies were received from 1308 questionnaires sent, giving a response rate of 52%. Twenty-five percent of respondents routinely screen for delirium, but of these only 55% use a screening tool validated for use in intensive care. The majority (80%) of those using a validated instrument used the Confusion Assessment Method for the Intensive Care Unit. Hyperactive delirium is treated pharmacologically by 95%; hypoactive delirium is treated pharmacologically by 25%, with haloperidol the most common agent used in both. Over 80% of respondents agreed that delirium prolongs mechanical ventilation and hospital stay and requires active treatment. Conclusions: This UK survey demonstrates screening for delirium is sporadic. Pharmacological treatment is usually with haloperidol in spite of the limited evidence to support this practice. Hypoactive delirium is infrequently treated pharmacologically.