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Objective: Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals’ perceptions of hygiene might drive practices. Methods: We conducted qualitative interview research with eight nurses in the United States who were employed in various patient-care roles. We analyzed the data using an interpretative phenomenological analysis methodology to explore how nurses described their perceptions of, and experiences with, hygiene. We developed themes that explored individual, workplace, and management influences on perception of hygiene. Results: Developed themes include practical hygiene, risky business, and hygiene on trial; the latter theme described the conflict between how nurses perceived their own hygiene practices and how they felt hospital management perceived these practices. Other findings included that participants distinguished between policy-mandated use of sanitizer and a personal sense of cleanliness; the latter was more likely to be associated with scrubbing or removal of contaminants than with use of protectants. Conclusion: While participants asserted support for facility hand hygiene policies, their behavior in certain instances might be mediated by broadly defined emergent situations and a belief that it is not currently possible to establish a causal link between an healthcare-associated infections and a specific individual or occurrence. Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions, to encourage ownership, and emphasizing detailed cases as training content to take advantage of individuals’ sensory responses to hygiene.

Impaired swallowing can lead to malnutrition, dehydration, choking, reduced quality of life and death.5–7 Because so many people are at risk of developing AP, a significant emphasis of this Statement is on prevention. [...]microaspiration due to abnormal swallowing results from a wide range of pathologies, and so heterogeneous patient groups are included in published studies on AP. Every hospital and care home should have at least one oral health ‘champion’ promoting good oral healthcare. Oral examination should be performed in all hospitalised patients at risk of AP or with suspected AP, and at least weekly in care home residents, checking for infection (eg, candidiasis), quality of dentition, food residue and cleanliness of mucosal surfaces.

Learning disability is the preferred term used in the UK to refer to individuals who have ‘significantly reduced ability to understand new or complex information, to learn new skills’ and a ‘reduced ability to cope independently which starts before adulthood with lasting effects on development’.1 Individuals with learning disability represent a widely heterogeneous group of people and can be associated with a broad range of primary diagnoses and comorbidities.2 There is no definitive record of the number of people with learning disability in England. A series of measures have been introduced by the National Health Service (NHS) to help improve the identification of people with learning disability.4 The life expectancy of people with learning disability is reduced compared with the general population; only 37% of adults with learning disability live beyond 65 years of age compared with 85% of the general population.2 Pneumonia is the most common cause of death among adults with learning disability and is also a common cause of death in CYP with learning disability, with bacterial pneumonia accounting for a significant proportion of these (adults 24%, children 21%).5 A further 16% of adult and 3% of paediatric deaths in the learning disability population are caused by aspiration pneumonia (AP).5 CAP is a major contributor to the increased hospitalisation risk that has been described for people with learning disability and results in longer hospital stays than the general population.6 People with learning disability also experience increased rates of repeated admission secondary to CAP.7 As CAP is a major cause of death in people with learning disability, prevention, early detection and proactive management are key to reducing mortality from avoidable causes.8 It is important that public sector organisations make reasonable adjustments in their approach or provision to ensure that people with learning disability have equitable access to good quality healthcare.9 10 Scope Learning disability is variously defined. [...]the statement is structured with an emphasis on risk factor identification and instigation of preventive measures. Engagement and assessment Engaging effectively with the person with learning disability and their parents/carers is fundamental to the early identification of CAP risk factors and the judicious implementation of preventive care and treatment.

Amyloidogenic proteins are an important part of the constitution of our bodies; such examples, in humans alone, include their roles in peptide hormone storage, melanin biosynthesis and neural growth and repair, to name just a few.1 A key step in the growth and formation of amyloid fibrils is elongation, the addition of protein monomers to the fibril ends. However, it is currently thought that this process can result in the formation of cytotoxic oligomers which, in vivo, can lead to neurodegenerative diseases. This research focused on synthesising two chemical linkers in order to conjugate a known amyloid-forming protein of interest with a strand of deoxyribose nucleic acid (DNA). As a result, it was hoped the effect of DNA on amyloid fibrils could be investigated, with the extent to which amyloid formation could be influenced and controlled explored, and thus the toxicity of the oligomers examined. Amyloid also have many material applications and hence the potential use of the materials in which these templated amyloid could be used could also be studied.The first linkers to be made were maleimide chemical linkers, N-(6-acetamidopyridin-y-yl)- 2-(2,5-dioxo-2,5-dihydro-1H-pyrrol-1-yl)acetamide (linker 1A) and N-6-acetamidopyridinyl-6-(2,5-dioxo-2,5-dihydro-1H-pyrrol-1-yl)hexanamide (linker 1B). Synthesis of linker 1A proved challenging, but linker 1B led to more positive results. After synthesis and characterisation, the conjugation with the protein and DNA was carried out; the formation of the conjugates was validated using ultra-violet visible spectrometry, mass spectrometry, gel electrophoresis and amyloid formation assays using a fluorescent probe.The second linkers produced were also maleimide linkers, 6-maleimidohexanoic acid Nhydroxysuccinimide ester (linker 2A) and 2-cyanoethyl 2-((3aR,4S,7aS)-4,7-dimethyl-1,3- dioxo-1,3,3a,4,7,7a-hexahydro-2H-4,7-epoxyisoindol-2yl)ethyl)diiospropylphosphoramidite (linker 2B). Conjugation to the DNA followed, with linker 2A conjugated successfully using a solution-based method, and thus the addition of the protein to the linker-DNA compound; likewise to linker 1B, the conjugation was monitored using ultra-violet-visible spectrometry, 6 mass spectrometry, gel electrophoresis and analysis of 96 well microplates. Conversely, the hand coupling of linker 2B to DNA attached to a solid-support bead was unavailing.

Health risks associated with dysphagia in adults with intellectual impairment are well documented. There is little research into compliance with dysphagia recommendations in environments where care is provided for adults with intellectual impairment. This is a pilot study into carer compliance with Speech-Language Pathology recommendations. We aimed to investigate the level of compliance with dysphagia recommendations in day centers and the factors that might affect compliance using a questionnaire. Twenty-seven clients were observed. Results showed an overall high level of compliance with recommendations (82%), with figures ranging from 64% compliance with appropriate utensils to 100% with direct support recommendations. Areas of noncompliance were evident, with level of dependence of clients and training of carers being key issues. Implications for practitioners are discussed.

This study aims to develop an understanding of the lived experience of family carers of people with PIMD and dysphagia, in relation to mealtimes and food. Policy in recent years has begun to address the inequalities faced by people with learning disabilities and it is striving to improve their lives and the services offered to them. People with profound intellectual and multiple disabilities (PIMD) often have additional eating and drinking difficulties (dysphagia). People with dysphagia require ongoing support and guidance, to maximize their health, specifically their nutrition and hydration. In order to ensure that this support is appropriate, useful and sensitive to the needs of individuals and their families, it is important to try and view mealtimes through the eyes of these individuals and their families. The aims of this study emerged from observations made during my clinical work as a Speech & Language Therapist (SLT) and from engaging in discussion with family carers. In particular it has become increasingly clear from clinical practice that family carers often have different points of view about their son or daughter with profound intellectual and multiple disabilities, than those of professionals. These different points of view are often not clearly articulated by carers or professionals, and clinical interventions may become marked with conflict. This study is sited within a mental health and learning disability NHS trust in the north east of England. It utilises a phenomenological methodology and employs mixed methods to obtain data. Data collection took place between June 2013 and August 2014. Medical descriptions do not capture how it feels to live with impairment and resulting disability. Only when we examine this and allow individuals to tell their stories, as experts in their experiences, can we understand and offer support accordingly and ensure more functional and beneficial interactions and interventions. Findings are presented around four themes – the meaning of food and mealtimes, relationships, roles within the family and challenges. Findings are discussed in relation to the existing literature and recommendations are made for practice and for future research. During this study the adult child is mainly referred to as the ‘child’. For clarity, this is not in any way meant to convey the individual’s presentation as having PIMD as akin to being a child. The term is used to represent the relationship between the parents and the child. Despite the fact that the individuals are adults, they are still the children of the parents, and the relationship is a parent-son/daughter relationship. For brevity the term ‘child’ is used in preference to ‘adult child’. The use of the term has been agreed with the parents participating in the study. All names are assumed and have been chosen by the participants. In the course of this thesis the direct giving of food to the individuals with disabilities is termed ‘feeding’. I acknowledge this term may be associated with potentially negative connotations. The term ‘feeding’ has been used because it is the term used widely in the literature, because it was used by the family carers in their narratives and because there is no other suitable substitute which adequately describes the direct provision of food from one person in to the mouth of another.

This chapter contains sections titled: Development of supervision systems in our department Models of supervision Reflections on supervision References