Laura Wyness

Nurses' experiences of recruitment and migration from developing countries: a phenomenological approach

BackgroundThere is growing concern globally at the current flows of nurse migration, particularly from low-income to middle and high-income countries. Recruitment practices of many countries such as Ireland are thought to be fuelling this rate of migration. This paper aims to establish the perceptions and opinions of those involved in the recruitment process on their role in recruitment and the effects recruitment has on both source and destination countries.MethodsA purposive sample of 12 directors of nursing, from major academic teaching hospitals in Dublin and hospitals in South Africa and the Philippines were recruited. Ten overseas nurses were also recruited. A phenomenological approach was used with semi-structured interviews as the data collection method.ResultsThere were pronounced differences in opinions between the Irish and the overseas directors on recruitment and its effects on the health systems of the source countries. Difficulties in the retention of staff were highlighted by both groups of directors. Other findings included the language and cultural differences experienced by the overseas nurses.ConclusionRecruitment of overseas nurses should not be left to the individual employer even in the presence of government guidelines. An international effort from all the involved parties is required to formulate a solution to this complex issue in order to protect both the health systems of individual countries and the nurses right to migrate.

The effectiveness of metal on metal hip resurfacing: a systematic review of the available evidence published before 2002

BackgroundConventional total hip replacement (THR) may be felt to carry too high a risk of failure over a patients lifetime, especially in young people. There is increasing interest in metal on metal hip resurfacing arthroplasty (MoM) as this offers a bone-conserving option for treating those patients who are not considered eligible for THR. We aim to evaluate the effectiveness of MoM for treatment of hip disease, and compare it with alternative treatments for hip disease offered within the UK.MethodsA systematic review was carried out to identify the relevant literature on MoM published before 2002. As watchful waiting and total hip replacement are alternative methods commonly used to alleviate the symptoms of degenerative joint disease of the hip, we compared MoM with these.ResultsThe data on the effectiveness of MoM are scarce, as it is a relatively new technique and at present only short-term results are available.ConclusionIt is not possible to make any firm conclusions about the effectiveness of MoM based on these early results. While the short-term results are promising, it is unclear if such results would be replicated in more rigorous studies, and what the long-term performance might be. Further research is needed which ideally should involve long-term randomised comparisons of MoM with alternative approaches to the clinical management of hip disease.

Nutrition and Development: Short and long term consequences for health

This Task Force report reviews the evidence that the seeds of many adult diseases are sown in utero and in infancy. The report, written by experts in the field, summarises current knowledge in this area. It illustrates how early life nutrition can bring about changes in organ development and function, thus programming risk of disease in adult life. It also considers what might be done in early life to reduce the burden of future ill health. Nutrition and Development: Short- and Long-Term Consequences for Health includes chapters on the history of this topic area, normal growth and development, and current recommendations and practice in relation to nutrition and diet in early life. Chapters exploring the possible mechanisms and pathways of critical windows for development cover the effects of diet and nutrition in early life on organ and skeletal development, the role of sex hormones in programming disease susceptibility, the establishment of gastrointestinal microbiota, and the impact of early life nutrition on cognitive and neurological development.

The role of red meat in the diet: nutrition and health benefits

Red meat has been an important part of the human diet throughout human evolution. When included as part of a healthy, varied diet, red meat provides a rich source of high biological value protein and essential nutrients, some of which are more bioavailable than in alternative food sources. Particular nutrients in red meat have been identified as being in short supply in the diets of some groups of the population. The present paper discusses the role of red meat in the diets of young infants, adolescents, women of childbearing age and older adults and highlights key nutrients red meat can provide for these groups. The role of red meat in relation to satiety and weight control is discussed as the inclusion of lean red meat in a healthy, varied diet may help weight loss as part of an energy-reduced diet. A summary of the UK advice on the amount of red meat that can be consumed as part of a healthy, varied diet is also provided.

Successful Large System Change: At What Cost?

Abstract This paper analyses a case study of the re-organization of a regional orthopaedic service. The purpose of the research was to demonstrate the utility of a model of large system change through a retrospective analysis of how the re-organization was planned, managed and implemented. The theoretical framework for the retrospective analysis of the case was the Coghlan and McAuliffe (2003) model of large system change. Documentary analysis allowed an understanding of the steps taken in the change process. Semi-structured interviews were retrospectively conducted with key stakeholders to gain a deeper understanding of the impacts of the change process. The Coghlan and McAuliffe model of large system change provided a very good structure for this retrospective analysis of the re-organization of orthopaedic services. It facilitated the exploration of a change that from an external perspective was considered successful. Through this exploration a number of important lessons have been highlighted. The analysis highlights the importance of a systems perspective. Interviewee responses demonstrate how failure to take adequate account of the systems future needs is likely to impact negatively on continuing progress in the orthopaedic services and on future change initiatives within the organization. This paper, through the retrospective analysis of a case study, uses empirical data to demonstrate the utility of a model of large system change. The findings highlight the weaknesses in change models that fail to pay attention to the consolidation and sustainability of change by neglecting the impact of the change on the wider system.

Trichotillometry: the reliability and practicality of hair pluckability as a method of nutritional assessment.

BackgroundA nutritional assessment method that is quick and easy to conduct would be extremely useful in a complex emergency, where currently there is no agreed practical and acceptable method. Hair pluckability has been suggested to be a useful method of assessing protein nutritional status. The aim was to investigate the reliability of the trichotillometer and to explore the effects of patient characteristics on hair epilation force.MethodsThree observers plucked hair from twelve participants to investigate the within- and between-observer reliability. To investigate the effect of patient characteristics on hair pluckability, 12 black African and 12 white volunteers were recruited. Participants completed a short questionnaire to provide basic information on their characteristics and hair.ResultsMean hair pluckability measurements for the 12 participants obtained by the three observers (39.5 g, 41.2 g and 32.7 g) were significantly different (p < 0.001). Significant variation between patients was also found (p < 0.001). None of the patient characteristics significantly affected hair pluckability, with the exception of age, although this relationship was not consistent.ConclusionDue to significant variation in measurements, hair pluckability does not appear to be a reliable method for assessing adult nutritional status. Hair pluckability could be a useful method of nutritional assessment in complex humanitarian emergencies but only if the reliability was improved.

The Grampian Mobile Information Bus: An overview of the early implementation and process evaluation of a mobile, community-based health information service

Abstract The Grampian Mobile Information Bus (MIB) is a community-based intervention that provides health and related information for young people aged 1218 years living in rural areas in the north-east of Scotland. The MIB is a partnership project involving health and local authorities and voluntary organisations, and operates as a mobile outreach service for this group of young people. This paper provides an overview of the early implementation and evaluation of the MIB initiative. The strengths and limitations of the project and its evaluation are discussed. Findings suggest that this initiative proved very popular with the intended target group, with users reporting high levels of satisfaction. In addition, it suggests that an initiative of this nature has the potential to mobilise local agencies in addressing their health and local needs. However, at this early stage in the projects lifetime, it is impossible to determine if changes made to the provision of services with local communities, attributed to the work of the MIB project, can be sustained in the longer term. This will require further research.

Nutrition in early life and the risk of asthma and allergic disease

The prevalence of reported cases of asthma and allergic disease has seen a marked increase throughout the world since the 1960s, particularly in more developed, westernised countries. A key focus of research in this area has been the possible adverse effects of foetal and infant exposure to food allergens. There is some evidence that foetal and infant exposure to a range of allergens via the mother and her breast milk is important in the development of normal immune tolerance. Current advice is that pregnant and breastfeeding women do not need to avoid potential food allergens unless they are allergic themselves, or are advised to modify their diet by a health professional. Delaying the introduction of common food allergies beyond 6 months is unlikely to reduce the likelihood of food allergy and allergic disease. The findings of current ongoing trials investigating the potential benefits of early introduction on allergenic foods into the diet of children-as well as the comprehensive review of complementary and young-child feeding advice currently being conducted by the Scientific Advisory Committee on Nutrition-will help inform guidance in this area.