Timothy B. Kelly

Are older patients’ cardiac rehabilitation needs being met?

Aims. The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme. Background. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake. Design. Mixed methods. Methods. A purposive sample of 31 older men and women (≥65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview. Results. Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0·01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: ‘The sensible thing to do’, ‘Assessing the impact’ and ‘Nothing to gain’. Conclusions. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed. Relevance to clinical practice. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person’s perspective could help guide more appropriate intervention strategies.

Older people's views on what they need to successfully adjust to life with a hearing aid

This article reports a study exploring what older people believe would enable them to adjust to and gain maximum benefit from wearing a hearing aid. A mixed methods approach was employed during 2006 involving interviews with key stakeholders, a survey across three Scottish health board areas and focus groups. Nine key stakeholders from six national and local organisations were interviewed about the needs of older people being fitted with hearing aids. In total, 240 older people belonging to three different types of hearing impaired older people were surveyed: long-term users of hearing aids, new hearing aid users, and those on a waiting list from urban and rural areas (response rate = 24%). A series of eight follow-up focus groups with 31 audiology patients was held. Health professionals appeared to neglect appropriate provision of information and overly rely on technological interventions. Of 154 older people already fitted with hearing aids, only 52% of hearing aid users reported receiving enough practical help post fitting and only 41% reported receiving enough support. Approximately 40% reported not feeling confident in the use of their aids or their controls. Older people wanted more information than they received both before and after hearing aid fitting. Information provision and attention to the psychosocial aspects of care are key to enabling older people to adjust and optimise hearing aid benefit.

Molecular cloning, sequencing, expression, and characterization of an immunogenic 43-kilodalton lipoprotein of Bartonella bacilliformis that has homology to NlpD/LppB.

ABSTRACT A recombinant clone expressing an immunoreactive antigen ofBartonella bacilliformis was isolated by screening a genomic DNA library with serum from a patient with the chronic verruga phase of bartonellosis. The clone, pBIPIM-17, contained a partial open reading frame that expressed an immunoreactive fusion protein. Subsequent rescreening of the library by plaque hybridization resulted in the isolation of recombinant clones that contain the entire open reading frame. The open reading frame (ORF-401) is capable of encoding a protein of 401 amino acids with a predicted molecular mass of 43 kDa. The deduced amino acid sequence of the encoded protein was found to be highly homologous to a recently identified bacterial lipoprotein (LppB/NlpD) which has been associated with virulence. Evidence has been provided to show that the 43-kDa antigen of B. bacilliformis is a lipoprotein and that it is likely to use the same biosynthetic pathway as other bacterial lipoproteins. This is the first report to date that characterizes a lipoprotein of B. bacilliformis. The immunogenicity of the B. bacilliformis LppB homologue was demonstrated by Western blot analysis using sera from patients with clinical bartonellosis. Sera from patients who had a high titer forBartonella henselae, the causative agent of bacillary angiomatosis and cat scratch disease, also recognized the recombinant 43-kDa antigen, suggesting that a homologue of this antigen is present in B. henselae. Using a cocktail of synthetic peptides corresponding to predicted major antigenic sites, polyclonal antiserum specific for the LppB homologue of B. bacilliformis was generated. This antiserum did not recognize the NlpD homologue of Escherichia coli or the 43-kDa antigen ofB. henselae.

Advancing Stages of Group Development Theory: The Case of Institutionalized Older Persons

ABSTRACT Using content analysis to analyze process recordings, the developmental patterns of two groups of older institutionalized persons are presented. The similarities to and differences from the stages of group development described by Bennis and Shepard; Garland, Jones, and Kolodny; and Schiller are discussed. Findings suggest that vulnerability to institutional power and the resultant dependence on the social worker were critical variables influencing how the groups developed over time. Differential principles for applying stages of group development theory to practice are offered.

School-based child sexual abuse prevention programs: moving toward resiliency-informed evaluation

Although recent years have seen an increase in the range of child sexual abuse prevention programs delivered in schools, there have been relatively few efficacy studies. Those conducted have focused primarily on intrinsic child factors and have often lacked an explicit theoretical framework. We offer resiliency theory as a useful and apposite theoretical framework for program evaluation. Resiliency theory suggests that a wider range of factors should be considered, including intrinsic (personal characteristics) and extrinsic (environmental) factors. Such factors may increase risk or, alternatively, protect children from the negative effects of adversity. We argue that a resiliency perspective to efficacy studies should recognize a long-term view on children’s capacity to cope and can employ both standardized and contextual resiliency-informed measures.

The folder feedback system: Making research content more understandable, enjoyable, and usable 1

This paper describes the use and evaluation of the folder feedback system. The folder feedback system is a useful teaching tool based in principles of adult learning. It is designed to help organize student learning, increase communication with the instructor, insert an element of fun into the class, and assist with student/teacher relationship building. An evaluation of the teaching tool produced mixed results. The treatment group received higher grades than the comparison group, yet in all other measures no differences were found.

Inquiry-Based Learning for Interprofessional Education

Abstract This chapter describes the development and evaluation of an interdisciplinary group-based inquiry-based learning (IBL) project across two professional degree programmes in Scotland – educational psychology and social work. After outlining the policy and practice contexts for interdisciplinary inquiry-based learning, we articulate how IBL can facilitate professional identity development, mirror key aspects of professional practice such as interprofessional collaboration, and provide deep interdisciplinary learning. It is argued that the process of IBL provides an authentic and complex practice scenario which allows for the articulation and development of professional knowledge, values, identities and roles in collaboration with another professional grouping. The process of IBL development is described and we report on the results of a small-scale qualitative evaluation of the short-term outcomes of the IBL approach to teaching and learning. The IBL activity enhanced students’ appreciation of interdisciplinary collaboration and allowed them to practice relevant skills. The views and reflections of students are reported and reinforce the relevance and efficacy of the approach. The chapter concludes with a series of suggestions and advice for the replication of using IBL as a tool to enhance and facilitate interdisciplinary learning.

Group Work for People Touched by HIV/AIDS Yesterday and Today

This article recounts the experience of a support group in the early days of the AIDS pandemic. After identifying the personal, interpersonal, and environmental issues that were part of the work of this early support group, the article reflects on how far we have come in addressing peoples needs around HIV/AIDS. The importance of group work in working at personal and political levels is highlighted.

‘Risk is King and Needs to take a Backseat!’ Can social workers’ experiences of moral injury strengthen practice?

This paper considers the idea that moral injury may result from social workers being exposed to sustained ethical stress – the stress experienced when workers cannot base their practice on their values. It is suggested that a particularly salient feature of agency working which might contribute to the experience of ethical stress is risk aversion. This paper is based on a study of one hundred criminal justice social workers in Scotland, who were questioned on their experiences of ethical stress and risk aversion. Quantitative and qualitative data were collected and analysed using standard multiple regression and inductive thematic analysis, respectively. Findings demonstrated that how risk-averse an agency was contributed in a unique and significant way to the worker’s experience of ethical stress. Qualitative comments illustrated why this relationship might exist, but also demonstrated that a variety of views were held by social workers and that ethical stress was not experienced by all. The findings are discussed in terms of moral injury and its links with risk aversion, bureaucracy, neoliberal hegemony, notions of ‘underclass’, personal moral codes and professional integrity. Explicitly exploring these related concepts in social work education might impact on the new generation of social workers and strengthen the profession.

Development and Validation of the Needs Inventory for Caregivers of the Hospitalized Elderly

As the population continues to age, more and more families are faced with caring for aging family members and the concurrent increase in stress and needs brought about by hospitalization of the aging family member. The social service staff at Wesley Woods Genatnc Hospital wished to evaluate their services and explore the impact of a family conference conducted by a social worker/registered nurse team on the needs experienced by the family members of patients in psychiatry and neuropsychiatry units. A search of the current literature, however, revealed a lack of reliable and valid instruments designed to measure the perceived needs of caregivers of hospitalized geriatric patients. Therefore, the development of an instrument that could measure the perceived psychoeducational needs of such caregivers was undertaken. The Needs Inventory for Caregivers of Hospitalized Elders (NICHE) was field-tested and supportfor the instrument s validity and reliability was found.