Evaluation of a dementia awareness programme in UK schools: a qualitative study.

OBJECTIVES: 'Dementia Friends' is a programme used to raise awareness of dementia, developed by the Alzheimer's Society, which has been delivered across the UK to diverse populations, including adolescents. However, there is little evidence available with regards to adolescents' perceptions of the programme and its impact. This study aims to explore this in a group of adolescents from the south of England. STUDY DESIGN: Focus group discussions. METHODS: Thirty adolescents aged between 11 and 16 years were recruited from two schools in East Sussex, England. All had participated in a Dementia Friends session in the past month. Focus group discussions were transcribed, coded and themes were created using inductive thematic analysis. RESULTS: Four themes were identified: (1) perceptions and experiences of dementia, (2) outcomes and learning from Dementia Friends session, (3) reactions to the Dementia Friends session and (4) identified future learning needs. CONCLUSIONS: Adolescents had generally positive opinions about Dementia Friends, particularly the interactive nature of the session. Whilst they felt participating in Dementia Friends improved their attitudes and knowledge, they were often left wanting to learn more. Future research needs to empirically evaluate the extent to which Dementia Friends may improve attitudes and knowledge of dementia.

The influence of care home managers on the implementation of a complex intervention: findings from the process evaluation of a randomised controlled trial of dementia care mapping.

BACKGROUND: Many people with dementia live in care homes, where staff can struggle to meet their complex needs. Successful practice improvement interventions in these settings require strong managerial support, but little is known about how managers can support implementation in practice, or what factors support or hinder care home managers in providing this support. Using Dementia Care Mapping™ (DCM) as an example, this study explored how care home managers can support the implementation of complex interventions, and identified factors affecting their ability to provide this support. METHODS: We undertook interviews with 48 staff members (managers and intervention leads) from care homes participating in the intervention arm of the DCM EPIC trial of DCM implementation. RESULTS: Managerial support played a key role in facilitating the implementation of a complex intervention in care home settings. Managers could provide practical and financial support in many forms. However, managerial support and leadership approaches towards implementation were highly variable in practice, and implementation was easily de-stabilised by management changes or competing managerial priorities. How well managers understood, valued and engaged with the intervention, alongside the leadership style they adopted to support implementation, were key influences on implementation success. CONCLUSIONS: For care home managers to effectively support interventions they must fully understand the proposed intervention and its potential value. This is especially important during times of managerial or practice changes, when managers lack the skills required to effectively support implementation, or when the intervention is complex. It may be unfeasible to successfully implement new interventions during times of managerial or practice instability. TRIAL REGISTRATION: Current Controlled Trials ISRCTN82288852 , registered 16/01/2014.

Postoperative pain. Expectation and experience after coronary artery bypass grafting.

A study of 43 patients undergoing coronary artery bypass grafting was conducted in order to compare pre-operative expectation of pain severity and duration to actual postoperative experience. As judged by linear visual analogue scores, patients expected more pain than they experienced (p = 0.0359). For the majority of patients, pain duration was less than expected. Eighty-four per cent of patients reported that their pain was better or the same as expected. Ninety-five per cent of patients were satisfied or very satisfied with postoperative analgesia. The authors conclude that, although the standard of postoperative analgesia after coronary artery bypass grafting remains objectively poor (the median postoperative pain score was 4 on a 10 cm linear visual analogue pain score), patients are usually satisfied with their pain relief. The authors suggest that this may be related to patients' pre-operative overestimation of postoperative pain severity. The authors caution against giving patients unrealistic expectations of the quality of postoperative analgesia.

The influence of vascular pressure and different primes on the fluid balance of, and oxygen supply to, the patient during CABG.

Detrimental changes of blood and erythrocyte rheology, and fluid exchange between the vascular and interstitial spaces, which influence the rate that oxygen is supplied to the patient, occur during cardiac bypass surgery. Venous flow is subject to a pulsatile and uncertain variation, because the vena cava is more than 30 mmHg below atmospheric pressure. This occurs because the patient is about 1 m above the air-blood surface of the bypass reservoir. Before any reliable study of fluid exchange can be undertaken this effect must be controlled. It was then established that optimum oxygen exchange occurs when equilibration of the plasma oncotic pressure and the capillary hydrostatic pressure is achieved without alteration of the interstitial fluid volume. At the lower arterial blood pressures used during bypass, it is necessary to reduce the plasma oncotic pressure by using an appropriate volume of crystalloid prime.

Mivacurium chloride: a study to evaluate its use during propofol-nitrous oxide anaesthesia.

We assessed the neuromuscular and cardiovascular effects of mivacurium chloride, a neuromuscular blocking agent, in 33 patients during propofol-nitrous oxide anaesthesia. Neuromuscular function was assessed with supramaximal stimuli of the ulnar nerve, using surface electrodes at the wrist, with repeat trains of four. Mivacurium given as a bolus of 0.15 mg.kg-1 (ED95 x 2) was found to be haemodynamically stable. Intubating conditions assessed at 2 and 2.5 min were either good or excellent. All patients developed a block of 100% in a mean (SD) time of 105 (34) s. There were mean (SD) intervals of 12 (2.4) min before the reappearance of the first twitch of the train of four (T1) following the bolus dose, and 15.8 (3.1) min for the T1 to reach 25% of its control value (TC). Seventeen patients received an infusion of mivacurium to maintain neuromuscular blockade (T1:TC 10-20%) with a mean (SD) infusion rate of 6.9 (2.2) micrograms.kg-1.min-1. Recovery from neuromuscular blockade was assessed with spontaneous offset or augmented with edrophonium following either the initial bolus or an infusion. Following a bolus it took a mean (SD) of 26.2 (3.7) min for the fourth twitch of the train of four (T4):T1 ratio to reach 0.7. In patients receiving an infusion with spontaneous offset it took a mean (SD) time of 12.0 (2.2) min to reach the T4:T1 ratio of 0.7 from a T1:TC value of 8.8. Edrophonium significantly decreased the recovery time in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Regional anaesthesia and cough effectiveness. A study in patients undergoing caesarean section.

We report the results of a study of the effects of spinal and epidural anaesthesia for Caesarean section on commonly used indicators of a patient's ability to cough effectively. Both spinal and epidural anaesthesia, after the achievement of a block adequate for surgery, were associated with statistically significant decreases (p less than 0.05) in all the respiratory variables recorded: forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate and maximum expiratory pressure. We conclude that although the observed changes are unlikely to impair the normal patient's ability to cough effectively in these circumstances, there may be clinically significant impairment in the presence of an inadvertently high block or in a patient with pre-existing pulmonary disease.

Caesarean section in a patient with haemoglobin SC disease and a phaeochromocytoma.

The anaesthetic management of a patient with haemoglobin SC disease for lower segment Caesarean section and excision of a phaeochromocytoma is described. The patient was given a general anaesthetic for the surgical procedure after exchange transfusion had achieved an haemoglobin A concentration of greater than 50%. A live infant was delivered and a suprarenal phaeochromocytoma was excised during a 6.5 hour procedure. The patient's postoperative recovery was uneventful.

High and low offenders compared.

Prisoners with extensive criminal histories were compared with those having a relatively minor history of crime in respect of a large number of variables, in order to evaluate factors associated with recidivism and hence of predictive use. It was found that most of the generally regarded concomitants of delinquency were more prevalent in the high offenders, some much more so. Of special significance were a history of mental illness and prolonged absence from the parental home in childhood.

Correlates of suicidal history in male prisoners.

The relationship between suicide and previous attempt thereto is generally recognized. In this study of adult male prisoners, those with a history of attempted suicide were compared with age-matched controls in order to evaluate factors associated with suicidal behaviour. As well as confirming its relationship with certain other factors (notably mental illness and addiction) it was found that prisoners with many previous convictions were much more likely to have attempted suicide. It is suggested that conviction rate might be a useful addition to the measures already employed in assessing suicidal risk.

Midazolam and flumazenil in the anaesthetic management of trigeminal nerve thermocoagulation.

A technique is described for the anaesthetic management of trigeminal nerve thermocoagulation by administration of repeated doses of midazolam and flumazenil. "Wake-up" times after administration of flumazenil in 20 patients were shorter than those reported during spontaneous recovery from methohexitone or propofol anaesthesia. The midazolam dose required for a second phase of sedation after antagonism of the first with flumazenil was significantly less than that for the first phase of sedation. There was no evidence of postoperative resedation. Reversal of sedation was associated with an increase in arterial pressure.

High frequency ventilation and afferent vagal activity.

Recordings were made from pulmonary afferent fibres in the vagus nerves of anaesthetised dogs during conventional and high frequency ventilation. In single and multiple fibre preparations, the mean spike counts per minute at 14 breaths/minute were in the ranges 36.9-155.3 and 755-1921, respectively. These counts decreased by up to 61 and 44% respectively at 100 breaths/minute, and by 27-89% and 22-51% at 200 breaths/minute. At this frequency there was a further decrease of between 19 and 65% when the positive end expiratory pressure was removed. The findings of this study are intuitively acceptable, since pulmonary stretch receptor activity is proportional to tidal volume, and are in keeping with the clinical impression that high frequency ventilation per se does not eliminate respiratory drive.

Intubating conditions following pre-induction priming with alcuronium.

Three priming doses of alcuronium have been investigated and, using a logistic transformation technique, the priming dose required to produce adequate intubating conditions in 99% of patients at 60 seconds following the second dose of alcuronium has been deduced. This dose, 106.5 micrograms/kg is extremely high and may be unsafe if used, since 30% of our patients complained of side effects when given a priming dose of only 50 micrograms/kg.