Hospice volunteers: bridging the gap to the community?

Current demographic, policy and management changes are a challenge to hospices to develop their volunteering practices. The study upon which this paper is based aimed to explore good practice in volunteer involvement and identify ways of improving care through developing volunteering. The project consisted of a narrative literature review; a survey of volunteer managers; and organisational case studies selected through purposive diversity sampling criteria. A total of 205 staff, volunteers, patients and relatives were interviewed across 11 sites in England in 2012. This article focuses on one of the findings – the place that volunteers occupy between the hospice and the community beyond its walls. External changes and pressures in society were impacting on volunteer management, but were viewed as requiring a careful balancing act to retain the ‘spirit’ of the hospice philosophy. Honouring the developmental history of the hospice was vital to many respondents, but viewed less positively by those who wished to modernise. Hospices tend to be somewhat secluded organisations in Britain, and external links and networks were mostly within the end‐of‐life care arena, with few referring to the wider volunteering and community fields. Volunteers were seen as an informal and symbolic ‘link’ to the local community, both in terms of their ‘normalising’ roles in the hospice and as providing a two‐way flow of information with the external environment where knowledge of hospice activities remains poor. The diversity of the community is not fully represented among hospice volunteers. A few hospices had deliberately tried to forge stronger interfaces with their localities, but these ventures were often controversial. The evidence suggests that there is substantial scope for hospices to develop the strategic aspects of volunteering through greater community engagement and involvement and by increasing diversity and exploiting volunteers' ‘boundary’ position more systematically to educate, recruit and raise awareness.     

Macrophage polarization: the answer to the diet/inflammation conundrum?

Macrophages, a heterogeneous and ubiquitous cell population representing up to 15% of the cellular content of different types of tissue, are the principal cell mediators in response to pathogens, inflammation process, tissue homeostasis and repair and play a pivotal role in atherosclerosis and insulin resistance because of their capacity to be the major source of inflammatory cytokines, which can function through paracrine and endocrine mechanisms. Recently, differently activated macrophage populations have been described, depending on a large variety of microenvironmental signals, and it is now recognized that their activation plays a crucial role in the development and progression of atherosclerosis. There is good evidence of the ability of conjugated linoleic acids and polyphenolic compounds to modulate inflammation in experimental models involving macrophages. This observation leaves room to the intriguing hypothesis that macrophage polarization could represent one of the unifying mechanisms through which specific food components can exert anti-inflammatory effects in humans, contributing to the prevention of chronic diseases strongly linked to inflammation, such as atherosclerosis. Future studies should be addressed to substantiate this hypothesis, investigating whether or not physiological concentrations of food-derived metabolites can perturb macrophage activation in vitro. On the in vivo side, the evaluation of macrophage populations in tissues, however complex, should be included among the analyses performed in observational and intervention studies, in order to understand if macrophage activation is involved in the anti-inflammatory activity of a specific dietary regimen.     

Potential complications of neonatal cephalhaematoma in the community: when to refer to the paediatric team?

Neonatal cephalhaematoma is commonly seen after a minor birth trauma, e.g. from vacuum-assisted deliveries. It is usually considered benign and resolves spontaneously without any treatment. Considerable parental anxiety may be associated with this condition and thus primary health care professionals play a significant role in providing reassurance to the new parents. Complications, although rare, are known to occur and can be potentially serious. A degree of uncertainty is often seen among primary health care professionals about whether to refer such cases to hospital. Recognition of the complications by primary health care professionals and early involvement of the paediatric services are essential to prevent serious complications such as meningitis and osteomyelitis. A case of bilateral cephalhaematoma is presented which was suspected to be infected and needed in-patient hospital care. The potential complications of a cephalhaematoma are discussed and guidelines provided for expediting early and appropriate referral of complicated cases to the paediatric services.     

EpiData: the natural heir to EpiInfo 6?

EpiData is an epidemiological software developed by the EpiData Association (www.epidata.dk). Following the EpiInfo 6 philosophy, Epidata, offers all the advantages of EpiInfo 6: simplicity, applicability, few operation and communication system requirements, widening them with a clear focus on data quality and documentation plus the advantages that, for many users, has the Windows operating system. The aim of this Note is to introduce to potential users the strengths and limitations of EpiData, a software that can become in a short time the equivalent to what EpiInfo 6 was a few years ago.     

Parsons revisited: from the sick role to...?

This article revisits Parsons' insights on medicine, health and illness in the light of contemporary debates in medical sociology and beyond. A preliminary balance sheet of the Parsonian legacy is first provided, taking on board standard accounts and criticisms of Parsons' work within medical sociology to date. The remainder of the article, in contrast, involves a close re-reading of Parsons in the light of contemporary sociological debates on the body, emotion, trust, uncertainty and health, including late modern and postmodern interpretations of his work. Parsons, it is concluded, despite his (many) critics and detractors, has much to contribute here, not simply in terms of past insights, but also with regard to the present and future.     

Taking integrated care management to the street: can we find the road to our triple aim?

Hudson Health Plan, through a Chronic Illness Demonstration Project, is investigating the value that integrated behavioral and medical health case management brings to stakeholders of a comprehensive assessment and patient assistance program. The New York State Department of Health funds the pilot program dubbed the Westchester Cares Action Program. Hudson Health Plan and its behavioral health vendor, Beacon Health Strategies, are engaged in a 3-year study aimed at improving quality of life and health outcomes while reducing costs for 250 of New York State's highest utilizing, most costly "fee-for service" patients. This article describes the program, the team, and the tools that the program uses. It also discusses the challenges, successes, and lessons learned during its first 15 months of operation.     

Domiciliary visits to the old and the mentally ill: how valuable?

In the early days of the British National Health Service, domiciliary visits were a continuation of the tradition whereby general practitioners (GPs) met consultants in the patient's home. The nature of domiciliary visits, which still attract a special fee, has since changed. We analysed the effectiveness of all domiciliary visits undertaken in a NHS trust providing primary care, mental health and elderly care services to a population of 470,000. Data were obtained from domiciliary visit claim forms and from questionnaires completed by the consultant, the referring GP and consultant peer reviewers. The largest number of visits (total 234) was in geriatric medicine 48.9%, followed by old-age psychiatry 44.9%. Geriatric medicine was more likely than psychiatry to admit patients to hospital (19%) after a visit. All domiciliary visits in old-age psychiatry were done during the day (9 am to 5 pm). Only 2% of GPs stated that they attended any of the domiciliary visits; almost all thought that the outcome of domiciliary visits was of value. Old-age-psychiatry peer reviewers believed that all visits in that specialty were appropriate; in geriatric medicine this figure was 77% and in other psychiatric specialties 65%. The findings indicate that domiciliary visits were not being used routinely as a pathway to hospital admission, though they were often used to expedite admission or gain a quick consultant opinion; the visits were valued by GPs. The practice of domiciliary visits differs greatly from the definition in NHS terms and conditions of service. One or other should be altered.