Whistle‐blowing and workplace culture in older peoples' care: qualitative insights from the healthcare and social care workforce

Inquiries in the UK into mistreatment of older people by healthcare employees over the last 30 years have focused on introducing or supporting employee whistle‐blowing. Although whistle‐blowers have made an important contribution to patient safety it remains a controversial activity. The fate of whistle‐blowers is bleak, often resulting in personal and professional sacrifices. Here we draw on the views of healthcare and social care employees working with older people to explore perceptions of whistle‐blowing as well as alternative strategies that may be used to raise concerns about the mistreatment of patients by co‐workers. Whistle‐blowing was perceived as a negative term. Managers said they promoted open cultures underpinned by regular team meetings and an open‐door ethos. Others described workplace norms that were somewhat at odds with these open culture ideals. Whistle‐blowing was considered risky, and this led to staff creating informal channels through which to raise concerns. Those who witnessed wrongdoing were aware that support was available from external agencies but preferred local solutions and drew upon personal ethics rather than regulatory edicts to shape their responses. We argue that the importance of workplace relationships and informal channels for raising concerns should be better understood to help prevent the mistreatment of vulnerable groups.     

New horizons in the understanding of the causes and management of diabetic foot disease: report from the 2017 Diabetes UK Annual Professional Conference Symposium

Diabetes‐related foot disease remains a common problem. For wounds, classic teaching recommends the treatment of any infection, offloading the wound and ensuring a good blood supply, as well as ensuring that the other modifiable risk factors are addressed and optimized. There remain, however, several questions about these and other aspects of the care of diabetes‐related foot disease. Some of these questions are addressed in the present report; in particular, the impact of newer technologies in the identification of any organisms present in a wound, as well as the use of novel approaches to treat infections. The use of new remote sensing technology to identify people at risk of developing foot ulceration is also considered, in an attempt to allow early intervention and prevention of foot ulcers. The psychological impact of foot disease is often overlooked, but with an increasing number of publications on the subject, the cause‐and‐effect role that psychology plays in foot disease, such as ulcers and Charcot neuroarthropathy, is considered. Finally, because of heterogeneity in diabetic foot studies, comparing results is difficult. A recently published document focusing on ensuring a standardized way of reporting foot disease trials is discussed.     

Discrimination between glioblastoma multiforme and solitary metastasis using morphological features derived from the p:q tensor decomposition of diffusion tensor imaging

The management and treatment of high‐grade glioblastoma multiforme (GBM) and solitary metastasis (MET) are very different and influence the prognosis and subsequent clinical outcomes. In the case of a solitary MET, diagnosis using conventional radiology can be equivocal. Currently, a definitive diagnosis is based on histopathological analysis on a biopsy sample. Here, we present a computerised decision support framework for discrimination between GBM and solitary MET using MRI, which includes: (i) a semi‐automatic segmentation method based on diffusion tensor imaging; (ii) two‐dimensional morphological feature extraction and selection; and (iii) a pattern recognition module for automated tumour classification. Ground truth was provided by histopathological analysis from pre‐treatment stereotactic biopsy or at surgical resection. Our two‐dimensional morphological analysis outperforms previous methods with high cross‐validation accuracy of 97.9% and area under the receiver operating characteristic curve of 0.975 using a neural networks‐based classifier. Copyright © 2014 John Wiley & Sons, Ltd.