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Similarly, in some cases nursing staff and carers felt that 'Do Not Attempt Resuscitation' (DNAR) orders were inappropriately based on staff assumptions about the quality of life of patients with intellectual disabilities.
Some carers felt that decisions about whether or not to provide active treatment for patients with intellectual disabilities were being inappropriately influenced by staff assumptions about quality of life or by staff members' fear of treating patients who they perceived to be challenging.
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Vaccination costs were calculated by considering: catch-up vaccination: vaccination of all HCWs (n = 133) one year after the outbreak based on the list price for Infanrix® IPV (diphtheria, tetanus, acellular pertussis and inactivated poliomyelitis) vaccine (€34.50 per vial) [ 19, 20 ]; vaccination of newly employed HCWs staff (assumption 10% per year) for a period of 10 years.
Extracts of the DoH Staffing Assumptions used from the grid are reproduced in Table 1.
fewer than 16% of the units reached the DoH staffing assumptions for speech and language therapy.
only 42% of units studied reached the DoH staffing assumptions for physiotherapy.
The Stroke Strategy Staffing Assumptions grid published in the NHS Workforce Planning Resource [ 10], National Institute for Health and Clinical Excellence (Nice) Quality Standards Stroke Topic Expert Group Meeting [ 11] and the DoH's Progress in Improving Stroke Care [ 12] provides the DoH staffing WTE assumption and an aspirational staffing WTE for stroke units.
By contrast, the OT staffing levels were strikingly different between our calculations giving 2.1 per 10 beds compared to only 0.6 in the DoH staffing assumptions.
We also used the terms 'assumption' and 'aspirational' to be consistent with the labels from the Stroke Strategy Staffing Assumptions grid.
We recognise the simplicity of our calculation; nevertheless, what is obvious is that our post hoc analysis gave figures for PT of 1.7 per 10 beds comparable to the DoH staffing assumptions of 1.5 per 10 beds.
The low staffing level reported in the ATRAS survey is consistent with the National Sentinel Stroke Audit [ 13] which, for example, recorded a median of 0.3 SALT per 10 beds (range 0.2-0.6 0.2-0.66 compared to the DoH staffing assumptions of 0.8 SALT per 10 beds.
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