Search PubMed⌕ Search

Biomedical subjects

S A Kirk

Publications and source records attributed to S A Kirk.

At least 19 recordsLinked to original sources
PubMed2003

Assessing the quality of care of multiple conditions in general practice: practical and methodological problems.

OBJECTIVE: To investigate practical and methodological problems in assessing the quality of care of multiple conditions in general practice. SETTING: Sixteen general practices from two socioeconomically diverse regions in the UK. METHOD: Quality of care was assessed in 100 randomly selected patient records in each practice using an established set of quality indicators covering 23 conditions commonly seen in primary care. Inter-rater reliability assessment was carried out for five of the conditions. RESULTS: Conducting simultaneous quality assessment across multiple conditions is highly resource intensive. Poor data quality and the low prevalence of some items of care defined by the indicators are significant problems. Scores for individual indicators require very large samples for reliable assessment. Quality scores are more reliable when reported at a higher unit of analysis. This is particularly true for indicators and conditions with low prevalence where data may need to be aggregated to the level of groups of conditions or organisational providers. There is no single ideal way of aggregating quality scores. CONCLUSION: The study identified some of the practical and methodological difficulties in assessing quality of care across multiple conditions. For improved quality assessment, advances in information technology and improvements in data quality are required for more efficient and reliable data extraction from medical records, together with the development of methods for combining scores across indicators, conditions, and practices. However, electronic data extraction methods will still be based on the assumption that the care recorded reflects the care provided.

Disease↗
PubMed1995

The effect of characteristics of human service workers on subsequent morale and turnover.

The authors examine the relationship of sociopsychological characteristics of human services workers to their subsequent morale and continuance on the job. Eighty-two intensive case managers (half of them social workers) who had caseloads of clients with severe mental disorders were invited to participate in a four-wave panel study. Explored are the relationships between 16 predictors (general background, prior work experience and training, and social psychological variables) and worker outcomes (beliefs, attitudes, perceptions, and turnover). The major finding was that better personal well-being at the time of hiring was the most consistent and significant predictor of lower burnout, higher job satisfaction, and generally higher worker morale at later points in time. Those from higher social class backgrounds and those with lower starting salaries were more likely to leave the job. Those workers with more experience had a tendency to perceive greater client improvement.

Adult↗
PubMed1994

Pro-inflammatory and anti-inflammatory effects of the stable prostaglandin D2 analogue, ZK 118.182.

This study examined the pro- and anti-inflammatory effects of the stable prostaglandin (PG) D2 analogue, ZK 118.182 and the mechanism by which prostaglandins may exert their anti-inflammatory activity. Co-injected locally, ZK 118.182, like PGE2 and PGD2, dose-dependently increased plasma leakage induced by intradermal injection of bradykinin in rabbit skin. Infused i.v., ZK 118.182 (0.45 microgram/kg/min), a dose which did not affect systemic blood pressure, inhibited oedema formation in rabbit skin induced by the neutrophil-dependent agonists, formyl-methionyl-leucyl-phenylalanine (FMLP) and leukotriene B4 (LTB4). However, it did not modify plasma leakage induced by the neutrophil-independent mediators, bradykinin and platelet-activating factor (PAF). In contrast, neutrophil accumulation in response to LTB4 and FMLP was not affected in animals infused with ZK 118.182. In vitro, ZK 118.182, like PGE2 and PGD2 inhibited FMLP-induced superoxide anion (O2-) production by rabbit neutrophils. The compound, however, had minimal effects on O2- production induced by phorbol myristate acetate (PMA). ZK 118.182 inhibited to a small extent FMLP but not PMA-induced neutrophil adherence. These results show that depending on the route of administration, the PGD2 analogue, ZK 118.182, exhibits either pro- or anti-inflammatory effects. The anti-inflammatory effect may be related to the ability of the compound to inhibit increased microvascular permeability induced by neutrophil activation without interfering with neutrophil accumulation. This latter effect may be due to the analogue's capacity to suppress neutrophil secretion to a greater extent than neutrophil adherence.

Animals↗
PubMed1993

Changes in health and job attitudes of case managers providing intensive services.

OBJECTIVE: The health, personal life, and attitudes of case managers providing intensive services to severely mentally ill clients were evaluated to see how the managers changed over their first 18 months on the job. The authors report here on changes on major variables related to health status and job attitudes. METHODS: A cohort of 82 case managers newly hired during the first year of New York State's intensive case management program was followed for 18 months. A battery of measures of health, life events, life satisfaction, social support, job situation, and job attitude was administered by mail questionnaire at job entry and at three, 12, and 18 months to case managers who remained employed in the program. RESULTS: Approximately 80 percent of the eligible (still-employed) case managers responded at each time point; 64 were still employed at the end of the study. Over time they experienced increasing amounts of job stress and emotional exhaustion, depersonalized clients more, and reported significantly more stress-related physical symptoms and depressive symptoms. However, their sense of personal accomplishment and their job satisfaction remained stable. CONCLUSIONS: Case managers appeared able to overcome job pressures and persevere in their professional commitment. What difficulties they had appeared to level off after one year, at least among those who continued in their positions. Although the findings do not indicate that case managers need intensive help, early support and preventive intervention for job difficulties would be helpful.

Adult↗
PubMed1991

Practitioner involvement in clinical evaluation.

Contrary to popular belief, social workers are evaluating their practice, but what they do falls short of the use of quantitative procedures that researchers have promoted. Data obtained from a survey of social workers drawn from the National Association of Social Workers national membership list suggest that the gap between practitioners and clinical researchers may stem in part from different mindsets as well as from actual differences in the commitment to the importance of clinical evaluation. Moreover, in the minds of practitioners there appears to be a sharp distinction between formal single-subject design studies and the general evaluative tasks in which they routinely engage.

Adult↗
PubMed1991

Assessing assessment in social work.

This article reviews trends in social work assessment that are likely to shape the future of clinical practice. In contrast to the rich contextual information provided by traditional psychosocial approaches to assessment, classification systems like DSM-III-R can lead to oversimplification and loss of information that is important to intervention planning. The movement toward the use of continuous, dimensional alternatives to categorical classifications will have a significant effect on clinical assessment and treatment monitoring. Technical advances and efforts to conceptualize and operationalize the contextual complexities of clients' lives will be increasingly important in the future.

Classification↗
PubMed1989

DSM-III-R: the conflict over new psychiatric diagnoses.

The inclusion of three new diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) has generated much controversy. Many women's groups and mental health organizations objected to paraphilac rapism, premenstrual dysphoric disorder, and masochistic personality disorder. Findings from a national survey of social workers' attitudes about DSM indicated that the majority of respondents did not support adoption of the proposed diagnoses, although many were undecided. The conflict has reopened the debate about the manual among mental health professionals. The opinions of social work practitioners potentially can influence whether these and other controversial diagnoses are included in the upcoming DSM-IV.

Attitude of Health Personnel↗
PubMed1982

Profiles of children with severe oral language disorders.

The major purpose of this study is to determine whether children assigned to classes for severe oral language handicaps in California by a multidisciplinary diagnostic team exhibit a characteristic ITPA performance profile or a number of distinct profiles. A factor analysis and a cluster analysis was made on the scores of 237 children. It was found that on the factor analysis the results showed a clear auditory-vocal factor and a visual-motor factor. All five tests in the visual-motor channel were superior to the five tests in the auditory-vocal channel. Within the auditory-vocal channel the lowest scores were in auditory association and grammatic closure. Ninety-seven percent of the oral language handicapped children had the lowest scores on these two subtests. It appears from these results that the major deficit of children assigned to severe oral language classes is a deficit in the central organization process, formerly referred to as "central aphasia, or inner language".

Child↗
PubMed1978

Uses and abuses of the ITPA.

This paper describes the circumstances leading to the development of the Illinois Test of Psycholinguistic Abilities (ITPA) and discusses the malpractices in administration, scoring, and interpretation of the test. Certain relevant research endeavors are summarized and evaluated. These include (1) equivalence of the experimental and research editions, (2) outcomes and pitfalls of factor analysis, (3) the relationship of ITPA scores tothose of the WISC and Stanford-Binet, (4) ethnic differences shown on the ITPA, (5) differences among groups of atypical children, and (6) ITPA correlates of reading disabilities. A critique is presented regarding the misuse of the ITPA with subjects beyond the range of the norms and possible uses of the test in areas for which it was not originally intended. Emphasis is placed on the major use of the test as being a clinical indicator in determining differential abilities and disabilities (intraindividual differences) among cognitive, perceptual, and memory functions in young children.

Child↗
PubMed1978

Aftercare for alcoholics: services of community mental health centers.

Fewer than half of the patients hospitalized for alcoholism treatment received aftercare from a community mental health center, the variables significantly related to receipt of aftercare being number of previous hospitalizations and referral to the hospital by self or family rather than by a court.

Adult↗
PubMed1977

Who gets aftercare? A study of patients discharged from state hospitals in Kentucky.

A cohort of 579 patients discharged from state mental hospitals in Kentucky during a one-year period was studied to determine the amount and nature of after-care services provided to them. A total of 319 received some form of attercare from community mental health centers during the two to three years after discharge. The majority received at least one service that could be classified as individual therapy or chemotherapy, about one-third received evaluation or rehabilitation services, and only a few had family interviews or group therapy. The majority of those receiving services had contact with psychiatrists, nurses, or other mental health professionals; less than half had contact with social workers or psychologists. In general the aftercare services tended to be medically oriented, brief, and limited in number. They were provided to a majority of the patients within their first month in the community.

Adult↗