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PubMed1989

Overview of a research programme designed to address key issues in the planning and delivery of services for people with mental handicap.

This paper describes the programme of mental handicap research funded by the UK Department of Health, which addresses issues of policy, planning and service delivery of key interest to all involved professionals. The author is manager of the research programme and the research discussed covers the provision of good community residential care, hospital contraction, costs, other services in the community, supporting children with mental handicaps at home with their families, and the special needs of certain groups.

Activities of Daily Living↗
PubMed1996

The Strategy for Action on Farmers' Emotions (SAFE): working to address the mental health needs of the farming community.

Within the United Kingdom farmers are considered to be the fourth highest occupation group at risk of committing suicide. However, the mental health needs of the farming community are currently poorly understood or addressed by mental health nurses and community mental health teams. This is unacceptable both in terms of the presented level of risk, and in the direction of the most recent mental health review, which suggests that mental health nurses have unique skills in identifying and responding to suicidal behaviour. By building upon the practice of the first author, this paper outlines the Strategy for Action on Farmers' Emotions (SAFE), which develops a comprehensive strategy to respond to the mental health needs of the farming community. Where it is applicable, it is vital that these needs are brought from the margins to the mainstream of policy and service provision. This paper suggests that this position will only be achieved once an increased understanding of farming life and culture is gained.

Agriculture↗
PubMed2005

Language, therapeutic relationships and individualized care: addressing these issues in mental health care pathways.

Care pathways are used extensively in inpatient medical and surgical services to facilitate the delivery of evidence-based health care. There is a growing interest in their use in the mental health arena. However, questions remain about their acceptability to service users and staff. Most current literature is aimed at communicating the value of care pathways. Consequently, issues that are particularly pertinent to mental health, like language, therapeutic relationships and individualized care have not been fully addressed. This paper reports on the development of a care pathway in residential services in Nottingham. It will illustrate how by working in multidisciplinary groups with service users and carers these issues were incorporated into a comprehensive pathway that follows the service user's journey from admission to discharge. The paper concludes by highlighting some of the challenges of care pathway implementation and suggests ways they can be overcome.

Communication↗
PubMed2005

A comprehensive collaborative patient safety residency curriculum to address the ACGME core competencies.

CONTEXT: Patient safety currently receives only scant attention in most residency curricula. Safety is a subject that transcends the US Accreditation Council for Graduate Medical Education's 6 core competencies. OBJECTIVE: To design and implement a new patient safety curriculum in collaboration with the Schools of Nursing and Pharmacy, in such a way as to address all 6 competencies. SETTING AND PARTICIPANTS: The curriculum applies to a university-based family medicine residency programme with 45 residents at 5 sites, including urban, suburban and rural sites. CURRICULUM DESIGN: The curriculum includes introductory workshops for faculty and residents, a series of didactic courses, individual portfolios and a series of small group exercises including chart reviews, case presentations and a longitudinal quality improvement project. The activities are run by a multidisciplinary team. OUTCOME MEASURES: Main outcome measures include assessment of resident performance in curriculum activities and in an annual objective structured clinical examination (OSCE) that includes standardised patient interviews, simulations and a written examination. Programme evaluation will include comparison of OSCE performance with that at a neighbouring residency. RESULTS: Residents identified safety problems and system-based solutions using a safety journal. Cases of polypharmacy were identified using journals and chart reviews, and medication changes proposed and discussed. At resident practice sites, residents identified safety priorities based on a staff survey and proposed system-based solutions. Results of the OSCE will be presented elsewhere. CONCLUSIONS: A new patient safety curriculum was successfully introduced into a family medicine residency. The curriculum integrates patient safety into residents' daily activities and incorporates input from the disciplines of nursing and pharmacy so as to help build more effective clinical teams and inculcate a culture of safety.

Clinical Competence↗
PubMed1995

Use of the 3-nitro-2-pyridine sulfenyl protecting group to introduce N epsilon-branching at lysine during solid-phase peptide synthesis. I. Application to the synthesis of a peptide template containing two addressable sites.

TASPs (template-assembled synthetic peptides) are generated by the covalent attachment of linear peptides to a common peptide backbone, thus generating larger synthetic peptides/proteins with prefolded structure. In this work we present a strategy for the synthesis of a heterotemplate-assembled synthetic peptide containing two addressable sites. This orthogonal protection strategy would allow the selective introduction of different peptide chains via the epsilon-amino functions of template lysines being protected by either fluorenylmethoxycarbonyl (Fmoc) or 3-nitro-2-pyridine sulfenyl (Npys) groups. The N alpha-Boc-N epsilon-Npys-L-lysine required for solid-phase peptide synthesis (SPPS) is not readily available at a reasonable cost. To facilitate the more widespread use of this reagent we have compared the two published procedures for synthesizing this protected amino acid and evaluated the suitability of the products for SPPS. Two resin-bound peptides, a tripeptide Ac-G-K-Npys)-G-resin and an octapeptide template Ac-P1-K2-K3-L4-K5-K6-P7-G8-resin, were synthesized by SPPS. The epsilon-amino functions of lysines K2 & K6 and K3 & K5 of the octapeptide were protected by Fmoc and Npys groups, respectively. Secondly, these peptides were used to evaluate various reagents and reaction conditions for the deprotection of the epsilon-amino function of lysines bearing the N epsilon-Npys protecting group. A procedure for the optimized selective and quantitative deprotection of the Npys group from the epsilon-amino function of lysine in a resin-bound peptide using 2-mercaptopyridine-N-oxide is described.

Amino Acid Sequence↗
PubMed2006

Addressing the mysteries of perforin function.

Perforin is a cytolytic protein stored in secretory granules of CTL and NK cells. It synergizes with proapoptotic serine proteases, granzymes, to deliver the lethal hit to virus-infected or transformed target cells. The mechanism of perforin action has not been described beyond its original characterization in the 1980s, and its role in human disease has remained elusive. This article addresses recent key advances in genetic, clinical and biochemical studies that have reignited the current interest in perforin biology.

Animals↗
PubMed2004

Addressing the epidemic of chronic kidney disease in Australia.

The Australia Diabetes, Obesity and Lifestyle Study (AUSDIAB) study provided, for the first time in Australia, a snapshot of the prevalence of kidney damage, reduced kidney function, hypertension and diabetes in the adult population. With this information, and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) registry, that has recorded kidney failure statistics for many years, the extent of the chronic kidney disease burden in Australia is being better defined. This burden is even more pronounced in the Indigenous population where the incidence of kidney disease and kidney failure is increased several-fold. Diabetes is the second most common cause of kidney failure among Australians. The number of patients with diabetes accepted to dialysis has doubled in the last 7 years, the mean body weight of patients commencing dialysis has increased 7 kg in the past decade and the mean age at acceptance to dialysis is rising in a linear fashion (presently 60 years). These facts, together with a static transplant rate, all point to the prevalence of dialysis likely staying at or increasing beyond the present yearly growth rate of 6-7%. The evidence shows that a large proportion of chronic kidney disease patients are dying of cardiovascular risk factors before they reach dialysis or transplantation. There are many gaps in delivering appropriate preventative treatment to these patients. A relatively small reduction in the rise in dialysis numbers that might flow from an effective prevention of progression program, could make a significant impact on the spiralling numbers and associated cost of kidney failure treatment in Australia. We now need to develop and implement a national kidney disease strategy designed to address the whole continuum of chronic kidney disease from its earliest stage right through to dialysis and transplantation.

Australia↗
PubMed2004

International collaboration to address common problems in health care: processes, practicalities and power.

This article reports on an international collaborative study into the management of chronic leg ulcers by nurses working in the community in Kronoberg, Sweden and the East Riding and Hull, UK. The management of leg ulcers like many other services provided by nurses working in the community is one that is growing out of community need, often without matching resources. This article reports on some of the processes that were involved and some of the practical considerations that were faced and addressed in formulating and conducting an international collaborative study. The article also explores the 'power' international collaboration brings to the research enterprise.

Health Knowledge, Attitudes, Practice↗
PubMed2005

Addressing the challenges of the global nursing community.

AIM: To describe both the initial and the subsequent impact of the 2001 Global Nursing Partnerships Conference: 'Strategies for a Sustainable Workforce', the first ever forum of its type, on the key challenges facing the global nursing community. DESIGN: Identification of short- and long-term outcomes through descriptive review of immediate post-conference evaluations and follow-up questionnaires sent out 13 months later to nursing leaders in the participating countries. METHODS: Content analysis of quantitative data from 61 immediate post-conference evaluations and 13 follow-up questionnaires, as well as qualitative data from participant comments on the evaluation forms and questionnaires. FINDINGS: Analysis indicated conference participants viewed the conference as a beneficial forum to collaboratively examine nursing workforce issues and trends, develop country-specific nursing action plans, establish and strengthen national and international partnerships, and build stronger international nursing bodies. CONCLUSION: The Global Nursing Partnerships Conference was an international success--addressing the unique challenges facing nursing leaders in developed and developing countries and the needs of nurses throughout the world.

Congresses as Topic↗
PubMed2006

Addressing measurement error bias in nurse staffing research.

OBJECTIVE: To assess the extent of measurement error bias due to methods used to allocate nursing staff to the acute care inpatient setting and to recommend estimation methods designed to overcome this bias. DATA SOURCES/STUDY SETTING: Secondary data obtained from the California Office of Statewide Health Planning and Development (OSHPD) and the Centers for Medicare and Medicaid Services' Healthcare Cost Report Information System for 279 general acute care hospitals from 1996 to 2001. STUDY DESIGN: California OSHPD provides detailed nurse staffing data for acute care inpatients. We estimate the measurement error and the resulting bias from applying different staffing allocation methods. Estimates of the measurement errors also allow insights into the best choices for alternate estimation strategies. PRINCIPAL FINDINGS: The bias induced by the adjusted patient days method (and its modification) is smaller than for other methods, but the bias is still substantial: in the benchmark simple regression model, the estimated coefficient for staffing level on quality of care is expected to be one-third smaller than its true value (and the bias is larger in a multiple regression model). Instrumental variable estimation, using one staffing allocation measure as an instrument for another, addresses this bias, but only particular choices of staffing allocation measures and instruments are suitable. CONCLUSIONS: Staffing allocation methods induce substantial attenuation bias, but there are easily implemented estimation methods that overcome this bias.

Bias↗
PubMed2004

Analysis of the functional integrity of cryopreserved human liver cells including xenografting in immunodeficient mice to address suitability for clinical applications.

BACKGROUND: The availability of well-characterized human liver cell populations that can be frozen and thawed will be critical for cell therapy. We addressed whether human hepatocytes can recover after cryopreservation and engraft in immunodeficient mice. METHODS: We isolated cells from discarded human livers and studied the properties of cryopreserved cells. The viability of thawed cells was established with multiple in vitro assays, including analysis of liver gene expression, ureagenesis, cytochrome P450 activity, and growth factor-induced cell proliferation. The fate of transplanted cells was analysed in immunodeficient NOD-SCID mice. RESULTS: After thawing, the viability of human hepatocytes exceeded 60%. Cells attached to culture dishes, proliferated following growth factor stimulation and exhibited liver-specific functions. After transplantation in NOD-SCID mice, cells engrafted in the peritoneal cavity, a heterologous site, as well as the liver itself, retained hepatic function and proliferated in response to liver injury. Transplanted hepatocytes were integrated in the liver parenchyma. Occasionally, transplanted cells were integrated in bile ducts. CONCLUSIONS: Cryopreserved human liver cell showed the ability to retain functional integrity and to reconstitute both hepatic and biliary lineages in mice. These studies offer suitable paradigms aimed at characterizing liver cells prior to transplantation in people.

Animals↗
PubMed2005

Using physiologically-based pharmacokinetic modeling to address nonlinear kinetics and changes in rodent physiology and metabolism due to aging and adaptation in deriving reference values for propylene glycol methyl ether and propylene glycol methyl ether acetate.

Reference values, including an oral reference dose (RfD) and an inhalation reference concentration (RfC), were derived for propylene glycol methyl ether (PGME), and an oral RfD was derived for its acetate (PGMEA). These values were based on transient sedation observed in F344 rats and B6C3F1 mice during a two-year inhalation study. The dose-response relationship for sedation was characterized using internal dose measures as predicted by a physiologically-based pharmacokinetic (PBPK) model for PGME and its acetate. PBPK modeling was used to account for changes in rodent physiology and metabolism due to aging and adaptation, based on data collected during Weeks 1, 2, 26, 52, and 78 of a chronic inhalation study. The peak concentration of PGME in richly perfused tissues (i.e., brain) was selected as the most appropriate internal dose measure based on a consideration of the mode of action for sedation and similarities in tissue partitioning between brain and other richly perfused tissues. Internal doses (peak tissue concentrations of PGME) were designated as either no-observed-adverse-effect levels (NOAELs) or lowest-observed-adverse-effect levels (LOAELs) based on the presence or the absence of sedation at each time point, species, and sex in the two-year study. Distributions of the NOAEL and LOAEL values expressed in terms of internal dose were characterized using an arithmetic mean and standard deviation, with the mean internal NOAEL serving as the basis for the reference values, which was then divided by appropriate uncertainty factors. Where data were permitting, chemical-specific adjustment factors were derived to replace default uncertainty factor values of 10. Nonlinear kinetics, which was predicted by the model in all species at PGME concentrations exceeding 100 ppm, complicate interspecies, and low-dose extrapolations. To address this complication, reference values were derived using two approaches that differ with respect to the order in which these extrapolations were performed: (1) default approach of interspecies extrapolation to determine the human equivalent concentration (PBPK modeling) followed by uncertainty factor application, and (2) uncertainty factor application followed by interspecies extrapolation (PBPK modeling). The resulting reference values for these two approaches are substantially different, with values from the latter approach being seven-fold higher than those from the former approach. Such a striking difference between the two approaches reveals an underlying issue that has received little attention in the literature regarding the application of uncertainty factors and interspecies extrapolations to compounds where saturable kinetics occur in the range of the NOAEL. Until such discussions have taken place, reference values based on the former approach are recommended for risk assessments involving human exposures to PGME and PGMEA.

Administration, Inhalation↗
PubMed2001

Preventive care in the emergency department: a systematic literature review on emergency department-based interventions that address smoke detectors in the home.

OBJECTIVES: To assess the effectiveness of an emergency department (ED)-based strategy to identify and counsel selected patients about the importance of an operational smoke detector in the home and to offer a graded recommendation regarding such a strategy. METHODS: A systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. Two Medline combined searches were performed using the following terms: emergency medical services and counseling, protective devices and smoke detectors, accidents, home, burns, fires, and residential fires. A free-text search of indexed and nonindexed citations in Emergency Medical Abstracts from 1977 to 1999 and a search of the Cochrane Library were also performed. In addition, reviewers performed independent Medline searches and suggested four additional studies. Studies selected for inclusion in this systematic review were required to meet the following criteria: 1) report ED-based research and 2) address the topic of fire and burn prevention with some pertinent discussion of ED-based interventions. The initial inclusion criteria had restricted studies to those that reported the results of counseling strategies for smoke detectors. The authors later decided to consider, as indirectly relevant, studies that did not investigate counseling strategies. Data from the selected studies were extracted using the template form, and the validity and applicability of the results to emergency practice were assessed. Recommendations were derived following criteria developed by a systematic review of preventive interventions in the ED. RESULTS: Six articles were closely reviewed. Four of the six studies met the inclusion criteria. One other study that did not meet the inclusion criteria was also considered. No study focused specifically on the counseling of ED patients about smoke detectors. CONCLUSIONS: Following the criteria of the graded recommendations used for the parent project. a recommendation cannot be made either for or against an ED-based strategy to counsel patients on the importance of smoke detectors. No studies located in our review directly assessed the effectiveness of such a strategy. Based on the retrospective case series study of the potential opportunity for a home fire safety intervention during an emergency medical services visit and the Safe Block Project study, it may be worthwhile to consider further research on the effectiveness of systems-level/structural interventions, with a targeted focus on strategies that attempt to overcome barriers associated with active interventions.

Emergency Service, Hospital↗
PubMed1997

Single strand conformation polymorphism analysis of PCR-tDNA fingerprinting to address the identification of Bacillus species.

The suitability of tDNA-PCR fingerprinting to identify species of the genus Bacillus was tested on 75 strains. Strains belonging to the same species or the same phylogenetic cluster were correctly grouped. Among B. stearothermophilus strains, different pattern types were found. This could be due to the unclear taxonomic situation of these strains, rather than to a failure of the tDNA-PCR. Single strand conformation polymorphism (SSCP) of the PCR products allowed species discrimination within the 'B. subtilis group', but not within the 'B. cereus group'. The tDNA-PCR, alone or coupled with SSCP analysis, is useful to address Bacillus species identification, particularly for those species which are not phylogenetically tightly clustered.

Bacillus cereus↗
PubMed2006

Addressing the learning deficit in breastfeeding: strategies for change.

This paper summarizes the findings of the learning needs assessment described in this issue. Limitations and strengths are discussed. The paper describes a national, multi-sectoral, multidisciplinary picture. Our respondents may over-represent those with an interest in breastfeeding; if so, the true picture may be even more problematic than described here. Major deficits were identified in the knowledge and skills of practitioners from all backgrounds and all sectors. Many professionals report poor knowledge about breastfeeding and have low levels of confidence and clinical competence. Organizational constraints and barriers to effective education and practice include fragmentation of care and education, lack of facilities, and a low priority being given to breastfeeding. There is a range of current educational provision, although not all is fit for purpose. Voluntary organizations seem to have higher standards than do some current professional learning opportunities. Preferred methods of training include practical observation and mentorship, volunteer counsellor involvement in training programmes, as well as self-study and online opportunities. Recommendations include: a funded, mandatory, interagency and multidisciplinary approach; appropriate content; support at local and national levels; breastfeeding education to be included in clinical governance and audit mechanisms; and further research and evaluation to examine optimum ways of providing education and training. Organizational barriers could be addressed through a public health policy and evidence-based approach.

Breast Feeding↗
PubMedDate not supplied

Is current hydrogeologic research addressing long-term predictions?

Hydrogeology is a field closely related to the needs of society. Many problems of current national and local interest require predictions of hydrogeological system behavior, and in a number of important cases, the period of prediction is tens to hundreds of thousands of years. It is argued that the demand for such long-term hydrogeological predictions casts a new light on the future needs of hydrogeological research. Key scientific issues are no longer concerned only with simple processes or narrowly focused modeling or testing methods but also with assessment of prediction uncertainties and confidence, couplings among multiple physicochemical processes occurring simultaneously at a site, and the interplay between site characterization and predictive modeling. These considerations also have significant implications for hydrogeological education. With this view, it is asserted that hydrogeological directions and education need to be reexamined and possibly refocused to address specific needs for long-term predictions.

Forecasting↗
PubMed1984

Stepfamilies: a concern health education should address.

In this country there are more than 1 million children who find themselves in a stepfamily situation. Coping with the changes involved can be a difficult process. Health educators need to recognize the fact that many children are in this situation. Through the subunits included in the family life unit, young people can be taught how to deal with the issues involved. In so doing, health education will be addressing another major family life problem in our society.

Child↗
PubMed2005

Advocacy to action: addressing coordinated school health program issues with school boards.

As the need for Coordinated School Health Programs (CSHP) increases, so does recognition of the importance for advocating with local school boards for their support. Identifying the diversified make up of school board members and implementing effective strategies to advocate for coordinated school health can help facilitate the successful inclusion of such a program. With increasing emphasis placed on standardized testing and the "basic" curriculum, school board members need to become aware of specific benefits a CSHP can provide their district. With the relationship between health status and academic achievement confirmed in scientific research, school boards may begin paying more attention to providing high-quality health services and health instruction for students. This article presents items to consider and steps to take before, during, and after addressing a local school board for their support in implementing a CSHP.

Consumer Advocacy↗