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Biomedical subjects

Adrian Jones

Publications and source records attributed to Adrian Jones.

8 recordsLinked to original sources
PubMed2006

Multidisciplinary team working: collaboration and conflict.

The aim of this paper is to report on findings identifying some of the difficulties encountered by the multidisciplinary team in the development and implementation of a care pathway for patients diagnosed with schizophrenia. Policy direction has shifted towards greater team working and blurring of professional boundaries. Moreover, there is greater need to deliver care according to set standards and for patients to reach particular outcomes of care. Care pathways are relatively new for psychiatry and will potentially uncover tensions within the team. Data were collected by participant observation and semistructured interviews over a period of 12 months on an acute psychiatric unit. The care team developed the care pathway and the process of development and implementation was observed through action research. Cross-sectional indexing was used to analyse the data, and themes were developed using interview and observational data collection methods. Clinicians argued strongly for clear role boundaries but also defended their perceived control over health care from other professions. The findings indicate that designing a care pathway for people with schizophrenia may produce conflicting perceptions from the team. Conflict may arise through professions being unwilling to accept plurality over roles, which may hinder progress in meeting the needs of patients. The findings also counter the impression that care pathways can be implemented with little impact on the team.

Conflict, Psychological↗
PubMed2006

Stridor in Crohn disease and the use of infliximab.

Extraintestinal manifestations of Crohn disease are well recognized. Upper airway obstruction is a very rare but important complication that usually responds to high-dose steroids. We report a case of Crohn disease initially presenting with respiratory symptoms and subsequently resulting in acute severe upper airway obstruction, which failed to respond to steroids but dramatically responded to the first documented use of infliximab in this context.

Adult↗
PubMed2005

Severe chronic active Epstein-Barr virus infection mimicking steroid-dependent inflammatory bowel disease.

Severe chronic active Epstein-Barr virus infection is a rare, debilitating, nonneoplastic, inflammatory disorder for which there is no definitive treatment. We describe a Caucasian child who initially presented with clinical and histopathologic features consistent with inflammatory bowel disease, for whom additional investigations led to the diagnosis of severe chronic active Epstein-Barr virus infection.

Biopsy, Needle↗
PubMed2004

Using nitrogen stable isotope ratios (delta 15N) of macroalgae to determine the effectiveness of sewage upgrades: changes in the extent of sewage plumes over four years in Moreton Bay, Australia.

Nitrogen loading to aquatic ecosystems from sewage is recognised worldwide as a growing problem. The use of nitrogen stable isotopes as a means of discerning sewage nitrogen in the environment has been used annually by the Ecosystem Health Monitoring Program in Moreton Bay (Australia) since 1997 when the technique was first developed. This ("sewage plume mapping") technique, which measures the delta(15)N isotopic signature of the red macroalga Catenella nipae after incubation in situ, has demonstrated a large reduction in the magnitude and spatial extent of sewage nitrogen within Moreton Bay over the past 5 years. This observed reduction coincides with considerable upgrades to the nitrogen removal efficacy at several sewage treatment plants within the region. This paper describes the observed changes and evaluates whether they can be attributed to the treatment upgrades.

Environmental Monitoring↗
PubMed2004

Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials.

OBJECTIVE: To assess the efficacy of topical non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis. DATA SOURCES: Medline, Embase, Scientific Citation Index, CINAHL, Cochrane Library, and abstracts from conferences. REVIEW METHODS: Inclusion criterion was randomised controlled trials comparing topical NSAIDs with placebo or oral NSAIDs in osteoarthritis. Effect size was calculated for pain, function, and stiffness. Rate ratio was calculated for dichotomous data such as clinical response rate and adverse event rate. Number needed to treat to obtain the clinical response was estimated. Quality of trial was assessed, and sensitivity analyses were undertaken. RESULTS: Topical NSAIDs were superior to placebo in relieving pain due to osteoarthritis only in the first two weeks of treatment. Effect sizes for weeks 1 and 2 were 0.41 (95% confidence interval, 0.16 to 0.66) and 0.40 (0.15 to 0.65), respectively. No benefit was observed over placebo in weeks 3 and 4. A similar pattern was observed for function, stiffness, and clinical response rate ratio and number needed to treat. Topical NSAIDs were inferior to oral NSAIDs in the first week of treatment and associated with more local side effects such as rash, itch, or burning (rate ratio 5.29, 1.14 to 24.51). CONCLUSION: Randomised controlled trials of short duration only (less than four weeks) have assessed the efficacy of topical NSAIDs in osteoarthritis. After two weeks there was no evidence of efficacy superior to placebo. No trial data support the long term use of topical NSAIDs in osteoarthritis.

Administration, Topical↗
PubMed2002

Research and organizational issues for the implementation of family work in community psychiatric services.

BACKGROUND: The need for evidence-based practice (EBP) to guide and develop mental health services remains fundamental for modern services. Aim. To discuss issues that impact upon implementation of EBP and practice development using family work (FW) as an example. METHODS: A selection of the FW literature was reviewed drawing on sources including the Cochrane Library, Cinahl and Medline. Keywords used were FW, community mental health team and research design. FINDINGS: Centralized policy initiatives and guidelines that are themselves guided by evidence of randomized controlled trials predominantly risk alienating practitioners and clients/carers. Family work has some demonstrable clinical benefits although models differ and the active therapeutic agent remains unclear. Its adoption into routine care is also hindered by a productivity management outlook that seeks to maximize stretched resources and whose values are likely to be internalized by practitioners. The dichotomous position of previous research and practice development make implementation of EBP difficult and highlights the need for strategic planning that embraces both factors. CONCLUSION: The current drive to increase EBP requires a bi-directional process of influence that allows individual practitioners and clients/carers to become producers of evidence and not simply recipients. The authors support wider adoption of case study research designs to reflect the unpredictable nature of mental health care. Adoption of assertive community treatment models within community services is most likely to promote the excellence management model and accommodate EBP such as FW.

Community Health Nursing↗
PubMedDate not supplied

Improving care for people with learning disabilities.

In November 1998, a project group began a review of acute hospital service provision in Sheffield for people with learning disabilities and their carers. The aim was to produce recommendations for future development. Throughout the project, patients with learning disabilities and their carers were consulted along with professionals and focus groups representing people with learning disabilities. The project group identified the need for new audit tools and integrated care pathways, changes to documentation and working practices, as well as the need to develop training. The group presented its findings to the executive of the newly formed Sheffield Teaching Hospitals NHS Trust, which gave full support for the group's recommendations to be implemented throughout the trust.

Humans↗