NHS debt crisis forces a rethink.
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Hospital Design and Construction↗
Biomedical subjects
David Cottrell
Publications and source records attributed to David Cottrell.
Health professionals in multi-disciplinary and multi-agency teams: changing professional practice.
The article draws on an Economic and Social Research Council (ESRC)-funded research project that aimed to investigate the reality behind the rhetoric of "joined up thinking". The research project was a qualitative, multi-method study involving three phases, including observation and documentary analysis; interviews; and focus groups around decision making and knowledge sharing. The article reflects on the perspectives and experiences of health professionals and their colleagues in multi-agency teams about the impact of multi-agency teamwork on their professional knowledge and learning, and on their ways of working. Actual and potential conflicts between professionals are explored about models of understanding, about roles, identities, status and power, about information sharing, and around links with other agencies. Dilemmas of team building and of conflicting values and knowledge are exemplified from health professionals' accounts, using theoretical models of "communities of practice" and "activity theory". The article presents groups of strategies that health professionals and their colleagues in multi-agency, multi-professional teams use to overcome barriers and to strengthen team cohesion. The conclusion reflects on some implications of our findings in theory and practice for professionalism within integrated, multi-professional teams that are building new ways of working.
Allied Health Occupations↗
Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data.
BACKGROUND: Questions concerning the safety of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression in children led us to compare and contrast published and unpublished data on the risks and benefits of these drugs. METHODS: We did a meta-analysis of data from randomised controlled trials that evaluated an SSRI versus placebo in participants aged 5-18 years and that were published in a peer-reviewed journal or were unpublished and included in a review by the Committee on Safety of Medicines. The following outcomes were included: remission, response to treatment, depressive symptom scores, serious adverse events, suicide-related behaviours, and discontinuation of treatment because of adverse events. FINDINGS: Data for two published trials suggest that fluoxetine has a favourable risk-benefit profile, and unpublished data lend support to this finding. Published results from one trial of paroxetine and two trials of sertraline suggest equivocal or weak positive risk-benefit profiles. However, in both cases, addition of unpublished data indicates that risks outweigh benefits. Data from unpublished trials of citalopram and venlafaxine show unfavourable risk-benefit profiles. INTERPRETATION: Published data suggest a favourable risk-benefit profile for some SSRIs; however, addition of unpublished data indicates that risks could outweigh benefits of these drugs (except fluoxetine) to treat depression in children and young people. Clinical guideline development and clinical decisions about treatment are largely dependent on an evidence base published in peer-reviewed journals. Non-publication of trials, for whatever reason, or the omission of important data from published trials, can lead to erroneous recommendations for treatment. Greater openness and transparency with respect to all intervention studies is needed.
Adolescent↗
Ulcerative tongue lesion secondary to cytomegalovirus.
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AIDS-Related Opportunistic Infections↗
Deliberate self-harm in children and adolescents: association with social deprivation.
BACKGROUND: It has been demonstrated that adult suicidal behaviour is associated with unemployment and social deprivation. The association between self-harm and social deprivation in young people is less clear. AIMS: To examine the relationship between social deprivation and deliberate self-harm in children and adolescents in an UK district. METHOD: Computer records of patients under 18 years of age presenting with self-harm at the district casualty department were analysed in Hull and East Yorkshire. The relationship with social deprivation was examined using Townsend scores. RESULTS: 730 young people presented with self-harm during a period of two years. Socio-economic deprivation was associated with overdose, self-injury, and poisoning by illicit substances. After controlling for the proportion of single parent households, moving households with children, and adult long-term sickness in each ward, partial correlations remained significant between overdose, self-injury, and Townsend scores. CONCLUSIONS: The results highlight the importance of socio-economic deprivation in the aetiology of deliberate self-harm in young people. Primary and secondary prevention programs cannot be successful without taking this into consideration.
Adolescent↗
Clinical supervision of SpRs: where does it happen, when does it happen and is it effective? Specialist registrars.
OBJECTIVES: To establish what supervisory methods are used in postgraduate medical education and to determine how effective, particularly in relation to patient care, these methods are perceived to be. DESIGN: We carried out a national validated questionnaire survey of medical directors (MDs) of National Health Service (NHS) trusts (both community and hospital), educational supervisors (ESs) and specialist registrars (SpRs). SAMPLE: Seven specialties were selected to represent the potential range of supervisory practices: anaesthesia, general practice, laboratory science, medicine, paediatrics, psychiatry and surgery. These involved 15 ESs and 15 SpRs from each specialty (n = 210) and 100 MDs. MAIN OUTCOME MEASURES: Quantitative data were analysed using the following tests when appropriate: frequency counts, cross tabulations, descriptives, Kruskal-Wallis, Mann-Whitney, chi-square and Fisher exact tests. Qualitative data were also obtained. RESULTS: A total of 91% of SpRs had a formally designated ES. There was evidence of change in perceptions of the roles of supervising consultants. Supervisory practice is highly variable and there are significant differences between ESs and SpRs in perceptions of frequency and effectiveness of supervision. None of the supervisory activities, including ensuring patient safety, were rated as receiving significant or full coverage. CONCLUSIONS: Supervision is considered to be both important and effective but there is inadequate coverage and frequency of supervision activities. At the least this indicates a need for more explicit guidance for ESs and SpRs.
Clinical Competence↗
Early development and unstable genes in schizophrenia: preliminary results.
BACKGROUND: Trinucleotide repeats have been associated with schizophrenia, but the evidence, based on cross-sectional clinical information, is equivocal. AIMS: To examine the relationship between genomic CAG/CTG repeat size and premorbid development in schizophrenia. METHOD: Early development and premorbid functioning of 22 patients with DSM-IV diagnosis of schizophrenia were assessed by parental interviews. Repeat expansion detection (RED) technique was used to measure genomic CAG/CTG repeat size, and PCR for CAG repeat size at the ERDA-1 and CTG 18.1 loci. RESULTS: There was an inverse association between CAG/CTG size and perinatal complications. Patients with speech and motor developmental delay had larger repeats. The results were not due to expansion in the ERDA-1 and CTG 18.1 genes. CONCLUSIONS: CAG/CTG repeat expansion is associated with speech and motor developmental delay in schizophrenia. We propose that the developmental model may be useful for research into the genetics of schizophrenia.
Adult↗
What is effective supervision and how does it happen? A critical incident study.
OBJECTIVES: To identify the key features of supervision from the perspectives of educational supervisors and specialist registrars. DESIGN: Critical incident study. Telephone interviews were conducted with selected informants representing a range of specialties. The sample comprised educational supervisors with an identified interest in supervision, specialist registrars and GP trainees in the Yorkshire region. RESULTS: Educational supervisors and specialist registrars were generally agreed on what constitutes effective supervision: direct supervision was seen as very important. Educational supervisors and specialist registrars had very different concerns in relation to ineffective supervision: specialist registrars were concerned with inadequate supervision whilst educational supervisors were concerned with failures in direct supervision and poorly performing trainees. Supervision practices varied between specialties; in this study there seemed to be particular problems in anaesthesia, medicine and paediatrics. CONCLUSIONS: Direct supervision and the quality of the supervisory relationship are key to effective supervision. There is a need for clear guidance on supervision and the establishment of appropriate procedures and mechanisms to resolve difficulties relating to inadequate supervision for trainees and performing trainees. Insufficient numbers of supervisors have received training in supervision.
Attitude of Health Personnel↗
Practitioner review: The effectiveness of systemic family therapy for children and adolescents.
BACKGROUND: Systemic family therapy has become a widely used intervention in child and adolescent mental health services over the last twenty years. METHODS: This paper reviews the development of systemic family therapy, briefly describes the theory and techniques associated with the most prominent contemporary strands of systemic practice, and examines the empirical justification for using systemic family therapies with children and adolescents. RESULTS: There is a paucity of well-designed randomised controlled trials of systemic therapies with children and adolescents and those trials that do exist evaluate older structural and strategic therapies. Methodological limitations of existing research include the use of unrepresentative participants, small sample sizes and wide age ranges. There is a lack of credible no-treatment or alternative treatment controls, tests of clinical as opposed to statistical significance, and conceptually relevant outcome measures that examine underlying interactional mechanisms. The term 'family therapy' encompasses a wide range of interventions and it is not always clear what treatment intervention has been delivered. Nevertheless, there is good evidence for the effectiveness of systemic family therapies in the treatment of conduct disorders, substance misuse and eating disorders, and some support for their use as second-line treatments in depression and chronic illness. CONCLUSIONS: Systemic family therapy is an effective intervention for children and adolescents but further well-designed outcome studies are needed using clearly specified, manualised forms of treatment and conceptually relevant outcome measures.
Adolescent↗