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Helen Smith

Publications and source records attributed to Helen Smith.

34 records · Page 2Linked to original sources
PubMed2004

Evaluation of an after hours telephone support service for rural palliative care patients and their families: A pilot study.

OBJECTIVE: To report on the introduction and evaluation of an after hours telephone support service for palliative care patients and their families at home. DESIGN: Descriptive evaluation using an audit of telephone logbook, text analysis of reflective journals, questionnaire and interviews. SETTING: Palliative care call service in Grafton, New South Wales, Australia. SUBJECTS: The participants were health professionals using the Palliative Care Service in Grafton (48 in total) and nurses providing the palliative care service (21 in total). RESULTS: Twelve calls were taken by the nurses during the pilot study. Three major themes emerged from the analysis: preparation involving publishing the after hours telephone support service (AHTSS) and nurse workshop; benefits such as support to families and health service resourcing; and nurses' experiences regarding personal impact and building support for each other. CONCLUSION: It appears from the evaluation responses of health professionals and nurses that knowing the service was there was a great security and reduced the sense of isolation predominant in the experience of rural families caring for a palliative care patient at home. Based on the positive evaluation, the area health service provided ongoing funding for the service and is exploring avenues to extend the program into other areas. The service now requires a re-evaluation at 18 months and will form the second phase of the study that is currently being organised.

After-Hours Care↗
PubMed2004

Community hospitals: an under-recognized resource for palliative care.

In the UK there are concerns that, in certain groups of dying patients such as the old, those with non-cancer diagnoses and those in rural areas, the quality of care is unacceptably variable. There has been no systematic survey of the extent to which community hospitals provide general palliative care for such patients. Therefore, by means of a structured questionnaire we asked senior nurses/managers at all 478 community hospitals in the UK for information on staff expertise, facilities and specialist equipment, liaison arrangements with specialist palliative care providers, priorities, practice and policy in end-of-life care. Of the 346 hospitals (72%) that responded, only 28 were in urban areas. 73% of hospitals employed at least one nurse with additional training in palliative care, 72% had access to 24-hour specialist palliative care advice and 51% had separate overnight accommodation for relatives, but only 22% had designated palliative care beds. Most hospitals did not have written policies or guidelines for patient assessment or symptom control. These findings add to evidence that community hospitals represent an important resource to improve access to palliative care for groups that are currently under-served.

Health Facility Size↗
PubMed2004

Spurious hyperphosphataemia caused by an IgA paraprotein: a topic revisited.

BACKGROUND: There are reports in the literature describing artefactually raised phosphate concentrations in serum samples of patients with myeloma. However, IgA paraproteins have been reported only rarely as a potential cause. METHODS: Following the detection of a grossly elevated phosphate concentration in a patient with an IgA paraprotein and another with an IgG paraprotein, we estimated phosphate concentrations in a further 73 patients with paraproteins using the Bayer ADVIA 1650 and Ortho Vitros 950 analysers. The latter method has been reported to be unaffected by pseudohyperphosphataemia. RESULTS: Deproteinization of the serum samples containing the IgA and IgG paraproteins showed that they were responsible for the interference. No significant difference in serum phosphate concentrations measured by the two analysers was noted for the larger study of serum IgG or IgM paraproteins. However, a statistically significant but clinically trivial difference in phosphate concentration was noted for serum IgA paraproteins, with the Ortho Vitros 950 giving slightly higher phosphate concentrations. Deproteinization of these samples yielded similar phosphate concentrations. Phosphate estimation in serum samples without paraproteins using both analysers yielded results that were not statistically different. CONCLUSION: On occasion, serum samples containing IgA paraproteins may give rise to erroneous phosphate concentrations when the Bayer ADVIA is used

Biochemistry↗
PubMed2004

The effect of clozapine on the social behaviour schedule in patients attending a forensic psychiatry day hospital.

This study examined the difference in the functional capacity of patients receiving clozapine, compared with those prescribed other antipsychotic medication, who attend the forensic psychiatry day hospital at Murray Royal Hospital, Perth. (This facility caters for 34 patients. It provides a number of advantages such as access to therapies and supervision of mental state and medication at this critical time in the care pathway.) This study was cross-sectional in nature and examined the patients' demographic details, diagnosis and medication. A functional assessment was carried out using the social behaviour schedule (SBS) for each patient. We discovered that there was a marked difference in the hostility scores between clozapine patients and non-clozapine patients. Only 10.5% of clozapine patients had a severe score (more than two) on the SBS whereas 61.5% of those not receiving clozapine had a severe score. The non-clozapine group had more socially unacceptable habits and were more destructive than patients receiving clozapine, as scored by the SBS. The slowness and under-activity items were more severe in the clozapine patients. The non-clozapine group scored higher in the category of other behaviours that might impede progress, particularly drug-taking.

Affective Disorders, Psychotic↗
PubMed2004

Evidence-based obstetric care in South Africa--influencing practice through the 'Better Births Initiative'.

Ensuring that health professionals practise according to evidence-based standards is important since it affects the quality and cost of care patients receive. The purpose of this research was to use a focused change programme (the Better Births Initiative) to influence obstetric practice of 10 hospitals in Gauteng, South Africa. The findings show some important improvements in practice following the implementation of the BBI; providers at some sites reduced the use of enemas, shaving and episiotomy, and increased use of oral fluids and companionship during labour. Qualitative data suggest that an interactive approach to implementing evidence-based practice can influence health professionals decisions to change practice, and that good working relationships and enthusiastic staff are central to effective change.

Delivery, Obstetric↗
PubMed2003

Surveillance of invasive meningococcal disease in Queensland, 2002.

During 2002, 124 cases of invasive meningococcal disease were notified in Queensland. This was similar to the previous year (n = 128). Four (3.2%) of the cases died. Trends by age and serogroup were generally similar to previous years and were consistent with the overall patterns of this disease in Australia. However, an apparent increase in serogroup C, which infected 41 per cent of cases, needs continued monitoring. This report highlights the need for continued surveillance of morbidity and mortality patterns and management of this disease. Ongoing surveillance will monitor the impact of the National Meningococcal C Vaccination Programme, commenced in early 2003. This report also highlights the need for ongoing community education to ensure people seek medical attention early after onset of the illness. This report shows that when general practitioners considered meningococcal disease as a diagnosis, their patients were admitted to hospital sooner than patients in whom this diagnosis was not initially considered. Acknowledging that early disease may present diagnostic difficulties, further awareness raising amongst general practitioners is required to promote early recognition and referral.

Adolescent↗
PubMed2002

Peri-ventricular grey stimulation versus motor cortex stimulation for post stroke neuropathic pain.

Central post stroke pain is often difficult to manage satisfactorily with conventional treatment modalities for pain. In the last decade functional neurosurgery has offered hope with motor cortex stimulation achieving significant alleviation of pain in some patients. Unfortunately this has led to the neglect of chronic stimulation of deep grey matter as another modality of treating this condition. In this article we present our experience with motor cortex stimulation and that with deep grey matter stimulation in patients with post stroke pain. We argue that both modalities have a significant role and that what is required are better methods of identifying particular patients who are more likely to respond to one or the other.

Aged↗
PubMed2002

A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people.

PURPOSE: To identify the most common beliefs concerning the negative consequences of falling and determine whether these motivate avoidance of activity. DESIGN AND METHODS: A questionnaire assessing feared consequences of falling was completed by 224 community-living people aged older than 75. Beliefs about the consequences of falling were related to demographic characteristics, falling history, and avoidance of activity. The questionnaires were completed again by 166 participants 6 months later. RESULTS: Commonly feared consequences of falling were loss of functional independence and damage to identity. These fears were correlated with avoidance of activity (after adjusting for age, sex, and recent falling history) and predicted avoidance in activity 6 months later (after adjusting for baseline levels of avoidance). IMPLICATIONS: Concerns about damage to social identity, as well as functional incapacity, are common and may motivate avoidance of activity.

Accidental Falls↗
PubMed2002

Conditionally discharged restricted patients and the need for long-term medium security.

In the context of a larger investigation of follow-up of a specific group of mentally disordered individuals, the study described here examined the characteristics of all 55 people conditionally discharged for the first time from a medium secure unit in the West Midlands over a 13-year period. A retrospective case note analysis was undertaken. The findings illustrate that these patients are a distinct group. They were mainly single men who had committed a grave offence. The majority had an extensive criminological history with early onset of offending and chronic mental illness. Fifty percent of those with a criminal record had received at least one custodial sentence prior to the index offence. Co-morbid substance misuse was common, as was a history of self-harm. There were high levels of previous contact with psychiatric services and compulsory in-patient treatment. Most were detained under the Mental Health Act category of mental illness. A quarter had been transferred from a special hospital prior to conditional discharge into the community. The characteristics of this sample demonstrate clearly the need for the provision of long-term medium secure facilities and allied services.

Adult↗
PubMed2001

Evidence-based obstetrics in four hospitals in China: An observational study to explore clinical practice, women's preferences and provider's views.

BACKGROUND: Evidence-based obstetric care is widely promoted in developing countries, but the success of implementation is not known. Using selected childbirth care procedures in four hospitals in Shanghai, we compared practice against evidence-based information, and explored user and provider views about each procedure. METHODS: Observational study. Using the Cochrane Library, we identified six procedures that should be avoided as routine and two that should be encouraged. Procedure rate determined by exit interviews with women, verified using hospital notes. Views of women and providers explored with in depth interviews.The study sites were three hospitals in Shanghai and one in neighbouring province of Jiangsu. 150 women at each centre for procedure rate, and 48 in-depth interviews with women and providers. RESULTS: Vaginal births were 50% (303/599) of the total. Of the six practices where evidence suggests they should be avoided as routine, three were performed with rates above 70%: pubic shaving (3 hospitals), rectal examination (3 hospitals), and episiotomy (3 hospitals). Most women delivered lying down, pain relief was rarely given, and only in the urban district hospital did women routinely have a companion. Most women wanted support or companionship during labour and to be given pain relief; but current practice is insufficient to meet women's needs. CONCLUSION: Obstetric practice is not following best available evidence in the hospitals studied. There is a need to adjust hospital policy to support the use of interventions proven to be of benefit to women during childbirth, and develop approaches that ensure clinical practice changes.

Journal Article↗
PubMedDate not supplied

School connectedness, anger behaviors, and relationships of violent and nonviolent American youth.

PROBLEM: Youth violence research often focuses on risk factors arising from early familial interactions rather than school-related factors. METHODS: Via an Internet questionnaire, 282 girls and boys (ages 7-19, mean 15.3) from 47 states and Washington, DC, reported on school connectedness, interpersonal relationships, and anger behaviors. FINDINGS: Substantial percentages of violent youth did not perceive themselves to be liked by classmates and reported loneliness. If not liked by classmates, 80% hated school. Likers and haters of school differed on seven variables (all p < or = .01). CONCLUSIONS: Insufficient attention is paid to the alienation experienced by disliked and lonely students. Mental health nurses could play a pivotal role in fostering change in the social climate of schools and helping youth to achieve better anger management and social skills.

Adolescent↗
PubMedDate not supplied

Slow dawning for GPs.

Explore the source record for details and available documents.

Attitude of Health Personnel↗