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Biomedical subjects

Jane Hughes

Publications and source records attributed to Jane Hughes.

At least 19 recordsLinked to original sources
PubMed2007

Old age mental health services in England: implementing the National Service Framework for Older People.

BACKGROUND: There is much variation in the services provided for older people with mental health problems. In England, the National Service Framework for Older People (NSFOP) sought to address these inconsistencies and improve care. This study describes the situation three years after its publication. METHODS: A postal survey of old age psychiatrists collected data on the NSFOP mental health model: the range of specialist mental health provision, the nature of the specialist:generic service interface and the degree of interdisciplinary/interagency working. RESULTS: Three hundred and eighteen (72%) consultants responded. Considerable differences existed in the deployment of key professionals within community teams, with more than a third lacking ring-fenced social work time. Few services had dedicated rehabilitation beds and nearly a third lacked separate facilities for people with organic and functional illnesses. Increasing numbers of consultants had access to a memory clinic and there was some suggestion that liaison services were developing, but little indication of increased support for care homes. Several services had yet to agree protocols with primary care, or to implement measures promoting effective information-sharing and integrated care, and there was little evidence that the introduction of the Single Assessment Process (SAP) had significantly changed practice. Although just over half of consultants reported that mental health services were improving, less than a quarter considered community provision adequate. CONCLUSIONS: Three years after the publication of the NSFOP there remained significant gaps in services for older people with mental health problems and substantial variation in provision between districts.

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PubMed2006

Integrated specialist assessment of older people and predictors of care-home admission.

BACKGROUND: Effective community-based care for older people requires the integration of assessment approaches by old age psychiatry, geriatric medicine and social services care management. This study examines the value of such collaboration in the assessment of older people at risk of entering care homes. METHOD: A randomized controlled trial of integrated assessment (care management with additional clinical assessment by old age psychiatrist or geriatrician) versus care management assessment only, for older people at risk of care-home admission. Older people's characteristics, physical and cognitive functioning, depression, behaviour and quality of care measures were recorded at assessment and 6 months. Differences in clinicians' and care managers' recommendations and placement rates between experimental and control groups were analysed. Logistic regression, examining associations between different needs-related characteristics and the likelihood of care-home admission, was used to characterize placement decisions. RESULTS: Clinicians recommended fewer older people for placement than did care managers in their usual assessments (a reduction of 85%). This did not, however, translate into a reduction in actual numbers of placements, although placements were delayed in those receiving the integrated assessment. Placements of those receiving the integrated assessment were influenced more by clinical factors, most notably cognitive impairment, which clinicians detected more readily than care managers. CONCLUSIONS: In this at-risk group, integrated assessment offers a means of potentially both delaying care-home admissions and taking account of a wider range of factors in placement decisions. Such an approach is viewed as an important policy goal both in the UK and internationally.

Affect↗
PubMed2006

Levels of integration and specialisation within professional community teams for people with dementia.

BACKGROUND: Delivering integrated and specialist mental health services for the growing population of older people with dementia in Britain is a key concern of the present government. AIMS: To consider the nature of current practice among multi-disciplinary and single discipline health and social care teams providing a service to people with dementia and compare the quality of service offered. METHODS: A postal survey of professional community teams in North West England, providing services to people with dementia. Responses were analysed according to a number of standards measuring service quality, developed from research and policy documents. A response rate of 59% yielded a final sample of 52 teams. RESULTS: Multi-disciplinary teams scored more highly than single discipline teams on many of the measures used. Single discipline teams achieved a higher score on just one measure, culturally sensitive services. Generally teams were found to provide a more integrated, targeted and person-centred service, as measured in this study, compared with earlier findings. Teams performed less well on measures of flexibility and culturally sensitive provision. CONCLUSIONS: These findings indicate some potential gains from integration, and highlight the level of work still needed to achieve it. Further research is needed to build on the structural and process measures used in this research in order that the costs and outcomes consequent upon these practices can be measured.

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PubMed2006

Standards of care in day hospitals and day centres: a comparison of services for older people with dementia.

BACKGROUND: Current policy in England emphasises the importance of caring for highly dependent older people for as long as possible at home. It is therefore crucial that day care services are effective and widely available. AIM: To compare the type and standard of care provided for older people with dementia in day centre and day hospital settings. METHODS: A cross-sectional postal survey design was employed. Representatives from three-quarters of identified specialist day care services for older people with dementia in the North West of England provided information on a range of indicators including: basic structural features; delivery of care; service content; and quality measures. RESULTS: Day hospitals tended to have more day care places and a greater number of attendees, but lower occupancy rates than day centres. Day hospitals reported higher standards of care in relation to systematic assessment and care planning, promotion of rehabilitation, carer involvement and individualised provision of care. They were also more likely to employ building design features to encourage independence and choice for people with dementia. A higher proportion of day centres provided services exclusively to older people with dementia and a greater proportion of staff in day centres had undergone specific training in caring for people with dementia. Day centres were also more likely to have effective transport arrangements in place. CONCLUSION: The standards developed for the study were sufficiently reliable to allow for an acceptable estimate of quality. Day centres and day hospitals appeared to perform two distinct, but complementary functions. These results provide key material for shaping the provision of day care for older people with dementia, especially given the absence of national standards in this area.

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PubMed2006

Care management for older people: does integration make a difference?

England and Northern Ireland provide examples of different degrees of integration of health and social care within broadly similar administrative and funding frameworks. This paper examines whether integrated structures appear to impact upon the operation of care management, a key approach to providing coordinated care for vulnerable older people. There appeared to be more evidence of integrated practice between health and social care in Northern Ireland than England, although some key features, such as intensive care management, were no more evident. It is concluded that further investigation is required as to the extent to which integrated structures have impacted upon patterns of professional working and underlying beliefs about roles.

Aged↗
PubMed2006

Molecular bacterial diversity of a forest soil under residue management regimes in subtropical Australia.

A major operational change in exotic pine plantations of subtropical Australia has been the decision to retain postharvest residues on site. A long-term field experiment was established in February 1996 to examine the impacts of residue management regimes [i.e. the postharvest residues removed (G0R), natural amount of residues retained (G1R) and residue quantity doubled and retained (G2R)] on tree growth (F1 hybrid pine) and sustainable soil management. Twelve soil samples, which included the above three residue regimes with four replicates, were collected at plantation age 6.4 years. A 16S rRNA gene clone library was established following soil community DNA extraction, polymerase chain reaction amplification and cloning. A total of 324 clones, including 27 from each sample, were randomly selected and sequenced to represent the bacterial composition and diversity of the clone library and thus the soil bacterial community under the residue management regimes. Phylogenetic analyses indicated that Acidobacteria (37.6%) and Proteobacteria (35.6%) were the dominant components of the soil bacterial community, followed by Actinobacteria (14.7%), Chlamydiae/Verrucomicrobia (7.3%), Unclassified Bacteria (3.8%) and Gemmatimonadetes (1.0%). Analysis of molecular variance revealed that there was no significant difference in bacterial composition and diversity among the residue management regimes or their replicated samples.

Actinobacteria↗
PubMed2006

Care managers' time use: differences between community mental health and older people's services in the United Kingdom.

Since the community care reforms of the early 1990s, care management in the United Kingdom has become the usual means of arranging services for even the most straightforward of social care needs. This paper presents data from a diary study of care managers' time use, from a sample of social services commissioning organizations representing the most common forms of care management practiced in England at the end of the 20th century. It compares the working practices of care managers in community mental health service settings to the practices of those situated in older people's services. Evidence is provided to suggest that while the former follow a more clinical model of care management, those working with older people take an almost exclusively administrative approach to their work. In addition, the multidisciplinary nature of mental health service teams appears to facilitate a more integrated health and social care approach to care management compared to the approach to older people's services. Further enquiry is needed as to the comparative effectiveness of these different modes of working in each service setting.

Adolescent↗
PubMed2005

Analyses of soil fungal communities in adjacent natural forest and hoop pine plantation ecosystems of subtropical Australia using molecular approaches based on 18S rRNA genes.

Soil fungal communities were studied using 18S rDNA-based molecular techniques. Soil DNA was analyzed using temperature gradient gel electrophoresis (TGGE), single-stranded conformational polymorphism (SSCP), cloning and sequencing methods, following community DNA extraction and polymerase chain reaction (PCR). The extracted community DNA was successfully amplified using the primer pair of EF4f-Fung5r which produced ca. 550bp 18S rDNA fragments. TGGE screening of the PCR products showed some differences in band position and intensity between two soil samples in adjacent natural forest (YNF) and hoop pine plantation (YHP) ecosystems at Yarraman in subtropical Australia. TGGE and SSCP could be used for screening PCR products. However, care must be exercised when interpreting the TGGE and SSCP results with respect to microbial diversity, because one band may not necessarily represent one species. It is recommended that the PCR products should be purified before TGGE or SSCP screening. SSCP screening of the clone sequences revealed differences among the clones. Sequence and phylogenetic analyses revealed that all obtained clones were affiliated to the kingdom Fungi, including three phyla, i.e., Zygomycota, Ascomycota and Basidiomycota. Our results suggested that community DNA extraction, PCR, cloning, SSCP screening of clones, sequencing of selected clones and phylogentic analyses could be a good strategy in investigation of soil fungal community and diversity.

Ascomycota↗
PubMed2005

Building postgraduate capacity in medical and public health research in Vietnam: an in-service training model.

In Vietnam, needs to update medical and public health research capacity, but advanced training in research methodology in universities is still very limited. The first university-certified research training course aimed at physicians was conducted in Ho Chi Minh City in 2000. This paper describes the processes, outcomes and lessons learned from the project, to enable the training course to be repeated to increase research capacity among health professionals in Vietnam and other developing countries. Based on needs assessment, the 9-month, part-time course offered advanced training in practical research skills, including epidemiology, biostatistics and qualitative research methods. Thirty-seven trainees (teaching staff, interns and clinicians) completed the course, which included four group research projects. With active support from university management, the course was rigorous and participation was excellent. Trainees's knowledge of research methodologies increased, and their self-evaluation of achievement of the training objectives was high. The total score of the epidemiology and biostatistics test improved from 56% (median) in the pre-course test to 83% in the post-course test. The group research project results were disseminated through a conference and publication in peer-reviewed journals. The course has since been repeated twice as a 1-month intensive course to accommodate trainees from distant regions. This type of rigorous in-service research training at universities and teaching hospitals in developing countries appears to be an effective, sustainable approach. It also holds promise for producing research data that are responsive to a country's own needs and which are likely to be applied in health policy and practice. Further evaluation of the impact and cost of such models is indicated.

Biomedical Research↗
PubMed2005

Variations in care management arrangements for people with mental health problems in England.

Since 1989, government policy in the United Kingdom has advocated that social services providers develop care management systems in order to deliver coordinated and individually tailored packages of care to all user groups. This cross-sectional postal survey describes national variations in care management arrangements for people with mental health problems in England on 14 key indicators developed from previous research. One hundred and one social services providers (response rate: 77%) completed two questionnaires: The first related to care management arrangements for all user groups, and the second related specifically to arrangements for people with mental health problems. Significant national variation was found. Furthermore, there was little evidence of integration between health and social care, of care management being delivered through specialist multidisciplinary mental health teams, and of selective arrangements targeted at those most in need. The results are discussed in the context of apparently widespread disparity between existing care management arrangements and government policy guidance.

Case Management↗
PubMed2004

Novel application of a whole blood intracellular cytokine detection assay to quantitate specific T-cell frequency in field studies.

We optimized a whole blood intracellular cytokine assay to quantitate the frequency of specific CD4+ and CD8+ T cells in small volumes of whole blood from infants from developing countries. The assay is performed in two steps. First, whole blood is stimulated in the presence of specific antigens for 6-18 h, ending with cryopreservation of fixed white cells. These stimulation steps were specifically adapted to be practical and reliable in a rural, developing country field setting. Later, in a more resourceful setting, interferon-gamma producing CD4+ or CD8+ T cells are detected by flow cytometry. The assay proved sensitive and specific for detecting mycobacteria-specific immunity 10 weeks after Bacillus Calmette-Guerin (BCG) vaccination of newborns from a rural field site.

BCG Vaccine↗
PubMed2004

The structure of MSK1 reveals a novel autoinhibitory conformation for a dual kinase protein.

Mitogen and stress-activated kinase-1 (MSK1) is a serine/threonine protein kinase that is activated by either p38 or p42ERK MAPKs in response to stress or mitogenic extracellular stimuli. MSK1 belongs to a family of protein kinases that contain two distinct kinase domains in one polypeptide chain. We report the 1.8 A crystal structure of the N-terminal kinase domain of MSK1. The crystal structure reveals a unique inactive conformation with the ATP binding site blocked by the nucleotide binding loop. This inactive conformation is stabilized by the formation of a new three-stranded beta sheet on the N lobe of the kinase domain. The three beta strands come from residues at the N terminus of the kinase domain, what would be the alphaB helix in the active conformation, and the activation loop. The new three-stranded beta sheet occupies a position equivalent to the N terminus of the alphaC helix in active protein kinases.

Adenosine Triphosphate↗
PubMed2004

The value of specialist clinical assessment of older people prior to entry to care homes.

OBJECTIVE: to ascertain the value of employing a specialist clinician's contribution to the assessment of older people prior to care home entry. DESIGN: randomised controlled trial. METHOD: 256 older people at risk of care home entry were randomly allocated to either a control group, who received the usual care management assessment, or to an experimental group who, in addition, received a clinical assessment by a geriatrician or old age psychiatrist. The value of the additional assessment was evaluated by an analysis of clinical recommendations, questionnaires eliciting the views of stakeholders and research interviews with older people and their carers at initial assessment and 6 months. Data on service use and costs over 6 months and on destination at 6 and 12 months were also collected. RESULTS: the clinical assessment uncovered covert morbidity previously unknown to care managers particularly in respect of cognitive impairment and was adjudged acceptable to the different stakeholders involved. Those receiving the clinical assessment experienced less deterioration in their physical functioning, had less contact with nursing homes and emergency services and their carers experienced reduced levels of distress. Overall, the costs of care for those receiving the assessment were no greater with NHS costs actually lower. CONCLUSIONS: the potential benefits in involving specialist clinicians in the assessment process include identifying previously undiagnosed conditions and enhancing care managers' decision making. Such an assessment could be provided at a modest marginal cost. The approach is fully compatible with proposals for the role of the community geriatrician and commensurate with current good clinical practice in old age psychiatry.

Aged↗
PubMed2004

Past and present patterns of connectivity among populations of four cryptic species of freshwater mussels Velesunio spp. (Hyriidae) in central Australia.

We examined genetic structure and levels of connectivity among subpopulations within each of four cryptic species belonging to the freshwater mussel genus Velesunio. We used allozymes and a fragment of the mitochondrial cytochrome c oxidase I gene to examine genetic variation in populations from isolated waterholes, belonging to four major inland drainages in eastern Australia. Based on evidence from other invertebrates in the region we predicted that, in each species, we would find evidence of historical connectivity among populations from different drainages. This was clearly not the case, as for the two species that occurred in more than one drainage there was evidence of both current and past restriction to gene flow. Moreover, given the potential for extensive dispersal of these mussels through the river systems during flood times via their fish hosts, we predicted low levels of genetic variation among populations from waterholes in the same drainage. Contrary to our expectations, all four species showed some evidence of restricted gene flow among waterholes within drainages. This suggests that either (a) mussel larvae are not produced during flood times, when their fish hosts would be free to move between waterholes, or (b) mussel larvae are attached to their hosts at these times, but the fish movement is limited between waterholes.

Analysis of Variance↗
PubMed2003

X-linked hyper IgM (HIGM1) in an African kindred: the first report from South Africa.

BACKGROUND: The objective of this study was to describe the clinical and molecular features of the first South African family with X-linked hyper-IgM syndrome (HIGM1). METHODS: Diagnoses were based on immunoglobulin results and the absence of CD40 ligand (CD40L) expression on activated T-cells. Complete molecular characterisation involved CD40L cDNA sequencing, and genomic DNA analysis by polymerase chain reaction amplification, restriction enzyme digestion and sequencing. A PCR-based diagnostic assay was established for carrier detection and prenatal diagnosis in this family. RESULTS: There were originally six children, three males and three females. The eldest boy died after being diagnosed with hypogammaglobulinaemia, before HIGM1 was considered. This disorder was diagnosed in the second eldest boy at the age of 5 years, after failing to detect CD40L expression on his activated T-cells. A deficiency of CD40L was also confirmed in the youngest male at the age of 5 years. Both younger brothers have since died of infections relating to HIGM1. Molecular investigation showed that exon 3 was deleted from the CD40L mRNA of the affected males. Genomic DNA analysis identified a 1.5 kilobase deletion, spanning exon 3 and including extended flanking intronic sequence. Carrier status in the mother was confirmed by RT-PCR of her CD40L mRNA. Genetic analysis of the three female children was deferred because they were below the legal consenting age of 18 years. A PCR-based assay for genomic DNA was established for easy identification of female carriers and affected males in the future. CONCLUSIONS: This study confirmed the diagnosis of HIGM1 in the first South African family to be investigated and identified a novel mutation in the CD40L gene.

CD40 Ligand↗
PubMed2003

Public funding for residential and nursing home care: projection of the potential impact of proposals to change the residential allowance in services for older people.

BACKGROUND: This paper investigates the potential effects of a policy change in the funding of UK residential care. The White Paper Modernising Social Services (Cm 4169, 1998) outlined plans to change the distribution of the Residential Allowance (RA), payable in support of residents in independent residential or nursing home care, from a component of income support paid direct to establishments to a grant to local authorities. This change was intended to remove the perverse incentive in accessing independent residential care more favourably than local authority care. A further objective was to encourage local authorities to use the grant to support home-based alternatives to residential care. The policy rests on a model in which price signals dictate the choice of care for an older person. By, in effect, raising the price of independent residential and nursing home care, the policy provides an incentive for authorities to seek alternatives to institutional care. METHODS: Managers from 16 UK social services departments attended a focus group discussion, completed questionnaires and provided information to assist in calculating the potential diversionary effect of the policy. RESULTS: Managerial estimates indicated a small diversionary effect of the policy; A potential effect of 0.26 and 0.19 per 1000 older people diverted from residential and nursing care respectively. CONCLUSIONS: The study indicated that wider organisational factors other than price are likely to play a greater role in deciding whether an older person is admitted to care. Changes in public funding alone do not reflect the complexities involved in decision-making concerning the residential placement of older people.

Aged↗