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PubMed1996

Reconceptualizing the theory-practice gap in mental health nursing.

The purpose of this paper is to identify the key problems in bridging the gap between theory and practice in the education of mental health nurses and to propose a strategy for overcoming these problems. The paper begins by reviewing the existing literature on the subject of the theory-practice gap, and identifying the unique problems which mental health nursing faces in attempting to address them. It then goes on to propose a unified model of clinical nursing practice, nurse education and user involvement, which would place nurse educators at the forefront of radical reform of mental health services.

Clinical Competence↗

PubMed2002

Treatment of methamphetamine use disorders: an update.

Methamphetamine (MA) is a major public health and criminal justice problem in much of the Western and Midwestern US, and its use seems to be increasing east of the Mississippi River. MA use can produce significant psychiatric and medical consequences, including psychosis, dependence, overdose, and death. Cognitive behavioral therapy and contingency management are among the most promising approaches for treatment of MA abuse and dependence. A multisite study evaluating the Matrix Model of outpatient treatment will soon be completed to provide data on this manualized approach. An ambitious program of pharmacotherapy development research is currently being sponsored by the National Institute on Drug Abuse (NIDA) in geographic areas significantly affected by MA use. The development of treatments for MA-related problems is particularly critical for a number of user groups including MA users who experience persistent psychosis, pregnant women and women with children, gay and bisexual men, and MA users involved in the criminal justice system.

Amphetamine-Related Disorders↗

PubMed2000

Hybrid optimization techniques for the workshift and rest assignment of nursing personnel.

In this paper, a detailed model and an efficient solution methodology for the monthly workshift and rest assignment of hospital nursing personnel is presented. A model that satisfies the rules of a typical hospital environment based both on published research data and on local hospital requirements is designed. A hybrid methodology that utilizes the strengths of operations research and artificial intelligence was used for the solution of the problem. In particular, an approximate integer linear programming (ILP) model is firstly solved and its solution is further improved using local search techniques. Finally, a tabu search strategy that uses as its neighborhood the solution space that the local heuristics define is presented. The use of heuristics is required because one of the main user requirements involving the user preference for specific workstretch patterns is not, for efficiency reasons, explicitly modeled in the ILP. In addition, for comparison and evaluation purposes the CLP based ILOG solver is also used to solve the same problem. The inferior computational results obtained with the ILOG solver do verify the speed and efficiency of the hybrid solution approach suggested in this paper. Extensive computational results are presented together with a detailed discussion on the quality, the computational efficiency and the operational acceptability of the solutions.

Artificial Intelligence↗

PubMed2003

Treating dyspepsia with acupuncture and homeopathy: reflections on a pilot study by researchers, practitioners and participants.

OBJECTIVES: For people with dyspepsia who are receiving orthodox general practice care, what is the effect on outcome and on NHS costs of adding treatment by a choice of acupuncture or homeopathy? This paper describes and reflects upon a pilot study with user involvement. DESIGN: A randomised pilot study. Patients chose between acupuncture and homeopathy and were then randomised to this preference or to the control group of normal GP care. SETTING AND PARTICIPANTS: Sixty people with dyspepsia (>/=2 weeks) presenting in one UK general practice were recruited in consultations and by letter to those on repeat prescriptions. There were few exclusion criteria. The homeopath and the acupuncturist treated the patient individually according to their normal practice for up to 6 months. After the trial there was a focus group for participants. OUTCOME MEASURES: SF-36 health survey, Measure Yourself Medical Outcome Profile (MYMOP), and General Well-being Index (GWBI). Counts of prescriptions, consultations and referrals from practice computer records. RESULTS: No trend or significant difference between the groups for clinical outcome or NHS costs. Major costs for the 6 months, mean (S.D.) cost per patient, were general practitioner consultations pound 8 (18), prescriptions pound 64 (73), acupuncture pound 175 (52), homeopathy pound 105 (33). Participants gave insights and suggestions which will inform the full trial design. CONCLUSIONS: Reflection on the pilot study data and experience by participants, treating practitioners and researchers led to modifications in the design and a sample size calculation. How to demonstrate individual responses to treatment remains a problem.

Acupuncture Therapy↗

PubMedDate not supplied

The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study.

Three issues characterise the background to the MECCA study: A) Throughout Europe, most patients with severe forms of psychotic disorders are cared for in the community. The challenge now is to make processes in community mental health care more effective. B) There are widespread calls to implement regular outcome measurement in routine settings. This, however, is more likely to happen, if it provides a direct benefit to clinicians and patients. C) Whilst user involvement is relatively easy to achieve on a political level, new mechanisms may have to be established to make the views of patients feed into individual treatment decisions. The MECCA study is a cluster randomised controlled trial following the same protocol in community mental health teams in six European countries. In the experimental group, patients' subjective quality of life, treatment satisfaction and wishes for different or additional help are assessed in key worker-patient meetings every two months and intended to inform the therapeutic dialogue and treatment decisions. The trial tests the hypothesis that the intervention--as compared to current best standard practice--will lead to a better outcome in terms of quality of life and other criteria in patients with psychotic disorders over a one year period. This more favourable outcome is assumed to be mediated through different treatment input based on more appropriate joint decisions or a more positive therapeutic relationship in line with a partnership model of care or both. Moreover, the study will hopefully reveal new insights into how therapeutic processes in community mental health care work and how they can be optimised.

Community Mental Health Services↗

PubMed2001

Farm and personal characteristics of the clientele of a community-based animal-health service programme in northern Malawi.

The social background, farm characteristics, indicators of income and self-evaluation returns of 96 randomly selected users of a Basic Animal Health Service (BAHS) programme in northern Malawi were compared with those of 96 matched past-users and 96 non-users, respectively. All 288 farms were visited between July and October 1997. Data analysis was performed using univariate and multivariate techniques. The results showed that, on average, BAHS users had larger cattle herds (16.3) than part-users (14.7) or non-users (12.4). Similarly, the annual yields of crops were higher for users compared to either of the other groups. Users occupied better houses and owned a larger number of farm and household items than did part-users or non-users. A third of all farmers were engaged in additional income generation to lessen the risk of poverty. However, analysis of the livestock management and the educational background of the farmers suggested that usage of the BAHS programme was not only determined by already existing 'wealth'. Improved livestock husbandry and management measures, which do not require capital investment, were more frequently applied by users compared to either of the other groups. Non-users and part-users had attained a lower level of education, were less open towards improved farming methods and felt less knowledgeable than BAHS users. The average straight-line distances from farms using BAHS to their respective village animal health worker (2.2 km) or veterinary assistant (2.9 km) were similar but varied according to ecological zone. Intensified extension and awareness meetings in villages will be required to get more non-users involved in BAHS.

Adult↗

PubMed2001

Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States.

This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

Attitude of Health Personnel↗

PubMed2001

Internet and technology transfer in acute care hospitals in the United States: survey-2000.

This paper provides the results of the survey-2000 measuring technology transfer and, specifically, Internet usage. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business-to-business and customers. These results are compared with responses to the same questions in survey-1997. Changes in response are noted and discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the third of three articles based upon the results of the survey-2000. Readers are referred to prior articles by the author, which discuss the survey design and provide a tutorial on technology transfer in acute care hospitals. (1) Thefirst article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes. (2)

Health Care Sector↗

PubMed2001

Intranet usage and potential in acute care hospitals in the United States: survey-2000.

This paper provides the results of the Survey-2000 measuring Intranet and its potential in health care. The survey measured the levels of Internet and Intranet existence and usage in acute care hospitals. Business-to-business electronic commerce and electronic commerce for customers were measured. Since the Intranet was not studied in survey-1997, no comparisons could be made. Therefore the results were presented and discussed. The Intranet data were compared with the Internet data and statistically significant differences were presented and analyzed. This information will assist hospitals to plan Internet and Intranet technology. This is the third of three articles based upon the results of the Survey-2000. Readers are referred to prior articles by the author, which discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.(1) The first article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes. (2) The second article based upon the survey results discusses distribution of Internet usage and rating of Internet usage applied to specific applications. Homepages, advertising, and electronic commerce are discussed from an Internet perspective.

Computer Communication Networks↗

PubMed1999

Total purchasing, community and continuing care: lessons for future policy developments in the NHS.

The introduction of total purchasing pilots (TPPs) into the National Health Service (NHS) gave general practitioners (GPs) significant new opportunities to take responsibility for the development of community and continuing care (CCC) services. Based on five case studies of TPPs involved in developing CCC this paper asks three questions: (1) to what extent were the TPP's involvement in CCC informed by an awareness of CCC policy?; (2) were TPPs involved in joint commissioning to develop integrated purchasing or provision which was informed by population based needs assessment?; (3) were TPPs seeking to involve users, carers and voluntary agencies in their plans? The findings indicate that TPPs showed little awareness of national or local policy for CCC, although their project initiatives did address some of the policy issues (in particular a recognition of the need for joint working at the practice level). At the time of fieldwork, four of the case study TPPs had begun to investigate the potential for integrated purchasing, and three of them had relatively sophisticated models of both horizontally and vertically integrated provision of care. However, the TPPs developments were not based on systematic population based needs assessment. The paper concludes that there is potential for the primary care led groups proposed in the recent white papers in England, Scotland and Wales to improve integration of care both horizontally and vertically. However, they may need policy guidance and push to: encourage them to put CCC high on their agenda for action; to work with people with expertise in population based, prevention focused, needs assessment; and to find innovative ways to include users, carers and voluntary agencies. Incentives or levers (such as control over budgets) may be needed to promote joint working between staff in different agencies.

Journal Article↗

PubMed1999

Older people's health information needs.

This paper, originally given at the Health Libraries Group conference 'First aid for the front line' in September 1998, argues that older people's health information needs are in many respects little different to anyone else's. It looks at different formats of information that may be helpful for older people, and at the needs of two specific groups, carers and elders from ethnic groups. Direct user involvement in the development of information is seen as important. It is emphasized that there is a particular need for primary care workers to know how other services, such as those within social care and the voluntary sector, operate. The paper ends by looking at the information professional's role in providing resources and training to such workers, and suggests a broader remit for the profession as a whole, to help to ensure social inclusion for older people.

Aged↗

PubMed1997

Studying the future: a Delphi survey of how multi-disciplinary clinical staff view the likely development of two community mental health centres over the course of the next two years.

Two community mental health centres (CMHCs) in North Staffordshire, England were the sites for a recent Delphi survey of multi-disciplinary clinical staff. The views of staff were sought on the likely developments over the next 2 years, at the CMHC where they worked. Each group of staff independently produced healthy numbers of suggestions, with few contradictions; and displayed predominantly positive attitudes, both towards particular suggestions and the future in general. Summarized results were classified within seven themes, producing similar distribution patterns for both CMHCs. The most frequently occurring themes were changing staff roles and CMHC functions and developments in therapies and skills. Mid-placed themes concerned community development and communication/continuity. The least frequently reported themes covered general management, user involvement and quality assurance. Issues raised by the study are discussed and related to other published works, followed by consideration of how the findings might be utilized. Clinical staff have generated a large number of suggestions and, importantly, via rounds of confidential voting, indicated the group consensus on each item. Consequently, management of change should stand a high chance of success. Finally, one means of taking the findings forward is described.

Attitude of Health Personnel↗

PubMed1999

Progress's Pilgrim: a critical narrative of research in progress.

There is increasing interest in the use of stories to develop nursing and health care practice. This paper reports on how we used story to understand and develop research on nursing practice. Story (or narrative) and science can be seen as distinct but complementary paradigms. We have found that a story framework can help researchers to reflect on a process of social scientific investigation, and to consider how to 'go on' in that process. In a study on 'Community psychiatric nurses' empowerment of people with enduring mental disorders in the community: involving users to develop services' we have encountered a number of interesting and challenging issues related to design and use of methods. We present these issues within a framework of story analysis, focusing on issues related to empowerment. This analysis draws on Burke's 'pentad' of story elements as a framework for narrative analysis. We present the elements of the 'story of the study-as-funded' and as it was carried out through the pilot stage, and outline the story of developments in the main study. 'Trouble' in a story centres on a problematic 'ratio' of story elements. The 'trouble' at this stage in the progress of our study relates to lack of fit between some parts of the instruments (the methods) and the goal (empowerment), and to the status of the CPNs as actors or agents. Narrative analysis sensitizes us to these issues of 'trouble' and provides a means of addressing them. Like John Bunyan's Pilgrim, we have learned through our progress; unlike Pilgrim, we know not our end.

Community Mental Health Services↗

PubMed2002

Need for appropriate written information for patients, with particular reference to head and neck cancer.

Patients need and want written information. There is evidence that giving comprehensible information increases overall satisfaction with the care given by healthcare professionals. This paper provides a review of the literature on patients' need for appropriate information, with particular reference to head and neck cancer, based on searches of electronic databases. Head and neck cancers are among the least common cancers in the UK but these patients have very specific and great needs. Written information is a cost-effective intervention that complements verbal advice given by healthcare professionals. Evidence suggests that patient information leaflets are poor and are in language that is difficult for the public to understand. Considerable time, effort and user involvement are required to produce acceptable and appropriate information leaflets for patients.

Communication↗

PubMed2002

Comparing the campaigning profile of maternity user groups in Europe--can we learn anything useful?

OBJECTIVE: To compare the extent to which women in three European countries were able to exert influence over the organization and delivery of maternity policy and the factors likely to determine their success. DESIGN: Semi-structured interviews used to collect data, which was analysed in a framework that emphasized the importance of contextual environment. SETTING AND PARTICIPANTS: Representatives of 19 lay maternity user organizations in England, the Netherlands and Germany interviewed during 1996 and 1997. VARIABLES STUDIED: Each interviewee was asked to provide details of their aims and objectives, activities and networks and perception of success. Four areas of contextual environment were used to account for variations. MAIN OUTCOME MEASURE: Self-reported accounts of success in influencing policy agenda, credibility with opinion formers, campaigning activities and political networking were compared between and across countries. RESULTS: Marked differences between both the aspirations and the achievements of groups in the three countries. CONCLUSIONS: Understanding the differences between countries in relation to user involvement entails locating research within the social, political and cultural context of health-care, consumerism and citizen participation.

Consumer Organizations↗

PubMed1998

Mental health services in Asia: international perspective and challenge for the coming years.

In contrast to European countries and the United States of America, there has been a steady increase in the psychiatric inpatient population in Japan between 1960 and 1993. Japan has the biggest number of psychiatric beds in the world, both in absolute and relative numbers per population. However, Japan now focuses on community based services and the human rights of patients. In other Asian countries, the number of psychiatric beds is relatively small; however, the numbers are increasing each year in China, the Republic of Korea, Philippines, Indonesia and in many other countries in Asia. These countries are still facing the challenge of increasing psychiatric services and to improve the quality of care with scarce mental health resources. Should Asian countries take the similar path to European countries and develop mental health services? This review provides an overview of Asian mental health services and discussing the following issues: how many psychiatric beds do we need in Asia?; public vs private psychiatric services?; financing scheme to promote community based care in Asia; mental health services in primary health care; family education and user involvement in Asia; and the challenge for psychiatrists in Asia.

Asia↗

PubMedDate not supplied

Illegal drug use, alcohol and aggressive crime among Mexican-American and white male arrestees in San Antonio.

This research explores the relationship between use of certain drugs and aggressive crimes among Mexican-American and White male arrestees in San Antonio, Texas, for 1992. This is based on a Drug Use Forecasting (DUF) sample of 534 male arrestees administered a drug urine analysis test and questionnaire by the Department of Justice and the city of San Antonio. Using a four-way asymmetrical analysis, logit-models were tested to examine the relationships between the response variable, the types of crimes charged (nonaggressive versus aggressive) and a set of exploratory variables, ethnicity (White versus Hispanic), drug test results (positive versus negative), and alcohol use (infrequent versus frequent). The logit-analysis allows the specification of a subset of relevant models to be tested for their adequacy of fit. Findings indicate a complex but interpretable pattern between drug use, alcohol use patterns, and aggressive crimes. A surprising finding was that more aggressive crimes were committed by all men testing negative for drugs. Mexican-Americans with frequent alcohol use and testing positive for drugs were twice as likely to commit an aggressive crime (a crime associated with violence) than Whites in the same subgroup. The implication of these findings for prevention strategies aimed at alcohol and other drug users involved in violent behavior is discussed.

Adult↗

PubMed1996

Community service needs of people with HIV infection in London.

The objectives of this study were to describe the expressed needs for community services of HIV-infected individuals by disease stage, gender and transmission category and the barriers which prevent the receipt of such services. Structured interviewer-administered questionnaires concerning a 6-month retrospective period were used to obtain information on need for community services and problems which prevented the receipt of services. The study sample included 70 homosexual men with asymptomatic HIV disease, 42 homosexual men with symptomatic non-AIDS, 53 homosexual men with AIDS, 23 heterosexual men, 29 heterosexual women, 9 male and 9 female injecting drug users. The main outcome measures were the extent to which needs for community services were met and person/service combinations for which problems or barriers prevented the receipt of community services. On average, subjects expressed a need for 10 categories of community services over the 6-month period: homosexuals expressed a mean of 10, heterosexuals 10, injecting drug users 11, subjects with asymptomatic HIV infection 9, subjects with symptomatic non-AIDS 11, subjects with AIDS 13, men 9 and women 14. A total of 58% of community service needs were always met, 6% were rarely not met, 16% were sometimes not met, 6% were often not met and 14% were not met at all. The extent to which subjects felt that their needs were met was similar for the different study groups, but the needs of women were met somewhat less frequently than those of men. Similarly, people with AIDS felt that their needs were met slightly less often. Reported levels of unmet need were high for a wide range of services. The most common reason subjects gave for not having received a community service for which they expressed a need was ignorance of where or how to obtain the service. This was mentioned in one-third of all such cases. Anxieties over the competence with which a service would be rendered was mentioned in 13% of cases and long waiting times in 11%. The frequencies of unmet need for many community services were high and often seemed to arise either from a lack of awareness on the part of subjects on how and where services could be obtained or from doubts about the relevance of services offered. Both of these barriers should be surmountable through the provision of better information to patients, extending user involvement in service development and the better co-ordination of service delivery through care management approaches.

Adult↗