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PubMed1984

Carcinogenic agents in cigarette smoke and the influence of nitrate on their formation.

The nitrate level of a nonfilter reference cigarette was elevated from 0.52% to 1.2, 1.8, 2.4 and 3.05%, respectively, by addition of sodium nitrate. Data from the mainstream smoke analyses of these cigarettes were compared. Yields of carbon monoxide and carbon dioxide were not significantly altered as a result of nitrate elevation. Tar, nicotine, benzo[a]pyrene (BaP) and catechol in mainstream smoke were reduced while yields of nitrogen oxides (NOx), volatile N-nitrosamines (VNA) and tobacco-specific N-nitrosamines (TSNA) were significantly increased. On the basis of previous bioassays with smoke condensates from high-nitrate cigarettes, it was expected that the cutaneous tumorigenicity of these tars would be reduced due to lower levels of BaP (and other carcinogenic PAH) and catechol. However, the total carcinogenic potential of whole smoke from high nitrate cigarettes is considered by us to be significantly increased due to the elevated yields of Nox, VNA and TSNA. The nitrosamines are regarded as a major group of carcinogens in tobacco smoke; the nitrogen oxides are the most important precursors for the endogenous formation of N-nitrosamines upon smoke inhalation. The findings of this model study support the recommendation that the nitrate content of tobacco products should be reduced.

Carcinogens↗

PubMed1985

On the analysis of 1-nitronaphthalene, 1-nitropyrene and 6-nitrochrysene in cigarette smoke.

A method was developed for the analysis of 1-nitronaphthalene, 1-nitropyrene, and 6-nitrochrysene in mainstream cigarette smoke, using [14C]1-nitronaphthalene, [14C]1-nitropyrene, and [14C]6-nitrochrysene as tracers and internal standards. Cigarette smoke condensate was collected and the appropriate fractions containing the labelled standards were obtained by a series of solvent partitions and column chromatography. Recovery of internal standards ranged from 60 to 70%. The fractions were analyzed by capillary gas chromatography with electron capture detection and by combined capillary gas chromatography-mass spectrometry. 1-Nitronaphthalene (less than 10 ng/cigarette), 1-nitropyrene (less than 10 ng/cigarette), and 6-nitrochrysene (less than 1 ng/cigarette) were not detected in the mainstream smoke of the University of Kentucky 1R1 cigarette, a US commercial 85 mm non-filter cigarette, or a French commercial 70 mm non-filter cigarette.

Chromatography, Gas↗

PubMed2006

Improved real-time puff-by-puff GC-MS system for whole smoke analysis.

An automated puff-by-puff mainstream smoke (MSS) system is developed to monitor real-time whole smoke in mainstream cigarette smoke using gas chromatography (GC)-mass spectrometry (MS). The whole-smoke analysis is based on automated sample collection and injection into the GC-MS system. The important feature of this system is the real-time rapid analysis that is simple, sensitive, precise, flexible, and exhibits low carryover of volatile and semivolatile smoke constituents. The system is equipped with an automated sampling and switching valve and a smoking machine. The key improvements of the system, as compared with current and alternative methodologies, include minimizing variations caused by operator sampling techniques, the real-time analysis of MSS, the detection of flavorants in MSS from a single puff of cigarette smoke, the ability to analyze numerous smoke constituents from either whole smoke or the gas phase of a single puff, the ability to monitor a few selected smoke constituents in whole smoke using multiple puffs, and its good feasibility compared with solvent extraction and impinger trapping procedures for volatile organic compounds in MSS. System configuration and sampling methodologies are described. Sensitivity, flexibility, precision, feasibility, carryover, and applications of the system are discussed.

Journal Article↗

PubMed2002

Social processes and outcomes of in-school contact between deaf and hearing peers.

Studies of social processes and outcomes of the placement of deaf students with hearing peers cannot be easily summarized, but can be grouped into a least four major categories of focus: social skills, interaction and participation, sociometric status and acceptance, and affective functioning. We review 33 studies available since 1980 in which a mainstreamed or included deaf sample was compared to another group. Studies indicated (1) that hearing students were more socially mature than deaf students in public schools, (2) that deaf students interacted with deaf classmates more than hearing ones, (3) that deaf students were somewhat accepted by their hearing classmates, and (4) that self-esteem was not related to extent of mainstreaming. There was a tendency for studies to use observational methods with very young children, teacher evaluations with middle school children, and questionnaires with older children. Three major areas of methodology limit general conclusions: samples, measurements of variables, and experimental manipulations. The reviewed studies provide a basis for understanding the social processes and outcomes in these placement situations; however, it is not possible to make broad generalizations about effects of placement.

Journal Article↗

PubMed2006

National survey of accommodations and alternate assessments for students who are deaf or hard of hearing in the United States.

This paper reports the results of the National Survey of Accommodations and Alternate Assessments for Students who are Deaf or Hard of Hearing in the United States (National Survey). This study focused on the use of accommodations and alternate assessments in statewide assessments used with students who are deaf or hard of hearing. A total of 258 participants responded to the survey, including 32 representing schools for the deaf, 168 from districtwide/school programs, and 58 from mainstreamed settings. These schools and programs served a total of nearly 12,000 students who are deaf or hard of hearing nationwide. The most prevalent accommodations used in 2003-2004 statewide standardized assessments in mathematics and reading were extended time, an interpreter for directions, and a separate room for test administration. Read aloud and signed question-response accommodations were often prevalent, used more often for mathematics than in reading assessments. Participants from mainstreamed settings reported a more frequent use of accommodations than those in schools for the deaf or districtwide/school programs. In contrast, schools for the deaf were most likely to have students participate in alternate assessments. The top three alternate assessment formats used across all settings were out-of-level testing, work samples, and portfolios. Using the National Survey results as a starting point, future research will need to investigate the validity of accommodations used with students who are deaf or hard of hearing. In the context of the No Child Left Behind Act of 2001 accountability policies, the accommodations and alternate assessment formats used with students who are deaf or hard of hearing may result in restrictions in how scores are integrated into state accountability frameworks.

Chi-Square Distribution↗

PubMed2004

New Zealand Māori quality improvement in health care: lessons from an ideal type.

There is no single best approach to quality improvement. Quality improvement has been adapted from its predominantly Japanese origins to form distinct, hybrid systems embedded in national cultures. These systems have seldom been studied despite their potential internationally to inform the local management of health care organizations. This article suggests six lessons from an 'ideal type' of one such system, New Zealand Māori quality improvement in health care. Mapped against 'mainstream' concepts of quality improvement, the lessons are to: emulate the character of leaders in health care; encourage 'cultural governance'; operate the health care organization as a 'family'; move forward with eyes on the past; foster spiritual health; and respect everything for itself. These lessons support a global struggle by indigenous peoples to have their national cultures reflected in programmes to improve their health care, and have potential relevance to mainstream services. By increasing cultural competence, responsiveness to indigenous health needs, and awareness of insights from another culture, the lessons reveal opportunities to improve quality by incorporating aspects of a Māori ideal type.

Culture↗

PubMedDate not supplied

Chemical studies on tobacco-specific N-nitrosamines in the smoke of selected cigarettes from the U.S.A., West Germany, and France.

Studies on the variations of biologically important smoke constituents of popular cigarettes in several European countries and in the United States include investigations on the types and levels of volatile (VNA) and tobacco-specific nitrosamines (TSNA). GLC-TEA and HPLC-TEA methods are used to determine the VNA and TSNA in mainstream and sidestream smoke of cigarettes. This report presents data on the smoke of some West German cigarettes which demonstrate that the VNA levels are about the same as those in the smoke of U.S. cigarettes; but that they are lower than those in the smoke of French cigarettes, made of dark tobacco types. The tobacco-specific nonvolatile N-nitrosamines determined in the mainstream smoke of commercial U.S. blended cigarettes (N-nitrosoanatabine, N-nitrosonornicotine and 4-(N-methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone together) ranged from 680 to 830 ng per cigarette, while those for commercial West German products ranged from 340 to 780 ng per cigarette in nonfilter brands and from 180 to 450 ng in filter-tipped cigarettes. The analyzed French products contained 1010 to 1380 ng of these compounds in the smoke of each cigarette.

Chromatography, Gas↗

PubMed1993

Homeopathy.

Homeopathy is a form of complementary medicine which relies heavily on observation and experience. The three distinguishing characteristics of homeopathy are that remedies are prescribed on the totality of a person's symptoms, that the remedy likely to cure a person is a dilution of that substance which would cause the same symptoms in a healthy person, and that remedies are prepared using microdoses of substances which are diluted and then vigorously shaken. Mainstream medicine criticizes homeopathy by saying that its gentleness has outlived its usefulness and treatment successes are probably no more than placebo action. In addition, its critics charge that homeopathy is unscientific, runs counter to the "laws of nature" and will not stand up to scientific scrutiny. Homeopaths reply that mainstream medicine is dangerous, that homeopathy works in children and animals (usually thought resistant to placebo), and that several good controlled clinical trials have shown positive results. There is a difference between showing that homeopathy works and adequately accounting for its mechanism of action. Clinical trials have concentrated on the former and remain unexplained in the latter.

Complementary Therapies↗

PubMed1995

Bacterial mutagenicity of cigarette smoke and its interaction with ethanol.

The mutagenicities of mainstream cigarette smoke (CS), a cigarette smoke condensate (CSC) and smokers' urines were investigated by using batteries of Salmonella typhimurium and Escherichia coli strains. The S9-mediated mutagenicity of CSC was remarkably enhanced when using nitroreductase- and especially O-acetyltransferase-overproducing derivatives of the classical strains TA98 and TA100, with the following rank of sensitivity: YG1024 > YG1029 > YG1021 > TA98NR > YG1026 > TA98 > TA100 > TA100-DNP6 > TA100NR > TA98-1,8-DNP6. With YG1024, a doubling of spontaneous revertants was observed with as little as 1/110 of the smoke condensate recovered from one cigarette under our experimental conditions. Similarly, the S9-mediated mutagenicity of mainstream CS was considerably increased in YG1024 and YG1029, the O-acetyltransferase-overproducing derivatives of TA98 and TA100, respectively. In the absence of S9 mix, the concentrates of 23 urine specimens from five smokers failed to revert S. typhimurium TA98 and YG1024, and were equitoxic in E. coli WP2 and its repair-deficient counterpart CM871 (uvrA-, recA-, lexA-). In the presence of S9 mix, all specimens were mutagenic, with an average YG1024:TA98 ratio of 6.6:1. These patterns suggest that the bacterial mutagenicity of smoke-associated complex mixtures is mainly due to aromatic amines. The mutagenicities of other typical constituents of CS, i.e. the polycyclic aromatic hydrocarbon benzo[a]pyrene (BP) and the tobacco specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), were not appreciably enhanced in the O-acetyltransferase-overproducing strain YG1029, compared to its parental strain TA100. Moreover, BP and NNK induced less than additive mutagenic responses when combined at high doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetyltransferases↗

PubMed1988

Effects of acculturation and socioeconomic status on obesity and diabetes in Mexican Americans. The San Antonio Heart Study.

The authors hypothesized that increased socioeconomic status and acculturation of Mexican Americans to mainstream US society would be accompanied by a progressive lessening of obesity and non-insulin-dependent diabetes mellitus. This hypothesis was tested in 1979-1982 in the San Antonio Heart Study, a population-based study of 1,288 Mexican Americans and 929 non-Hispanic whites, aged 25-64 years, randomly selected from three San Antonio neighborhoods: a low-income barrio, a middle-income transitional neighborhood, and a high-income suburb. Socioeconomic status was assessed by the Duncan Socioeconomic Index, a global measure of socioeconomic status based on occupational prestige. Acculturation was assessed by three scales which measure functional integration with mainstream society, value placed on preserving Mexican cultural origin, and attitude toward traditional family structure and sex-role organization. In Mexican-American men, increased acculturation was accompanied by a statistically significant, linear decline in both obesity and diabetes, while socioeconomic status had no significant effect on either outcome. In Mexican-American women, on the other hand, increased acculturation and increased socioeconomic status were accompanied by statistically significant, linear declines in both outcomes. However, the effects of acculturation on obesity and diabetes prevalence in women were stronger than the effects of socioeconomic status. In women, obesity also appeared to be a more important mediator of the relation between socioeconomic status and diabetes than of the relation between acculturation and diabetes. The results of this study suggest that culturally mediated factors exert a more pervasive influence on obesity and diabetes in Mexican Americans than do socioeconomically mediated factors. The influence of socioeconomic status in women, however, cannot be ignored, particularly with regard to obesity.

Acculturation↗

PubMed2005

Phenols, quinolines, indoles, benzene, and 2-cyclopenten-1-ones are oviductal toxicants in cigarette smoke.

Previously, we showed that pyridines and pyrazines in cigarette smoke inhibit oviductal functioning in vitro in nanomolar and picomolar doses. The purpose of this study was to determine the lowest observable adverse effect levels (LOAELs) of phenols, quinolines, indoles, benzene, and 2-cyclopenten-1-ones found in mainstream smoke solutions on ciliary beat frequency, oocyte pickup rate, and infundibular smooth muscle contraction using the hamster oviduct. After solid phase extraction, mainstream smoke solution fractions were tested in the oviductal assays. The active fractions were analyzed using gas chromatography-mass spectrometry to identify individual chemicals. Using this approach, benzene, eleven phenolic, two indole, two quinoline, and two 2-cyclopenten-1-one derivatives were identified in the active fractions. Commercially available authentic standards of the identified compounds were tested in dose-response studies on hamster oviducts. The LOAELs were determined for each compound using the ciliary beat frequency, oocyte pickup rate, and infundibular smooth muscle contraction rate assays. Indole, the compound with the highest potency, showed inhibition of ciliary beat frequency (10(-13) M), oocyte pickup rate (10(-14) M), and infundibular smooth muscle contraction rate (10(-15) M) in femtomolar doses. All of the other compounds tested, except phenol, which only showed inhibition at millimolar concentrations, were inhibitory in picomolar, nanomolar, or micromolar concentrations. Derivitization of phenol increased its toxicity in the oviductal assays, especially when a methyl or ethyl group was substituted on the fourth position. The indoles, quinolines, and four phenolic compounds had both high potencies and efficacies in the oviductal assays.

Animals↗

PubMed1998

Identification of cigarette smoke components that alter functioning of hamster (Mesocricetus auratus) oviducts in vitro.

Previous studies have shown that solutions of mainstream and sidestream cigarette smoke decrease both ciliary beat frequency and oocyte cumulus complex pick-up rate of hamster oviducts in vitro. The purpose of this study was to identify the component(s) in smoke that produces these effects. Chemicals reported to be ciliotoxic in other systems were tested on hamster infundibula at various concentrations to determine whether a dose-response inhibition of ciliary beat frequency occurred. In addition, the concentration of each test component was measured in mainstream and sidestream smoke solutions (whole, particulate, and gas phase). All test components (acrolein, formaldehyde, phenol, acetaldehyde, and potassium cyanide [KCN]) inhibited ciliary beat frequency in a dose-dependent manner. Inhibition of ciliary beat frequency was at least partially reversible for all test compounds except acrolein. The concentrations of acrolein, formaldehyde, and phenol that were required to inhibit beat frequency were at least 3-50 times higher than their corresponding concentrations in smoke solutions. In contrast, cyanide was present in all smoke solutions at concentrations sufficient to inhibit ciliary beat frequency. Cilia on the outer surface of the infundibulum function in picking up the oocyte cumulus complex. Oocyte cumulus complex pick-up rate was measured in vitro at KCN concentrations shown to inhibit ciliary beat frequency. Pick-up rate was likewise inhibited by KCN and remained significantly depressed after washout of KCN. These data show that cyanide is a potent inhibitor of both ciliary beat frequency and oocyte cumulus complex pick-up rate and that its concentration in smoke solutions is sufficiently high to explain the previously reported inhibition of these oviductal processes.

Acetaldehyde↗

PubMed1975

Perceived sources of stress among first-year medical students.

A survey of first-year medical students at the University of Toronto shows that academic factors are viewed as the most stressful and social factors as the least stressful. Among anticipated sources of stress those dealing with perceived failure are highly stressful, and those dealing with sexual aspects of the doctor-patient relationship are much less so. Factor analysis reveals that sources of stress are multidimensional rather than unidimensional. Particular socio-demographic antecedent variables are much more highly correlated with stress than are others. In particular, it is found that students in subgroups differing from "mainstream" students feel more stress than their mainstream counterparts. Feelings of stress are also found to be positively related to possible consequences of stress, such as frequency of thinking about dropping out and to number of days off school because of illness.

Achievement↗

PubMed2003

Development of an undergraduate medical curriculum: the McGill experience.

In 1997 the Faculty of Medicine at McGill University received a grant from the Molson Foundation. The primary project deliverable, which the authors describe, was an online, multimedia-enhanced, undergraduate medical curriculum. The decision to develop an electronic curriculum was predicated on the belief that the integration of educational technology within mainstream material delivered a "value added" component to both students and faculty, which would, in turn, facilitate teaching and learning. Pedagogical values were deemed to include: (1) the ability to use the media to implement adult learning principles such as learner-centered, self-directed and guided learning, (2) the inherent interactivity of the technology, (3) the potential of the technology to provide a powerful means for fostering forms of "termless" learning that students will need to practice medicine, (4) recognition that use of multimedia can address, in part, the variety of learning styles evidenced by students in the lecture hall and classroom, and (5) the provision of opportunities for horizontal and vertical curricular integration. In addition, it was anticipated that an electronic curriculum would permit: (1) easy incorporation of informatics within mainstream curricula, (2) centralization and standardization of curricular material, (3) editorial functionality for revisions and updates, (4) wide accessibility of material irrespective of venue, (5) search functionality for faculty and students, (6) the ability to perform curriculum inventory, and (7) the potential for use to compensate for decreased faculty time. The ongoing experience at McGill has shown that the merging of technology and pedagogy requires a substantial commitment of resources and recognition of faculty time and change-management issues.

Academic Medical Centers↗

PubMed1999

Complementary therapies: overview and state of the art.

Studies to determine the prevalence of complementary and alternative medicine (CAM) use among cancer patients show international interest in a wide collection of therapies and a broad span of use, ranging from 7% to 64% of patients sampled. The absence of consistent results across studies is due primarily to differing definitions of unconventional cancer therapies from study to study. Treatments promoted as alternatives to mainstream cancer cures (e.g., the recently disproved "cancer cure" of Italy's Dr. Di Bella) should be distinguished from complementary therapies, which are applied as adjuncts to mainstream care in an integrated fashion. The latter include mind-body techniques and herbal remedies, among many other remedies, all aimed at symptom control and enhanced quality of life. This differentiation provides a clearer understanding of CAM activity and enables selective evaluation of CAM's clinical effects. It permits us to avoid accepting or rejecting all of CAM out of hand. Health care professionals as well as patients and their families have become increasingly knowledgeable about complementary therapies that can be helpful to patients with cancer. Many such therapies have been well studied (meditation, tai chi), and others remain highly questionable (homeopathy, electromagnetics). Their benefits and potential problems are reviewed.

Complementary Therapies↗

PubMed1996

Sepsis/septic shock: participation of the microcirculation: an abbreviated review.

OBJECTIVE: An overview of the importance of understanding mechanisms occurring in the microcirculation during septic and endotoxic shock. The thesis of the paper is to place emphasis on this important vascular network to ultimately benefit the patient. DATA SOURCES: Early descriptions of vascular reactions to endotoxin which suggest that the microcirculation is a major site of attack during shock. More recent studies were sought out and examined as to their possible impacts on the microcirculation. STUDY SELECTION: Early comprehensive studies concerning vascular reactions in the microcirculation during shock were selected. Subsequent studies identified from the mainstream scientific medical literature describe the actions of blood, cells, and the emerging significant role of the vascular endothelium among other factors. A consensus view is identified, pointing to the causes of a malfunctioning microcirculation during shock. DATA EXTRACTION: Data gathered from reports in the mainstream, well-established basic and clinical literature, from reviews and forum reports, from studies by well-established investigators, and from more recent reports of excellent quality. DATA SYNTHESIS: The microcirculation undergoes massive alterations during sepsis/septic shock. There are numerous changes, including slowing of capillary blood flow due to depressed perfusion pressure as a result of systemic pressure reduction and local arteriolar constriction. Observations suggest that the microcirculation is shut off early in severe sepsis, allowing the effects of hypoperfusion and attacks by microorganisms to prevail in their destructive capabilities. Widespread capillary dilation may ultimately occur. However, with blood flow diverted through some arteriovenous channels, important areas of capillary exchange are bypassed. Decreased capillary blood flow during shock results from failure to allow normal passage of cellular elements, including erythrocytes and neutrophils. This defect occurs, in part, because of decreased perfusion pressure, decreased deformability of red and white cells, constricted arterioles, circulating obstructive fragments (including hemoglobin), and plugging of microvessels with "sludge." Other factors are adherence of cells to capillary and venular epithelial membranes creating increased resistance to flow, loss of fluid through abnormal transcapillary exchange, differential vascular resistance changes between various beds (e.g., intestinal vs. muscle), and the relative absence of regulatory neurohumoral control of small vessel segments of the circulation. During sepsis/septic shock, endothelial cells are reported to modulate vascular tone, control local blood flow, influence the rate of leakage of fluids and plasma proteins into tissues, modulate the accumulation and extravasation of white cells into tissues, and influence white cell activation. As a result of the predominance of many destructive factors, a subsequent round of tissue damage may occur. Because of prolonged capillary vascular stasis, deficient flow, and factors released from injured cells, the microcirculation becomes a trap for uncontrolled bacterial growth enhanced by sustained hypoxemia, acidosis and toxemia. These events may combine to contribute to the loss of normal cell integrity and death of the host. CONCLUSIONS: The purpose of this review is to draw the readers' attention to the growing list of adverse factors occurring in the microcirculation during sepsis/septic shock. A further aim is to point to the realization of the complexity of factors which may contribute to the importance of a well-functioning microcirculation.

Animals↗

PubMed2000

Evaluation of an ambu-bag valve with a self-contained, colorimetric end-tidal CO2 system in the detection of airway mishaps: an animal trial.

OBJECTIVE: Capno-Flo (Kirk Specialty Systems, Carrouton, TX) is a portable pulmonary resuscitator (self inflating ambu-bag--valve system) with a self-contained, colorimetric end-tidal CO2 detector that has the ability to provide continuous CO2 monitoring for up to 2 hours. The purpose of this study is to determine the accuracy and time interval for the Capno-Flo monitor to detect acute airway obstructions and hypopharyngeal extubations in an intubated animal model. SUBJECTS: Five anesthetized, non-paralyzed, mechanically ventilated Yorkshire minipigs. METHODS: Complete and partial airway obstruction was simulated with complete and partial cross-clamping of the endotracheal (ET) tube. Placement of the ET tube into the hypopharynx was performed to simulate accidental extubation. In addition to the Capno-Flo colorimetric indicator, both sidestream (SS) and mainstream (MS) capnography were used to monitor end-tidal CO2 and comparison. The time intervals for the capnograph wave to flatten and for the monitor to display "zero" were recorded after each airway alteration. Each experiment was carried out for 180 seconds, and a total of 25 trials was performed. RESULTS: Complete obstruction produced a color change in the Capno-Flo monitor in 9+/-2 seconds and flattening of the SS and MS waveform in 8+/-2 seconds and 6+/-2 seconds, respectively. The SS and MS monitors displayed zero in 49+/-7 seconds and 19+/-1 seconds, respectively. Partial obstruction did not produce color change, a flattening of the wave, or a monitor display of zero. Hypopharyngeal extubation produced a color change in 10+/-2 seconds, flattening of the SS and MS waveform in 7+/-2 seconds and 7+/-1 seconds, respectively. The SS and MS monitors displayed "zero" in 76+/-16 seconds and 18+/-3 seconds, respectively. CONCLUSION: The Capno-Flo identified all complete airway obstructions and hypopharyngeal extubations rapidly. The CF monitor performed comparable to the SS and MS capnographs. Neither the Capno-Flo, nor the sidestream, nor the mainstream capnographs detected partial airway obstruction. The clinical application of this portable inexpensive capnometer in the continuous monitoring of the intubated patient, especially the transport patient, should be investigated further.

Airway Obstruction↗

PubMed2006

Standards and quality measures for services for people with intellectual disabilities.

PURPOSE OF REVIEW: In our modern, performance managed National Health Service, quality has become a key target. Quality assurance has become a statutory duty and the National Health Service is inundated with policy documents and performance measures in most areas of mainstream healthcare. Performance against such measures will be monitored by powerful independent regulatory bodies. It is therefore timely to look at what specific quality measures there are for services for people with intellectual disability. RECENT FINDINGS: Tension exists as to the need for developing specific targets for the population with intellectual disabilities when the philosophy of care is for real social inclusion where 'all means all'. To what extent will existing quality standards for mental health services suffice when we know that often people with intellectual disabilities have real issues accessing these services? This paper highlights published quality measures and standards from primary care through mainstream secondary care and specialist mental health services. It also discusses the policy context and current development of regulatory standards as these continue to evolve. SUMMARY: Evidence for meeting quality standards will increasingly dominate the delivery and funding of healthcare in the National Health Service.

Continuity of Patient Care↗