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PubMed1997

Sequence of drug use among serious drug users: typical vs atypical progression.

Sequence of drug use was examined in a secondary analysis of two samples of serious drug users: one of 152 men and one of 133 women. The proportions of drug users following specified patterns of drug use onset were compared to proportions obtained in previous research in samples of high school youth, and serious drug users. The serious drug users were substantially different from high school samples in their progression of drug use. The serious drug users were less likely to follow the typical sequence identified in previous studies (alcohol, then marijuana, followed by other illicit drugs). They were more likely to have used marijuana before using alcohol, and more likely to have used other illicit drugs before using marijuana. We also found that atypical sequencing was associated with earlier initiation of the use of illicit drugs other than marijuana and greater lifetime drug involvement. These findings suggest that for a large number of serious drug users, marijuana does not play the role of a 'gateway drug'. We conclude that prevention efforts which focus on alcohol and marijuana may be of limited effectiveness for youth who are at risk for serious drug abuse.

Adult↗

PubMed2000

Relevance of mandates, notifications and threads in the management of continuity of care.

Availability of electronic healthcare records (EHCR) and geographical networks allows nowadays to realise a set of functionalities to support continuity of care. Actual exchange of complete clinical information, common centralised records, common decisions within an agreed protocols are not mandatory. Sub-optimal alternatives, involving easier management, are possible. In fact, the crucial challenge for continuity of care is the mutual awareness of the multiple perspectives by the actors contributing to patient's care. The various actors should timely know changes in the status of: mandates, i.e. who is involved in the care provision and thus is responsible for a "local" record. knowledge about the patient, i.e. active and inactive problems, impressions, relevant findings. provision of healthcare activities, i.e. plans, orders and performed activities. The decisions on the actual implementation depend on the healthcare context, as implemented within the information system. For example, the mechanism for notifications involves decisions on the quality and quantity of information that must be exchanged, as well as on the modalities for the exchange, regulated by individual user's profiles. Each notification could be sent as a message to a central repository, and then each authorized user could select within the repository the pertaining messages. Or a notification could be sent directly to the list of professionals involved in the care of a patient, that asked for it in their profile. Mandates may be used to regulate the access of the users to the patient's information. This approach was embedded in a European standard under development in CEN/TC251 (CONTSYS--"System of concepts to support continuity of care").

Computer Communication Networks↗

PubMed1975

Serratia arthritis in heroin users.

Septic arthritis due to Serratia species was seen in four users of intravenous heroin. In all cases, the organism was cultured from joint aspirates. Both the clinical presentation and the involvement of the sacro-iliac and knee joints were notably similar to the Pseudomonas septic arthritis encountered in other heroin users. All four patients responded satisfactorily to therapy although one had a residual flexion contracture of the knee. Twelve previously reported cases of Serratia arthritis are reviewed.

Adult↗

PubMed1999

The distribution of 3,4-methylenedioxymethamphetamine "Ecstasy"-induced c-fos expression in rat brain.

Rats were injected with 3,4-methylenedioxymethamphetamine ("Ecstasy") and assessed for changes in locomotor activity and for the expression of the immediate early gene c-fos throughout the brain. A dose-dependent increase in locomotor activity was seen with 3,4-methylenedioxymethamphetamine (0, 5 and 20 mg/kg) that continued for at least 2 h following administration. Dose-dependent increases in c-fos expression were seen in much of the cortex, forebrain, brainstem and cerebellum in rats given 3,4-methylenedioxymethamphetamine. Expression was pronounced in 5-hydroxytryptamine terminal regions including the medial prefrontal cortex, caudate-putamen, nucleus accumbens, olfactory tubercle, islands of Calleja, lateral septum, paraventricular hypothalamus and paraventricular thalamus. High levels of c-fos expression were also seen in the supraoptic and median preoptic nuclei, regions involved in the control of fluid balance and body temperature, respectively. This is potentially important since deaths in 3,4-methylenedioxymethamphetamine users have been linked to hyperthermia and hyponatremia. In the brainstem, two regions of high c-fos expression were Barrington's nucleus, which is involved in micturition, and the pontine reticular nucleus oralis, a region involved in motor control of mastication. Activation of this latter structure may partly explain the bruxism (grinding of the jaw) reported by human 3,4-methylenedioxymethamphetamine users. Robust c-fos expression was seen in the cerebellum, particularly in the flocculus, and this may explain the reported deleterious effects of 3,4-methylenedioxymethamphetamine on balance and co-ordination. Significant c-fos expression was also seen in the ventral tegmental area, amidst the cell bodies of mesolimbic and mesocortical dopamine neurons, and in the median and dorsal raphe, where the serotonergic innervation of the forebrain originates. Double-labelling of fos-positive neurons with 5-hydroxytryptamine showed that only a small number of serotonergic neurons in the raphe expressed c-fos following 3,4-methylenedioxymethamphetamine. The widespread distribution of 3,4-methylenedioxymethamphetamine-induced c-fos expression seen in this study can be linked to the profound alterations in physiological function, mood and behaviour produced by this drug.

Animals↗

PubMed1998

Low biologic aggressiveness in breast cancer in women using hormone replacement therapy.

PURPOSE: Hormone replacement therapy (HRT) has been associated with an increased risk for breast cancer. Cancers in women who use HRT are often less advanced, and lower mortality has been reported in those who use HRT than in nonusers. We sought to explain this by a comparison of indicators of tumor aggressiveness in patients who received HRT with those in patients who did not. PATIENTS AND METHODS: A population-based cohort of 477 postmenopausal women with breast cancer were interviewed for the use, type, and duration of HRT. Clinical variables and indicators of tumor aggressiveness (histologic grade, hormone receptors, DNA ploidy, S-phase fraction, and c-erbB-2 oncoprotein overexpression) were analyzed. RESULTS: Breast tumors from HRT users were smaller (odds ratio, 0.47; P=.005), had better histologic differentiation (P=.04), and had a lower proliferation rate (S-phase fraction, P=.009) than tumors from nonusers. These differences persisted after adjustments for age and method of diagnosis (mammography screening v self-referral) by multiple logistic regression. No significant differences were observed in the estrogen (ER) or progesterone receptor content, c-erbB-2 oncogene overexpression, or axillary node involvement. A subgroup analysis showed that the tumor proliferation rates among HRT users were significantly lower only if HRT had been used at the time of diagnosis (P=.001). The type of HRT (estrogen v combination of estrogen and progesterone) was not associated with any clinical parameter or tumor phenotype. The association of HRT with lower proliferation rate and smaller tumor size was exclusively caused by ER-positive tumors (P=.0001 and P=.0035 v P > .1, respectively). CONCLUSION: The results indicate that breast cancer in women who receive HRT is biologically less aggressive than those without previous HRT. The lower cell-proliferation rate and smaller tumor size found in ER-positive tumors from current HRT users suggest a direct ER-mediated growth inhibitory effect of HRT on established breast tumors. This may at least partly explain why breast cancer in HRT users has a more favorable clinical course.

Aged↗

PubMed2002

Artificial neural network assessment of substitutive pharmacological treatments in hospitalised intravenous drug users.

Artificial neural networks (ANNs) provide better solutions than linear discriminant analysis (LDA) to problems of classification and estimation involving a large number of non-homogeneous (categorical and metric) variables. In this study, we compared the ability of traditional LDA and a feed-forward back-propagation (FF-BP) ANN with self-momentum to predict pharmacological treatments received by intravenous drug users (IDUs) hospitalised for coexisting medical illness. When medical staff considered detoxification appropriate they usually suggested methadone (MET) and (or) benzodiazepines (BDZ). Given four different treatment options (MET, BDZ, MET+BDZ, no treatment) as dependent variables and 38 independent variables, the FF-BP ANN provided the best prediction of the consultant's decision (overall accuracy: 62.7%). It achieved the highest level of predictive accuracy for the BDZ option (90.5%), the lowest for no treatment (29.6), often misclassifying no treatment as BDZ. The LDA yielded a lower mean accuracy (50.3%). When the untreated group was excluded, ANN improved its absolute recognition rate by only 1.2% and the BDZ group remained the best predicted. In contrast, LDA improved its absolute recognition rate from 50.3 to 58.9%, maximum 65.7% for the BDZ group. In conclusion, the FF-BP ANN was more accurate than the statistical model (discriminant analysis) in predicting the pharmacological treatment of IDUs.

Adult↗

PubMed2004

Increased serum levels of nitric oxide metabolites among users of levonorgestrel-releasing implants [corrected] a possible role in progestin-induced bleeding.

BACKGROUND: Nitric oxide (NO) is a potent angiogenic and vasodilator factor that could be involved in progestin-induced bleeding. This study aimed to assess possible changes in the serum levels of NO metabolites in users of levonorgestrel-releasing implants (LNG-implants) [corrected] and to identify any correlation between some of their clinical characteristics and NO metabolite levels. METHODS: This cross-sectional study included 37 LNG-implants [corrected] users; a single 5 ml venous blood was collected at different periods of [corrected] use. Women were divided into users with acceptable menstrual bleeding (n 5 13) [corrected] and those having abnormal bleeding patterns (n 5 24) [corrected] The controls are 13 age-matched healthy women; they were fertile, had regular menstruation and did not use any contraceptive method in the previous 3 months. NO was determined by the evaluation of its oxidation products (nitrites and nitrates) where the nitrates were reduced to nitrites with cadmium filings; total serum concentrations of nitrites were measured by using the Griess reaction. RESULTS: The mean serum levels of NO metabolites were significantly higher in the LNG-implants [corrected] users than in the controls (mean+/-SE) 34.9+/-11.3 versus 6.1+/-1.5 mumol/l (P<0.001) [corrected] The mean serum levels of NO metabolites were significantly higher in the LNG-implants [corrected] users with abnormal bleeding patterns than in those with normal bleeding patterns (mean+/-SE) 41.3+/-7.4 versus 23.2+/-5.8 mumol/l (P<0.001) [corrected] There was a positive correlation between NO levels and both prolonged spotting and heavy/prolonged bleeding days (P<0.001 and P<0.01, respectively) and negative correlation between NO levels with the duration of use and length of the menstrual cycle (P<0.05). CONCLUSION: The significantly increased serum levels of NO metabolites among LNG-implants [corrected] users may primarily reflect an increase in its endometrial production, possibly secondary to its increased liberation by systemic vascular endothelium. This may result in enhanced endometrial angiogenesis and vascular dilatation which can induce and perpetuate abnormal excessive/prolonged uterine bleeding.

Adult↗

PubMed2002

[Safety in radiotherapy: Control of software and informatics systems].

The development of computerized systems in radiotherapy opens new challenging possibilities. There is however a major risk of specific errors if the use of such systems is not properly controlled. On the other hand, the software sophistication, such as encountered in modern treatment planning systems (TPS), makes it very difficult to set up efficient quality assurance programs compatible with the workload of users in charge of daily routine. From the analysis of previous accidents involving TPS, we can conclude that the major risks are erroneous calculations of monitor units resulting from a poor understanding of the software capabilities combined to a lack of vigilance with respect to the data obtained from a computer. To reduce the risks, it is necessary to setup a comprehensive quality assurance program covering all steps of the process, including commissioning of a new system and systematic checks of individual treatment plans. Such a program offers the users the opportunity to acquire a deeper understanding of the system and avoid potential pitfalls. There is presently a lack of consensus for an international protocol related to quality assurance of computerized systems in radiotherapy. It is therefore important to define protocols at the national level, with special consideration of the aspects which are more likely to generate significant errors.

Computer Simulation↗

PubMed2004

Learning to DISCERN online: applying an appraisal tool to health websites in a workshop setting.

This study examined the application of DISCERN-validated criteria for judging the quality of printed information on treatment-to online health information in a workshop setting. A survey was conducted amongst 57 participants attending DISCERN Online workshops. Participants were health information users-health care and information providers, consumers (patients/carers), and consumer representatives. Workshops involved using DISCERN to appraise a health website. Participants completed questionnaires before and after the workshop, and at 2 months follow-up. Responses revealed that participants accessed online health information for professional (85.7%) and personal (75%) reasons. Less than half (41%) had applied some form of quality criteria to online information prior to attending the workshop. Despite varying levels of expertise, participants found DISCERN and the supporting materials accessible. The majority (96.2%) agreed DISCERN would help users discriminate between high- and low-quality online treatment information, and would be applicable to a wide variety of such information. At follow-up, most (89.6%) reported that their attitude to consumer health information of all types had changed-mostly becoming more critical or systematic. It is possible that general schemes such as DISCERN will provide users with simple and flexible skills for dealing with the wide range of treatment information available.

Adult↗

PubMed1996

Tobacco promotion and susceptibility to tobacco use among adolescents aged 12 through 17 years in a nationally representative sample.

OBJECTIVES: The purpose of this study was to examine whether youth participation in tobacco promotion campaigns is associated with susceptibility to tobacco use. METHODS: Data were collected from telephone interviews of a national random sample of 1047 adolescents 12 to 17 years of age. RESULTS: A proportional odds model was used to estimate the effects of age, gender, presence of a tobacco user in the household, awareness of tobacco promotions, knowledge of a young adult or adolescent friend owning a promotional item, participation in tobacco promotions, and receipt of free tobacco samples or direct mail from tobacco companies on susceptibility to tobacco use. All of the covariates, except for receiving direct mailings and knowing a young adult friend who owned a promotional item, were significantly associated with susceptibility. CONCLUSIONS: There is a strong association between an awareness of and involvement with tobacco promotions and being susceptible to tobacco use or a user of tobacco products.

Adolescent↗

PubMed2002

C-quence: a tool for analyzing qualitative sequential data.

C-quence is a software application that matches sequential patterns of qualitative data specified by the user and calculates the rate of occurrence of these patterns in a data set. Although it was designed to facilitate analyses of face-to-face interaction, it is applicable to any data set involving categorical data and sequential information. C-quence queries are constructed using a graphical user interface. The program does not limit the complexity of the sequential patterns specified by the user.

Algorithms↗

PubMed1997

Australia's public health response to HIV and HCV: a role for 'affected' communities.

This paper identifies a number of the key elements that underpinned the success of Australia's public health response to minimizing the spread of HIV. It is argued that one major factor was the high level of collaboration between health care professionals and "affected" communities, such as injecting drug users, sex industry workers and gay men. This collaboration allowed for the negotiation, development and implementation of the range of innovative HIV initiatives that were ultimately responsible for keeping HIV in the injecting drug use and sex industry to low levels. Despite the central role played by injecting drug users and their peer based organizations, the significance of their activities has gone largely unacknowledged by senior health bureaucrats and politicians. As a consequence, advice from injecting drug users and their peer-based organizations on the current hepatitis C epidemic has been largely ignored. Instead of learning from Australia's HIV experience and involving these groups in consultation and advisory roles, the Federal Government has reverted to accepting advice from only established mainstream organizations. It is argued that the success of infection control outside mainstream communities, such as among injecting drug users, can most effectively be achieved through the involvement of these "affected" communities. There is a need at the local, national and international levels to ensure both the involvement of "affected" communities and that recognition is given to them for the significant and essential role they play in infection control.

Journal Article↗

PubMed2004

Visuospatial memory impairments in users of MDMA ('ecstasy').

RATIONALE: Previous studies have presented conflicting findings regarding visuospatial span deficits in MDMA ('ecstasy') users, possibly attributable to a lack of distinction between simple visuospatial span and visuospatial working memory span. Both draw upon central executive processing, while the latter also involves concurrent goal-orientated visuospatial processing. OBJECTIVES: This study compared visuospatial working memory span for MDMA users and controls. An additional concurrent task also loading on the central executive tested for inter-group differences related to central executive workload. METHOD: MDMA user group (25 current users, 10 previous users and 18 non-users) was between-participants, and dual task condition (concurrent alphabetic generation, random letter generation, and no dual task) was within-participants. The visuospatial working memory task required participants to serially recall a spatial sequence while simultaneously completing a visual judgement task, and was completed on its own and under dual task conditions. RESULTS: Overall, non-users performed significantly better than both MDMA user groups. However, contrary to expectation, the performance decrement among users was no worse with concurrent random generation than under control conditions. Analyses controlling for background variables and the use of other drugs in the previous 3 months showed that the main effect of MDMA remained significant following control for intelligence, alcohol, amphetamines and cocaine, among other potential confounds. Unclear results were found following control for cannabis use. CONCLUSIONS: The MDMA users experienced deficits in visuospatial working memory span. The lack of interaction between dual task condition and user group may be due to inter-group differences in central executive utilisation under different task conditions.

Adult↗

PubMed1995

Integrated clinical information system.

SIDOCI (Système Informatisé de DOnnées Cliniques Intégrées) is a Canadian joint venture introducing newly-operating paradigms into hospitals. The main goal of SIDOCI is to maintain the quality of care in todayUs tightening economy. SIDOCI is a fully integrated paperless patient-care system which automates and links all information about a patient. Data is available on-line and instantaneously to doctors, nurses, and support staff in the format that best suits their specific requirements. SIDOCI provides a factual and chronological summary of the patient's progress by drawing together clinical information provided by all professionals working with the patient, regardless of their discipline, level of experience, or physical location. It also allows for direct entry of the patient's information at the bedside. Laboratory results, progress notes, patient history and graphs are available instantaneously on screen, eliminating the need for physical file transfers. The system, incorporating a sophisticated clinical information database, an intuitive graphical user interface, and customized screens for each medical discipline, guides the user through standard procedures. Unlike most information systems created for the health care industry, SIDOCI is longitudinal, covering all aspects of the health care process through its link to various vertical systems already in place. A multidisciplinary team has created a clinical dictionary that provides the user with most of the information she would normally use: symptoms, signs, diagnoses, allergies, medications, interventions, etc. This information is structured and displayed in such a manner that health care professionals can document the clinical situation at the touch of a finger. The data is then encoded into the patient's file. Once encoded, the structured data is accessible for research, statistics, education, and quality assurance. This dictionary complies with national and international nomenclatures. It also contains personalized profiles: questionnaires based on the predetermined choices of the information most relevant to the specific user. The SIDOCI clinical dictionary also includes the hospital's suggested or mandatory interventions, clinical guidelines, and protocols. These clinical guidelines are customized at the hospital, service, and professional levels. Common interventions have been regrouped so that health professionals may apply the appropriate diagnostic, therapeutic, educational, or other intervention plans. The clinical dictionary also serves as a teaching and continuing education tool. The patient profile is a permanent record containing information on allergies, blood type, primary and secondary diagnoses, ongoing treatments, and prior hospitalizations. The problem list dealing with the current hospitalization includes symptoms, signs, and diagnoses. This standard clinical record facilitates communication between the services and provides a quick overview of the patient's history should emergency treatment be required. This health information system integrates Requests and Results, Progress Notes, and Analysis of the results. In addition, functions inherent to a patient's clinical cycle such as Administrative Management of episodes, Adaptation to physical and professional structures of the hospital, Messages between health professionals, and Electronic signature constitute the basis of SIDOCI. The most exciting aspect of this research project is its social impact: a more efficient health care system will improve the lives of all citizens. Moreover this applied research project involves the information industry and directly calls for the input of users such as doctors, nurses and hospital support staff.

Hospital Information Systems↗

PubMed2002

Examination of new environmental control applications.

The aim of this study was to examine the application of new Environmental Control Systems (ECSs) in the homes of users and caregivers. The research questions were: (1) Can new ECS applications improve the activities of daily living (ADL) of people with significant functional limitations who require personal assistance? (2) Can new ECS applications replace home services and lessen caregiver burden? To answer these questions, user satisfaction regarding ECS applications, impact on ADL, technical performance, and caregiver burden were examined. This collaborative investigation involving a local community health care center, a telephone monitoring service, an industrial partner, and a university research team used a case study approach. Five users with moderate cognitive problems or significant functional limitations who required personal assistance were chosen, along with their caregivers, for a 3-month in-home trial to test new ECS alternatives. The ECS in the study featured remote control functions (e.g., door lock release, outside intercom), specific verbal reminders (e.g., reminders to turn off stove elements), and automatic functions (e.g., night-lights in the bathroom and hallway). Information was collected in the users' homes with three standardized questionnaires and a company-designed questionnaire. The overall technical performance of the ECS was found to be in most cases moderately efficient. Participant satisfaction revealed that ECS alternatives needed improvement with respect to the service aspects such as follow-up services and repair/servicing. Caregiver burden was lessened for psychological aspects but not for physical tasks. Users seemed to have a positive perception of the impact of the ECS on many of their ADL. We learned six lessons from this 15-month case study, namely: (1) the use of remote control by people with moderate cognitive impairments was difficult; (2) verbal reminders were greatly appreciated; (3) the automatic ECS applications needed more adjustment; (4) reactions varied depending on the participant's perspective; (5) other assessment tools might have been better suited to mild cognitive problems; and (6) removal of a beneficial product at the conclusion of the evaluation phase raised ethical considerations.

Activities of Daily Living↗

PubMed2005

MicroGen: a MIAME compliant web system for microarray experiment information and workflow management.

BACKGROUND: Improvements of bio-nano-technologies and biomolecular techniques have led to increasing production of high-throughput experimental data. Spotted cDNA microarray is one of the most diffuse technologies, used in single research laboratories and in biotechnology service facilities. Although they are routinely performed, spotted microarray experiments are complex procedures entailing several experimental steps and actors with different technical skills and roles. During an experiment, involved actors, who can also be located in a distance, need to access and share specific experiment information according to their roles. Furthermore, complete information describing all experimental steps must be orderly collected to allow subsequent correct interpretation of experimental results. RESULTS: We developed MicroGen, a web system for managing information and workflow in the production pipeline of spotted microarray experiments. It is constituted of a core multi-database system able to store all data completely characterizing different spotted microarray experiments according to the Minimum Information About Microarray Experiments (MIAME) standard, and of an intuitive and user-friendly web interface able to support the collaborative work required among multidisciplinary actors and roles involved in spotted microarray experiment production. MicroGen supports six types of user roles: the researcher who designs and requests the experiment, the spotting operator, the hybridisation operator, the image processing operator, the system administrator, and the generic public user who can access the unrestricted part of the system to get information about MicroGen services. CONCLUSION: MicroGen represents a MIAME compliant information system that enables managing workflow and supporting collaborative work in spotted microarray experiment production.

Computational Biology↗

PubMed2005

Scapular kinematics during transfers in manual wheelchair users with and without shoulder impingement.

BACKGROUND: Scapular function during humeral elevation has been reported in groups with and without shoulder impingement pathology. To date, no one has assessed scapular kinematics during upper extremity loaded tasks that manual wheelchair users must perform on a daily basis. Therefore, the objective of this study was to compare scapular kinematics and muscle activation patterns during two different wheelchair transfers in groups of manual wheelchair users with and without shoulder impingement. METHODS: A case controlled study of manual wheelchair users, with and without shoulder impingement was performed. Twenty-three male manual wheelchair users (13 without shoulder impingement, 10 with shoulder impingement) performed transfers toward the involved or dominant limb (lead limb transfer) and away from the instrumented limb (trail limb transfer). Position and orientation measures of the thorax, scapula and humerus were obtained using an electromagnetic tracking system. Muscle activity data were collected using telemetered electromyography. Each subject performed three trials of wheelchair transfers to each side. FINDINGS: Manual wheelchair users with impingement performed transfers with reduced thoracic flexion, increased scapular internal rotation, and increased humeral internal rotation as compared to those without impingement. Differences were found between the tasks in the scapular motions and EMG amplitude. Trail limb transfer presented with reduced scapular upward rotation and posterior tip as compared to the lead limb transfer task. Increased muscle activity for the lower trapezius and serratus anterior muscles was demonstrated in the trail limb transfer. INTERPRETATION: This study provides the first kinematic description of scapular kinematics during transfer tasks. Shoulder impingement and direction of transfer does affect transfer task performance in manual wheelchair users. Scapular kinematics and muscle patterns during transfers may predispose manual wheelchair users to the development of shoulder pathology.

Adult↗

PubMed2006

Professionalizing action research--a meaningful strategy for modernizing services?

BACKGROUND: This paper outlines how a specific action research approach can be used to secure practice development in services which have found sustained change difficult. For the purpose of this paper discussion focuses upon using professionalizing action research (a form of action research) to secure transformation in acute inpatient mental health services. This speciality has experienced long-term difficultly in meaningful practice change. Not limited to this context parallels can be made with other health and social care services requiring significant modernization. AIM: The aim is to critically discuss the use of professionalizing action research as an approach to sustainable change. DISCUSSION: clarifies whether this method is a suitable vehicle for change, which is ideally suited to services which have a poor record of practice development. METHOD: A review of action research and practice development literature forms the basis of this paper. The literature is sourced through bulletin boards, electronic databases and the British Library Classification Scheme. Keywords searched are action research, team learning, managing change and practice development. Following definition; the components of professionalizing action research are analysed using the themes of educative base, problem focus, improvement and involvement. FINDINGS: The educative base of professionalizing action research is collaborative reflective practice which is used to initiate meaningful change, rooted in everyday practice. The benefit of this is that change actions are based in real-time situations. The problem focus component of professionalizing action research is used to emphasize the views of service users and carers. This is positive in terms of the patient and public involvement agenda although this theme does emphasize limitations of the approach. The final components are involvement and improvement, these are debated as pluralistic notions and the implications of this are acknowledged. CONCLUSION: Reviewing the literature and theoretical application indicates the value of professionalizing action research as a process for modernization. The strength of the approach lies in the opportunity for team learning and change which is grounded in the context of services and pursued through collaboration.

Acute Disease↗