Ongoing Need (ongoing + need)

Distribution by Scientific Domains

Selected Abstracts

Theory of mind functioning in mentally disordered offenders detained in high security psychiatric care: its relationship to clinical outcome, need and risk

David Murphy
Background,Theory of mind (ToM) refers to the cognitive mechanisms that allow us to infer our own mental states and those of others. Whilst ToM deficits are frequently observed among individuals with schizophrenia, little is known about their relationship to functional outcome. Aims,Among patients with schizophrenia in a high security hospital, to test whether ToM performance, in relation to other cognitive and clinical variables, is related to measures of subsequent clinical outcome. Methods,ToM was assessed using the modified advanced test (MAT) and the revised eyes task (RET). Outcome, including ongoing need and risk, was assessed using the HoNOS secure, CANFOR and HCR-20 respectively three years post ToM assessment. Results,Performance on the RET was the only variable to be significantly correlated with the symptom ratings of the HoNOS secure and the HCR-20 total scores. Performance on the RET also accounted for approximately half of the variance in the CANFOR ratings and a third in the risk management item ratings of the HCR-20. Age, number of years diagnosed with schizophrenia and other aspects of cognition were also significantly correlated with the HoNOS security scale. Conclusions,The results suggest that social perceptual ToM may be a useful prognostic indicator, but also that ToM impairments may represent an unmet need. Replication of the work with larger and more diverse samples of people with schizophrenia is necessary, as well as trials of therapeutic effort directed at improvement of ToM impairments. Copyright 2007 John Wiley & Sons, Ltd. [source]


I. Penman
There is increased recognition of the importance of accurate staging of malignancies of the GI tract and lung, greater use of neoadjuvant therapies and more protocol-driven management. This is particularly important where regional lymph node involvement significantly impacts on curability. Multidetector CT and PET scanning have resulted in greater detection of potential abnormalities which, if positive for malignancy, would change management. There is also a greater recognition that many enlarged nodes may be inflammatory and that size criteria alone are unreliable in determining involvement. In other situations, especially pancreatic masses, not all represent carcinoma as focal chronic pancreatitis, autoimmune pancreatitis etc can catch out the unwary. A preoperative tissue diagnosis is essential and even if unresectable, oncologists are increasingly reluctant to initiate chemotherapy or enroll patients into trials without this. The approach to obtaining tissue is often hampered by the small size or relative inaccessibility of lesions by percutaneous approaches. As such novel techniques such as endoscopic ultrasound (EUS) guided FNA have been developed. A 120cm needle is passed through the instrument and, under real-time visualisation, through the gastrointestinal wall to sample adjacent lymph nodes or masses. Multiple studies have demonstrated the safety and performance of this technique. In oesophageal cancer, confirmation of node positivity by has a major negative influence on curative resection rates and will often lead to a decision to use neoadjuvant chemotherapy or a non-operative approach. Sampling of lymph nodes at the true coeliac axis upstages the patient to M1a status (stage IV) disease and makes the patient incurable. In NSCLC, subcarinal lymph nodes are frequently present but may be inflammatory. If positive these represent N2 (stage IIIA) disease and in most centres again makes the patient inoperable. Access to these lymph nodes would otherwise require mediastinosocopy whereas this can be done simply, safely and quickly by EUS. Overall the sensitivity for EUS , FNA of mediastinal or upper abdominal lymph nodes is 83,90% with an accuracy of 80,90%. In pancreatic cancer performance is less good but pooled analysis of published studies indicates a sensitivity of 85% and accuracy of 88%. In a recent spin-off from EUS, endobronchial ultrasound (EBUS) instruments have been developed and the ability to sample anterior mediastinal nodes has been demonstrated. It is likely that this EBUS , FNA technique will become increasingly utilised and may replace mediastinoscopy. The development of techniques such as EUS and EBUS to allow FNA sampling of lesions has increased the role of non-gynaecological cytology significantly in recent years. Cytology therefore remains important for a broad range of specialties and there is ongoing need for careful and close co-operation between cytologists and clinicians in these specialties. References:, 1. Williams DB, Sahai AV, Aabakken L, Penman ID, van Velse A, Webb J et al. Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut. 1999; 44: 720,6. 2. Silvestri GA, Hoffman BJ, Bhutani MS et al. Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer. Ann Thorac Surg 1996; 61: 1441,6. 3. Rintoul RC, Skwarski KM, Murchison JT, Wallace WA, Walker WS, Penman ID. Endobronchial and endoscopic ultrasound real-time fine-needle aspiration staging of the mediastinum ). Eur Resp J 2005; 25: 1,6. [source]

Movement and change: independent sector domiciliary care providers between 1995 and 1999

Patricia Ware
Abstract Promoting the development of a flourishing independent sector alongside good quality public services was a key objective of the community care reforms of the last decade. This paper charts some of the ways the independent domiciliary care sector is changing, as local authorities shift the balance of their provision toward independent sector providers and away from a reliance on in-house services. Two surveys of independent domiciliary care providers were carried out in 1995 and 1999. The aims of the studies were to describe the main features of provider organisations, such as size of business, client group and funding sources; to examine the nature of provider motivations and their past and future plans; to consider how local authorities manage the supply side of social care markets; and to examine the effects on providers of the development of the mixed economy. The first survey in 1995 was conducted in eight local authority areas, which by 1999 had increased to 11 because of the creation of three new unitary authorities. The findings are based on 261 postal surveys together with 111 interviews between the two studies. The research illustrates a domiciliary care market that is still relatively young with many small but growing businesses. There are considerable differences in the split between in-house and independent sector services in individual authorities and a common perception among independent providers that in-house services receive favourable treatment and conditions. Spot or call-off contracts continue to be the most common form of contract although there are moves toward greater levels of guaranteed service and more sophisticated patterns of contracting arrangements. There remains an ongoing need to share information between local authorities and independent providers so that good working relationships can develop with proven and competent providers. [source]

Survival to discharge among patients treated with CRRT

R. Wald
Continuous renal replacement therapy (CRRT) is widely used in critically ill patients with acute renal failure (ARF). The survival of patients who require CRRT and the factors predicting their outcomes are not well defined. We sought to identify clinical features to predict survival in patients treated with CRRT. We reviewed the charts of all patients who received CRRT at the Toronto General Hospital during the year 2002. Our cohort (n = 85) represented 97% of patients treated with this modality in 3 critical care units. We identified demographic variables, underlying diagnoses, transplantation status, location (medical-surgical, coronary or cardiovascular surgery intensive care units), CRRT duration, baseline creatinine clearance (CrCl), and presence of oliguria (<400 ml/d) on the day of CRRT initiation. The principal outcome was survival to hospital discharge. Among those alive at discharge, we assessed whether there was an ongoing need for renal replacement therapy. Greater than one-third (38%, 32/85) of patients survived to hospital discharge. Three (9%) of the survivors remained dialysis-dependent at the time of discharge. Survivors were younger than non-survivors (mean age 56 vs 60 y.), were on CRRT for a shorter duration (7 vs 13 d.), and had a higher baseline CrCl (79 vs 68 ml/min). Patient survival varied among different critical care units (medical surgical 33%, coronary 38%, and cardiovascular surgery 45%). Multivariable logistic regression revealed that shorter duration of CRRT, non-oliguria, and baseline CrCl > 60 ml/min were independently associated with survival to hospital discharge (p < 0.05). Critically ill patients with ARF who require CRRT continue to have high in-hospital mortality. A shorter period of CRRT dependence, non-oliguria, and higher baseline renal function may predict a more favorable prognosis. The majority of CRRT patients who survive their critical illness are independent from dialysis at the time of hospital discharge. [source]

Long-term follow-up of a 10-month programme in curriculum development for medical educators: a cohort study

Aysegul Gozu
Context, There is an ongoing need for curriculum development (CD) in medical education. However, only a minority of medical teaching institutions provide faculty development in CD. This study evaluates the long-term impact of a longitudinal programme in curriculum development. Methods, We surveyed eight cohorts of participants (n = 64) and non-participants (n = 64) from 1988 to 1996 at baseline and at 6,13 years after completion of a 10-month, one half-day per week programme offered annually, which included a mentored CD project, workshops on CD steps, a final paper and a presentation. Results, Fifty-eight participants (91%) and 50 non-participants (78%) returned completed follow-up surveys. In analyses, controlling for background characteristics and baseline self-rated proficiencies, participants were more likely than non-participants at follow-up to report having developed and implemented curricula in the past 5 years (65.5% versus 43.7%; odds ratio [OR] 2.41, 95% confidence interval [CI] 1.03,5.66), to report having performed needs assessment when planning a curriculum (86.1% versus 58.8%; OR 5.59, 95% CI 1.20,25.92), and to rate themselves highly in developing (OR 3.57, 95% CI 1.36,9.39), implementing (OR 3.04, 95% CI 1.16,7.93) and evaluating (OR 2.74, 95% CI 1.10,6.84) curricula. At follow-up, 86.2% of participants reported that the CD programme had made a moderate or great impact on their professional careers. Responses to an open-ended question on the impact confirmed continued involvement in CD work, confidence in CD skills, application of CD skills and knowledge beyond CD, improved time management, and lasting relationships formed because of the programme. Conclusions, Our results suggest that a longitudinal faculty development programme that engages and supports faculty in real CD work can have long-lasting impact. [source]

An exergy calculator tool for process simulation

Juan M. Montelongo-Luna
Abstract The constant tightening of environmental regulations and the ongoing need to reduce operating costs have posed a challenge for the design of any chemical process. Process engineers use process simulators to help them perform calculations that will, ultimately, result in design parameters or operating conditions for a plant or process. Exergy is a potential indicator that can aid in the design of energy efficient chemical processes and plants. The exergy concept has been increasingly used as a tool to locate the critical energy use in many industrial processes, both chemical and non-chemical. However, currently most process simulators in the market do not offer the capability of calculating the exergy of a process. An open-source exergy calculator has been created by embedding the calculation procedure in an open-source chemical process simulator. This improves process simulation by including a potential tool for design teams to quickly evaluate several process options in detail in order to understand their energy utilisation. A simple exergy analysis for a gas processing facility is used to demonstrate the capabilities of the tool. The analysis shows where the largest quantities of exergy are being consumed within the plant, thus pointing to areas where improvement in energy usage can be made. The use of exergy as a potential design and retrofit tool is also discussed. Copyright 2007 Curtin University of Technology and John Wiley & Sons, Ltd. [source]

Empirical Research on Performance Improvement

Anthony Marker
In 2002, James Klein published a study based on a content analysis of research articles in PIQ from 1997 through 2000. That study was aimed at determining how much empirical research was being reported in HPT and what the focus of that research was. Klein found that only about one third of the articles published in PIQ represented empirical research. The current study replicates Klein's research for the years of 2001 through 2005. Results indicate that there has been a significant increase in empirical research published in PIQ in the last five years with empirical research now accounting for more than one half of all PIQ articles. Further clarification of the levels of evaluation for non-instructional interventions and the refinement of research questions in the field are suggested as ongoing needs. An analysis detailing the comparison of the two studies is provided. [source]