FAMILY COURT REVIEW, Issue 4 2003
The Challenge to Law Schools
The process of preparing lawyers and other professionals to work for the benefit of troubled children requires an understanding of concepts that extend far beyond the traditional course structure currently employed in American law schools. It is clear that mental health problems of children and families, compounded by substance abuse, influence behavior, resulting in children entering family and juvenile courts as victims of abuse or neglect and committing criminal acts. It is incumbent on law schools to incorporate training in fields far different from the traditional didactic experience in legal curricula if they are to address the current needs of children and familes who are ensnared in the nation's juvenile justice system. The beginning point of this process is within the legal training apparatus of America. Law schools must expand their curriculum to incorporate other disciplines to produce an advocate capable of serving the interest of children and society. [source]

Working within the context of relationships: Multidisciplinary, relational, and reflective practice, training, and supervision

INFANT MENTAL HEALTH JOURNAL, Issue 6 2009
Deborah J. Weatherston
First page of article [source]

Augmented Lagrangian coordination for distributed optimal design in MDO

INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN ENGINEERING, Issue 13 2008
S. Tosserams
Abstract Quite a number of coordination methods have been proposed for the distributed optimal design of large-scale systems consisting of a number of interacting subsystems. Several coordination methods are known to have numerical convergence difficulties that can be explained theoretically. The methods for which convergence proofs are available have mostly been developed for so-called quasi-separable problems (i.e. problems with individual subsystems coupled only through a set of linking variables, not through constraints and/or objectives). In this paper, we present a new coordination approach for multidisciplinary design optimization problems with linking variables as well as coupling objectives and constraints. Two formulation variants are presented, offering a large degree of freedom in tailoring the coordination algorithm to the design problem at hand. The first, centralized variant introduces a master problem to coordinate coupling of the subsystems. The second, distributed variant coordinates coupling directly between subsystems. Our coordination approach employs an augmented Lagrangian penalty relaxation in combination with a block coordinate descent method. The proposed coordination algorithms can be shown to converge to Karush,Kuhn,Tucker points of the original problem by using the existing convergence results. We illustrate the flexibility of the proposed approach by showing that the analytical target cascading method of Kim et al. (J. Mech. Design-ASME 2003; 125(3):475,480) and the augmented Lagrangian method for quasi-separable problems of Tosserams et al. (Struct. Multidisciplinary Opt. 2007, to appear) are subclasses of the proposed formulations. Copyright © 2007 John Wiley & Sons, Ltd. [source]

The Impact of a Multidisciplinary, Integrated Approach on Improving the Health and Quality of Care for Individuals Dealing With Multiple Chronic Conditions

AMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 1 2006
Christina M. Krause PhD
This study examined the effects of using a multidisciplinary, integrated, whole,person, team advocate approach to educate and empower participants with multiple chronic illnesses and coordinate, monitor, and support their health care process. Individuals (N = 39) from Midwest hospitals participated and completed self,report instruments. Changes in participants' functioning were also measured with diagnostic measures completed by the team advocates. The results indicate that the participants' perceptions of physical functioning, physical well,being, control, self,efficacy, and life satisfaction increased. Additionally, health,related behavior changes were reported, and short,term costs were significantly lower than projected costs. Finally, the participants rated their health care services in the program as more effective than previous health care services. [source]

Acute obstetric emergency drill in England and Wales: a survey of practice

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2005
Elizabeth R. Anderson
Multidisciplinary training for obstetric emergencies is an issue of current interest and debate in the UK. This paper presents a survey of current practice in obstetric emergency drill training in England and Wales. A wide range of training methods and opinions about these methods are demonstrated in this survey. There is much interest in improving the management of obstetric emergencies and this is to be encouraged. However, reliable methods to assess and thereby optimise methods are urgently required in order that women and their babies can realise the maximum benefit from these complex interventions. [source]

Is multidisciplinary learning effective among those caring for people with diabetes?

DIABETIC MEDICINE, Issue 10 2002
N. Munro
Abstract The role of multi-professional learning for those providing clinical services to people with diabetes has yet to be defined. Several assumptions are generally made about education in the context of multi-professional settings. It is argued that different professions learning together could potentially improve professional relationships, collaborative working practices and ultimately standards of care. Greater respect and honesty may emerge from a team approach to learning with a commensurate reduction in professional antagonism. Personal and professional confidence is reportedly enhanced through close contact with other professionals during team-based learning exercises. We have examined current evidence to support multidisciplinary learning in the context of medical education generally as well as in diabetes education. Previous investigation of available literature by Cochrane reviewers, aimed at identifying studies of interprofessional education interventions, yielded a total of 1042 articles, none of which met the stated inclusion criteria. Searches involving more recent publications failed to reveal more robust evidence. Despite a large body of literature on the evaluation of interprofessional education, studies generally lacked the methodological rigour needed to understand the impact of interprofessional education on professional practice and/or health care outcomes. Nevertheless, planners continue to advocate, and endorse, joint training between different groups of workers (including nurses, doctors and those in professions allied to medicine) with the objective of producing an integrated workforce of multidisciplinary teams. Whilst the concept of multi-professional learning has strong appeal, it is necessary for those responsible for educating health care professionals to demonstrate its superiority over separate learning experiences. [source]

Chronic fatigue syndrome: an endocrine disease off limits for endocrinologists?

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2003
R. Baschetti
Abstract Endocrinologists were not included in the multidisciplinary working groups that prepared two recent reports on chronic fatigue syndrome, despite its unequalled clinical overlap with Addison's disease, which is a classic endocrine disorder. The failure to include at least one endocrinologist in those panels may explain why in their extensive reports there is not a single word about the 42 clinical features that chronic fatigue syndrome shares with Addison's disease, including all the signs and symptoms listed in the case definition of this syndrome. [source]

MAKING FAMILIES AND CHILDREN A HIGH PRIORITY IN THE COURTS

FAMILY COURT REVIEW, Issue 4 2002
California's Center for Families, Children & the Courts
This article describes the California Administrative Office of the Court's (AOC's) Center for Families, Children & the Courts (CFCC). CFCC is an interdisciplinary unit that brings together all of the AOC's work on statewide policies and practices related to families and children in the court system. CFCC thus models the unified family court model within the state AOC. CFCC's projects and activities are described to show the effectiveness of its multidisciplinary and collaborative approach in addressing complex policy and practice issues. It is hoped that readers may discover aspects of CFCC's work that could be adapted to their own jurisdiction or practice. [source]

Shared patients: multiple health and social care contact

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2001
J. Keene PhD
Abstract The paper describes results from the ,Tracking Project', a new method for examining agency overlap, repeat service use and shared clients/patients amongst social and health care agencies in the community. This is the first project in this country to combine total population databases from a range of social, health care and criminal justice agencies to give a multidisciplinary database for one county (n = 97 162 cases), through standardised anonymisation of agency databases, using SOUNDEX, a software programme. A range of 20 community social and health care agencies were shown to have a large overlap with each other in a two-year period, indicating high proportions of shared patients/clients. Accident and Emergency is used as an example of major overlap: 16.2% (n = 39 992) of persons who attended a community agency had attended Accident and Emergency as compared to 8.2% (n = 775 000) of the total population of the county. Of these, 96% who had attended seven or more different community agencies had also attended Accident and Emergency. Further statistical analysis of Accident and Emergency attendance as a characteristic of community agency populations (n = 39 992) revealed that increasing frequency of attendance at Accident and Emergency was very strongly associated with increasing use of other services. That is, the patients that repeatedly attend Accident and Emergency are much more likely to attend more other agencies, indicating the possibility that they share more problematic or difficult patients. Research questions arising from these data are discussed and future research methods suggested in order to derive predictors from the database and develop screening instruments to identify multiple agency attenders for targeting or multidisciplinary working. It is suggested that Accident and Emergency attendance might serve as an important predictor of multiple agency attendance. [source]

Towards a model for assessing workers' risks resulting from the implementation of information and communication systems and technologies

HUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 1 2006
Ricardo Vyhmeister
The authors investigate the effects of information and communication systems and technologies (ICST) on workers' health and safety. A multidisciplinary and convergent perspective is used to define a model that evaluates the risks associated with the implementation of any information system. The model incorporates the organizational, individual, and social elements that affect workers' risks. Special attention has been paid to the incorporation of ergonomic and organizational factors including culture, technological change, and informatics ethics. © 2006 Wiley Periodicals, Inc. Hum Factors Man 16: 39,59, 2006. [source]

The acceptance of systemic thinking in various fields of technology and consequences on the respective safety philosophies

HUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 3 2003
Willy Geysen
Systemic thinking aims to develop a common language that makes it possible for scientists of different disciplines and technologies to communicate with one another. The specific methodology of systemic thinking is a means of tackling complex, interrelated problems by applying a holistic approach that focuses on the interrelation of individual aspects. In this article, an attempt is made to show the impact of systemic thinking in different areas of science and technology. In particular, the authors argue that a multidisciplinary, systemic approach can play an important role in developing a general theory of safety science. © 2003 Wiley Periodicals, Inc. Hum Factors Man 13: 231,242, 2003. [source]

Hydrological and biogeochemical processes in a changing Amazon: results from small watershed studies and the large-scale biosphere-atmosphere experiment

HYDROLOGICAL PROCESSES, Issue 12 2006
Christopher Neill
Abstract The Amazon Basin is the world's largest tropical forest region and one where rapid human changes to land cover have the potential to cause significant changes to hydrological and biogeochemical processes. The Large-Scale Biosphere-Atmosphere Experiment in Amazonia (LBA) is a multidisciplinary, multinational research program led by Brazil. The goal of LBA is to understand how the Amazon Basin functions as a regional entity in the earth system and how these functions are changing as a result of ongoing human activity. This compilation of nine papers focuses on a central LBA question in the area of nutrient dynamics and surface water chemistry,how do changes in land use alter fluxes of dissolved and particulate materials from uplands across riparian zones and down the channels of river corridors? These papers cover work conducted in small watersheds on a wide range of topics within the spirit and geographical focus area of LBA: water balance and runoff generation, nutrient transformations in riparian zones and stream channels, carbon fluxes in water moving from land to water and the influence of soils on flowpath structure and stream chemistry. Important new insights can be gained from these and other studies. Forest clearing for pastures results in a decrease in soil hydraulic conductivity that forces water into surficial flowpaths throughout most of the rainy season across wide regions of the Amazon. Riparian zones along small forest streams appear to be very effective in removing nitrate arriving from the uplands, while forest streams take up nitrate at very low rates, allowing them to travel downstream for long distances. Although substantial, the contribution of dissolved organic C (DOC) to the carbon flux from forests to streams appears to be lower than the flux of dissolved inorganic C that is subsequently outgassed as CO2. Remaining key challenges within LBA will be to synthesize existing data sets on river networks, soils, climate, land use and planned infrastructure for the Amazon to develop models capable of predicting hydrologic and biogeochemical fluxes at a variety of scales relevant to the development of strategies for sustainable management of the Amazon's remarkable forest, soil and freshwater resources. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Enhancing technology development through integrated environmental analysis: Toward sustainable nonlethal military systems

INTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 2 2010
Oral S. Saulters
Abstract New technologies are not only critical in supporting traditional industrial and military success but also play a pivotal role in advancing sustainability and sustainable development. With the current global economic challenges, resulting in tighter budgets and increased uncertainty, synergistic paradigms and tools that streamline the design and dissemination of key technologies are more important than ever. Accordingly, a proactive and holistic approach can facilitate efficient research, design, testing, evaluation, and fielding for novel and off-the-shelf products, thereby assisting developers, end users, and other diverse stakeholders in better understanding tradeoffs in the defense industry and beyond. By prioritizing mechanisms such as strategic life-cycle environmental assessments (LCEA); programmatic environment, safety, and occupational health evaluations (PESHE); health hazard assessments (HHA); and other innovative platforms and studies early within systems engineering, various nonlethal military technologies have been successfully developed and deployed. These efforts provide a framework for addressing complex environment, safety, and occupational health risks that affect personnel, infrastructure, property, socioeconomic, and natural/cultural resources. Moreover, integrated, comprehensive, multidisciplinary, and iterative analyses involving flexible groups of specialists/subject matter experts can be applied at various spatiotemporal scales in support of collaborations. This paper highlights the Urban Operations Laboratory process utilized for inclusive and transformative environmental analysis, which can translate into advantages and progress toward sustainable systems. Integr Environ Assess Manag 2010;6:281,286. © 2009 SETAC [source]

Systematic review of the effectiveness of integrated care pathways: what works, for whom, in which circumstances?

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2009
Davina Allen RGN BA(Hons) PhD
Abstract Aim, Integrated care pathways (ICP) are management technologies which formalise multidisciplinary team-working and enable professionals to examine their roles and responsibilities. ICPs are now being implemented across international healthcare arena, but evidence to support their use is equivocal. The aim of this study was to identify the circumstances in which ICPs are effective, for whom and in what contexts. Methods, A systematic review of high-quality randomised controlled trials published between 1980 and 2008 (March) evaluating ICP use in child and adult populations in the full range of healthcare settings. Results 1For relatively predictable trajectories of care ICPs can be effective in supporting proactive care management and ensuring that patients receive relevant clinical interventions and/or assessments in a timely manner. This can lead to improvements in service quality and service efficiency without adverse consequences for patients. 2ICPs are an effective mechanism for promoting adherence to guidelines or treatment protocols thereby reducing variation in practice. 3ICPs can be effective in improving documentation of treatment goals, documentation of communication with patients, carers and health professionals. 4ICPs can be effective in improving physician agreement about treatment options. 5ICPs can be effective in supporting decision-making when they incorporate a decision-aide. 6The evidence considered in this review indicates that ICPs may be particularly effective in changing professional behaviours in the desired direction, where there is scope for improvement or where roles are new. 7Even in contexts in which health professionals are already experienced with a particular pathway, ICP use brings additional beneficial effects in directing professional practice in the desired direction. 8ICPs may be less effective in bringing about service quality and efficiency gains in variable patient trajectories. 9ICPs may be less effective in bringing about quality improvements in circumstances in which services are already based on best evidence and multidisciplinary working is well established. 10Depending on their purpose, the benefits of ICPs may be greater for certain patient subgroups than others. 11We do not know whether the costs of ICP development and implementation are justified by any of their reported benefits. 12ICPs may need supporting mechanisms to underpin their implementation and ensure their adoption in practice, particularly in circumstances in which ICP use is a significant change in organisational culture. 13ICP documentation can introduce scope for new kinds of error. Conclusions, ICPs are most effective in contexts where patient care trajectories are predictable. Their value in settings in which recovery pathways are more variable is less clear. ICPs are most effective in bringing about behavioural changes where there are identified deficiencies in services; their value in contexts where inter-professional working is well established is less certain. None of the studies reviewed included an economic evaluation and thus it is not known whether their benefits justify the costs of their implementation. [source]

Connecting what we do with what we know: building a community of research and practice

INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2009
Julianne Cheek PhD
How to think about, develop, maintain and optimize connections between research and practice remains a vexed and contested area in the increasingly complex multidisciplinary and inter-professional practice that constitutes contemporary healthcare and service delivery. A body of literature challenging linear and passive notions of research uptake has emerged which views research uptake as a dynamic, contextualized and active process. This paper explores the development of a successful and exciting community of research and practice involving a university and an aged care organization in Australia. The community of research and practice is premised on dynamic, contextual and active interaction between research and practice; where the categories of research and practice are not mutually exclusive or static; and where community is more than just a structure to facilitate collaborative research projects. It is proposed that the idea of a community of research and practice is a useful one in terms of seeking to better understand and provide strategies for knowledge translation between researchers and practitioners and those who are both. [source]

Scalp necrosis and giant cell arteritis: case report and issues in wound management

INTERNATIONAL WOUND JOURNAL, Issue 4 2005
Stefan J Landis
Abstract Scalp necrosis is rare in patients with giant cell arteritis. Here, we report the case of an 81-year-old woman who presented with a management problem that required a truly multidisciplinary approach to treatment. A combined approach of effective wound bed preparation with selective debridement, prolonged antimicrobial therapy, corticosteroid use and careful dressing choices resulted in a successful outcome in a potentially disastrous situation. [source]

Successes and Lessons Learned Implementing the Sepsis Bundle

JOURNAL FOR HEALTHCARE QUALITY, Issue 4 2009
Wayne E. Soo Hoo
Abstract: Sepsis is well described in the literature as a leading cause of possibly preventable death in the United States. Analysis of baseline data indicated capacity to reduce mortality, significant variation in clinical practice patterns and opportunities for reducing cost per case. Following an enterprise-wide challenge to save lives, a multidisciplinary, facility-based team was organized to improve sepsis care. Systematic improvements in recognizing sepsis and standardizing care resulted in a dramatic reduction in mortality and a significant reduction in direct variable cost. [source]

Current Practice, Demographics, and Trends of Critical Care Trained Emergency Physicians in the United States

ACADEMIC EMERGENCY MEDICINE, Issue 3 2010
Julie A. Mayglothling MD
Abstract Objectives:, Critical care medicine (CCM) is of growing interest among emergency physicians (EPs), but the number of CCM-trained EPs and their postfellowship practice is unknown. This study's purpose was to conduct a descriptive census survey of EPs who have completed or are currently in a CCM fellowship. Methods:, The authors created a Web-based survey, and requests to participate were sent to EPs who have completed or are currently in a CCM fellowship. Responses were collected over a 12-month period. Physicians were located via multiple whom electronic mailing lists, including the Emergency Medicine Section of the Society of Critical Care Medicine, Critical Care Section of the American College of Emergency Physicians, and the Emergency Medicine Residents' Association. The authors also contacted CCM fellowship coordinators and used informal networking. Data were collected on emergency medicine (EM) and other residency training; discipline, duration, and year of CCM fellowship; current practice setting; and board certification status, including the European Diploma in Intensive Care (EDIC). Results:, A total of 104 physicians completed the survey (97% response rate), of whom 73 had completed fellowship at the time of participation, and 31 of whom were in fellowship training. Of those who completed fellowship, 36/73 (49%) practice both EM and CCM, and 45/73 (62%) practice in academic institutions. Multiple disciplines of fellowship were represented: multidisciplinary (39), surgical (28), internal medicine (16), anesthesia (14), and other (4). Together, the CCM fellowships at the University of Maryland R Adams Cowley Shock Trauma Center and the University of Pittsburgh have trained 42% of all EM-CCM physicians, with 38 other institutions training from one to four fellows each. The number of EPs completing CCM fellowships has risen: from 1974 to 1989, 12 EPs; from 1990 to 1999, 15 EPs; and from 2000 to 2007, 43 EPs. Conclusions:, Emergency physicians are entering CCM fellowships in increasing numbers. Almost half of these EPs practice both EM and CCM. ACADAEMIC EMERGENCY MEDICINE 2010; 17:325,329 © 2010 by the Society for Academic Emergency Medicine [source]

Adolescents with Type 1 Diabetes: transition between diabetes services

JOURNAL OF CLINICAL NURSING, Issue 6 2006
Kate Visentin MN
Aim., The research aimed to develop a sustainable and coordinated approach to facilitating the transition between diabetes services for adolescents. The objectives were to: (1) involve key diabetes health delivery stakeholders in expressing their concerns and issues about current service delivery and ways to improve same, and (2) reveal from the perspective of the adolescents living with Type 1 Diabetes their experiences surrounding the process of transition. Background., This paper presents research that sought to identify the major concerns and issues that stakeholders had about transition and to reveal the experience of transition for the adolescent with Type 1 Diabetes. Key representatives from seven public diabetes services in Adelaide, South Australia worked collaboratively to answer the objectives of this inquiry. Approach., Interview data were generated and analysed using a response focus framework provided by fourth generation evaluation research. In this study, the focus was on common concerns, claims and issues raised by health care professionals (n = 21) and adolescents (n = 10) aged between 15 and 18 years about transferring from children's to adult diabetes services. Findings., Data revealed education and dietetic advice was reactive rather than proactive and that the paediatric model of care is philosophically and practically different to the adult model of diabetes care. Three phases of transition were identified: preparation, formal transition and evaluation. Our findings indicated that these stages of transition were not being fully implemented in health units. Conclusion., The project findings have set the scene to establish a multidisciplinary working party to work collaboratively across agencies to develop effective transition pathways. Relevance to clinical practice., The role of diabetes nurse educators and dietitians in South Australia is under-used throughout the transition process. Diabetes nurse educators are in an ideal position to prepare, coordinate and evaluate transitional processes. [source]

Interdisciplinary practice , a matter of teamwork: an integrated literature review

JOURNAL OF CLINICAL NURSING, Issue 4 2001
Antoinette Mccallin BA
,,The aim of this literature review is to explore the development of interdisciplinary practice. ,,The terms interdisciplinary, multidisciplinary, and inter-professional are problematic. Definitions must be viewed carefully, as interpretations tend to reflect historical socialization patterns that are now out of kilter with contemporary understandings. ,,Changing inter-professional interactions, teams and teamwork are examined; findings indicate that explanations of interdisciplinary teamwork should be all-inclusive of the particular cultural conditions and contextual determinants that affect team practice. ,,Findings need to be viewed with caution because what is applicable in one country may not be automatically transferable to another, where particular socio-political contexts shape interdisciplinary practice. [source]

Community-oriented primary care: a multidisciplinary community-oriented approach to primary care?

JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 1 2001
Penny Lenihan
Abstract Developing more of a local public health focus, and involving local communities in Great Britain in health care decision-making, are key aspects of the radically changing face of primary care. Community-oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ,Modern and Dependable NHS', but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Staffing in acute hospital wards: part 1.

JOURNAL OF NURSING MANAGEMENT, Issue 5 2003
The relationship between number of nurses, ward organizational environment
This paper is one of two that explores relationships between nursing staff resources, ward organizational practice and nurses' perceptions of ward environments. Here we examine relationships between staff numbers, care organization and nursing practice. A subsequent paper examines the effects of grade mix and staff stability. The data were collected in the mid-1990s from a nationally representative sample of 100 acute hospital wards and 825 nurses. Our analyses provide important insights for managers seeking to achieve the strategic aims set out in Working Together, and subsequent National Health Service (NHS) policy placing emphasis on making the best use of nurses, focussing on mobilising their knowledge, skills and talents within the context of extended work roles. Findings show that number of nurses is associated not only with ward organizational systems but also with a range of care processes and staff outcomes which hitherto have been linked only to ward organizational systems. The latter have been identified as providing different opportunities for developing multidisciplinary working and nurses' autonomy but the central importance of having an adequate number of staff to achieve these aims has been largely overlooked in research. Having fewer nurses was associated with both hierarchical ward organizational structures and hierarchical attitudes to care provision, denoting lower standards of nursing practice. A larger nursing complement was significantly associated with devolved organizational structures but no link was established between more staff and higher standards of nursing practice. When there were more staff there was a positive association with nurses' perceptions of multidisciplinary collaboration, their ability to cope with workload and job satisfaction. Employing an adequate number of nurses to provide care is clearly beneficial for nurses themselves. Patients are also likely to benefit from a lower incidence of ,hierarchical practice' associated with having a low nurse/bed ratio within a ward. [source]

Expanding roles within mental health legislation: an opportunity for professional growth or a missed opportunity?

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2007
J. HURLEY msc nursing
This paper aims to highlight both the necessity, and the way forward for mental health nursing to integrate proposed legislative roles into practice. Argued is that community mental health nursing, historically absent from active participation within mental health law in the UK, is faced with new and demanding roles under proposed changes to the 1983 Mental Health Act of England and Wales. While supporting multidisciplinary training for such roles, the imperative of incorporating nursing specific values into consequent training programs is addressed through the offered educative framework. This framework explores the issues of power, ethics, legislative thematics and application to contemporary service structures. [source]

Overlap in bibliographic databases

JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 12 2003
William W. Hood
Bibliographic databases contain surrogates to a particular subset of the complete set of literature; some databases are very narrow in their scope, while others are multidisciplinary. These databases overlap in their coverage of the literature to a greater or lesser extent. The topic of Fuzzy Set Theory is examined to determine the overlap of coverage in the databases that index this topic. It was found that about 63% of records in the data set are unique to only one database, and the remaining 37% are duplicated in from two to 12 different databases. The overlap distribution is found to conform to a Lotka-type plot. The records with maximum overlap are identified; however, further work is needed to determine the significance of the high level of overlap in these records. The unique records are plotted using a Bradford-type form of data presentation and are found to conform (visually) to a hyperbolic distribution. The extent and causes of intra-database duplication (records duplicated in the one database) are also examined. Finally, the overlap in the top databases in the dataset were examined, and a high correlation was found between overlapping records, and overlapping DIALOG OneSearch categories. [source]

Review article: the management of hepatocellular carcinoma

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010
R. CABRERA
Aliment Pharmacol Ther,31, 461,476 Summary Background, Hepatocellular carcinoma is the leading cause of death in cirrhosis. A majority of patients present at an advanced stage with poor prognosis. Aim, To review the current screening, diagnosis and management strategies involved in hepatocellular carcinoma. Methods, A literature search was performed using PubMed for publications with a predetermined search string to identify relevant studies. Results, Hepatocellular carcinoma is dramatically increasing in incidence that is mostly attributed to chronic hepatitis C and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and its clinical phenotype diabetes and obesity. Cirrhosis is the major predisposing risk factor and its presence necessitates close surveillance for hepatocellular carcinoma with serial imaging studies. Hepatocellular carcinoma can be diagnosed by its unique radiological behaviour of arterial enhancement and washout on delayed images. The Barcelona Clinic Liver Cancer staging classification system is a clinically useful algorithm for the management of patients with hepatocellular carcinoma. The simultaneous presence of cirrhosis in the patients complicates their management and monitoring for cirrhosis-related complications is important. Conclusions, Early diagnosis and definitive treatment remains the key to long-term outcome. A multidisciplinary approach is critical to the successful management of hepatocellular carcinoma. Studies combining sorafenib with locoregional or other targeted molecular therapies are likely to improve responses and outcome. [source]

Review article: the current management of acute liver failure

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010
D. G. N. CRAIG
Aliment Pharmacol Ther,31, 345,358 Summary Background, Acute liver failure is a devastating clinical syndrome with a persistently high mortality rate despite critical care advances. Orthotopic liver transplantation (OLT) is a life-saving treatment in selected cases, but effective use of this limited resource requires accurate prognostication because of surgical risks and the requirement for subsequent life-long immunosuppression. Aim, To review the aetiology of acute liver failure, discuss the evidence behind critical care management strategies and examine potential treatment alternatives to OLT. Methods, Literature review using Ovid, PubMed and recent conference abstracts. Results, Paracetamol remains the most common aetiology of acute liver failure in developed countries, whereas acute viral aetiologies predominate elsewhere. Cerebral oedema is a major cause of death, and its prevention and prompt recognition are vital components of critical care support, which strives to provide multiorgan support and ,buy time' to permit either organ regeneration or psychological and physical assessment prior to acquisition of a donor organ. Artificial liver support systems do not improve mortality in acute liver failure, whilst most other interventions have limited evidence bases to support their use. Conclusion, Acute liver failure remains a truly challenging condition to manage, and requires early recognition and transfer of patients to specialist centres providing intensive, multidisciplinary input and, in some cases, OLT. [source]

Projections of the effects of climate change on allergic asthma: the contribution of aerobiology

ALLERGY, Issue 9 2010
L. Cecchi
To cite this article: Cecchi L, D'Amato G, Ayres JG, Galan C, Forastiere F, Forsberg B, Gerritsen J, Nunes C, Behrendt H, Akdis C, Dahl R, Annesi-Maesano I. Projections of the effects of climate change on allergic asthma: the contribution of aerobiology. Allergy 2010; 65: 1073,1081. Abstract Climate change is unequivocal and represents a possible threat for patients affected by allergic conditions. It has already had an impact on living organisms, including plants and fungi with current scenarios projecting further effects by the end of the century. Over the last three decades, studies have shown changes in production, dispersion and allergen content of pollen and spores, which may be region- and species-specific. In addition, these changes may have been influenced by urban air pollutants interacting directly with pollen. Data suggest an increasing effect of aeroallergens on allergic patients over this period, which may also imply a greater likelihood of the development of an allergic respiratory disease in sensitized subjects and exacerbation of symptomatic patients. There are a number of limitations that make predictions uncertain, and further and specifically designed studies are needed to clarify current effects and future scenarios. We recommend: More stress on pollen/spore exposure in the diagnosis and treatment guidelines of respiratory and allergic diseases; collection of aerobiological data in a structured way at the European level; creation, promotion and support of multidisciplinary research teams in this area; lobbying the European Union and other funders to finance this research. [source]

A prospective pilot study of a multidisciplinary home training programme for lateral epicondylitis

MUSCULOSKELETAL CARE, Issue 1 2007
Pia Nilsson PTR
Abstract Objective:,To evaluate a new multidisciplinary structured home training programme for patients with lateral epicondylitis compared to conventional attendance. Design:,This study utilized a prospective non-randomized design to compare the effect of a home exercise programme against a pragmatic approach to managing patients with lateral epicondylitis in a primary care setting in Sweden. Subjects:,A total of 78 patients, presenting to their general practitioner with lateral epicondylitis were recruited from two separate geographical areas. The patients were divided into two group, 51 entered the intervention group and 27 entered the control group. Methods:,The intervention group was treated with a specific home training programme, ergonomic advice and when necessary wrist and/or night bandages. The control group was treated with conventional treatment, e.g. corticosteroid injections, stretching or no intervention. Pain and function were evaluated by the PRFEQ. An electronic hand-power gauge measured strength and stamina. Sick-leave absence was collected via the regional Social Insurance Office. Results:,After four weeks the intervention group experienced less sick-leave, less pain, better function and returned to work earlier than the control group. After 16 weeks the intervention group still had significantly better function than the control group and were taking less sick-leave. Pain decreased more in the intervention group but this was not significant. There was no difference in grip strength between the two groups. Conclusion:,A structured home training programme can improve function and reduce sick leave in patients with lateral epicondylitis. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Towards multidisciplinary teamworking in musculoskeletal care: evolution of a service

MUSCULOSKELETAL CARE, Issue 2 2004
Roberta Ainsworth MCSP SRP MSc BA (Hons)
[source]

Strategic Frame Analysis: Providing the "evidence" for evidence-based communications

NEW DIRECTIONS FOR YOUTH DEVELOPMENT, Issue 124 2009
Tiffany Manuel
This article describes the five major phases of research associated with Strategic Frame Analysis, an approach to communications research and practice that advances new ways of pursuing social change of entrenched and complex social problems. This multimethod approach is characterized by multidisciplinary and iterative research techniques that give emphasis to empirical testing of potential frame effects. The logic behind this constellation of methods and the order in which they are taken up in the research cycle is discussed as an introduction to the articles that follow that review specific parts of the research trajectory. [source]