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Professional Roles (professional + role)
Selected AbstractsExploring Boundaries in the Nurse-Client Relationship: Professional Roles and ResponsibilitiesPERSPECTIVES IN PSYCHIATRIC CARE, Issue 2 2003Cindy A. Peternelj-Taylor MSc TOPIC. The creation and maintenance of boundaries as they pertain to the nurse-client relationship. PURPOSE. To challenge readers to reflect on their fiduciary responsibilities by identifying boundary crossings and violations. SOURCES. Review of the literature and the authors' clinical and teaching experiences. CONCLUSIONS. Although self-awareness and monitoring, debriefing, and availing oneself of supervision and education are important tools in creating and maintaining boundaries, in the final analysis, the nursing profession needs nurses who have the ability to make decisions about boundaries based on the best interests of the clients in their care. [source] Dental students' motivation and the context of learningEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 1 2009Bettina Tjagvad Kristensen Abstract This qualitative study shows dental students' motives for choosing the dental education and how the motives influence their motivation at the first semester of study. Further the study demonstrates the relevance of the context of learning. This issue is of importance when planning a curriculum for the dental education. The material consists of interviews with eight dental students. The results show that dental students were focused on their future professional role, its practical dimensions and their future working conditions. Their motivation for choosing the dental education was found to influence their motivation for studying and their experience of the relevance of the first semester. The dental students who had co-education with the medical students at the first year of study missed a dental context and courses with clinically relevant contents. In conclusion, our data signify the importance of the context of learning. It is recommended that a future curriculum for the dental school should be designed in a way where basic science subjects are taught with both theoretically as well as practically oriented subjects and in a context which is meaningful for the students. [source] Dental hygienists' views on communicative factors and interpersonal processes in prevention and treatment of periodontal diseaseINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 3 2010J Stenman To cite this article: Int J Dent Hygiene,8, 2010; 213,218 DOI: 10.1111/j.1601-5037.2010.00459.x Stenman J, Wennström JL, Abrahamsson KH. Dental hygienists' views on communicative factors and interpersonal processes in prevention and treatment of periodontal disease. Abstract:, Objective:, The aim of this study was to explore views of DHs on communicative issues and interpersonal processes of importance in the prevention and treatment of periodontal disease. Method:, The qualitative method of Grounded Theory (GT) was chosen for data sampling and analysis. Audio-taped and open-ended interviews were conducted with 17 dental hygienists. The interviews were transcribed verbatim and analysed in a hierarchical coding process, according to the principles of GT. Result:, In the analysis a core category was identified as ,to be successful in information and oral health education and managing desirable behavioural changes'. The core concept was related to four additional categories and dimensions; (i) ,to establish a trustful relationship with the patient', (ii) ,to present information about the oral health status and to give oral hygiene instructions', (iii) ,to be professional in the role as a dental hygienist' and (iv) ,to have a supportive working environment in order to feel satisfaction with the work and to reach desirable treatment results'. Conclusion:, The results describe a psychosocial process that elucidates the importance of building a trustful relationship with the patient, feeling secure in one's professional role as a DH and last but not least, the importance of having support from colleagues and the clinical manager to be successful in the prevention and treatment of periodontal diseases. [source] Professional practices and experiences with complementary medicines: a cross-sectional study involving community pharmacists in EnglandINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2007Joanne Barnes associate professor in herbal medicines Objective As retailers of complementary medicines (CMs), pharmacists are well placed to advise consumers on the safe and effective use of these products; where CMs are available in pharmacies, pharmacists should be well informed about such products. This study explored the extent to which CMs are available in community pharmacies in England, and examined pharmacists' experiences, professional practices and training with regard to these products. Method A cross-sectional study was conducted, involving a structured questionnaire posted to community pharmacists. Coded follow-up mailings were sent to non-responders after 2 and 4 months, and a reminder telephone call made after 3 months. Setting All community pharmacists in six areas (Devon, Cornwall, Bradford, Leeds, Manchester, Stockport) of England (total n = 1337). Key findings The response rate was 66.5%. Overall, 92% of respondents reported that CMs (excluding vitamins/minerals) are sold in the pharmacy in which they practise, 81% had received requests from patients/consumers for specific CMs in the previous year, and 58% had recommended CMs. Around 70% of respondents rarely/never asks about CMs use when counter-prescribing conventional medicines or when receiving reports of suspected adverse drug reactions (ADRs) associated with conventional medicines. In total, 40% of respondents had undertaken training in complementary/alternative medicine (CAM). Pharmacists who had undertaken training were more likely to ask patients/consumers specifically about use of CMs when counter-prescribing conventional over-the-counter (OTC) medicines (37.0% versus 23.4%, respectively; ,2 = 17.4; P = 0.0003) and when receiving reports from patients/customers of suspected ADRs associated with conventional (prescribed or OTC) medicines (35.6% versus 23.8%, respectively; ,2 = 13.0; P = 0.0003). Conclusion CMs are widely available in pharmacies in England, and pharmacists interact with users of these products. An opportunity exists for pharmacists to embrace a professional role as expert advisors on CMs. However, pharmacists' training, professional practices and competence with respect to CMs first need to improve. [source] Psychiatric nurses' attitudes towards patient autonomy in depot clinicsJOURNAL OF ADVANCED NURSING, Issue 4 2001Bodil Svedberg RPN Psychiatric nurses' attitudes towards patient autonomy in depot clinics Aim.,The aim of this qualitative study was to explore how psychiatric nurses experience patient autonomy in relation to their professional role in depot clinics. Background.,The administration of depot neuroleptics at outpatient clinics is a common task for psychiatric nurses in many countries. The procedure is characterized by brief contacts often allowing little opportunity for adequate monitoring of the treatment and a dialog between nurses and patients. As nurses have an important role in involving patients in decision-making, there is a need to analyse the nurses' attitudes towards giving depot neuroleptics from the perspective of autonomy. Method.,Nine experienced psychiatric nurses were interviewed using open-ended questions. The steps of a phenomenological descriptive method guided the data analysis. Findings.,The structure describes how benevolent attitudes towards patient autonomy motivated the nurses' interventions in relation to how they experienced their own professional authority. The structure consists of four variations: (1) Beneficent interventions used with patients perceived as co-operative when the nurses experienced a high degree of professional authority. (2) Paternalistic interventions used with patients perceived as ambiguous towards medication when the nurses experienced an arbitrary professional authority in collaboration with team members. (3) Weak paternalistic interventions used with patients perceived as unwilling when the nurses experienced having sufficient professional authority in the treatment situation. (4) Nonmaleficent interventions used with patients perceived as being resigned when the nurses experienced a low degree of professional authority within the team. Conclusions.,The findings indicate that psychiatric nurses' experience of their professional authority is closely related to the organization of the depot treatment and that brief contacts do not favour the establishment of collaborative relationships with patients. When injection-giving nurses, as patients' key workers, have overall responsibility for co-ordinating the patients' treatment they can encourage patient autonomy by helping patients understand the meaning of depot medication and its benefits. Further clinical research regarding the involvement of nurses in the treatment as well as patients' experiences of treatment with depot neuroleptics is needed to allow suggestions about improvements of the organization of the treatment. [source] Swedish Registered Nurses' incentives to use nursing diagnoses in clinical practiceJOURNAL OF CLINICAL NURSING, Issue 8 2006Lena Axelsson BSc Aims and objectives., The purpose of this study was to describe Registered Nurses' incentives to use nursing diagnoses in clinical practice. Background., The use of nursing diagnoses is scarce in Swedish patient records. However, there are hospital wards were all nurses formulate and use nursing diagnoses in their daily work. This leads to the question of what motivates these nurses who do use nursing diagnoses in clinical practice. Design., A qualitative descriptive design. Methods., A purposeful sampling of 12 Registered Nurses was used. Qualitative interviews to collect data and a content analysis were performed. Results., Five categories were identified: identification of the patient as an individual and as a whole, a working tool for facilitating nursing care, increasing awareness within nursing, support from the management and influence on the professional role. The principle findings of this study were: (i) that the Registered Nurses perceived that nursing diagnoses clarified the patient's individual needs and thereby enabled them to decide on more specific nursing interventions, (ii) that nursing diagnoses were found to facilitate communication between colleagues concerning patient care and thus promoted continuity of care and saved time and (iii) that nursing diagnoses were perceived to increase the Registered Nurses' reflective thinking leading to a continuous development of professional knowledge. Conclusions., The present findings suggest that the incentives to use nursing diagnoses originate from effects generated from performing a deeper analysis of the patient's nursing needs. Further research is needed to test and validate the usability and consequences of using nursing diagnoses in clinical practice. Relevance to clinical practice., Motivating factors found in this study may be valuable to Registered Nurses for the use and development of nursing diagnoses in clinical care. Moreover, these factors may be of relevance in other countries that are in a similar situation as Sweden concerning application of nursing diagnoses. [source] A preliminary analysis of narratives on the impact of training in solution-focused therapy expressed by students having completed a 6-month training courseJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2010S. SMITH ba (hons) ba pgctlt rmn rnt fhea Accessible summary ,,Students who participated in a six month training course in SFBT reported significant changes in their relationships with clients. ,,They reported increased trust in clients as people, increased confidence in their own professional role, and increased enthusiasm for working with clients. ,,Students demonstrated an in-depth knowledge and understanding of solution focused principles and practice, enabling them to own their practice and respond creatively to individual clients. ,,It is suggested that substantive training in solution focused brief therapy may help to enhance the professional role and cultural identity of participants, particularly those from a nursing background. Abstract Solution-focused brief therapy (SFBT) is a therapeutic approach utilized in a wide variety of settings. Its roots are in systemic and family therapy, and the emphasis in practice is on helping clients identify what their life will be like when they no longer have their problem, and how close they are to experiencing that situation now. The literature suggests that SFBT is at least as effective as other forms of psychotherapy. This pilot-study explored the impact of a training course in SFBT on the nurses who took part. Interviews were carried out with participants (n= 8) and narrative accounts were analysed and grouped according to emerging themes. Three major themes were perceived; Trust in clients, Positivity and Confidence, and these were supported by interconnected minor themes relating to the eclectic use of the approach, the use of language within the approach, and the application of SFBT in wider life. It is argued that training in SFBT may have a positive impact on the therapeutic and professional role of nurses, and that further studies are required to explore the impact of SFBT training on the professional and cultural identity of nurses. [source] The role of second health professionals under New Zealand mental health legislationJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2006A. J. O'BRIEN rgn rpn ba mphil The development of generic statutory roles in mental health care has been the subject of discussion by New Zealand nurses for the past decade. One such role is that of second health professional in judicial reviews of civil commitment. Issues identified by New Zealand nurses have also been raised in England, where it seems that nurses are likely to assume the role of Approved Mental Health Worker under English mental health law. A survey of mental health nurses found that few had received any preparation for the role of second health professional and 45% did not feel adequately prepared for the role. Some of these issues are reflected in a New Zealand inquiry which resulted in the Ministry of Health developing a written report form for second health professionals. However, the form has the potential to reduce the mental health nursing role to a narrow legal role. Statutory roles such as that of second health professional challenge mental health nurses to critically reflect on the conceptual and ethical basis of their practice. While traditional concepts such as therapeutic relationships and advocacy need to be reviewed in light of these changes, nurses need to be vigilant in articulating the moral and clinical basis of their roles. The development of guidelines for he second health professional role is suggested as a way of supporting clinical practice in this area. [source] An Inside View: Professional Judges' and Lay Judges' Support for Mixed TribunalsLAW & POLICY, Issue 2 2003Sanja Kutnjak Ivkovi This paper studies the level of specific and general support for mixed tribunals, a form of lay participation in the government. The analyses focus on the opinions provided by 229 Croatian lay judges and eighty professional judges , the insiders in mixed tribunals. The results indicate that the judge's lay or professional role in the criminal justice system and the type of court exhibit stronger influence on the general level of support than any of the variables measuring specific support. Nevertheless, the perceived frequency of lay judges' comments, the most direct measure of members' crucial activity during trials and deliberations among the specific variables included in the models, is significantly related to the respondents' general opinions about mixed tribunals. [source] Responding to the crisis: RALLY's developmental and relational approachNEW DIRECTIONS FOR YOUTH DEVELOPMENT, Issue 120 2008Gil G. Noam The authors introduce the RALLY (Responsive Advocacy for Life and Learning in Youth) approach. RALLY is a school- and afterschool-based approach addressing academic success, youth development, and mental health for youth. Based on developmental and relational principles, RALLY's main goals are to promote students' resiliency, development, and academic functioning, as well as to reduce the typical adolescent's risks. By implementing a new professional role of RALLY practitioners, who are developmental specialists and interconnect the different social worlds of students, RALLY creates the resources to provide social opportunities and quality practices to meet students' needs and facilitate their growth. A three-tiered system helps to implement mental health and educational practice, thus providing differential support for students with different needs. Early identification of risks and resiliencies helps to avoid chronicity and pinpoint adequate treatments as soon as possible. [source] Norwegian and Swedish preceptors' views of their role before and after taking part in a group supervision programNURSING & HEALTH SCIENCES, Issue 2 2009Agneta Danielsson rnt Abstract The research literature has shown the expectations towards preceptors and their need of support in their role. Group supervision has been used for many years to promote nurses in their professional role, but no study has been found on how group supervision can support them as preceptors. This study aimed to explore how group supervision could influence the preceptors' views of their role and how they valued this participation. Forty-eight preceptors, who took part in a 1 year group supervision program conducted by nurse lecturers, filled in open-ended questionnaires before the first and after the last session. The data were analyzed by means of qualitative content analysis. The findings showed changes in the participants' views of the preceptor role, indicating that this group supervision model had a positive influence on the preceptors' pedagogical and professional thinking and supported their attainment of good preceptorship. Further research is needed in using group supervision as a tool to support preceptors. [source] What do Swedish physiotherapists feel about research?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2002A survey of perceptions, attitudes, engagement, intentions Abstract Background and Purpose Although the past decades have witnessed an increase in physiotherapy research, there remains a concern about the translation of research into clinical practice, a problem that to date has attracted relatively limited interest. The aim of the present study was to investigate perceptions and attitudes toward research, intentions to perform as well as actual engagement in research-related activities in a sample of Swedish physiotherapists. Method A cross-sectional design was used, and 343 Swedish physiotherapists responded to a postal questionnaire (representing a response rate of 61.7%). Questions about research-related activities were measured on a Likert-type scale, whereas questions referring to attitudes toward research used a semantic differential scale. Results The physiotherapists considered research as an important part of their professional role. Reading research literature was perceived as the most important research activity, and all mean attitude ratings were on the positive side of the scale. High workload and lack of time were the most commonly mentioned barriers to participation in research-related activities. Although Swedish physiotherapists read a large variety of journals, they most frequently read in their own language. Conclusions The physiotherapists in this study were generally positive about research, which offers hope for an increased use of evidence-based practice in the future. In order to facilitate this development, easily accessible summaries could be provided. A cultural change within the profession, allowing more time for reading and discussing research reports should be encouraged. Copyright © 2002 Whurr Publishers Ltd. [source] Clinician observation of physiological trend monitoring to identify late-onset sepsis in preterm infantsACTA PAEDIATRICA, Issue 9 2008Christopher J Dewhurst Abstract Aim: To determine whether trends in routinely collected physiological variables can be used retrospectively to classify infants according to the presence or absence of late-onset neonatal sepsis. Methods: Case control study. Thirty infants born ,32 weeks of gestation who developed late-onset sepsis were matched with 30 controls for gestational and postnatal age but remained sepsis free. For each infant, 25 clinicians inspected 48 h of routine monitoring of heart rate, respiratory rate and oxygen saturation. Clinicians were asked to determine whether the recording was obtained from an infant who did or did not develop sepsis and also indicate how confident they were in their judgement. Clinicians were stratified into three groups by professional role. Results: The median correct assignment of infant's recordings was 67% (IQR 62,72). When very confident, this improved to 82% (IQR 67,88). Overall sensitivity was 53% (IQR 43,63) and specificity 80% (IQR 67,87). Advanced neonatal nurse practitioners consistently assigned babies to the correct group more often than other professional groups. Conclusion: The simple observation physiological trend graphs can classify infants according to the presence or absence of late-onset neonatal sepsis. The accuracy of this method is good to strong but varies with experience of neonatal intensive care. [source] Evaluating the impact of a cancer supportive care project in the community: patient and professional configurations of needHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2007Kristian Pollock PhD MA PGCHE Abstract Advances in cancer care and treatment have created a new and somewhat anomalous category of patients with a diagnosis of non-curative disease who still have a considerable period of life remaining. During much of this time they may remain relatively well, without manifest need for clinical care. The responses of patients to this challenging situation are largely unknown. However, it has been assumed that because they confront a difficult experience they will need, or can benefit from, professional intervention. The implementation of pre-emptive support measures is anticipated to improve patients' resilience in coping with their illness and approaching death. This study aimed to investigate the impact of the keyworker role in a 3-year cancer supportive community care project to identify and provide for the needs of patients with a diagnosis of non-curative cancer. It was a qualitative study incorporating face-to-face interviews and focus groups with 19 healthcare professionals and 25 patients and carers from an urban East Midlands locality and a thematic analysis of qualitative interview and focus group transcripts. The project was positively evaluated by patients, carers and professionals. However, the findings raised questions about the different configuration of ,need' within the lay and professional perspectives and how this should most appropriately be addressed. In contrast to widespread professional assumptions about patients' need for counselling, many patients preferred to turn to their friends and families for support, and to adopt a stance of emotional and personal self-reliance as a strategy for coping with their predicament. The study highlights the continuing orientation of services around professional, rather than patient, agendas and the momentum towards increasing specialisation of professional roles and the medicalisation of everyday life that flows from this. [source] When doctors disagree: a qualitative study of doctors' and parents' views on the risks of childhood food allergyHEALTH EXPECTATIONS, Issue 3 2008Wendy Hu MBBS Dip Paed MHA PhD FRACGP Abstract Objective, To examine the views of doctors which underpin clinical practice variation concerning an uncertain health risk, and the views of parents who had sought advice from these doctors, using the example of childhood food allergy. Study design, Qualitative study involving in-depth interviews and participant observation over 16 months. Focus groups and consultation audio-recordings provided corroborative data. Setting, Three specialist allergy clinics located in one metropolitan area. Participants, Eighteen medical specialists and trainees in allergy, and 85 parents (from 69 families) with food allergic children. Results, Doctors expressed a spectrum of views. The most divergent views were characterized by: scientific scepticism rather than precaution in response to uncertainty; emphasis on quantifiable physical evidence rather than parental histories; professional roles as providers of physical diagnosis and treatment rather than of information and advocacy; libertarian rather than communitarian perspectives on responsibility for risk; and values about allergy as a disease and normal childhood. Parents held a similar, but less divergent range of views. The majority of parents preferred more moderate doctors' views, with 43% (30 of 69) of families expressing their dissatisfaction by seeking another specialist opinion. Many were confused by variation in doctors' opinions, preferring relationships with doctors that recognized their concerns, addressed their information needs, and confirmed that they were managing their child's allergy appropriately. Conclusions, In uncertain clinical situations, parents do not expect absolute certainty from doctors; inflexible certainty may not allow parental preferences to be acknowledged or accommodated, and is associated with the seeking of second opinions. [source] The management of professional roles during boundary work in child welfareINTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 3 2010Christopher Hall Hall C, Slembrouck S, Haigh E, Lee A. The management of professional roles during boundary work in child welfare Int J Soc Welfare 2010: 19: 348,357 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. This article examines the ways in which child welfare professionals negotiate their roles and those of other professionals in home visits with clients, in this case the parents of young children. The concept of boundary work is developed within the context of the professional,client encounter. Drawing on Goffman's concept of ,footing', the analysis examines how professionals attend to ways of constructing family problems in terms of appropriate professional interventions , both from themselves and others. It is argued that the careful consideration of how problems merit interventions displays an adherence to the development of the supportive relations which move beyond strict professional remits. The article adds to the research evidence, which sees inter-professional coordination as a complex matter, located in everyday practice rather than as advocating more tightly monitored procedure. [source] Editorial: Patient experiences, family participation and professional rolesJOURNAL OF CLINICAL NURSING, Issue 2 2008Debra Jackson [source] Forensic nursing education in North America: Social factors influencing educational developmentJOURNAL OF FORENSIC NURSING, Issue 2 2009Arlene E. Kent-Wilkinson RN Abstract In the mid 1990s, some of the first formal forensic nursing educational programs were established. Now more than a decade later, courses exist at educational levels from certificate to doctorate programs, with little educational research having been conducted. This recent study explored forensic nursing knowledge as a specialty area of study and factors influencing educational development. This paper reports on social factors that facilitated and impeded educational development in the forensic nursing specialty from the perspective of forensic nurse educators in North America. Changing attitudes to previously sanctioned professional roles in society provided discussion for implications for forensic nursing practice. [source] Lay food and health worker involvement in community nutrition and dietetics in England: roles, responsibilities and relationship with professionalsJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2008L. A. Kennedy Abstract Background, Community-based food initiatives have developed in recent years with the aim of engaging previously ,hard to reach' groups. Lay workers engaged in community nutrition activities are promoted as a cost-effective mechanism for reaching underserved groups. The main objective of the study was to explore perceptions and definitions of lay food and health worker (LFHW) helping roles within the context of National Health Service (NHS) community nutrition and dietetic services in order to define the conceptual and practical elements of this new role and examine the interface with professional roles. Methods, Interpretive qualitative inquiry; semi-structured interviews with LFHW and NHS professionals employed by community-based programmes, serving ,hard-to-reach' neighbourhoods, across England. A total sampling framework was used to capture all existing and ,fully operational' lay food initiatives in England at the commencement of fieldwork (January 2002). Findings, In total, 29 professionals and 53 LFHWs were interviewed across 15 of the 18 projects identified. Although all 15 projects shared a universal goal, to promote healthy eating, this was achieved through a limited range of approaches, characterized by a narrow, individualistic focus. Lay roles spanned three broad areas: nutrition education; health promotion; and administration and personal development. Narratives from both professionals and LFHWs indicated that the primary role for LFHWs was to encourage dietary change by translating complex messages into credible and culturally appropriate advice. Conclusions, This research confirms the emerging discipline involving lay helping within the NHS and community dietetics. The primary role of LFHWs in the 15 projects involved was to support existing NHS services to promote healthy eating amongst ,hard to reach' communities. The activities undertaken by LFHWs are strongly influenced by professionals and the NHS. Inherent to this is a fairly narrow interpretation of health, resulting in a limited range of practice. [source] Nurse-Midwife and Scientist: Stuck in the Middle?JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2007Aleeca F. Bell The nurse-midwife and scientist share similar ethos (fundamental attitudes that guide action); yet, in their respective professional roles, ethos can translate into actions that appear discordant. Discord can lead to resolution, when examined through the primary principles of ethical conduct: autonomy, beneficence, nonmalfeasance, and justice. JOGNN, 36, 71-73; 2007. DOI: 10.1111/J.1552-6909.2006.00111.x [source] Community psychiatric nursing: focus on effectivenessJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2005G. CUNNINGHAM dphil ba rmn mba General Manager The focus for provision of mental health services is now the community in most developed countries. Different ways of organizing community mental health services are evident in the literature. Community psychiatric nurses (CPNs) have a key role to play in these services but the literature indicates that the CPN role varies from area to area within different models of service provision. This paper presents the findings of a study in which 13 service users and 15 CPNs in five focus groups discussed the effectiveness of mental health service. Selected staff and service users were chosen from a representative range of community mental health services across Northern Ireland. Service users expressed concern at the variety of CPN and other professional roles within multidisciplinary teams and some CPNs expressed dissatisfaction with their role and with role boundaries within teams. These findings suggest that further work is needed within community mental health services to ensure the role of the CPN remains effective and develops to meet the needs of service users. [source] Latest news and product developmentsPRESCRIBER, Issue 2 2007Article first published online: 1 MAR 200 Venlafaxine: same suicide risk Venlafaxine (Efexor) is probably not associated with a higher risk of suicide than citalopram, fluoxetine or dosulepin, even when prescribed for patients at higher risk, according to an analysis of the UK General Practice Research Database (BMJ, doi:10.1136/bmj.39041.445104.BE. Published 12 December 2006). The retrospective cohort study found that venlafaxine was associated with a significantly higher risk of completed and attempted suicide in adults than the other antidepressants but, after adjusting for risk factors, the authors concluded that much, if not all, of the difference could be explained by confounding. Raised glucose with thiazides not clinically significant? A new analysis of the ALLHAT trial suggests that the small increase in blood glucose levels associated with long-term thiazide therapy is not associated with an increased risk of cardiovascular events (Arch Intern Med 2006;166:2191-201). The ALLHAT trial compared cardiovascular outcomes in over 18 000 patients with hypertension who were treated with chlortali- done (Hygroton), amlodipine and lisinopril. After two years, fasting blood glucose had increased in all groups (by 0.47, 0.31 and 0.19mmol per litre respectively); compared with chlortalidone, the odds of developing diabetes were 45 per cent lower with lisinopril and 27 per cent lower with amlodipine. However, there was no significant link between fasting blood glucose levels and cardiovascular events, end-stage renal disease or death; developing diabetes was associated with an increased risk of CHD overall but this was not statistically significant for chlortalidone in particular. Withdrawing alendronate after five years' treatment Discontinuing treatment of osteoporosis with alendronate after five years does not significantly increase fracture risk for many women, a US study has shown (J Am Med Assoc 2006;296:2927-38). In this five-year extension to the Fracture Intervention Trial, 1099 women who had taken alendronate for five years were randomised to continue treatment or switch to placebo for a further five years. In those taking placebo, bone mineral density decreased by 2.4 per cent at the hip and 3.7 per cent in the spine but remained above pre- treatment levels. Continuing with alendronate was associated with a lower risk of clinical vertebral fractures (2.4 vs 5.3 per cent) but no significant reduction in morphometric vertebral fractures (9.8 vs 11.3 per cent respectively). The cumulative risk of nonvertebral fractures was 19 per cent in each group. The authors conclude that women at very high risk of clinical vertebral fractures may benefit from continuing alendronate, but for many discontinuation does not appear to increase fracture risk. Instructions on labels Patients with low levels of literacy are at high risk of not understanding medicines labelling (Ann Intern Med 2006;145:887-94). In 395 English-speaking adults, 71 per cent correctly repeated simple label instructions, but only 35 per cent could demonstrate the correct number of tablets involved. Low literacy levels were associated with a twofold increased risk of misunderstanding labelling. Statins campaign The National Prescribing Centre (NPC) has launched a campaign to increase prescribing of low-cost statins. Resources available from its website at www.npc.co.uk/statins.htm are divided into four categories: policy and guidance, therapeutics, implementation resources and monitoring tools. Formats include documents and case studies, Powerpoint presentations and E-learning workshops. patients feeling rested on waking and daytime functioning. The Z-drugs were also believed to cause fewer adverse effects. GPs believe in ,Z' drugs A survey of GPs in Lincolnshire has revealed that their beliefs about nonbenzodiazepine hypnotics are inconsistent with NICE guidance and published evidence (Br J Gen Pract 2006; 56:964-7). Responders believed that zaleplon (Sonata), zopiclone and zolpidem were superior to benzodiazepines in increasing sleep time, patients feeling rested on waking and daytime functioning. The Z-drugs were also believed to cause fewer adverse effects. The authors note that, while benzodiazepine prescribing is declining, that of the Z-drugs is increasing, and they suggest this may be explained by misplaced beliefs about their relative effectiveness and safety. Pharmacy EHC guidance Pharmacists can supply emergency hormonal contraception (EHC) in advance but should consider when it is clinically appropriate to do so, according to revised guidance from the Royal Pharmaceutical Society. The move follows support for advance supply from the British Pregnancy Advisory Service and Marie Stopes International. Pharmacists are advised to decline repeated requests and recommend contraception instead, and to counsel users on using EHC safely and appropriately. More support from NICE NICE has developed two databases to support implementation of its recommendations. The shared learning database (www.nice.org.uk/ sharedlearning) includes experiences of implementing NICE guidance. The second, known as ERNIE (Evaluation and Review of NICE Implementation Evidence), includes data provided by NICE on uptake of its advice and external information (www.nice.org.uk/ernie). Mental health briefings The DoH (www.dh.gov.uk) has published several briefing documents to explain the main changes to mental health legislation, covering professional roles, criteria for detention and supervised community treatment (SCT). SCT applies to patients with a stable chronic mental disorder who have been discharged from hospital and who, but for their treatment, may pose a risk to themselves or others. Patients remain the responsibility of the mental health team. Copyright © 2007 Wiley Interface Ltd [source] MAKING THE CORE CONTINGENT: PROFESSIONAL AGENCY WORK AND ITS CONSEQUENCES IN UK SOCIAL SERVICESPUBLIC ADMINISTRATION, Issue 2 2008KIM HOQUE In recent times, the UK has witnessed a steady growth in the use of agency workers to fill core professional roles in public sector organizations. Similar trends have been noted elsewhere, particularly in Australia and the US. In this paper our objective is to explore some of the consequences of this growth, drawing on case study research on social services. We point to a number of problems associated with the management of agency workers and to the potentially negative consequences for the quality of services. These problems, in turn, may impact on key aspects of a (largely functional) public service employment model founded on strong internal labour markets, employment stability and collegial ethos. We also note that while there are ways in which public organizations can manage this situation, certain constraints may prevent them from doing so. [source] Shifting the culture of continuing medical education: What needs to happen and why is it so difficult?THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2000Angela Towle PhD Faculty of Medicine Abstract A revolution in health care is occurring as a result of changes in the practice of medicine and in society. These include changing demographics and the pattern of disease; new technologies; changes in health care delivery; increasing consumerism, patient empowerment, and autonomy; an emphasis on effectiveness and efficiency; and changing professional roles. The issues raised by these changes present challenges for the content and delivery of the whole continuum of medical education. The ways in which continuing medical education (CME) needs to respond to these challenges are outlined. The Informed Shared Decision Making (ISDM) Project at the University of British Columbia is used as a case study to illustrate some of the practical problems in providing CME that address these current trends in health care, is effective, and is attractive to physicians. Two particular problems are posed: how to respond to a demonstrated need when there is no perceived need on the part of physicians and how to enable change agents on the margins to develop allies and get ownership from stakeholders and opinion leaders on the inside. Two strategies for change are discussed: the substantive incorporation of CME into the continuum of medical education and the involvement of patients in the planning and delivery of CME. A final challenge is raised for the leaders of CME to define and agree what "shifting the culture of CME" means and to make a commitment of time and energy into making it happen. [source] The Business of Emergency Medicine: A Nonclinical Curriculum Proposal for Emergency Medicine Residency ProgramsACADEMIC EMERGENCY MEDICINE, Issue 9 2009Thomas Falvo DO Abstract Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs. This article proposes the content, educational strategy, and needs assessment for an academic program entitled The Business of Emergency Medicine (BOEM). Developed as an adjunct to the (predominantly) clinical content of traditional emergency medicine (EM) training programs, BOEM is designed to enhance the existing academic curricula with additional learning opportunities by which EM residents can acquire a fundamental understanding of the nonclinical skills of their specialty. [source] Teledermatology in the U.K.: lessons in service innovationBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2007T.L. Finch Summary Background, Teledermatology has the potential to revolutionize the delivery of dermatology services by facilitating access to specialist services at a distance. In the U.K. over the previous decade there have been numerous attempts at introducing and using teledermatology; however, the development of teledermatology as routine service provision remains limited. Objectives, To identify factors that promote successful use of teledermatology as a part of routine service provision. Methods, A longitudinal qualitative study of teledermatology, drawing on data from in-depth semistructured interviews; observations of systems in practice; and public meetings. Data were analysed collectively by the research team using established qualitative analytical techniques to identify key thematic categories. The sample consisted of teledermatology services within the U.K. (n = 12) studied over 8 years (1997,2005). Individual participants (n = 68 interviews) were consultant dermatologists, researchers, teledermatology nurses, administrators, patient advocates, general practitioners and technologists. Results, The analysis compared services that did or did not become part of routine healthcare practice to identify features that supported the normalization of teledermatology. Requirements for using and integrating teledermatology into practice included: political support; perceived benefit and relative commitment that outweighs effort; pragmatic approaches to proving efficacy and safety; perception of risk as being ,manageable' on the basis of professional judgement; high levels of flexibility in practice (in terms of individuals, technology and organization); and reconceptualizing professional roles. Conclusions, Successful implementation of teledermatology as a routine service requires greater understanding of and attention to the interplay between social and technical aspects of teledermatology, and how this is accommodated both by healthcare professionals and the organizations in which they work. [source] Assessment in Clinical Psychology: A Perspective on the Past, Present Challenges, and Future ProspectsCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2006James N. Butcher Assessment emerged during the early twentieth century with the development of tests for assessing characteristics such as intelligence, personality, and suitability for employment. The long, interwoven relationship between clinical psychology and assessment began to change during the 1970s when many clinical psychologists became more involved in behavioral therapy and moved away from psychological testing and with the expanding role of managed care in the mental health services. Clinical assessment broadened into forensic, medical, and personnel applications with psychologists expanding professional roles. The status of assessment was reviewed and some challenges were highlighted. The potential for assessment to contribute to the understanding of mental health problems through collaborative cross-cultural study of psychopathology was suggested with the growing development of clinical psychology internationally. [source] | |||||||||||||||||||||||||||||||