The care programme approach: a patient perspective

This study explores the attitudes and experiences of one group of patients on the care programme approach living in an outer London borough. There was evidence to suggest that patients were unfamiliar with their treatment programmes and lacked knowledge regarding their care. Further research into patient attitudes to the CPA would be beneficial, since it was not possible to make precise conclusions based on this study.     

The care programme approach: a nursing perspective

As the role of the Acute Care Nurse Practitioner (ACNP) gains more recognition, ACNPs as well as prospective employers are eager to incorporate the position into a practice setting. Because the role is in its infancy, there has been limited experience from which to draw on to provide guidance in ACNP role implementation within a practice, either private or institutional. This article will provide foundational information and strategies on how to integrate the ACNP role into a practice setting. These strategies will be useful to not only the ACNP, but also nurse administrators, case managers, clinical nurse specialists, and nurse educators in acute and critical care who are responsible for seeking innovative ways to maintain seamless quality and cost-effective patient care.     

Hospital vs community care: a Romanian perspective

In the Summer of 1997, two Romanian charities which provide financial support to care for children with human immunodeficiency virus (HIV) living in Romania invited a team of healthcare professionals to conduct an independent audit of care for children nursed in hospital and community settings. The primary objective of the mission was to: witness hospital and community care of HIV positive children; work with Romanian healthcare professionals in the development of a simple user friendly audit tool for use in a variety of child care settings; and utilize the tool to audit and produce a written report related to care provision in the hospital and community home setting. The results of the audit exercise demonstrate that the provision of care for HIV positive children in the community homes exceeds that of similar children cared for in a tertiary hospital setting.     

Ethics in reproductive health care: a midwifery perspective

To monitor personal exposure to biologically effective solar-UV radiation, Bacillus subtilis spores on a membrane filter and UV-coloring labels were incorporated into a monitoring badge. The samples were covered with one of three types of filter sheet, dependent on the season, to reduce the amounts of exposure to measurable levels. Five fifth- or sixth-grade classes of primary schools, each consisting of 30-40 children, were chosen in northern (Sapporo), central (Tsukuba and Tokyo), and southern (Miyazaki and Naha) cities in Japan. In all four season, each child wore a badge on an upper arm for the entire waking hours, changing it daily, for a week. Upon collection of the badges, the survival of spores and the extent of coloration of the label were determined. The results were used to estimate the amount of daily exposure to biologically effective UV radiation, expressed as the value of spore inactivation dose. Unexpectedly, the average amounts of exposure were not directly correlated with the outdoor UV irradiance: in the two southern cities, despite high outdoor irradiance from spring to autumn, the average amounts of exposure were less than 3.1% of the average irradiance. Highly concentrated exposures occurred in two central cities on three days when extensive outdoor exercise took place. These results contradict the simple notion that children's exposure is in proportion to the outdoor UV irradiance, and support the view that the extent of solar-UV exposure is primarily determined by life-style rather than living location.     

Competing ideologies in health care: a personal perspective

With the introduction of general management and then of planned markets into the National Health Service (NHS), health care in the UK has gone through a massive amount of change. The effect on those working for the NHS has been 'challenging' and often confusing. This paper aims to clarify what is happening by taking an ideological perspective: what ideologies exist, how they are changing and the strategies being used to ensure their survival. Ideologies are basically about power. The relationship between market, managerial and professional ideologies is analysed using charters, codes of conduct and other associated documents. A tentative conclusion is reached that professional ideologies are able to adjust to the overriding market/consumerist ideology. However, the managerial ideology is having difficulty in gaining any real ground against the professional ideology and is having to move strategically by using audit, not just of finance, but also of clinical judgement, to gain power.     

Concept of emotion viewed from a prototype perspective.

Reports 7 studies that explored the possibility that the concept of emotion is better understood from a prototype perspective than from a classical one. Specifically it is argued that membership in the concept of emotion is a matter of degree rather than all-or-none (that the concept has an internal structure) and that no sharp boundary separates members from nonmembers (that the concept has fuzzy boundaries). Undergraduates served as Ss in all experiments. As hypothesized, the concept of emotion was found to have an internal structure: Happiness, love, anger, fear, awe, respect, envy, and other types of emotion could be reliably ordered from better to poorer examples of emotion. In turn, an emotion's goodness of example (prototypicality) ranking predicted how readily it comes to mind when one is asked to list emotions, how likely it is to be labeled as an emotion when one is asked what sort of thing it is, how readily it can be substituted for the word emotion in sentences without their sounding unnatural, and the degree to which it resembles other emotion categories in terms of shared features. (54 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care in the new Russia: a western perspective

OBJECTIVE: To evaluate the growth and insulin secretion from microencapsulated beta TC6-F7 cells in vitro and to assess the in vivo function of microencapsulated cells transplanted in rats with steptozotocin (STZ)-induced diabetes. METHOD: Alginate-poly-L-lysine encapsulated beta TC6-F7 cells were exposed to glucose, isobutylmethylxanthine (IBMX) and glucagon-like peptide I (7-36 amide) in a static in vitro challenge. In vivo, 2.5-3.5 x 10(7) encapsulated cells were implanted into diabetic rats. Graft function was evaluated by monitoring blood glucose concentrations and by an intraperitoneal glucose tolerance test. RESULTS: The cell density (number of cells per capsule) of cultured microencapsulated beta TC6-F7 cells increased almost 35-fold over a 55 day observation period to reach a plateau of approximately 3500 cells/capsule. While insulin secretion per capsule remained unchanged over the first 21 days of culture, a 7-fold increase was observed during the last 14 days of the 55 day observation period. Intraperitoneal transplantation of 3.5 x 10(7) encapsulated cells into diabetic rats resulted, within 24 hours, in reversal of hyperglycemia for up to 60 days. Post-transplantation blood glucose concentrations varied between 2 and 4 mM. Glucose clearance rates evaluated by an intraperitoneal glucose tolerance test at 30 days post-transplantation resulted in a markedly flat glucose clearance curve with blood glucose never rising above 4 mM. The glucose challenge of microencapsulated cells recovered 30 days post-transplantation resulted in a 2-fold increase in insulin response at glucose concentrations greater than 5.5 mM as compared to glucose-free media. In addition, immunostaining of recovered grafted tissue for insulin, reveals a strong presence of the peptide within the cell population. CONCLUSIONS: These data demonstrate the potential use of an immunoisolated beta-cell line for the treatment of diabetes.     

Influencing the rising costs of health care: a staff nurse's perspective

In the current atmosphere of rising health costs and increasing hospital expenditures, nurses must take an active role in seeking solutions to these problems. The staff nurse can positively influence the events that occur when a person is admitted into the hospital and can play a major role in the functioning of the organization as a whole, which in turn affects the larger domains of society.     

Autonomy and its implications for palliative care: a northern European perspective

The aim of this work was to analyze the use of some renographic parameters derived from the 99mTc-MAG3 renogram to classify post-transplantion studies in two groups: Normal functioning grafts (NFG) and delayed grafts function (DGF) which included Acute Tubular Necrosis (ATN) and Acute Rejection (AR). The analysis included data from 38 NFG, 33 ATN and 23 AR. The parameters calculated were: mean transit time (MTT), the Initial Uptake (IU) and the maximum activity (MA) of the renogram. The results obtained from this analysis show that ln(IU) is the best parameter to classify individuals in either group and that the use of MA or the MTT does not improve the results. Using a cutoff point of ln(IU) = 0.28 and a prevalence of 25% for DGF, the estimated predictive values were 92% for DGF and 99% for NFG.     

Social work with transport disabled persons: a wayfinding perspective in health care

Transport disabled persons confront extensive architectural and psychosocial barriers during their travel to community based health care services by mass transit. The current health care reform movement affords social work an opportunity to consolidate its expertise with this population. The Certificate of Need program is a method with which social work can provide service to people with transportation disabilities. Social work can also continue its use of the Americans with Disabilities Act and the Urban Mass Transportation Act to assist people with transport disabilities to access community based health care services.     

Somatization in cross-cultural perspective: a World Health Organization study in primary care

OBJECTIVE: The purpose of this study was to examine the phenomenon of somatization in different cultures by determining its frequency and correlates in primary care settings in 14 countries. METHOD: Consecutive primary care patients (N = 25,916) were screened with the 12-item General Health questionnaire, and a stratified sample (N = 5,438) was interviewed with the Composite International Diagnostic Interview. Interviewed patients were also assessed for physical disease burden, self-rated overall health, physician-rated physical health status, number of disability days, and interviewer-rated occupational role functioning. The authors determined center-specific associations with the use of logistic regression analyses in which confounding variables were controlled. RESULTS: ICD-10 defined somatization disorder was relatively uncommon in most primary care settings. A less restrictively defined form was more common. Symptom rates were much higher in South American sites. There was a modest association with low education. Otherwise, frequency of unexplained somatic symptoms did not clearly vary according to geography or level of economic development. Somatizing patients were at elevated risk for self-reported disease burden, negative perception of their health, and comorbid depression and generalized anxiety disorder. Somatization was also commonly associated with disability. Cultures did not differ markedly in the pattern of these associated features. CONCLUSION: Somatization is a common problem in primary care across cultures and is associated with significant problems and disability.