bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preparation for family care‐giving: stroke as a paradigm case
Authors: BRERETON LOUISE 
Published: December 2007

Summary

This article considers the nurse's role in assisting family (informal) carers who adopt their role suddenly, following an acute health crisis. Carers of stroke survivors are used as a ‘paradigm’ case to highlight the challenges faced by family members at the time of hospital discharge.
The needs of family members who suddenly adopt a caring role are poorly understood, but greater awareness is needed as the Carers (Recognition and Services) Act (1995) provides statutory recognition of the rights of such individuals to an assessment of their needs, emphasizing the importance of carers making an informed choice based on a willingness and ability to adopt a care‐giving role.
Evidence suggests that new family carers are currently poorly prepared to take on their role, lacking the information and skills needed to provide good care. Nurses have a major role to play in preparing carers, but currently lack a systematic approach to assessment and intervention.
Further empirical work is required to establish more clearly the needs of new carers and to develop and evaluate appropriate intervention strategies to address their needs.
Admission to care: facilitating role transition amongst family carers
Authors: DELLASEGA CHERYL , NOLAN MIKE 
Published: December 2007

Summary

Admission to care after a period of family care‐giving has been the focus of much recent research.
Rather than being seen as an end in itself, admission is part of a process.
This article concentrates on ‘reaching the end’ of family care‐giving and the ‘new beginning’ of entering residential care.
A cross‐national study conducted in the USA and the UK is discussed, and similarities and differences in the two cultures are highlighted.
Decisions to enter a nursing home were often taken hurriedly and with lack of information in both countries.
Issues of quality of care and emotional responses by former carers were also important in both settings.
Including patient preferences in nurses' assessment of older patients
Authors: RULAND CORNELIA M. , KRESEVIC DENISE , LORENSEN MARGARETHE 
Published: December 2007

Summary

The refinement of a patient assessment tool for older patients, Lorensen's Self‐Care Capability Scale, is described where a systematic elicitation of patient preferences is included in the assessment.
This study tests a decision analytic approach as a strategy for formalizing subjective judgement, which makes it possible to include patients' own values and preferences in planning patient care.
Applying this technique to patient assessment contributes to explicitly tailoring nursing care decisions to desired outcomes as preferred by individual patients.
A shared approach to decision making between nurse and patient ensures a mutual understanding about goals, priorities and patient values through discussion and negotiation.
This pilot study supported the merit of including patient preferences systematically in the assessment of older patients.
The method provides an important decision aid for nurses in planning nursing care in accordance with patients' own values and preferences for care.
Developing clinically valid practice guidelines
Authors: Grimshaw Jeremy , Eccles Martin , Russell Ian 
Published: December 2007

AbstractValid guidelines, when appropriately disseminated and implemented, can lead to changes in clinical practice and improvements in patient outcome. Guidelines are more likely to be valid if they are developed using systematic reviews, national or regional guideline development groups (including representatives of key disciplines) and explicit links between recommenda‐ tions and scientific evidence. This paper discusses the practical implications of adopting this approach for guideline development and the role of peer review of guidelines as another element of the process to ensure validity. Considerable resources are required to develop evidence‐linked guidelines, but this investment can be recouped by relatively small changes in the process or outcome of care. Good leadership and technical support are required for the successful development of clinically valid guidelines, which is dependent upon the small‐group processes of guideline development panels and the translation of evidence into recommendations. Future guideline developers need to gain expertise in these areas. Research priorities are identified.
Clinical guidelines and the law: advice, guidance or regulation?
Authors: Hurwitz Brian 
Published: December 2007

AbstractProliferation of clinical guidelines has given rise to a number of concerns about the status of clinical advisory statements. Are guidelines advisory or mandatory? What regulatory functions do guidelines serve; do they allow clinical discretion a large enough role?Relationships between legislation and guidelines, and the way courts go about determining the legal status of guidelines, are explained. The following questions in the context of the law of negligence are addressed. Do doctors who deviate from guidelines place themselves at increased risk of being found liable in negligence if patients suffer injury as a result? Could compliance with guidelines protect health care workers from liability in such circumstances? What legal responsibility do the developers and issuers of guidelines have if their guidance is found to be faulty?Common law cases featuring clinical guidelines or protocols have been identified from the databaseLexis, which searches the full text of the transcripts and reports of court cases in UK, Commonwealth and United States jurisdictions. Secondary literature, identified from the bibliography of clinical guidelines maintained by the Department of Health Services Research at the University of Aberdeen (assembled fromDHSS‐DATA, Embase, GratefulMed, Medline andSIGLE) has also been consulted.The legal status of a guideline turns on whether its development and application have statutory backing, and whether the guideline embodies clinical practices accepted as proper by a responsible body of doctors. The mandatory effects of guidelines can be gauged, to some extent, by the sanctions that apply in the event of non‐compliance. US courts have ruled that guideline developers can be held liable for faulty guidelines, and that doctors cannot pass off their liability by claiming that adherence to guidelines has corrupted clinical judgement.Protocols and guidelines provide the courts with examples of clinical standards across a wide range of medical practice. As guidelines proliferate, so they will increasingly be used in court. However, adherence to guidelines has not automatically been equated with reasonable practice, and the courts seem unlikely to follow the standards enunciated in clinical guidelines without critically evaluating their authority, flexibility and scope of application.
Getting there from here: evidentiary quandaries of the US outcomes movement
Authors: Tanenbaum S. 
Published: December 2007

AbstractThe US outcomes movement assumes, and sometimes argues, the primacy for medical practice of probabilistic knowledge derived from methodologically rigorous statistical studies. ‘Evidence‐based medicine,’ then, is considered a course of clinical medicine prescribed by such research. Implementation of evidence‐based medicine has recently been uneven in the US, manifesting not only the expected ‘obstacles to implementation’ but several theoretical weaknesses of the applied science model of medical care.Outcomes researchers claim to provide certainty ‐ certainty of what probable, as it turns out ‐ in a world of clinical uncertainty. This paper argues that outcomes research actually exacerbates the inferential uncertainty of practising physicians who would use knowledge for practice. Two quandaries are discussed: whether to privilege rigorous or relevant research, and whether to privilege universal or local knowledge. In each case, the logic of ‘evidence‐based medicine’ is insuffcient to resolve the quandary and would seem to support conflicting resolutions. Recent developments in US health policy are cited as manifestations of these quandaries. Finally, the reader is asked not to disregard the political implications of the outcomes movement.
Central dimensions of clinical practice evaluation: efficiency, appropriateness and effectiveness ‐ I
Authors: O'Neill Declan , Miles Andrew , Polychronls Andreas 
Published: December 2007

AbstractSuccessful audit of clinical practice focuses upon the systematic investigation of key aspects of the everyday work of busy clinicians. We contend that the nature and quality of local clinical practice can be characterized by critical examinations of the effectiveness and appropriateness of practice and the efficiency with which effective, appropriate clinical care is delivered to patients. When such a baseline has been established, it becomes possible to compare and contrast characterized local practice with so‐called ‘evidence‐based’ practice and agree changes aimed at narrowing the discrepancy between the two. The nature of such changes can be described and their implementation into practice studied, with subsequent quantitative measurement and qualitative description of the resulting benefits to patients. A proper understanding of the concepts of efficiency, appropriateness and effectiveness in clinical care is clearly fundamental to the successful design and applications of methodologies aimed at securing measurable improvements in the quality of patient care. In this first of two articles we examine the concepts of efficiency and appropriateness in clinical practice, with particular emphasis on cost‐effectiveness and utilization review. The clinical effectiveness of health care intervention is treated in detail within the second paper, to be published within Volume 2 Number 2 of the Journal of Evaluation in Clinical Practice (Miles et al. 1996f).
Measuring the effects of casemix on outcomes
Authors: Orchard Carol 
Published: December 2007

AbstractParticipation in the measurement of population health and health care outcomes has become an explicit professional duty for doctors, but comparisons are difficult to make because outcomes are conceptually complex and largely qualitative. Observational data, particularly from routine hospital statistics, are useful complements to experimental data provided that their variable quality is taken into account and adjustments are made to minimize bias and confounding and to allow for the effects of differences in casemix, which are problematic because of the nature of severity.
Central dimensions of clinical practice evaluation: efficiency, appropriateness and effectiveness ‐ II
Authors: Miles Andrew , O'Neill Declan , Polychronis Andreas 
Published: December 2007

AbstractThat a treatment selected for a given condition works, or that it works better than alternative treatments, or that it was selected because it works as well as but is cheaper than alternative treatments, should be of pivotal concern to clinicians and is of central concern to patients and to health care managers. Attempts to address these concerns have resulted in what is now widely termed the ‘effectiveness movement’. The protagonists of the movement have been concerned to create a culture of evaluation and inquiry within which the formulation of evidence‐based clinical guidelines and their introduction into routine practice have played a prominent part. The need to ensure cost effectiveness of clinical intervention has been at least as emphasized as the need to ensure the clinical effectiveness of health care interventions. Although cost‐effectiveness analyses are now an indispensable feature of practice guideline formulation and treatment evaluation, few studies have examined any deterioration in patient outcome associated with successful cost containment. An adequate understanding of the concept of clinical effectiveness and the associated aims of the ‘effectiveness movement’ is central to an understanding of the future nature and extent of health service provision, not simply in the UK but also internationally. Having examined the concepts of efficiency and appropriateness previously (O'Neill, Miles & Polychronis 1996, Journal of Evaluation in Clinical Practice 2, 13–27) we move in this second of two articles to a detailed explanation of the concept of effectiveness, and to an examination of the derivation and use of clinical practice guidelines, concluding with a consideration of the role of practice guidelines in ensuring the cost effectiveness of health care intervention. The reservation is expressed that a ‘guidelines culture’, when established, will be manipulated by health care commissioners for largely political purposes, creating a systematic bias in the purchasing process that will actively disadvantage a range of patient groups.
Some methodological issues in the development of quality of life measures for the evaluation of medical interventions*
Authors: Kessler Ronald C. , Mroczek Daniel K. 
Published: December 2007

AbstractThis paper discusses a series of important methodological issues in developing targeted health‐related quality of life measures in studies of the effects of medical interventions. Such measures cannot be developed unless the evaluator understands the life domains that medical interventions affect. Qualitative discovery methods are needed to obtain this understanding. Once domains are targeted for measurement, careful and systematic laboratory pilot work should be used to select initial scale items. Psychometric evaluation of response patterns in subsequent field tests is needed to assess the measures. Less concern should be directed to internal consistency reliability of scales in the psychometric evaluation and more to the ability of short scales to reproduce total scale variance and to provide precise measurement within the range of the outcome where effects are expected. The paper closes with a discussion of modern methods of item response scaling that can be used to address these issues.
The involvement of pharmacists in professional and clinical audit in the UK: a review and assessment of their potential role
Authors: Panton Rhona , Fitzpatrick Raymond 
Published: December 2007

AbstractThis review addresses the uptake and implementation of the principles of audit by community, hospital and health authority pharmacists. The pressures to audit professional services are discussed, as are the barriers to cooperation among pharmacists and between pharmacists and prescribes in primary care. The development of standards of professional practice is then described taking into account the particular difficulty in developing standards for health care workers who are geographically separated from other members of the primary care team and are in commercial competition with each other. The review identifies audit of professional services in both community and hospital pharmacy and of clinical services in the latter. The role of pharmacists employed by health authorities to advise them and general practitioners on the optimum use of the drug budget is described and their potential role for involvement in audit is discussed. The particular advantages that pharmacists in hospital and health authorities have in developing the specific aspect of clinical audit related to medicines usage (drug utilization review) is then described. The potential for pharmacists to contribute to clinical and management audit is discussed.
Overview and critique of judgement and decision making in health care: social and procedural dimensions
Authors: Chase Jonathan , Crow Rosemary A. , Lamond Dawn 
Published: December 2007

AbstractThis paper presents an outline of the scope for the application of decision theory to health care. Firstly, the main approaches to and assumptions of decision theory are discussed. Secondly, health care decision making is reviewed. It is noted that decision theory can be applied to either the health care professional or to the lay person. Applications of decision theory to clinical practice, to the management of care and to resourcing are considered. Thirdly, some areas which would repay further research are identified. These include social processes in individual and group decision making, the temporal distribution of outcomes and the development of techniques capable of dealing with the complex and dynamic features of decisions. On the basis of the foregoing, some conclusions are drawn.
The progress of lay involvement in the NHS Research and Development programme
Authors: Oliver S. 
Published: December 2007

AbstractThe Central Research and Development Committee is seeking to involve lay perspectives in the NHS R&D Programme. This paper describes some recent examples of lay involvement in each step of the research process from setting the agenda to making use of research findings. Innovative approaches have involved lay people in identifying research need and in the subsequent commissioning process. Lay contributions have given particular emphasis to information and support, whether this is in maternity care, cancer care, HIV prevention, participation in clinical trials or systematically reviewing evidence of effectiveness. Difficulties in identifying appropriate lay people to involve in research, their different skills, their lack of resources and support and their need for time for thought and discussion with their peers have all posed problems. Suggestions for overcoming some of these obstacles are presented, including resources, training and support, and clarification of the role, nature and potential for lay involvement. Lastly this paper considers the urgent need to learn from the efforts made so far, possible approaches to evaluation and how this is being addressed by a newly convened advisory group to the Central R&D Committee.
Clinical guidelines: ways ahead
Authors: MRCGP C.W.R. Onion MD , FRCP T. Walley MD 
Published: December 2007

AbstractClinical guidelines are essential in promoting the implementation of evidence‐based practice within the NHS. But there are two broad schools of thought about their development and implementation: the first argues that guidelines should be entirely evidence‐based and tolerates a degree of complexity which may make the guideline impractical; the second argues that we need simple guidelines, and sacrifices the strength of evidence in favour of ease of application and dissemination. Both arguments have merits and flaws, which are discussed, and ways to integrate the strengths of both are considered.
Autism and epilepsy (and tuberous sclerosis?) in two pre‐adolescent boys: neuropsychiatric aspects before and after epilepsy surgery
Authors: Gillberg C. , Uvebrant P. , Carlsson G. , Hedström A. , Silfvenius H. 
Published: December 2007

AbstractWe report on two pre‐adolescent boys with a combination of severe seizure disorders and severe‐moderate autism who underwent brain surgery for their epilepsy at the ages of 9 and 10 years, respectively. Both boys became seizure‐free and initially improved dramatically with regard to autism symptoms. One of the boys continued to improve, but the other had a relapse to his pre‐operative state in conjunction with his pubertal grovirth spurt. Several years after surgery, one of the boys remained much improved with respect to his autism. The other subject showed some improvement with respect to self‐injury and aggression, and had slightly lower scores on screens for autism symptoms than in the year preceding epilepsy surgery. The histopathological examination of the brain tissue that was removed at surgery suggested a diagnosis of tuberous sclerosis in both cases.
Methods of transmission of hepatitis C
Authors: Tibbs C. J. 
Published: December 2007

Summary. The route of transmission of hepatitis C virus is still controversial. Parenteral exposure via blood or blood products leads to infection in the majority of cases, and the majority of intravenous drug users become infected by repetitive exposure to contaminated injection equipment. The risk of infection from a single need lipstick injury is 5–15% and may depend on the size of the innoculum. Other parenteral routes of transmission may include traditional healing practices and the use of contaminated medical equipment.Transmission is less common within a family but the prevalence of hepatitis C viral antibodies is higher in family members and sexual partners of carriers than in the general population. There are some well‐documented instances of acute hepatitis C occurring after a defined sexual exposure. Vertical transmission is rare unless the mother has high levels of circulating HCV RNA as may occur in those also infected with HIV. The detection of hepatitis C in saliva and the higher than expected prevalence of infection in dentists may point to the possibility of transmission by salivary contamination. There remain large numbers of hepatitis C carriers in whom no route of infection can be identified.
A high prevalence of antibodies to hepatitis C virus among commercial plasma donors from Western India
Authors: Jha J. , Banerjee K. , Arankalle V. A. 
Published: December 2007

Summary. A very high prevalence of anti‐hepatic C virus (anti‐HCV) antibodies (63/73, 86.3%) was noted among commercial plasma donors of an organization manufacturing blood products, studied in 1989. Retrospective serological analysis of these donors revealed continued high prevalence of anti‐HCV, i.e. 35/40 (87.5%) in 1988, 28/31 (90.3%) in 1987 and 86/94 (91.4%) in 1986. HCV RNA detection by polymerase chain reaction (PCR) demonstrated 15/33 (45.45%) plasma donors to be positive in 1989.Interestingly, 3/24 (12.5%) serum samples collected from employees of the organization were also anti‐HCV positive. All three anti‐HCV positive employees were directly associated with plasmapheresis. Of the three anti‐HCV positive employees one had been anti‐HCV positive since 1985, but the other two employees were negative during 1985–1987 and then became positive in 1987 and remained positive in 1989. One of these two employees was also a plasma donor.Commercial blood donors from a local blood bank had anti‐HCV prevalence of 13% which was significantly lower (P < 0.001) when compared with plasma donors of the organization and significantly higher than volunteer blood donors (<0.25%, P < 0.01).