The Phil Hearne course: an evaluation of a multidisciplinary mental health education programme for clinical practitioners

A description and evaluation of the pilot of a 30-week multidisciplinary mental health education programme (The Phil Hearne Course) is presented. The course was based upon the expressed service needs of an NHS Trust and upon the needs of users consulted during the developmental phase of the project. The course was designed to provide core skills, relating to effective assessment, communication, intervention and networking. These skills were thought to be applicable to all mental health disciplines. The course was evaluated positively by students and staff and was found to be effective in improving practice by providing a range of core skills for mental health workers. It was also determined that students tended to over-estimate their skills in core areas, particularly care planning and record-keeping. It is intended to develop the course into a distance learning, skills-based package.

Sociodemography of genital Chlamydia trachomatis in Coventry, UK, 1992-6

OBJECTIVE

To describe the sociodemographic and geographic risk factors for incident Chlamydia trachomatis genital infection.

DESIGN

Cross sectional retrospective study of cases diagnosed in local genitourinary clinics.

SETTING

Coventry, West Midlands, from 1992 to 1996.

SUBJECTS

582 female and 620 male Coventry residents aged 15-64 years diagnosed with one or more episodes of genital Chlamydia trachomatis infection by enzyme immunoassay. Subjects were assigned a Townsend deprivation score based on residence. The denominator population aged 15-64 years was derived from 1991 census data.

RESULTS

The mean annual incidence of genital chlamydia was 151 episodes (95% CI 140-163) per 100,000 population in men and 138 episodes (95% CI 128-149) per 100,000 population in women. Highest subgroup incidence was observed in 15-19 year old black women (2367 (95% CI 1370-4560) per 100,000), and 20-24 year old black men (1951 (95% CI 1158-3220) per 100,000). In univariate analyses, the most important risk factor for chlamydia infection in males was being black (incidence 1377 (95% CI 1137-1652) per 100,000 for black v 133 (95% CI 122-145) per 100,000 for white; RR 10.4, p < 0.0001) and for women was young age (incidence 475 (95% CI 415-540) per 100,000 for age group 15-19 years v 52 (95% CI 45-60) per 100,000 for age group 25-64 years; RR 9.1, p < 0.0001). In Poisson regression models of first episodes of genital chlamydia, for both males and females the effect of ethnic group could not be fully explained by socioeconomic confounding. There were significant interactions between age and ethnic group for both sexes and between age and level of deprivation for men. Geographical analysis revealed a high incidence of genital chlamydia in estates on the edge of the city as well as the urban core.

CONCLUSIONS

There is a complex interaction between geographical location, age, ethnic group, and social deprivation on the risk of acquiring genital Chlamydia trachomatis in Coventry. Better population based data are needed.

From chaos to complex order: personal values and resources in the process of psychotherapy

TOPIC

Chaos as a scientific metaphor for the therapeutic relationship.

PURPOSE

To provide an approach to psychotherapy of a psychotic experience through aspects of a single case.

SOURCES

Selective literature review and author's clinical work.

CONCLUSIONS

Appreciation of the water metaphor, and its deployment within Eastern philosophy and psychology, may help Western therapists develop further traditional interpersonal relations today.

Trans-axillary first rib excision for thoracic outlet syndrome

AIM

Thoracic outlet syndrome (TOS) is a clinical diagnosis treatable by excision of the first rib. This study was undertaken to assess the alleviation of symptoms following trans-axillary rib excision in patients with a diagnosis of TOS suggested by a positive Elevated Arm Stress Test and, by inference, to estimate the prevalence of the syndrome.

METHOD

A retrospective review of trans-axillary first rib excision was performed. No referrals were accepted from outwith the catchment area of our hospital. Post-operative symptomatic improvement was accepted as a confirmation of correct pre-operative diagnosis.

RESULTS

Over six years, 52 rib resections were performed in 46 patients, mean age (+/- S.D.) 38.8 (+/- 10.6) years. The indications for surgery were principally neurological symptoms (n = 42 excisions), arterial compromise (n = 5) and venous compromise (n = 5). Symptoms had been present for a mean of 15.8 months prior to surgery. The median follow-up after surgery was 33 months. 42 patients (48 resections) showed immediate improvement in symptoms following surgery, although symptoms recurred in three patients (4 resections) between 6 and 8 months post-operatively. In the final two years of this study, 20 resections resulting in symptomatic improvement were performed, suggesting a prevalence for TOS of at least 10 per 100,000 per year.

CONCLUSIONS

Thoracic outlet decompression was performed more frequently in this series than many previous reports, suggesting that TOS may be under-diagnosed.

Children with congenital pulmonary lymphangiectasia: after infancy

OBJECTIVE

The objective of this original report is to describe the characteristic chest imaging findings in children with primary congenital pulmonary lymphangiectasia who survive infancy.

CONCLUSION

In children with primary congenital pulmonary lymphangiectasia, increased interstitial markings decrease over time and increased hyperinflation is associated with persistent patchy areas of ground-glass opacity.

Ganglion of the hip joint--we present a logical approach to the exploration of a mass in the femoral triangle

Hip joint ganglion is a rare cause of a mass in the femoral triangle. Our patient presented with a swelling in the groin and a history of femoral hernia repair 5 years previously. Pre-operative assessment with ultrasound suggested a possible femoral artery aneurysm. We propose that safe exploration of a mass closely related to the femoral vessels must include vascular control.

What are psychiatric nurses needed for? Developing a theory of essential nursing practice

Contemporary developments in health care have encouraged a review of the professional status of psychiatric nursing. However, little study has been made, to date, of the discrete 'need' for psychiatric nursing within a multidisciplinary service. Employing an adapted grounded theory methodology, substantive theory was developed concerning the expressed need for psychiatric nursing, by patients, their carers and mental health professionals, based on six sites from England, Eire and Northern Ireland. The study found some consensus across both recipients and providers of mental health care, that the essential feature of nursing (the core category) involved a complex of relationships: 'knowing you--knowing me'. Within that complex, nurses either elected, or were required, to move--or 'toggle'--between three discrete domains of relating: the Ordinary Me (OM); the Pseudo-ordinary or Engineered Me (POEM); and the Professional Me (PM). Four internal dimensions involving the nurses' depth of knowing, power, use of time and use of translation, distinguished these domains. The emergent theory is discussed within the context of the emergent growth in user (consumer) influence and health care technology.

Pulmonary epithelial sodium-channel dysfunction and excess airway liquid in pseudohypoaldosteronism

BACKGROUND

Active sodium absorption is the dominant mechanism of ion transport in airway epithelium, but its role in pulmonary physiology and airway host defense is unknown. To address this question, we studied the function of airway epithelial cells and determined the frequency of pulmonary symptoms in patients with systemic pseudohypoaldosteronism, a salt-losing disorder caused by loss-of-function mutations in the genes for the epithelial sodium channel.

METHODS

In nine patients 1.5 to 22 years of age who had systemic pseudohypoaldosteronism, we tested for mutations in the genes for the epithelial sodium channel, estimated the rate of sodium transport in the airway, determined the volume and ion composition of airway surface liquid, reviewed clinical features, collected laboratory data pertinent to pulmonary function, and, in three adults, measured mucociliary clearance.

RESULTS

The patients with systemic pseudohypoaldosteronism had loss-of-function mutations in the genes for the epithelial sodium-channel subunits, no sodium absorption from airway surfaces, and a volume of airway surface liquid that was more than twice the normal value. The mean (+/-SE) mucociliary transport rate was higher in the 3 adult patients than in 12 normal subjects (2.0+/-0.7 vs. 0.5+/-0.3 percent per minute, P=0.009). Young patients (those five years of age or less) all had recurrent episodes of chest congestion, coughing, and wheezing, but no airway infections with Staphylococcus aureus or Pseudomonas aeruginosa. Older patients (those more than five years of age) had less frequent respiratory symptoms.

CONCLUSIONS

Patients with systemic pseudohypoaldosteronism fail to absorb liquid from airway surfaces; the result is an increased volume of liquid in the airways. These results demonstrate that sodium transport has a role in regulating the volume of liquid on airway surfaces.

Prevalence of sexual and drug-related HIV risk behaviors in the U.S. adult population: results of the 1996 National Household Survey on Drug Abuse

CONTEXT

Data on the prevalence of HIV risk behavior that are representative of the general population are needed to help evaluate the effectiveness of prevention programs.

OBJECTIVE

To use data from a large national interview survey to make estimates of the prevalence of sexual and drug-related HIV risk behaviors in the adult population of the United States.

DESIGN

Nationally representative cross-sectional survey with in-person interviews collecting information on drug use and sexual behavior.

SETTING AND PARTICIPANTS

12,381 U.S. adults aged between 18 and 59 who were respondents to the 1996 National Household Survey on Drug Abuse, as part of sample of the noninstitutionalized population. Interviews took place in respondents homes using face-to-face interviewer-administered and self-administered questionnaires.

RESULTS

In total, 2.8% of respondents were classified as having increased risk for HIV through sexual behavior; this represents 3.9 million persons. 1.7% reported some degree of risk through drug-related behaviors, representing 1.2 million persons. 3.5% of adults (5 million persons) were found to have some degree of HIV risk from sexual or drug-related behavior. Persons who were at risk through drug behavior were much more likely than others to be at risk through sexual behavior. Condom use was not related to HIV risk, although having a recent HIV test was found to be. Among those who reported some behaviors that placed them at increased risk for HIV infection, only 22% used a condom the last time they had sex with a regular partner.

CONCLUSIONS

The high rate of sexual risk behavior on the part of drug users suggests increasing condom use for this group should be a priority goal for programs, especially condom use with main partners. Survey work needs to be continued and improved to make it possible to assess the impact of successful local prevention efforts on national rates of HIV risk behavior.

Gastrointestinal haemorrhage after abdominal aortic grafting

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The need for psychiatric nursing: towards a multidimensional theory of caring

Contemporary developments in health care have encouraged a review of the professional status of psychiatric nursing. Although research has documented psychiatric nursing activity, little study has been made of the 'need' for psychiatric nursing within a multidisciplinary service. Employing adapted grounded theory methodology, substantive theory was developed concerning the expressed need for psychiatric nursing, by patients, their carers and mental health professionals. The study was based on six sites from England, Eire and Northern Ireland. The study found some consensus across both recipients and providers of mental health care, that the essential feature of nursing (the core category) involved a complex of relationships: 'knowing you, knowing me'. Within that complex, nurses either elected, or were required, to move--or 'toggle'--between three discrete domains of relating: the Ordinary Me (OM); the Pseudo-ordinary or Engineered Me (POEM); and the Professional Me (PM). Four internal dimensions involving the nurses' depth of knowing, power, use of time and use of translation distinguished these domains. The emergent theory extends current awareness of the importance of interpersonal relations in nursing. To what extent current health care policy, which emphasizes the promotion of alternative roles for nurses, will challenge this essential focus remains unclear.

The use of GAFchromic film to determine the absolute activity of beta emitters

A method of using GAFchromic film to determine the absolute activity of beta emitters by immersing the film in a bath of activity is described. This includes calculations of the effect of part of the radioactive solution being displaced by the film that is performing the measurement. Calculations have been performed for 90Y, 32P and 188Re. It is shown that for the film used in this study, this effect will cause a correction of the order of 15-20% for the three radionuclides studied. The results of the GAFchromic film measurement are compared with results obtained from liquid scintillation counting and from a commercial dose calibrator. It is shown that for 32P all methods were in reasonable agreement, but for 188Re, although the GAFchromic film and the liquid scintillation counting methods give similar results, the dose calibrator measurement differed by more than 20%. The GAFchromic film was also used to perform a direct measurement of the radiation dose at a distance of 0.5 mm from the surface of a cylindrical source of 188Re activity. This gave good agreement with the value of the dose predicted from theoretical calculations.

Condom use and HIV risk behaviors among U.S. adults: data from a national survey

CONTEXT

How much condom use among U.S. adults varies by type of partner or by risk behavior is unclear. Knowledge of such differentials would aid in evaluating the progress being made toward goals for levels of condom use as part of the Healthy People 2000 initiative.

METHODS

Data were analyzed from the 1996 National Household Survey of Drug Abuse, an annual household-based probability sample of the noninstitutionalized population aged 12 and older that measures the use of illicit drugs, alcohol and tobacco. The personal behaviors module included 25 questions covering sexual activity in the past year, frequency of condom use in the past year, circumstances of the last sexual encounter and HIV testing.

RESULTS

Sixty-two percent of adults reported using a condom at last intercourse outside of an ongoing relationship, while only 19% reported using condoms when the most recent intercourse occurred within a steady relationship. Within ongoing relationships, condom use was highest among respondents who were younger, black, of lower income and from large metropolitan areas. Forty percent of unmarried adults used a condom at last sex, compared with the health objective of 50% for the year 2000. Forty percent of injecting drug users used condoms at last intercourse, compared with the 60% condom use objective for high-risk individuals. Significantly, persons at increased risk for HIV because of their sexual behavior or drug use were not more likely to use condoms than were persons not at increased risk; only 22% used condoms during last intercourse within an ongoing relationship.

CONCLUSIONS

Substantial progress has been made toward national goals for increasing condom use. The rates of condom use by individuals at high risk of HIV need to be increased, however, particularly condom use with a steady partner.

A MAP kinase is activated late in plant mitosis and becomes localized to the plane of cell division

In eukaryotes, mitogen-activated protein kinases (MAPKs) are part of signaling modules that transmit diverse stimuli, such as mitogens, developmental cues, or various stresses. Here, we report a novel alfalfa MAPK, Medicago MAP kinase 3 (MMK3). Using an MMK3-specific antibody, we detected the MMK3 protein and its associated activity only in dividing cells. The MMK3 protein could be found during all stages of the cell cycle, but its protein kinase activity was transient in mitosis and correlated with the timing of phragmoplast formation. Depolymerization of microtubules by short treatments with the drug amiprophosmethyl during anaphase and telophase abolished MMK3 activity, indicating that intact microtubules are required for MMK3 activation. During anaphase, MMK3 was found to be concentrated in between the segregating chromosomes; later, it localized at the midplane of cell division in the phragmoplast. As the phragmoplast microtubules were redistributed from the center to the periphery during telophase, MMK3 still localized to the whole plane of division; thus, phragmoplast microtubules are not required to keep MMK3 at this location. Together, these data strongly support a role for MMK3 in the regulation of plant cytokinesis.

Regionalization of health services in Canada: a critical perspective

Since the introduction of universal health insurance in Canada in the late 1960s, the federal and provincial governments have been concerned with cost savings, efficiency of service delivery, equity in service provision, enhanced citizen participation, and increased accountability of decision-makers. A plethora of government royal commissions and task forces have recommended a similar range of options for addressing these concerns. Central to the reforms has been a proposed regionalized health system with an intermediary body responsible for functions previously assigned to local or central structures. For its supporters, regionalization offers a means of better coordinating and integrating health care delivery and controlling expenditures, and promises a more effective provision of services and an avenue for citizen participation in health care decision-making. All provincial governments except Ontario have introduced regional structures for health care, with the hope that these changes will increase efficiency, equity, and responsiveness. However, despite the alleged benefits, regionalization presents significant challenges. It faces obstacles to integrating and coordinating services in a manner that produces economies of scale; it requires an enhanced level of information that may be difficult to achieve; it is unlikely to involve citizens in health care decision-making; and it may actually lead to increased costs.

The future of the theory of interpersonal relations? A personal reflection on Peplau's legacy

The work of Hildegard Peplau represents the most significant influence, worldwide, on the development of psychiatric nursing practice. Her use of the Theory of Interpersonal Relations created the basis for defining the potential significance of the psychiatric nurse's role as a therapeutic agent. Forty years later she has indicated the means by which nurses might sharpen their focus on the person often overshadowed by the 'patient' label. Peplau's writings have, over this 40-year period, helped clarify the broad range of roles required of the nurse in general and in particular, within psychotherapeutic nursing.

Solution-focused therapies

This is the final part of the psychotherapy series, which has offered an overview and insight into some of the major talking therapies used by nurses. This series and extended material is being drawn together by Nursing Times and Phil Barker for a book on talking therapies. Previous topics covered in the series were: Psychodynamic psychotherapy, January 14 Humanistic therapies, February 11 Behavioural therapies, March 11 Family and systemic therapies, April 8.

Creativity and psychic distress in artists, writers and scientists: implications for emergent models of psychiatric nursing practice

Many of the great discoveries and developments in the sciences and the arts were made by people who were 'mentally different'. Some such pioneers or innovators had experiences that were indistinguishable from the phenomena defined as mental illness (or madness). It has been argued that such experiences are a necessary constituent of the creative process, and that this may apply to the sciences as much as to the arts. Increasingly, scientists propose a means by which it may be possible to identify (and eliminate) the factors that influence the altered states associated with mental illness. This may be an appropriate time to review the cultural and social significance of all forms of 'madness', especially in the light of emerging models of psychiatric nursing practice.

Role of human neurobehavioural tests in regulatory activity on chemicals

Psychological performance tests have been used since the mid-1960s in occupational and environmental health toxicology. The interpretation of significantly different test scores in neurobehavioural studies is not straightforward in the regulation of chemicals. This paper sets out some issues which emerged from discussions at an international workshop, organised by the United Kingdom Health and Safety Executive (HSE), to discuss differences in interpretation of human neurobehavioural test data in regulatory risk assessments. The difficulties encountered by regulators confronted with neurobehavioural studies seem to be twofold; some studies lack scientific rigor; other studies, although scientifically sound, are problematic because it is not clear what interpretation to place on the results. Issues relating to each of these points are discussed. Next, scenarios within which to consider the outcomes of neurobehavioural studies are presented. Finally, conclusions and recommendations for further work are put forward.

Perceptions of the psychiatric nurse's role: a pilot study

In this article, the authors report on a face-to-face survey of members of the public regarding the role of psychiatric nurses. One open-ended question was asked of 100 pedestrians in a city centre. The resulting data were analysed and then validated by a panel of senior psychiatric nurses. The researchers found a generally positive perception of the role, certainly in relation to the esteem in which nurses continue to be held, but detected that the stigma of mental illness still surrounds those who have to come in contact with mental health professionals. The researchers believe mental health nurses must be better prepared to articulate their contribution to mental health care to counteract public fear, and that the media can play an important role in this process.

Impact of lower atmospheric carbon dioxide on tropical mountain ecosystems

Carbon-isotope values of bulk organic matter from high-altitude lakes on Mount Kenya and Mount Elgon, East Africa, were 10 to 14 per mil higher during glacial times than they are today. Compound-specific isotope analyses of leaf waxes and algal biomarkers show that organisms possessing CO2-concentrating mechanisms, including C4 grasses and freshwater algae, were primarily responsible for this large increase. Carbon limitation due to lower ambient CO2 partial pressures had a significant impact on the distribution of forest on the tropical mountains, in addition to climate. Hence, tree line elevation should not be used to infer palaeotemperatures.

A mouse model for the renal salt-wasting syndrome pseudohypoaldosteronism

Aldosterone-dependent epithelial sodium transport in the distal nephron is mediated by the absorption of sodium through the highly selective, amiloride-sensitive epithelial sodium channel (ENaC) made of three homologous subunits (alpha, beta, and gamma). In human, autosomal recessive mutations of alpha, beta, or gammaENaC subunits cause pseudohypoaldosteronism type 1 (PHA-1), a renal salt-wasting syndrome characterized by severe hypovolemia, high plasma aldosterone, hyponatremia, life-threatening hyperkaliemia, and metabolic acidosis. In the mouse, inactivation of alphaENaC results in failure to clear fetal lung liquid at birth and in early neonatal death, preventing the observation of a PHA-1 renal phenotype. Transgenic expression of alphaENaC driven by a cytomegalovirus promoter in alphaENaC(-/-) knockout mice [alphaENaC(-/-)Tg] rescued the perinatal lethal pulmonary phenotype and partially restored Na+ transport in renal, colonic, and pulmonary epithelia. At days 5-9, however, alphaENaC(-/-)Tg mice showed clinical features of severe PHA-1 with metabolic acidosis, urinary salt-wasting, growth retardation, and 50% mortality. Adult alphaENaC(-/-)Tg survivors exhibited a compensated PHA-1 with normal acid/base and electrolyte values but 6-fold elevation of plasma aldosterone compared with wild-type littermate controls. We conclude that partial restoration of ENaC-mediated Na+ absorption in this transgenic mouse results in a mouse model for PHA-1.

Intensive care for people with serious mental illness

This article describes the development of a psychiatric 'intensive care' service for men and women with serious or enduring forms of psychotic disorder. The authors suggest that such a residential therapeutic service may be an essential part of the development of community care for the most vulnerable people served by mental health services.