Schizophrenia: problems of separation in families

BACKGROUND: In the past, family relationships of people with schizophrenia have mainly been investigated from a clinical viewpoint. The perspective of family development has generally been overlooked in this area of research. AIM: This paper reports a study exploring problems of development and detachment in families with an adult child with schizophrenia. METHOD: Using in-depth interviews, 51 parents of people with schizophrenia were questioned about their living situations and relationships with patients. FINDINGS: Spatial separation from the family home was often complicated or even prevented entirely, with patients permanently living in their parents' household or in the same neighbourhood. Many patients remained dependent on their parents' emotional, practical and financial support. Typically, the parent-child relationship was re-intensified, often with a concurrent loss of social contacts outside the family. From a biographical point of view, schizophrenia often caused problems for families by making parenthood permanent and lifelong parental support necessary. Many parents had to revise their expectations of both their ill child's development and their own personal plans. CONCLUSION: From the viewpoint of family psychology, schizophrenia is a serious obstacle to development that affects both patients and their parents. Family-related support should increasingly take into account the issue of the difficult detachment of patients from their parents.     

Sarcoidosis: in search of Kveim reactivity in vitro

Granuloma formation in patients with sarcoidosis may be evoked by the intradermal injection of homogenised sarcoid tissue (the Kveim reaction). Attempts to demonstrate an in vitro counterpart of the reaction have been unsuccessful. The cytokine interleukin-2 (IL-2) enhances immune responses in vivo and in vitro. We report here an attempt to amplify the Kveim reaction by the addition of IL-2. We studied the effect of Kveim reagent on the proliferative responses of peripheral blood mononuclear cells (PBMC) in the presence or absence of exogenous IL-2. Twenty-eight patients were studied and 14 healthy subjects served as controls. PBMC were cultured, in vitro, in the presence of Kveim reagent. Recombinant IL-2 or both of these combined. Proliferative responses were measured by [3H]-thymidine incorporation. The response of patients' PBMC in the presence of Kveim reagent at a dilution of 1:40 was significantly below the unstimulated response (P less than 0.01). Kveim reagent at a dilution of 1:40 also inhibited the proliferative response of patients PBMC to IL-2 (P less than 0.005); greater dilutions (1:100 and 1:1000) of Kveim reagent were not inhibitory. Responses of PBMC from control subjects (both unstimulated and IL-2 generated) were reduced in the presence of Kveim reagent, however, these reductions were not statistically significant.     

Said Another Way: Poetry in Leadership: An Enhancer of Relationships

Nursing is multidimensional, interactive, interdisciplinary, and complex. Almost anything that can be said about nursing can be said another way. Some things worth being said and heard will not follow the norms of journal presentation. A forum accommodates the emerging voice, the new format, the innovative approach. Nursing Forum, in an effort to honor the "independent voice" in nursing, presents here the voice who elects to enter the dialogue, but who does so "in another way."     

Research Fundamentals: Follow-up of Subjects in Clinical Trials: Addressing Subject Attrition

Many published clinical trials have less than adequate follow-up. When conducting a clinical trial, researchers attempt to minimize data loss; however, some data may not be collected, particularly when subjects are lost to follow-up. Careful planning of research protocols, including comprehensive initial data collection, identification of locators, flexible scheduling, systematic subject tracking, monitoring subject loss, and systematically approaching problem cases can ensure high follow-up rates. This article presents a compendium of techniques and procedures that researchers can use to enhance follow-up and address attrition in their studies. Finally, this article outlines statistical techniques that can be used to address the effects of missing data, particularly when patients are lost to follow-up.     

Implementation of clinical supervision in action: Part 2: implementation and beyond

This paper presents the second part of the findings of an Australian study examining the implementation of clinical supervision in a rural mental health service. A qualitative, exploratory approach was adopted, which included the auditing of relevant documentation and interviews with the nurses who oversaw the implementation process. Within this organization, implementation happened through five stages. The first two stages (preimplementation) were described in Part 1 of this paper. Part 2 describes stages 3-5, including: the strategic plan; implementing the strategic plan; and reflecting on the past and moving forward. The implementation model developed as a result of this research is presented in Part 3. The main findings from these stages included: the role of the implementation committee; the need for a strategic approach; the necessity of education and training; the ongoing importance of assessing organizational culture and considering the sustainability of clinical supervision.