Outcome of active disease in ankylosing spondylitis: A prospective study

Background: People with ankylosing spondylitis (AS) typically experience episodic exacerbations, but the extent to which they subsequently experience a sustained reduction in disease markers below recognized thresholds for active disease is unclear. Objective: To investigate changes in, and associations between, disease markers over 18 months in people with active AS. Methods: Within a cohort of 89 participants with AS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores of 4 or higher were used to identify those with active disease. Standard assessment tools were used to monitor participants prospectively at four consecutive six‐monthly intervals. Participants received standard treatments but none received anti‐tumor necrosis factor‐alpha (TNFα) medication during the study. Results: The median age of the cohort was 50 years (inter‐quartile range [IQR] 38.5–55.5), the median age of disease onset was 25 years (IQR 18–33) and the median disease duration was 18 years (IQR 13–27). Forty‐seven (53%) participants had a BASDAI score of 4 or higher on the first assessment, of whom 45 (51%) scored 4 or higher on all subsequent assessments. Furthermore, 38 (43%) and 16 (18%) participants scored BASDAI 5 or 6, respectively, or higher, throughout. BASDAI scores correlated strongly with Bath Ankylosing Spondylitis Functional Index (BASFI) scores. Compared with 19 (21%) participants whose BASDAI scores were consistently below 4 throughout, participants with persistently high BASDAI scores showed higher scores for anxiety and depression, and some evidence of functional deterioration during the study period. Conclusions: In this cohort, disease markers in most people with active AS were sustained above the standard threshold for active disease. This has important implications for planning care pathways and for optimal utilization of anti‐TNFα treatment. Copyright © 2009 John Wiley & Sons, Ltd.     

Detection of group C rotavirus in children with acute gastroenteritis in Blantyre, Malawi.

Among 606 children who were treated for acute gastroenteritis at the Queen Elizabeth Central Hospital in Blantyre, Malawi, Group C rotavirus (Gp C RV) was detected by enzyme-linked immunosorbent assay in fecal specimens from 16 (3.9%) of 408 inpatients and in 4 (2.0%) of 198 outpatients. Thirteen (65%) children excreting Gp C RV were coinfected with Group A rotavirus.     

Non-compliance and professional power

The non-compliance of patients with prescribed treatments is considered as a barrier to effective health care. Non-compliance has implications for the health of patients, effective use of resources and assessments of the clinical efficacy of treatments. Research into non-compliance has increased over the last 30 years. This seems to indicate that it is seen as an important area of concern for all health care professionals. Definitions of non-compliance are problematic, as are methods of assessment of its nature and frequency. Many factors which may account for non-compliance have been proposed, as well as methods to improve compliance. Research into these factors however, mainly based on a positivist epistemology, has failed to provide any conclusive answers to the problem. Sound clinical reasons are suggested as the basis for the increase in interest in non-compliance. It is contended, however, that it is not only these reasons that account for the identification of non-compliance as a problem. Non-compliant behaviour is seen as problematic, because it contravenes professional beliefs, norms and expectations regarding the ‘proper’ roles of patients and professionals. These have formed the basis of an ideology that views patients as passive recipients of health care. It has led to an inherent tendency to ‘blame’ the patient and view non-compliance as irrational and deviant. The professional view of non-compliance as irrational, is exemplified in the case of individuals with mental illness, where there are inherent assumptions that non-compliance can be seen primarily as a symptom of illness. This denies the legitimacy of patient choice, and has led to attempts to control compliance via suggested legislative measures. Serious moral and ethical problems arise from such measures, and can be seen as the ultimate legitimization of an ideology of non-compliance. The maintenance of professional power and control is suggested as central to the debates surrounding non-compliance. The ideological assumptions underpinning the concept of non-compliance need questioning, and a re-conceptualization of the roles of patients and professionals is required. This must involve a view of patients as active participators in their own health care. Research based on an interpretative epistemology, aimed at understanding individual action, rather than control, would seem a more appropriate model to pursue.     

Participation in continuing professional education in nursing: findings of an interview study

The evidence suggests that enrolled nurses and those working part-time and on night duty consistently attend less continuing professional education than their more senior, full-time and day duty colleagues This was substantiated in the findings of this study which also highlighted the paucity of opportunities for continuing education among unqualified practitioners In the light of recent developments within the health services, this inequitable provision of continuing professional education to all nursing practitioners will need to be addressed and resolved Continuing professional education provided on an arbitrary and random basis will not afford maximum positive outcomes for clients, the service and practitioners and has the potential to increase the levels of frustration among disadvantaged groups of nursing staff     

Project 2000 students' perceptions of their training

This paper reports on the findings of a study conducted into the perceptions of final year Project 2000 pre-registration students towards their pre-registration education programme The aim of the research was to discover how students perceive their training in terms of value, relevance, intellectual potency, teaching methods and organization Data were collected using the Hoste scale which has been developed for the evaluation of educational courses A convenience sample of students (n = 131) within one college of nursing were invited to participate Findings include a particularly high level of satisfaction with Project 2000 in terms of value, breadth and relevance Organization and liveliness of the course were perceived much less satisfactorily There was a trend for a statistically significant difference between the mean scores of the theoretical and practical components of the course The findings are discussed with particular reference to the perceptions of theory and practice within the educational programme     

The Impact of Drought on the Emotional Well-Being of Children and Adolescents in Rural and Remote New South Wales

ABSTRACT:  Context and Purpose: Between 2002 and 2006 New South Wales was in the grip of the worst drought for more than 100 years. Financial hardships have led governments to declare "Exceptional Circumstances." Little social research has investigated the impact of drought on children. For this study, children from rural and remote regions of New South Wales were asked for their interpretations of the impacts of drought on their lives. Methods: A multi-strategy approach combining qualitative and quantitative approaches was used to reveal deeper understanding of the impacts of drought. Students in Years 5 through 12 from six Central Schools in the rural southwest of New South Wales participated in focus groups and completed self-report questionnaires. Results: Quantitative self-reports indicated these students were not significantly more distressed than Australian norms. However, the themes that emerged from the students' statements indicated that the drought had been a very significant event for them. This qualitative information also indicated connections for these students to their families, schools, and communities. Conclusions: The emotional impacts of changes to family and community life appear to have been moderated by these students' positive attitudes toward their country lifestyle. These students have discussed the impact of drought on their environment, their livestock, financial resources, and their families. In the face of declining rural community networks, children should be supported through programs that maintain resilience in the face of recurring environmental stressors.     

Measuring care: the case of district nursing

This paper describes a district nursing study that considered the experiences and responses of primary health care professionals and their patients to changes taking place within the community. As a qualitative study it employed interviews as the main method of data collection and was informed by both ethnography and interpretative phenomenology. Forty-three study participants were interviewed, eliciting opinion on whether care is more than just a hands-on activity, whether patient need is being met and to what extent service policy is in tune with care delivery. Describing the views of primary health care professionals and patients in order to illustrate the complexity of the district nursing service and professional roles, the paper finds little shared vision between staff and managers of each other's responsibilities. It concludes that a more holistic approach to understanding professional roles is needed in order to satisfy the differing agendas of managers, staff and patients. It propounds the need for closer collaborative practice between health care professionals, for it finds that they value the ability to communicate as an essential element of their jobs. It reflects that, without such collaboration, it will be difficult for nurses to take a lead position on changes shaping community care.     

Evaluating the efficacy of reflective practice within the context of clinical supervision

This paper explores the efficacy of reflective practice within the context of clinical supervision. It examines some potential limitations that reflective practice has within the context of clinical supervision drawing upon the literature and the early stages of the author's empirical work. It concludes that whilst there is considerable congruence in the use of reflective practice within clinical supervision sessions, there are potential disadvantages in making the assumption that reflective practice should be an integral part of all forms of clinical supervision.     

Importance of information following myocardial infarction: a study of the self-perceived information needs of patients and their spouse/partner compared with the perceptions of nursing staff

A non-experimental research design using questionnaires, was undertaken to find out what information out of that commonly given following myocardial infarction (MI), patients and their spouse/partners rate as being most and least important. These results were then compared with the results obtained from nurse subjects, who were given the same instrument to complete. Eighteen subjects were recruited for each of the three subject groups. Results indicated that some congruency existed between the three groups in terms of what they perceived as the most and least important categories of information. Yet, the scores for some informational categories included on the instrument, were significantly different between the nursing and two other groups ( P <0·01). However, in relation to the patient and spouse/partner groups, only a weak difference ( P <0·10) was found for the category 'dietary information'. These findings and others are discussed, and recommendations are made for improving the information giving process post-MI.