Involving communities in health service planning in primary care

Recent health service policy in the United Kingdom has emphasized the need to involve local people in health service planning. This paper will describe how local communities were involved in the development of Primary Care Resource Centres. These centres are designed to provide a base for the delivery of a range of health, social welfare and information services within a community setting. Four centres in the process of being developed in one region were selected for in-depth study. The main method of data collection consisted of semi-structured interviews with key “stakeholders”, namely purchasers and providers of primary health care, social care providers, hospital outreach staff and local community and voluntary group workers (Weiss 1983). This paper examines how the health service organizations developing the centres involved local communities in planning them and the obstacles and difficulties encountered. The paper suggests lessons that can be learned for future community involvement in the planning of local health services.     

Clinical supervision: insider reports of a private world

An exploratory study, funded by the Department of Health, London and the Scottish Home and Health Department, Edinburgh, was conducted over an 18-month period to provide an informed view on possible assessment tools that could be used to assess the impact of clinical supervision (CS) in nursing and to report on the CS activities in 23 selected sites in England and Scotland. The study not only examined the utility of several standardized research instruments, to be reported separately, but also explored the experience of a small sub-sample of nurses ( n =34) engaged in CS, as supervisors and supervisees. Interviews were undertaken to help better understand some of the issues involved around the domains of structure, process and outcome. Respondents reported an enthusiasm for the opportunity to talk meaningfully to a trusted colleague about their personal circumstances at work. Such opportunities were particularly welcomed by nurses who wished to reflect upon their own practice with patients, especially when dealing with their clinical conditions which were upsetting, or otherwise challenging, and sometimes harrowing. Substantive and methodological areas of interest for future research are suggested.     

Stimulation of human cytotoxic T cells with HIV-1-derived peptides presented by recombinant HLA-A2 peptide complexes

HLA-A2 heavy chain and beta 2-microglobulin were expressed in Escherichia coli, and refolded in the presence of peptides derived from HIV-1 RT and gag proteins. When recombinant HLA-A2 molecules were attached to cells lacking HLA-A2, the cells became susceptible to lysis by HLA-A2-restricted cytotoxic T lymphocyte (CTL) clones specific for peptides derived from RT and gag proteins. Limiting dilution analyses of peripheral blood mononuclear cells from HIV-1-infected individuals showed that the recombinant HLA-A2 peptide complexes covalently immobilized on microspheres stimulated the development of HLA-A2 peptide-specific CTL. Preformed HLA-peptide complexes may provide an alternative to immunization procedures that depend upon intracellular processing of antigen to elicit T cell responses.      

A research-based method of selecting curriculum content

This paper reports on a study concerning the opinions of sisters and nurse teachers regarding the relevance of learning objectives for a specific teaching and learning course for hospital and community sisters. The respondents were 29 sisters who had attended the course, 32 sisters who had not attended the course but who were potential future 'consumers' and 25 nurse teachers. The results showed that a majority of the respondents rated 29 of the objectives as essential and these were suggested as the nucleus of the core curriculum for future courses. Responses to nine of the objectives showed statistically significant differences between the groups.     

The nursing process: implications for curriculum planning

The focus of this paper is an exploration of the implications for curriculum planning of adopting the nursing process; which, it is suggested, represents the most far-reaching innovation in British nursing of recent years. An examination of the abilities required by nurses in order for them to deliver care in this way shows that to encompass the philosophy of the nursing process, fundamental changes need to be made in the way nurses are prepared in schools of nursing. In particular, to those elements of the curriculum dealing with content and teaching methods.     

Quality of life and the right to die: an ethical dilemma

In an increasingly 'patient-centred' health service individuals are demanding to make independent judgements about their own fate. In keeping with this trend there is now a growing drive to review the current laws on euthanasia and assisted suicide. The issues in the euthanasia debate usually revolve around patients who are terminally ill and/or suffering intractable pain. However, pain is not the only determinant of an intolerable existence and the problems become more complex when existential quality of life issues are the focus. This can lead to difficult decision making for the health workers involved in care. The paper uses a case study approach to examine the ethical and legal issues surrounding euthanasia. The dilemma under discussion involves a quadriplegic patient who wished to commit suicide by refusing nutrition. The discussion offered centres around the principles of beneficence, non-maleficence and autonomy in relation to whether it was morally or legally appropriate to intervene with this patient's wishes by artificial feeding. Conclusions and recommendations are offered.     

Applying aspects of educational psychology to the practice of nurse teaching

One of the many facets of educational psychology to which the nurse teacher should give consideration is the nature of human knowledge. An individual interacting with his environment forms ideas or concepts which coalesce to create a mental organisation, or ‘conceptual framework’, that is unique to that individual. The nurse teacher takes account of this uniqueness of such a framework by assessing the conceptual position occupied by each of his learners, and by adapting his teaching strategies accordingly. Failure to do this can result in the inadequate learning of new ideas or concepts, in particular complex concepts such as are found in nursing. With reference to certain of the literature it is shown that the direct teaching of concepts does not occur, while the effectiveness of active learner participation is demonstrated as aiding the ‘personalisation’ of newly offered concepts, which then become truly part of the learner's conceptual framework.     

A systematic review on vaginal laser therapy for treating stress urinary incontinence: Do we have enough evidence?

Introduction and hypothesis

Current treatment strategies for stress urinary incontinence (SUI) raise concerns about safety and efficacy. The purpose of this systematic review was to present available evidence related to vaginal laser therapy as a treatment option for SUI.

Methods

We searched the MEDLINE (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017) and Cochrane Central Register of Controlled Trials (CENTRAL) (1999–2017) databases for relevant studies in this field. We aimed to include all observational studies (prospective and retrospective, randomized and nonrandomized) that reported outcomes on vaginal laser therapy as a treatment option for SUI.

Results

Thirteen studies were included that recruited 818 patients who underwent laser therapy for SUI. The methodological quality of most included studies was low, as they were either individual case–control studies, case series or poor-quality cohorts (Oxford Level of Evidence 3b and 4). According to the existing evidence, laser therapy may be a useful, minimally invasive approach for treating SUI. However, the methodological limitations of included studies render them prone to significant bias, limiting their scientific integrity.

Conclusions

As the demand for minimally invasive approaches for treating SUI increases, it is expected that more patients will seek alternative treatments over current standards (midurethral slings). Given the limitations of the existing studies, it seems that conducting future trials is necessary to elucidate this field.