ABUSE DURING PREGNANCY: CURRENT THEORY AND NEW CONTEXTUAL UNDERSTANDINGS

This study used Landenburger's theory, a process of leaving and recovering from an abusive relationship, as a framework to interview 35 pregnant women identified as being at high risk for abuse. Results are reported on 18 women who disclosed active abuse during the study. Landenburger's model was not a good fit. Our participants became trapped and endured violent relationships if they perceived this was the best situation for their unborn child. Additionally the chaos, instability, and lack of resources experienced by these women likely contributed to their inability to complete the four phases described by Landenburger's model for non-pregnant women     

Further evidence of construct validity of standardized patient‐based performance examinations

The purpose of this study was to gather additional evidence pertinent to the construct validity of standardized patient‐based clinical performance examinations. Specifically, the study determined whether students who indicated they had previously read about, seen, or worked up a case on the examination performed differently on that case from those students who had not. Overall, it was found that students with previous reading or direct experiences with cases on the test tended to have higher case mean scores on those cases than those who had not. These results demonstrated that scores on standardized patient‐based performance examinations are sensitive to the examinees’ various learning experiences.     

Why people enter treatment for alcohol problems: Findings from UK Alcohol Treatment Trial pre‐treatment interviews

Aim: To develop a model of why people seek professional treatment for drinking problems, grounded in what clients say about the process at treatment entry.

Participants: Three sets of consecutive entrants to the UK Alcohol Treatment Trial, sets commencing at intervals during trial recruitment (total n = 98).

Location: Statutory and non‐statutory alcohol problem treatment agencies in three areas of England and Wales.

Data: Open‐ended interviews according to a brief interview guide, leading to 400–800‐word post‐interview reports used for analysis (tape recordings used for auditing the interview and analysis process).

Analysis: Reports analysed by a team according to grounded theory principles, involving an iterative process with successive refinement of interviewing and analysis with each successive set of data.

Findings: A model of professional treatment entry was developed, refined and “tested” with the last set of data. The process of seeking professional treatment was depicted in the model as involving a realization of worsening, accumulating and multiple problems related to drinking, especially in health and family domains; in conjunction with, in most cases (but not all), a trigger event and/or family or professional influence; combined with rejection of the possibility of unaided change or non‐professional help; leading to the seeking or accepting of professional help.

Conclusions: The findings support conclusions already in the literature about the process of seeking professional help for a drinking problem, but provide further refinement of existing ideas: for example regarding the accumulation of drinking‐related problems, the ways in which a realization of those problems combines with triggers or pressure, and the complex role of the family and primary care professionals in assisting motivation to seek treatment.     

Expert clinician to clinical teacher: Developing a faculty academy and mentoring initiative

The lack of sufficient numbers of qualified nursing faculty to prepare nursing students for entry into the field of nursing is of national and international concern. Recruiting expert clinicians and preparing them as clinical teachers is one approach to addressing the faculty shortage. Adequate training for the new role is paramount to promote job satisfaction and reduce attrition. Various models for orienting and preparing expert nurse clinicians as clinical educators are reported in the literature with little consensus or research to support a single approach. This paper describes a collaborative effort to prepare experienced registered nurse clinicians for new roles as part-time clinical faculty. Using a blend of learning strategies (face-to-face, online, simulation, and group mentoring sessions), this training experience was designed to cover content while promoting discussion of issues and challenges and providing much-needed mentorship. Outcomes include 12 new clinical faculty, 25% from groups underrepresented in nursing, with nine newly employed as part-time clinical teachers.     

Use of a 585 nm Pulsed Dye Laser for the Treatment of Morphea

INTRODUCTION: The clinical presentation of morphea varies from localized plaques to generalized eruptions. Its cause remains unknown and medical treatments have often proved unsatisfactory. Studies have previously shown that improvement of hypertrophic scars and fibrotic skin can be achieved with the use of a 585 nm pulsed dye laser (PDL). METHODS: A case of plaque-type morphea was treated with 585 nm pulsed dye laser irradiation at an average fluence of 5.0 J/cm2 at bimonthly time intervals. RESULTS: Marked clinical improvement as evidenced by improved pliability and skin coloration was seen after 4 successive PDL treatments. No side effects or complications were encountered. CONCLUSION: Pulsed dye laser therapy is a viable treatment option for morphea. The mechanism of its effect in this condition remains unknown.     

Outcomes and costs of penetrating trauma injury in England and Wales

BACKGROUND: Penetrating trauma injury is generally associated with higher short-term mortality than blunt trauma, and results in substantial societal costs given the young age of those typically injured. Little information exists on the patient and treatment characteristics for penetrating trauma in England and Wales, and the acute outcomes and costs of care have not been documented and analysed in detail. METHODS: Using the Trauma Audit Research Network (TARN) database, we examined patient records for persons aged 18+ years hospitalised for penetrating trauma injury between January 2000 and December 2005. Patients were stratified by injury severity score (ISS). RESULTS: 1365 patients were identified; 16% with ISS 1-8, 50% ISS 9-15, 15% ISS 16-24, 16% ISS 25-34, and 4% with ISS 35-75. The median age was 30 years and 91% of patients were men. Over 90% of the injuries occurred in alleged assaults. Stabbings were the most common cause of injury (73%), followed by shootings (19%). Forty-seven percent were admitted to critical care for a median length of stay of 2 days; median total hospital length of stay was 7 days. Sixty-nine percent of patients underwent at least one surgical procedure. Eight percent of the patients died before discharge, with a mean time to death of 1.6 days (S.D. 4.0). Mortality ranged from 0% among patients with ISS 1-8 to 55% in patients with ISS>34. The mean hospital cost per patient was pound7983, ranging from pound6035 in patients with ISS 9-15 to pound16,438 among patients with ISS>34. Costs varied significantly by ISS, hospital mortality, cause and body region of injury. CONCLUSION: The acute treatment costs of penetrating trauma injury in England and Wales vary by patient, injury and treatment characteristics. Measures designed to reduce the incidence and severity of penetrating trauma may result in significant hospital cost savings.