Social work, general practice and evidence-based policy in the collaborative care of older people: current problems and future possibilities

While collaborative (or joint) working between social services and primary healthcare continues to rise up the policy agenda, current policy is not based on sound evidence of benefit to either patients or the wider community. Both sets of practitioners report benefits for their own work from adopting new arrangements for collaboration. The underlying assumption behind much of this activity is that a greater degree of integration provides benefits to both users and their carers, a perspective that at times obscures the issue of resource availability, especially in the form of practical community services such as district nursing and home help. At the present time there is insufficient evidence to demonstrate that formal arrangements for collaborative working (CW) are better than those forged informally between committed individuals or teams. Furthermore, arrangements for CW have not hitherto been widely evaluated in systematic studies with a comparative design and focus on outcomes for users and carers rather than on processes. In this paper we propose a number of process measures for future evaluation of CW: (1) study populations must be comparable; (2) details of how services are actually delivered must be obtained and colocation should not be assumed to mean collaboration; (3) care packages in areas of comparable resources should be examined; (4) both destinational outcomes and user‐defined evaluations of benefit should be considered; (5) possible disadvantages of integrated care also need to be actively considered; (6) evaluations should include an economic analysis. Those implementing new policies in Primary Care Trusts have, at present, little sound evidence to guide them in their innovative work. However, they should take the opportunity to rigorously test the advantages and disadvantages of collaboration.     

Intrathoracic kidney: A rare presentation of ectopic kidney

The thoracic kidney is the rarest form of renal ectopia. Furthermore, it is usually asymptomatic and discovered incidentally. It is seen as a mass in the posterior mediastinum or juxta-diaphragmatic on chest radiography. A computed tomography scan or magnetic resonance imaging is usually needed for a definitive diagnosis. The thoracic kidney typically exits the retroperitoneal space through the foramen of Bochdalek.     

The Role of Behavioral,Normative and Control Beliefs in Breast Self-Examination

ABSTRACT

Context: A limited number of studies have been conducted examining the role of beliefs in the prediction of breast self-examination (BSE) behavior in Australian women, particularly women under 50 years of age for which it is the primary method of early detection of breast cancer.

Objective: The present research investigated the differences in behavioral, normative and control beliefs between BSE performers and non-performers, within a theory of planned behavior framework, to assist in the development of specific education programs aimed at increasing BSE amongst this demographic group.

Method: Two hundred and fifty-three women enrolled in an undergraduate psychology course completed a questionnaire assessing beliefs regarding BSE. One month later, these women reported their BSE behavior during the previous month. Multivariate analyses were performed to identify belief-based differences between BSE performers and non-performers.

Results: Underlying behavioral and control, but not normative, beliefs about BSE distinguished between BSE performers and non-performers. Performers were more likely than non-performers to believe that engaging in BSE would be associated with identifying a lump or breast change sooner and detecting a breast cancer earlier in its course. Non-performers were more likely to perceive factors such as forgetting to perform the behavior, lack of time, lack of knowledge about how to perform the behavior, laziness, and a lack of confidence in their ability to identify lumps and breast changes as factors preventing their control over the performance of BSE.

Conclusions: The belief-based differences between BSE performers and non-performers found in this study can be used to inform health promotion strategies aimed at increasing BSE behavior in women less than 50 years of age.