The change process in alcoholics: client motivation and denial in the treatment of alcoholism within the context of contemporary nursing

Despite being constantly cited as a critical intervening variable in the recovery from alcohol problems, there is a paucity of literature on client motivation. This paper reviews the current literature which impacts on motivation and its importance in treatment and develops in a stepwise manner the revised expectancy/motivation hypothesis, tentatively explaining both motivation and denial as a natural process in behavioural change. Because of the revised expectancy/motivation hypothesis' distinctly defined stages which closely relate to the process of nursing and the qualitative and quantitative measurement it entails which the nursing process demands, it offers a particularly appropriate model for treatment within nurse practice.     

Pharmacoeconomics of diabetes surveillance and detection programmes

Primary prevention of insulin-dependent diabetes mellitus (IDDM, type I diabetes) remains a research goal. Primary prevention of non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) is likely to remain part of general health education on healthy lifestyles. However, the often delayed diagnosis of type II diabetes, accompanied by early development of complications, offers opportunities for detection programmes, provided that these can overcome the hurdle of the low annual incidence of this disease. By contrast, programmes for the detection of arterial risk factors and treatable complications of previously diagnosed diabetes are well established as an integrated, and thus efficient, annual review. The results of such review guide the different forms of management programmes such as educational programmes for foot care and smoking, drug therapy for hypertension, dyslipidaemia and early nephropathy, and crisis management (laser photocoagulation) of proliferative retinopathy. Such annual review, additional to review of lifestyle and metabolic control, offers opportunities for on-going preventive education and is now the basis of quality development and needs assessment technologies.     

Fetal home telemetry

A simple method whereby the fetal heart rate can be monitored in hospital while the mother is sitting at home has been developed. This paper describes a feasibility study undertaken to assess the practicality of its use.