Community involvement in health promotion: progress or panacea?

There are many arenas within which health promotion may be located.This paper addresses the issues involved in the developmentof health promotion in one such arena: the community healthmovement. This movement is complex and dynamic. When referenceis made to non-statutory health action, or to community involvementin health, this complexity may not be fully appreciated. Thereis a tendency for the range of activity to be reduced to itsmost "visible" form: self-help activity. However, there is moreto the community health movement than this. A typology is offered here in which three levels of community-basedactivity in Britain are identified. These are referred to asself-help groups, community health groups and community developmenthealth projects. The breadth and range of this activity reflectsthe inability of formalized health care to tackle many of theunderlying causes of ill-health. Each type of community healthactivity exists as a declaration of this failure, but some formsof activity may be welcomed by the health professions whilstothers may not. In particular the numerically small communitydevelopment health projects offer a significant challenge toformal health care because they seek to encourage collectivehealth activity by those who are least in control of their ownhealth. It is within the context of developing strategies for healthpromotion that community health action is most relevant. Nationaland local strategy documents suggest that community involvementis essential for the successful promotion of health. Fully comprehensiveparticipation by community groups signifies a major shift inour perceptions of health and health care. An appreciation ofthe existing range of health action in communities is an importantstarting point for medical health professionals engaged in thistask.     

FLUMAZENIL IN ALCOHOL WITHDRAWAL: A DOUBLE-BLIND PLACEBO-CONTROLLED STUDY

The purpose of the present study was to study -aminobutyricacid (GABA)-A receptor function in alcohol-dependent subjectsduring withdrawal, using the benzodiazepine antagonist flumazenil.In particular, we wanted to examine the hypotheses that an endogenousinverse agonist ligand at the GABA-A benzodiazepine receptor(GBzR) is active during withdrawal (in which case flumazenilshould be anxiolytic), or whether chronic alcohol intake resultsin a shift in sensitivity of the receptor in the inverse agonistdirection (in which case flumazenil should be anxiogenic). Resultsfrom 15 alcohol-dependent subjects in a double-blind placebo-controlledcross-over study showed that flumazenil was neither anxiolyticnor anxiogenic, although withdrawal scores were reduced duringthe course of the study. The fact that flumazenil was not anxiogenic,as it is in panic disorder, suggests that the GBzR is functioningdifferently in these two clinically similar conditions.     

An action research investigation into the feasibility of experienced registered sick children's nurses (RSCNs) becoming children's emergency nurse practitioners (ENPs)

• ? Emergency nurse practitioners (ENPs) formally developed in accident and emergency (A & E) departments as a direct response to waiting times for the walking wounded, the need to reduce junior doctors hours and changes in nursing practice.
• ? ENPs existed informally for many years in minor injuries units and specialist ophthalmic departments.
• ? This study aimed to examine whether or not the role of ENP could be applied to the specialist service of a paediatric casualty department.
• ? The results showed that 3% of patients could be seen and treated to conclusion by a children's ENP, and some patients could have their care accelerated by a children's ENP.
• ? The introduction of children's ENPs would have an impact on waiting times, junior doctors work-load and the quality of patient care.

     

Nurse-led case management for community dwelling older people: an explorative study of models and costs

Aim To compare community matrons with other nurses carrying out case management for impact on service use and costs. Background In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Methods Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. Results Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Conclusion Further research on cost-effectiveness of case management models is required. Implications for Nursing Management The case for continued investment in community matrons remains to be proven.     

The AJT Report News and issues that affect organ and tissue transplantation

Not all hospital‐wide electronic medical record systems accommodate the specific needs of the transplant center. This month, “The AJT Report” investigates what's missing, and what the transplant team can do about it. Also in this issue, a New York man is convicted of organ trafficking, and UNOS appoints a new director of their Department of Evaluation and Quality.     

The AJT Report: News and issues that affect organ and tissue transplantation

This month, transplant professionals weigh in on health‐care reform, and what the new law might mean for the field. Also “The AJT Report” takes a close look at what happened to the expanded immunosuppressant coverage provision.     

KLINEFELTER'S SYNDROME WITH MOSAICISM TRISOMY - 18

In recent years there have been a number of articles on sex chromosome abnormalities in association with Trisomy-18 (Uchida, 1962; Ricci, 1963; Haas, 1966; Cohen et al., 1967) but we are not aware of any such report in the Australian literature.     

Going the distance: Developing shared web-based learning programmes

Despite a high demand for continuing professional education, it is becoming more challenging to provide education in a resource-limited environment that meets the varied needs of learners. The advent of user-friendly, interactive communication technology led the University of British Columbia in Canada to explore the feasibility of developing a web-based distance learning programme shared by undergraduate and practising therapists to address this problem. Potential benefits and challenges of distance learning, undergraduate web-learning, pilot-test results and an assessment of therapists’ interests and needs are profiled.     

The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre

cutter j. & jordan s. (2012) Journal of Nursing Management
The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre Aim To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Background Surgeons and peri-operative nurses risk acquiring blood-borne viral infections during surgical procedures. Appropriate first-aid and prophylactic treatment after an injury can significantly reduce the risk of infection. However, studies indicate that injuries often go unreported. The ‘systems approach’ to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety. Methods A postal survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals, face-to-face interviews with selected participants and telephone interviews with Infection Control Nurses. Results The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. Only 54.9% (112/204) reported every injury. Surgeons were poorer at reporting: 70/133 (52.6%) reported all or >50% of their injuries compared with 65/71 nurses (91.5%). Conclusions Injuries are frequently under-reported, possibly compromising safety in operating theatres. Implications for nursing management A significant number of inoculation injuries are not reported. Factors influencing under-reporting were identified. This knowledge can assist managers in improving reporting and encouraging a robust safety culture within operating departments.