Some issues in the clinical, social and economic evaluation of new nursing services

This paper describes a study of a new nursing post, that of the adviser on incontinence. Some of the difficulties encountered in the study were the composition of a study and control group and evaluation of change in urinary incontinence. Retrospective checks on the two groups showed that the items in which they differed did not have any relationship with changes in incontinence or its management. The findings were unable to support the Regional Health Authority's hope that hospital admissions would be reduced or the more general belief that overall resource use would decline. In addition to improvements in incontinence half the subjects identified other benefits such as increased understanding of the problem and the opportunity to discuss it with someone with a knowledge of incontinence. Issues were also raised of the organization and nature of the advisers work load.     

An analysis of stigma and suicide literacy in responses to suicides broadcast on social media

Introduction

Broadcasting a suicide attempt on social media has become a public concern in China. Stigmatizing attitudes around such broadcast can limit help‐seeking and increase the likelihood of death. To reduce stigmatizing attitudes, this paper aims to detect stigma expressions in social media posts through language use patterns and then identify suicide literacy in responses to such broadcast.

Methods

Firstly, to examine linguistic patterns of stigma expressions, 6632 Weibo posts with keywords were collected and analyzed. Using 102 linguistic features, 2 classification models were built: one for differentiating between stigmatizing and nonstigmatizing attitudes, and one for differentiating between specific types of stigmatizing attitudes. Secondly, to identify the levels of suicide literacy, a content analysis was conducted on 4969 Weibo posts related to social media suicide.

Results

Firstly, the model accuracy ranged from 66.15% to 72.79%. Secondly, a total of 11.67% of the Weibo posts (n = 580) contained misinformation about suicide. In the category of knowledge of signs, 27.93% and 18.10% of posts endorsed the stigmatizing views that “suicide happens without warning” and “people who want to attempt suicide cannot change their mind quickly,” both of which were related to a stigmatizing belief that a suicide attempt on social media is not genuine. In the category of knowledge of treatments, 35.17% of posts endorsed the stigmatizing view that “people who have thoughts about suicide should not tell others about it.”

Discussion

This paper presents an opportunity for the dissemination of targeted online campaigns to increase mental health literacy and help‐seeking.     

Why are some care homes better than others? An empirical study of the factors associated with quality of care for older people in residential homes in Surrey,England

This paper reports an empirical study that investigated associations between the quality of care received by older people in residential settings and features of the care homes in which they live. Data were gathered from the first announced inspection reports (2002–2003) of all 258 care homes for older people in one county of England (Surrey). The number of inspected standards failed in each home was used as the main indicator of quality of care. Independent variables (for each home) were: size, type, specialist registration, on‐site nursing, ownership, year registered, location, maximum fee, vacancies, resident dependency, whether the home took publicly funded residents, care staff qualifications and managerial quality. Quality of care was modelled using a Poisson count maximum likelihood method based on 245 (91%) of the inspected homes for which relevant data were available. The results showed that quality of care (as defined by failures on national standards) was statistically associated with features of care homes and their residents. A higher probability of failing a standard was significantly associated with being a home that: was a for‐profit small business (adjusted risk ratio (RR) = 1.17); was registered before 2000 (adj. RR = 1.22), accommodated publicly funded residents (adj. RR = 1.12); was registered to provide nursing care (adj. RR = 1.12). Fewer failures were associated with homes that were corporate for‐profit (adj. RR = 0.82); held a specialist registration (adj. RR = 0.91); charged higher maximum fees (adj. RR = 0.98 per 100 pound sterling unit). A secondary analysis revealed a stronger model: higher scores on managerial standards correlated with fewer failures on other standards (r = 0.65, P < 0.001). The results of this study may help inform future policy. They are discussed in the context of alternative approaches to measuring quality of residential care, and in terms of their generalisability.     

Cost‐effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain

Cost‐effectiveness is a major criterion underpinning decisions in mainstream health care. Acupuncture is increasingly used in patients with chronic lower back pain (LBP), but there is a lack of evidence on cost‐effectiveness. The objective of this study was to assess the cost‐effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham. To determine effectiveness, we undertook meta‐analyses which found a significant improvement in pain in those receiving acupuncture and standard care compared with those receiving standard care alone. For acupuncture and standard care vs. standard care and sham, a weak positive effect was found for weeks 12 to 16, but this was not significant. For acupuncture alone vs. standard care alone, a significant positive effect was found at week 8, but not at weeks 26 or 52. The main outcome parameters for our cost‐effectiveness analysis were the incremental cost‐effectiveness ratio (ICER) of acupuncture treatment presented as cost (A$) per disability‐adjusted life‐year (DALY) saved. The WHO benchmark for a very highly cost‐effective intervention is one that costs less than gross domestic product per capita per quality‐adjusted life‐year (QALY) gained or DALY averted, or less than around $A52,000 in 2009 (the base year for the analysis). According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost‐effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost‐effective unless comorbid depression was included. According to the WHO cost‐effectiveness threshold values, acupuncture is a cost‐effective treatment strategy in patients with chronic LBP.     

Best Practice Guidelines on Publishing Ethics: A Publisher's Perspective, 2nd Edition

Wiley has updated its publishing ethics guidelines, first published in 2006. The new guidelines provide guidance, resources, and practical advice on ethical concerns that arise in academic publishing for editors, authors, and researchers, among other audiences. New guidance is also included on whistle blowers, animal research, clinical research, and clinical trial registration, addressing cultural differences, human rights, and confidentiality. The guidelines are uniquely interdisciplinary, and were reviewed by 24 editors and experts chosen from the wide range of communities that Wiley serves. They are also published in Advanced Materials, International Journal of Clinical Practice, Annals of the New York Academy of Sciences, Social Science Quarterly, and on the website http://exchanges.wiley.com/ethicsguidelines .