National Reference Group Research Articles

Implementing holistic practices in mental health nursing: A national consultation

BackgroundA national consultation exercise was held as part of a review of mental health nursing in England. ObjectivesTo gather views as to how best to develop mental health nursing to support a holistic approach to care, taking into account psychological, physical social and spiritual needs. DesignNational open consultation by email over a 3-month period. Participants326 written replies were received. The largest group of responses was from National Health Service (NHS) organisations (n=92, 28.2%); 69.9% of responses were from groups or organisations (n=225). MethodsA consultation document was devised by a national reference group, including four questions relating to the development of practice in the four domains of: psychological, physical, social and spiritual care. ResultsThe majority of responses supported mental health nurses (MHNs) providing psychological therapies (n=271, 95.1%). To support this happening, responders most frequently described a need for appropriate specialist training post-registration (n=114). To improve physical well-being of service users, the most frequent suggestion was that MHNs should promote healthy lifestyles, e.g. by encouraging physical activity and advising on ways to reduce illicit drug, alcohol and tobacco use (n=152). Responders most frequently cited the need for MHNs to understand resources to support social inclusion (n=110), e.g. knowing how to access local resources, benefits, housing and employment advice. MHNs were most frequently seen as requiring appropriate training to help them support spiritual/religious needs (n=96). ConclusionsThe consultation was successful in obtaining views, in particular, of organisations and groups. These subsequently influenced national recommendations made by the Chief Nursing Officer's Review of Mental Health Nursing.

It Takes Two: Reducing Adolescent Smoking Uptake Through Sustainable Adolescent–Adult Partnership

Purpose To assess the effects of a long-term intervention for tobacco use prevention that targets adolescents (Tobacco Free Duo). Methods School-based community intervention combined with repeated cross-sectional surveys over 7 years. The intervention was performed in the County of Västerbotten, Sweden, where survey data were collected in grade seven to nine schools on an annual basis for 7 years. Data for comparison were collected in grade nine on the national level in Sweden. In the intervention area, the annual number of seventh to ninth grade students participating in the study varied between 1300 and 1650. In the reference data, the number of participating ninth grade students approximated 4500 annually. Results A significant decrease of nearly 50% was seen in smoking prevalence in the intervention area. The decrease was evident in grades eight and nine (ages 14–15 years) in both boys and girls. At the start of the intervention, smoking prevalence in grade nine was 16.1% in the intervention area and 23% in the national reference group. Although the prevalence in the national sample remained stable, there was a decrease to 9.0% in the intervention area at the end of the study period. Conclusions These results suggest that the Tobacco Free Duo program contributed to a reduction in adolescent smoking among both boys and girls. Using a multi-faceted intervention that includes adolescent–adult partnership can reduce adolescent smoking uptake, and the intervention has been proven to be sustainable within communities.

An analysis of clinical process measures for acute healthcare delivery in Appalachia: The Roane Medical Center experience

ObjectiveTo survey management of selected emergency healthcare needs in a Tennessee community hospital.Materials and methodsIn this descriptive report, discharges and associated standard process measures were retrospectively studied for Roane Medical Center (RMC) in Harriman, Tennessee (pop. 6,757). Hospital data were extracted from a nationwide database of short-term acute care hospitals to measure 16 quality performance measures in myocardial infarction (MI), heart failure, and pneumonia during the 14 month interval ending March 2005. The data also permitted comparisons with state and national reference groups.ResultsOf RMC patients with myocardial infarction (MI), 94% received aspirin on arrival, a figure higher than both state (85%) and national (91%) averages. Assessment of left ventricular dysfunction among heart failure patients was also higher at RMC (98%) than the state (74%) or national (79%) average. For RMC pneumonia patients, 79% received antibiotics within 4 h of admission, which compared favorably with State (76%) and national (75%) average. RMC scored higher on 13 of 16 clinical process measures (p<0.01, sign test analysis, >95% CI) compared to state and national averages.DiscussionAlthough acute health care needs are often met with limited resources in medically underserved regions, RMC performed above state and national average for most process measures assessed in this review. Our data were derived from one facility and the associated findings may not be applicable in other healthcare settings. Further studies are planned to track other parameters and specific clinical outcomes at RMC, as well as to identify specific institutional policies that facilitate attainment of target quality measures.

Perinatal Periods of Risk: Analysis of Fetal–Infant Mortality Rates in Kansas City, Missouri

The Perinatal Periods of Risk (PPOR) technique was used to analyze resident fetal and infant death data from Kansas City, Missouri, for the period 1998-2002. Results offer important information that can be used to develop community-based prevention strategies related to racial/ethnic disparities in infant mortality rates (IMR). The PPOR approach for fetal and infant mortality can be mapped by birthweight at delivery and time of death into four strategic prevention areas: 1) Maternal Health/Prematurity (MHP), 2) Maternal Care (MC), 3) Newborn Care (NC), and 4) Infant Health (IH). For this analysis, all fetal and infant death certificates from the metropolitan Kansas City area were linked to their birth certificates and those associated with residents of Kansas City, Missouri, proper were used to create the dataset used in this analysis. Due to the small number of fetal and infant deaths among other ethnic groups, the analysis was restricted to a comparison of the disparity of IMR between Blacks, Whites, and a national non-Hispanic white reference group. The Kitagawa formula was used to determine contribution to excess deaths from birthweight-specific mortality and birthweight distribution rates. Logistic regression techniques were used to identify risk factors for death among Black fetuses and infants with very low birthweights and also deaths due to sudden infant death syndrome (SIDS). The PPOR analysis showed that of the excess deaths among black infants, when compared to a national reference group, 47% was attributable to MHP and another 29% was attributable to IH. Differences in MC and NC only accounted for 27 and 8% of the total excess deaths. During the study period, rates of sudden infant death syndrome (SIDS) were found to be significantly higher among Blacks as compared to Whites (2.12 vs. 0.81 per 1,000). An analysis of maternal characteristics for SIDS deaths among blacks using a step-wise logistic regression model, found that maternal age less than 20 years old, previous births, inadequate prenatal care, and being a Medicaid recipient were significant-adjusted odds ratios of 23.7 (95% Cl 10.48, 53.67), 8.4 (95% Cl 3.64, 19.21), 2.9 (95% Cl 1.38, 6.05) and 2.5 (95% Cl 1.04, 5.84), respectively. PPOR is an easy to use approach that helps focus community initiatives for improving maternal and infant health. In Kansas City, Missouri, efforts to further lower IMR in blacks can be achieved through the reduction of risk factors affecting maternal health and through maternal education to improve infant health.

Indicators of Social Quality

In October 2001, the Network Indicators of Social Quality started the process of creating social quality indicators. This project of the European Foundation on Social Quality was supported by the European Commission (DG Research) under Framework Programme 5 (van der Maesen et al. 2000). The Network consisted of representatives of universities from 14 partner countries and two European NGOs. Over its forty-two-month life the Network held four meetings. Three plenary meetings were organised with all assistants thanks to the financial support by the Dutch Scientific Foundation (NWO). Also through the creation of unique national reference groups on social quality, the Network has engaged more than a hundred scientists and policy makers in its work. The project was completed in April 2005. The intriguing question was how to theoretically legitimise the choice of social quality indicators compared to the indicators constructed in the context of 'quality of life' approaches, as developed for example by ZUMA of the University of Mannheim (Noll 2000; Berger-Schmit et al. 2000) and the European Foundation on the Improvement of Working and Living Conditions in Dublin (Fahey et al. 2002).

CANCER MORTALITY TRENDS IN A BLACKFOOT DISEASE ENDEMIC COMMUNITY OF TAIWAN FOLLOWING WATER SOURCE REPLACEMENT

Blackfoot disease is an endemic peripheral vascular disease found among people in a limited area on the southwest coast of Taiwan, where artesian well water has a high concentration of arsenic and was used since the turn of this century. This is an important public health problem and was noted by the authorities, who began improving the water supply in such communities in 1956. This enabled us to test the relationship between arsenic and malignant tumors using a specific exposed community. Study subjects were divided into four groups according to age (under or over 40 yr) and gender. Two methods were used for the estimation of the age-adjusted mortality rate ratios. First, using the first time interval (1971-1973) as the standard, the mortality rate ratio for all malignant tumors was estimated from this interval through to the last interval (1992-1994) using Poisson regression. Cancers that were found to be related to arsenic in previous reports, such as liver, lung, bladder, kidney, and skin cancers, were examined and other malignant tumors except these cancers were also assessed. The same calculations were performed for all of Chiayi and Tainan counties, excluding the study areas, which were used as the local reference, and for the general population of Taiwan, which was used as a national reference group. Second, mortality rate ratios for the study area were compared to the local and national reference for the same time intervals for each disease category. From our results, significantly declining trends for mortality rate ratios of all malignant tumors with 1971-1973 as the standard were found for the study areas, especially in females. A decrease of mortality rate ratios from malignant cancers, compared to the local or national references, was found in those aged over 40 yr for both sexes. The decreases are mainly due to a fall in internal and skin cancer mortality rates. In conclusion, our results suggest that the improvement of drinking water supply to eliminate arsenic exposure from artesian well water decreased the mortality incidence of arsenic-related cancers in blackfoot disease endemic communities.

Segmented Partisanship in a Southern Political Elite

Segmented partisanship combines the traditional conceptualization of party identification with the reality of different parties operating in different locales. Using a sample of campaign contributors in Georgia legislative elections, we analyze the importance of segmented partisanship by comparing the behavior and attitudes of segmented partisans to those with consistent party identifications. Segmented partisans are generally less active and less ideologically extreme than their consistent counterparts, with the differences across the groups varying with the salience of the appropriate state or national reference group. The net effect of segmented partisanship is to moderate the issue conflict between parties as some citizens seek the "best fitting" partisan identification.

Nutritional status in recently hospitalized and free-living elderly subjects.

Weight index (WI), triceps skinfold (TSF), serum albumin and delayed cutaneous hypersensitivity reaction (DCH) were measured in 96 hospitalized elderly patients and in 100 age- and sex-matched free-living controls. Using the 10th percentile of data obtained in the controls, WI was subnormal in 35% of the patients. Corresponding findings with regard to TSF, serum albumin and DCH were 32, 50 and 31%, respectively. The findings in the controls were mainly within the range observed in national reference groups. Patients were considered malnourished if they showed at least two variables (of which one was required to be anthropometric) below the cut-off limits used. When these limits were set at the 10th percentile of the recordings in the controls, the occurrence of undernutrition in the patients was 39%. By using the 5th percentile the corresponding figure was 16%. Malnourishment was most pronounced in patients with multiple organ disease and malignancy. It is concluded that low nutritional indices are a common occurrence in elderly subjects admitted to hospital and that undernutrition is related to the nature of the disease rather than age.

Teachers' Estimates of Test Content Covered in Class and First-Grade Students' Reading Achievement

This study investigated the relation between first-grade Chapter 1 students' test content coverage and performance on a standardized reading-achievement test. A survey designed to obtain teachers' estimates of test content coverage was administered to 14 regular classroom and 5 Chapter 1 reading teachers. Although Chapter 1 students' overall performance was lower than that of students in the National Reference Group on items rated as receiving high coverage by all teachers, Chapter 1 students' performance was relatively higher on high-coverage items than on those items rated as receiving low coverage by both groups of teachers. The study provides a strategy for obtaining teachers' estimates of test content coverage and an instructional context in which to assess students' opportunity to learn and their achievement-test performance. Results provide information useful for improving instruction.

EVALUATING A CORE CURRICULUM IN THE PEDIATRIC CLERKSHIP

For the year 1982-83, the cognitive portion of our required pediatric clerkship was defined as having only seven components: Nutrition, physical and behavioral development through adolescence; neonatology (excluding NICU); fluid and electrolytes; infectious diseases and immunization; accidents and poisonings; and selected genetic disorders. The evaluation instrument used was the subject test of the NBME part II (4 versions were used in 8 clerkships). Security of the examination was not breeched. Core questions, as defined by us, formed 45-48% of the examination. Our experimental design tested the hypothesis that the total mean score would rise over the eight successive clerkship modules, while the score would be constant. The hypothesis was refuted; both scores were reasonably stable. The core questions however were answered correctly consistently better than the non-core; 66% vs. 56% p<.01 a reassurance that emphasis in teaching may influence cognitive outcome. The mean normative NBME score ranged from 449 to 519 (i.e., −0.61 to +0.19 S.D. of the national reference group when the test is taken for licensure). Given only an average pediatric clerkship in the U.S. of 7 weeks (ours, 6 weeks) we suggest that a consensus core be defined in U.S. schools and that the NBME part II committtee, mirroring the schools, tailor the evaluation instrument to reflect that core.

Social Climates in Prison: An Attempt to Conceptualize and Measure Environmental Factors in Total Institutions

The development and standardization of a testing instrument designed to assess social climates in correctional institutions is described. The Correctional Institutions Environment Scale (CIES) has 86 items, organized in nine scales. The first three scales assess people relationship dimensions, subscales four through six assess institutional program dimensions, and subscales seven through nine measure system maintenance dimensions. The administration of the test to groups takes less than 30 minutes. Norms of a national reference group are presented, and four unit profiles are shown as examples. Various possible uses of the CIES are discussed with special attention to the potential utility of the instrument for the institutional administrator.