The TrueBlue study : is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes?

Background: In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.Methods: This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.Conclusion: The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.<br /

The Problem of Integrating Ethics into IS Practice

In this paper we discuss a number of implications which follow from the way that the information systems discipline has developed, largely separately, from computer ethics. These include the tendency of quantitative IS studies on ethics to focus on ethical decision making as the most significant activity in the business of behaving morally meaning that other aspects of moral behaviour are overlooked. A second, significant, implication is the difficulty of integrating ethical practice into IS development. This is manifest initially in terms of IS education but later in relation to the development, and use, of IS in the workplace. Focusing on information systems development, we discuss practice, focusing on ethics and IS practice especially rationalistic approach to decision making, the support that conventional development methodologies offer the moral agent followed by learning to practice or the business of integrating ethics into IS education and how to turn moral decision making into teachable ethical constructs. We conclude by offering some suggestions for future directions

On Being Relevant to the Future of IS Practice

In this essay, we argue that being relevant to practice must imply a concern with influencing future IS practices. Discussions of IS research relevance, however, are rarely explicit about how research is meant to shape the future. Drawing on Feenberg’s (2002) critical theory of technology and his concepts of primary-secondary instrumentalization and potentialities, we consider how IS research about the past can inform the future of IS practice. We then explore implicit assumptions about shaping the future in positivism, interpretivism and critical research, and consider how design science and action research may be addressing technological potentialities. We draw attention to Zald’s (1993) enlightenment model as an alternative to suggest how IS researcher might be more open to research approaches drawn from the humanities for social and technical critique. We conclude by considering the feasibility of our suggestions

Is practice placement capacity helping the NHS to recruit healthcare professionals?

YesPractice placements are a fundamental aspect of preparing students for working in the NHS and will influence where, and in what specialities, students work. Additionally, NHS leaders now consider the issues of recruitment and retention of NHS staff to be as serious as concerns over funding. NHS Providers have outlined the issues although there appears to be little, or no, consideration in terms of plans required for the most immediate future workforce. It is hypothesised that there is link between student healthcare placement capacity and workforce gaps. The policy of increasing training places and of funding practice placements may have a positive effect on practice placement provision and if so contribute to increasing the NHS workforce, but without further detail this impact remains unknown. Along with most aspects of service delivery, planning practice placements using the best available evidence will ensure that the impact on service delivery is minimised while maximising the experience for the next generation of NHS employees

A Generic Theory of Authentication to Support IS Practice and Research

This paper addresses a yawning gap in IS theory and practice. In the information systems (IS) discipline and profession, the concept of authentication is commonly limited in scope to the checking of assertions relating to identity. The effective conduct of organised activities depends on the authentication of not only assertions of those kinds, but also many other categories of assertion. The paper declares its metatheoretic assumptions, and outlines a pragmatic metatheoretic model whose purpose is to establish a workable framework for IS practitioners, and for researchers oriented to IS practice. Within this frame, a generic theory of authentication is proposed, encompassing not only commonly discussed kinds of assertions, but also other important categories relating to real-world properties, asset-value and content-integrity. This surfaces unaddressed opportunities for IS researchers in content-integrity authentication at the semantic level, relating to assertions of fact

Editorial

The University's Assessment, Learning and Teaching strategy commits us to publishing a journal showcasing staff activities in relation to Assessment, Learning and Teaching. The Assessment, Learning and Teaching Journal is practice-based, reflective and pragmatic, and comprises papers of up to 1,500 words and book reviews of up to 200 words. The journal is refereed, all submissions being reviewed by two reviewers. It is normally published three times a year both in hard copy and electronically

Preventing infective complications following leech therapy: Is practice keeping pace with current research?

Background: Despite several publications strongly advocating prophylactic antibiotics during leech therapy, and recent primary articles shedding new light on the microbiota of leeches, many units either do not use antibiotic prophylaxis, or are continuing to use ineffective agents. Methods: A 5-year follow-up of plastic surgery units in the United Kingdom and the Republic of Ireland was conducted in 2007 to ascertain current practice regarding the use of prophylactic antibiotics with leech therapy. A comprehensive literature search investigated primary research articles regarding the microbiota of leeches to update the reconstructive surgery community. Results: Despite published evidence to support the use of prophylactic antibiotics during leech therapy, 24% of units do not use antibiotic prophylaxis and 57% of those using antibiotics are using potentially ineffective agents. Advanced molecular genetic techniques, which allow accurate characterization of both culturable and nonculturable microbiota of the leech digestive tract, show a wider diversity than at first thought, with variable antiobiotic resistance profiles. Conclusions: Despite infection due to leech therapy being a well known and relatively common complication, many units are not using appropriate antibiotic prophylaxis. © 2009 Wiley-Liss, Inc. Microsurgery 2009