Cervical screening and the aftermath of childhood sexual abuse: are clinical staff trained to recognise and manage the effect this has on their patients?

Aims and objectives: To evaluate the training needs and awareness of childhood sexual abuse amongst clinical staff taking cervical screening samples in one inner city primary care trust. Background Studies exploring sexual abuse and nonparticipation in cervical screening have demonstrated that women can experience re-traumatisation if care during examinations is insensitive to their particular needs. Design: This was a mixed methods, service evaluation in three phases. Methods: A literature review, a questionnaire to cervical screening staff in an inner city primary care trust and a focus group of four staff drawn from questionnaire respondents to explore themes raised in the questionnaire data. Results: Data analysis of both quantitative and qualitative data showed that clinical staff underestimated the frequency of childhood sexual abuse although they were aware of the difficulties and reluctance some women experience undergoing gynaecological examinations. When women did disclose childhood sexual abuse or when staff suspected a history of childhood sexual abuse, staff reported feeling unsure of how they should proceed. There was no support or clinical supervision, and unmet training needs were identified. Conclusions: Nurses expressed anxiety around the potential of the screening test to cause more harm than good and at their inability to provide more help than listening. Staff wanted support and further training after completing their cervical screening training course to assist in their provision of sensitive care to patients who have experienced childhood sexual abuse. Relevance to clinical practice: Whilst our results cannot be generalised to a wider population, they may be meaningful for the community of cervical screening takers. We argue that screening staff require further training and professional support (clinical supervision) to increase their confidence when providing safe and sensitive practice for childhood sexual abuse survivors. If staff feel more confident and competent when responding to disclosure of childhood sexual abuse in screening situations, women who have experienced childhood sexual abuse might participate in the screening programme more readily

Project alliancing at National Museum of Australia: Collaborative process

Project alliancing is a new alternative to traditional project delivery systems, especially in the commercial building sector. The Collaborative Process is a theoretical model of people and systems characteristics that are required to reduce the adversarial nature of most construction projects. Although developed separately, both are responses to the same pressures. Project alliancing was just used successfully to complete the National Museum of Australia. This project was analyzed as a case study to determine the extent to which it could be classified as a “collaborative project”. Five key elements of The Collaborative Process were reviewed and numerous examples from the management of this project were cited that support the theoretical recommendations of this model. In the case of this project, significant added value was delivered to the client and many innovations resulted from the collective work of the parties to the contract. It was concluded that project alliances for commercial buildings offer many advantages over traditional project delivery systems, which are related to increasing the levels of collaboration among a project management team

Discovery and Presentation of Evidence in Adversary and Nonadversary Proceedings

In order to evaluate fully the advantage claimed for the adversary model we sought to add a third element that would test the hypothesis under a variety of conditions. The degree to which the evidence discovered in a case favors one party at the expense of another appeared to meet this criterion. This fact-distribution element is a pervasive condition of legal conflict resolution that, intuition suggests, may significantly influence information search and transmission. Further, this variable could be easily and accurately controlled by regulating the flow of favorable information acquired by the subjects during the experiment. The remainder of this article reports a laboratory experiment intended to cast light on both the specific claim made on behalf of the adversary system and the nature of information processing in legal systems generally

Anomalous aspects of magnetosheath flow and of the shape and oscillations of the magnetopause during an interval of strongly northward interplanetary magnetic field

On 15 Feb. 1978, the orientation of the interplanetary magnetic field (IMF) remained steadily northward for more than 12 hours. The ISEE 1 and 2 spacecraft were located near apogee on the dawn side flank of the magnetotail. IMP 8 was almost symmetrically located in the magnetosheath on the dusk flank and IMP 7 was upstream in the solar wind. Using plasma and magnetic field data, we show the following: (1) the magnetosheath flow speed on the flanks of the magnetotail steadily exceeded the solar wind speed by 20 percent; (2) surface waves with approximately a 5-min period and very non-sinusoidal waveform were persistently present on the dawn magnetopause and waves of similar period were present in the dusk magnetosheath; and (3) the magnetotail ceased to flare at an antisunward distance of 15 R(sub E). We propose that the acceleration of the magnetosheath flow is achieved by magnetic tension in the draped field configuration for northward IMF and that the reduction of tail flaring is consistent with a decreased amount of open magnetic flux and a larger standoff distance of the subsolar magnetopause. Results of a three-dimensional magnetohydrodynamic simulation support this phenomenological model

Guided self-help cognitive behavioural therapy for depression in primary care : a randomised controlled trial

Peer reviewedPublisher PD

Editorial: the anxiety of caring and the devaluing of nursing

Editorial only, no abstrac