Effects Of Mentholatum On Onychomycosis Of The Toenail

As many as 25% of the population age 60 years and older may be affected by onychomycosis, a chronic infection that is difficult to cure. Onychomycosis can cause pain and soft tissue injury that can lead to infection affecting gait from discomfort. Current oral medications available for the treatment of onychomycosis are costly and can pose the risk of serious side effects. The purpose of this study was to determine if the use of Mentholatum was an effective and cost-efficient means to treat onychomycosis of the toenail in elders. The Neuman Systems Model was used as the theoretical framework: specifically, Neuman\u27s secondary prevention interventions to support system stabilization. The null hypothesis of this study was stated as follows : There will be no effect on the onychomycosis of the toenails in the elderly treated with Mentholatum. A quasi-experimental design was used to compare photographs of the toenail prior to treatment and photographs of the toenail at completion of the treatment. The subjects were drawn from three nursing homes in a southern state. Permission was obtained from residents and 1 1 1 their responsible party for participation in the study. The 33 subjects ranged from 65 to 96 years. The Mentholatum was applied twice daily by a nurse researcher assistant. Digital photographs of the elder\u27s toe were graded by a panel of experts, three physicians and a podiatrist. The nail changes were graded on a 5-point Likert scale. The outcomes of the study revealed 90% of the subjects experienced some positive change in the nail growth, which indicated a statistical significance. Therefore, the null hypothesis was rejected. Because of the limitation in the length of the study, there was no determination if nail cure could be achieved

Managing bipolar moods without medication:a qualitative investigation

This thesis begins with a literature review examining whether family interventions for people diagnosed with Bipolar Disorder (BD) lead to better outcomes for their relatives, who often exhibit greater service utilisation and greater distress than the general population. Following a systematic search of the quantitative literature, ten papers were identified, analysed for relevant data, and assessed for their methodological rigour. Results indicated that family interventions may improve relatives’ feelings of carer burden and psychological distress, but that these conclusions must be treated with caution given methodological issues in the evidence base. Suggestions are made as to which type of family intervention clinicians should consider offering, and which priorities future researchers in this area may wish to address. Decisions not to use medication among people diagnosed with BD are often viewed as indicative of a ‘lack of insight’ into the nature of bipolar moods and medication. However, research has not examined the individual’s experiences once they decide to manage bipolar moods without medication. The empirical paper presented here seeks to elucidate the processes by which people manage bipolar moods without medication by using grounded theory methods. Ten participants were interviewed and a model developed from their data. This model suggests participants engaged in a complex decision-making process as to how to manage their moods, frequently with reference to beliefs they held about themselves and their mood, suggesting that the ‘lack of insight’ model may be inadequate for understanding the processes involved in managing bipolar moods without medication. On the basis of the model developed from the data, suggestions are made regarding clinical interventions and future research. There then follows a critical appraisal of the work conducted in the empirical paper, focussing on challenges in the area of recruitment, in the hope that reflections provided will aid future researchers in this area

Managing bipolar moods without medication:a qualitative investigation

Objectives Although many diagnosed with Bipolar Disorder (BD) choose to manage their moods without medication at some point, their experiences of doing so are not well understood. This paper aims to explore the processes by which people manage bipolar moods without medication. Methods Ten people diagnosed with BD who do not use medication were interviewed. Analysing their accounts using grounded theory methods led to developing a model of how they perceive the processes involved in managing moods without medication. Results Participants engaged in repeated evaluative processes around their strategies for managing moods. Some participants decided not to influence elevated moods due to their perceived advantages. Participants׳ intentions and actions were influenced by their perceptions of themselves and by the meanings they attached to bipolar moods, which were in turn influenced by feedback from others. Conclusions The complexity of the processes described by participants suggests that traditional models of explaining non-adherence may over-simplify some individuals׳ experiences. Future research could focus on identifying factors predictive of successful attempts to manage moods without medication. Professionals should place more emphasis on non-medication approaches in order to increase engagement with people who do not use medication. This may involve focussing on individual׳s longer-term goals rather than on modifying moods in shorter-term. Conclusions are based on participants who had experienced significant bipolar moods, but who largely seemed satisfied living without medication. Limitations Future research should ascertain whether such processes apply to a wider group of individuals who do not use medication for bipolar moods

The Patchwork text assessment - an integral component of constructive alignment curriculum methodology to support healthcare leadership development

Background: A responsive and innovative postgraduate programme curriculum that produces an effective and competent multi professional healthcare leader whom can lead within the United Kingdom (UK) and international healthcare context offers a promising approach to contributing towards the challenging global healthcare agenda. Aims: The aim of the study is to evaluate the impact of utilising constructive alignment curricular methodology incorporating the Patchwork Text Assessment on the healthcare leadership development of UK and international postgraduate students. Design: Case study design, incorporating Kirkpatrick's Five Levels of Evaluation Model. Settings and Participants: 12 post graduate students (multi-professional, UK and international) studying on a healthcare leadership and management programme at one UK University in the North West of England. Methods: Retrieval of the critical commentary produced and submitted by students as part of the Patchwork Text Assessment process. Data Analysis: Thematic content analysis approach. Results: Four key themes emerged demonstrating how the success of constructive alignment and the Patchwork Text Assessment in promoting deep learning for UK and international postgraduate healthcare leadership students is underpinned by principles of good practice and these include: a) Curriculum planners incorporating work based learning activities into the generated learning activities b) Curriculum planners creating the best learning environment so the student can achieve the learning activities c) Providing the learning activities that reflect the real world of healthcare leadership d) Providing students with opportunities to contextualise theory and practice through relevant patchwork activity and learning activities e) Equipping students with the transferable postgraduate skills (through learning activities and patch working) to embark on a journey of lifelong learning and continuous professional development f) Targeting the postgraduate programme /module intended learning outcomes and assessment patches against contemporary leadership qualities frameworks g) Providing students with opportunities to reflect in multi- professional groups that remain constant in terms of facilitator and supervisor h) Creating the learning opportunities for students to apply their learning to their own healthcare organisatio

Staff views on reflective practice groups in an inpatient assessment and treatment unit for people with intellectual disabilities

Purpose Although it is recommended that reflective practice groups (RPGs) are used to support staff in inpatient intellectual disability (ID) services, there is to date no research on their effectiveness or how staff perceive RPGs in these settings. This paper aims to evaluate staff perceptions of the RPGs in an assessment and treatment unit for people with ID and to ascertain the nature of any barriers for staff in attending the group. Design/methodology/approach Thirteen staff completed questionnaires ascertaining their views on the purpose, process and impact of the RPG run within the service. Questionnaires included a version of the clinical supervision evaluation questionnaire (CSEQ; Horton et al., 2008) adapted for this context and a questionnaire designed by the authors examining barriers to attending the group. Findings Staff responses indicated that they valued the group and perceived it as improving their clinical practice and their self-awareness. Staff did not always perceive group sessions as having clear aims and did not perceive the group as enhancing their well-being or their awareness of gaps in their skills. RPGs may be most effective if they form part of a service-wide approach to staff support and development. Originality/value To the best of the authors’ knowledge, this is the first evaluation of RPGs in inpatient ID services. The adapted CSEQ was found to be an easily implemented method of evaluating RPGs in an inpatient ID setting

Case study : Multi-dimensional Community Clinical Leadership Programme

In 2010 a multi-dimensional Community Clinical Leadership Programme was launched to create a future generation of world class leaders who can respond creatively and competently to the challenges facing the NHS. Workforce is our greatest asset and developing senior leadership skills will help set strategic direction for the NHS. It is envisioned that such leaders can lead community-based teams to deliver efficient, effective and evidence-based community health services

Dynamic Analysis of Unidirectional Pressure Infiltration of Porous Preforms by Pure Metals

Unidirectional pressure infiltration of porous preforms by molten metals is investigated numerically. A phenomenological model to describe fluid flow and transport phenomena during infiltration of fibrous preforms by a metal is formulated. The model describes the dynamics of the infiltration process, the temperature distribution, and solid fraction distribution. The numerical results are compared against classical asymptotic analyses and experimental results. This comparison shows that end effects may become important and render asymptotic results unreliable for realistic samples. Fiber volume fraction and initial temperature appear as the factors most strongly influencing infiltration. Metal superheating affects not only the length of the two-phase zone but also the solid fraction distribution in the two-phase zone. The effect of constant applied pressure, although significant on the infiltration velocity, is almost negligible on the two-phase zone length and on solid fraction distribution. When the initial preform temperature is below the metal melting point, and constant pressure is applied under adiabatic conditions, the flow ceases when sufficient solidification occurs to obstruct it. A comparison with literature experiments proves the model to be an efficient predictive tool in the analysis of infiltration processes for different preform/melt systems

Cross-national mixed methods comparative case study of recovery-focused mental health care planning and coordination in acute inpatient mental health settings (COCAPP-A)

Background: Serious concerns have been identified in relation to care planning, patient involvement and consent to treatment in mental health wards, including for those patients detained under the Mental Health Act. Further evidence is needed to develop care planning interventions that embed dignity, recovery and participation for all people using inpatient mental health care. Design: We propose to undertake a cross-national comparative study of recovery-focused mental health care planning in inpatient settings. This two-phase exploratory mixed methods study will produce theory and empirical evidence to complement that developed in our current study of community mental health services to inform a future whole systems intervention study. The study is guided by a theoretical framework emphasising the connections between different 'levels' of organisation (macro/meso/micro). In phase 1 we study the macro-level through the comparative analysis of English and Welsh policy contexts. In phase 2 concurrent quantitative and qualitative data will be collected at 6 NHS Trust/Health Board case study sites (meso-level) and within each site, a single micro-level mental health ward will be selected to provide in-depth qualitative data related to care planning processes. Phase 1: We will extend our current meta-narrative mapping review (Wong et al 2013) of English and Welsh policies and the international literature on personalised recovery-oriented care planning and coordination in community settings to include inpatient settings. We will provide a review of evidence that is useful, rigorous and relevant for service providers and decision-makers and to inform Phase 2. Phase 2: We are employing a concurrent transformative mixed methods approach with embedded case studies (Creswell 2009: 215). We will conduct six in-depth meso-level case study investigations across contrasting NHS Trusts in England (n=4) and Local Health Boards in Wales (n=2), selected to reflect variety in geography and population and include a mix of rural, urban and inner city settings providing routine inpatient care. A large sample of service users (total n=300), inpatient staff (n=300) and informal carers (n=150) will be surveyed about perceptions of acute mental health care and care planning, recovery oriented practices, therapeutic relationships and empowerment using validated questionnaires. Documents and interviews with managers, consultant psychiatrists, ward staff and informal carers (n=60) will also be generated relating to local contexts, policies and practices. In each site we will also select a single inpatient ward and conduct a series of case studies embedded within each organisational case study, to explore care planning in detail. We will invite a sample of service users (total n=36) to participate in in-depth interviews about care planning and structured narrative reviews of their care plans; undertake a structured review of anonymised care plans for a further sample (n=60) of consecutively discharged patients; and conduct observation of care planning processes (n= 18). Framework method will be employed to integrate and compare textual and statistical summaries of qualitative and quantitative analyses within each case study site, informed by the theoretical framework focused on recovery and personalisation. Armed with our set of six within-case analyses we will then conduct a cross-case analysis to draw out key findings from across all sites

The dissolution of solids in molten metals

In 2 vols.SIGLEAvailable from British Library Document Supply Centre-DSC:DX202231 / BLDSC - British Library Document Supply CentreGBUnited Kingdo