312 research outputs found
NHS research ethics committees : still need more common sense and less bureaucracy
National Health Service research ethics committees exist to ensure that research performed within the NHS complies with recognised ethical standards and to protect the rights, safety, and dignity of all actual or potential participants. In the past decade the operation of research ethics committees has come under, and continues to come under, close scrutiny. Researchers now consider the process of acquiring ethical approval to be so onerous that it is compromising clinical research. Medical educators also think that the process is too unwieldy to allow undergraduate students to acquire research experience, an essential learning outcome required by the General Medical Council
Available Funding Sources for Energy Efficient Project at Rural Grocery Stores
Presenters give a background on K-State Engineering Extension before detailing the Rural Energy for America Program (REAP) which provides energy assessments that can lead to cost savings. Assistance is provided to make energy efficient improvements including solar power
Improving child protection : a systematic review of training and procedural interventions
Aim: To synthesise published evidence regarding the effectiveness of training and procedural interventions
aimed at improving the identification and management of child abuse and neglect by health professionals.
Methods: Systematic review for the period 1994 to 2005 of studies that evaluated child protection training
and procedural interventions. Main outcome measures were learning achievement, attitudinal change,
and clinical behaviour.
Results: Seven papers that examined the effectiveness of procedural interventions and 15 papers that
evaluated training programmes met the inclusion criteria. Critical appraisal showed that evaluation of
interventions was on the whole poor. It was found that certain procedural interventions (such as the use of
checklists and structured forms) can result in improved recording of important clinical information and may
also alert clinical staff to the possibility of abuse. While a variety of innovative training programmes were
identified, there was an absence of rigorous evaluation of their impact. However a small number of onegroup
pre- and post-studies suggest improvements in a range of attitudes necessary for successful
engagement in the child protection process.
Conclusion: Current evidence supports the use of procedural changes that improve the documentation of
suspected child maltreatment and that enhance professional awareness. The lack of an evidence based
approach to the implementation of child protection training may restrict the ability of all health
professionals to fulfil their role in the child protection process. Formal evaluation of a variety of models for
the delivery of this training is urgently needed with subsequent dissemination of results that highlight those
found to be most effective
Should health professionals screen women for domestic violence? : systematic review
Objective To assess the evidence for the acceptability
and effectiveness of screening women for domestic
violence in healthcare settings.
Design Systematic review of published quantitative
studies.
Search strategy Three electronic databases (Medline,
Embase, and CINAHL) were searched for articles
published in the English language up to February
2001.
Included studies Surveys that elicited the attitudes of
women and health professionals on the screening of
women in health settings; comparative studies
conducted in healthcare settings that measured rates
of identification of domestic violence in the presence
and absence of screening; studies measuring
outcomes of interventions for women identified in
health settings who experience abuse from a male
partner or exĀpartner compared with abused women
not receiving an intervention.
Results 20 papers met the inclusion criteria. In four
surveys, 43Ā85% of women respondents found
screening in healthcare settings acceptable. Two
surveys of health professionals' views found that two
thirds of physicians and almost half of emergency
department nurses were not in favour of screening. In
nine studies of screening compared with no
screening, most detected a greater proportion of
abused women identified by healthcare professionals.
Six studies of interventions used weak study designs
and gave inconsistent results. Other than increased
referral to outside agencies, little evidence exists for
changes in important outcomes such as decreased
exposure to violence. No studies measured quality of
life, mental health outcomes, or potential harm to
women from screening programmes.
Conclusion Although domestic violence is a common
problem with major health consequences for women,
implementation of screening programmes in
healthcare settings cannot be justified. Evidence of the
benefit of specific interventions and lack of harm from
screening is needed
Scoping exercise on fallersā clinics : report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO)
The National Service Framework for Older People has stated the need for fall-prevention programmes. An appraisal of fallersā clinics launched by the National Institute for Health and Clinical Excellence (NICE) was suspended because of a lack of information regarding existing services and typology. This project aimed to determine the feasibility of conducting economic modelling to appraise fallersā clinics. To achieve this a national survey of services and reviews of the evidence of effectiveness of various models of fallersā clinics and screening tools were undertaken
Transition to adult services for children and young people with palliative care needs : a systematic review
Objective: To evaluate the evidence on the transition process from child to adult services for young people with palliative care needs.
Design: Systematic review
Setting: Child and adult services and interface between healthcare providers.
Patients: Young people aged 13 to 24 years with palliative care conditions in the process of transition.
Main outcome measures: Young people and their familiesā experiences of transition, the process of transition between services and its impact on continuity of care, and models of good practice.
Results: 92 studies included. Papers on transition services were of variable quality when applied to palliative care contexts. Most focused on common life threatening and life limiting conditions. No standardised transition programme identified and most guidelines used to develop transition services were not evidence based. Most studies on transition programmes were predominantly condition-specific (e.g. cystic fibrosis, cancer) services. Cystic fibrosis services offered high quality transition with the most robust empirical evaluation. There were differing condition-dependent viewpoints on when transition should occur but agreement on major principles guiding transition
planning and probable barriers. There was evidence of poor continuity between child and adult providers with most originating from within child settings.
Conclusions: Palliative care was not, in itself, a useful concept for locating transition-related evidence. It is not possible to evaluate the merits of the various transition models for palliative care contexts, or their effects on
continuity of care, as there are no long-term outcome data to measure their effectiveness. Use of validated outcome measures would facilitate research and service development
Easier than you Think ā Curbside Consult on the How-To of an Energy Audit and USDA Application
In 2016, K-State Engineering Extension entered into a partnership with the Kansas Corporation Commission to provide energy assessments to Kansas small businesses at no cost. Subsequent to the energy assessment, Engineering Extension works with the business to submit a USDA Rural Energy for America Program grant to implement energy efficiency or renewable energy projects and reduce operating costs. Facilities approved for the grant can receive a reimbursement of up to 25% of the projectās eligible costs. This session provides information on these projects and will inform attendees how to request assistance from Engineering Extension.
Through this program, Engineering Extension has assisted 16 rural grocery stores with a free energy assessment; five of these submitted REAP grants. Four have received grant approval and one is still pending. The four applications that have been approved encompass eight projects for a cost of 43,300. The annual energy savings for the eight projects amount to 279,000 kWh and $35,200. The USDA funding reduced the simple payback for these projects from 4.9 years to 3.7 years.
The Engineering Extension program not only meets the conference theme of sustainability through reduced consumption of natural resources required for energy generation, it also aids rural grocery stores in providing rural healthy food access. In addition to partnering with KCC and USDA, Engineering Extension has partnered with Blue Cross/Blue Shield of Kansas in its Pathways to a Healthy Kansas program. Three rural grocery stores in the Pathways to a Healthy Kansas program have requested an energy assessment through the KCC/K-State partnership
Systematic review of interventions for the secondary prevention and treatment of emotional abuse of children by primary carers
Background
Emotional abuse (or psychological maltreatment, as it is more commonly called in the US) is an inadequately researched and poorly understood concept, despite increasing awareness about the harm it can cause to childrenās lives. Although it unifies and underpins all types of maltreatment it also occurs alone and when it does, tends to elude detection and intervention. There have to date been no systematic reviews of the literature on the secondary prevention and treatment involving the parents or primary carers of emotionally abused children.
Objective
The objective of the review was to identify studies that evaluate the effectiveness of interventions in the secondary prevention and treatment of child emotional abuse involving the parents or primary carers of children aged 0 ā 19 years.
Methods
Studies were included if they involved any intervention which was directed at emotionally abusive parenting and that measured change in (i) emotional unavailability (ii) negative attributions (i.e. that involve the parent attributing negative intentions, beliefs or attitudes toward the child); (iii) developmentally inappropriate interactions; (iv) lack of recognition of childrenās boundaries; (v) inconsistency of parenting role; (vi) missocialisation or consistent failure to promote the childās social adaptation. The primary outcomes evaluated involved proxy measures of a range of parent, family and child outcomes including parental psychopathology, parenting attitudes and practices, family functioning and/or child behaviour and the childās development and adaptation.
.
A broad search strategy was developed in order to identify as many relevant studies as possible. An electronic search of a wide range of databases was carried about. No study type was excluded. The search was augmented by direct contact with academics and practitioners known in this field. The search included studies written in English, Spanish, French and German. Studies were included if the intervention was described, and the impact on at least one indicator of emotional abuse was assessed. Included
studies were critically appraised by two reviewers using standard criteria. Data were extracted using a standard proforma, and a qualitative synthesis of results was carried out.
Results
The initial search yielded 4248 publications of potential interest. Of these, 175 were obtained for possible inclusion or as background material. A total of 21 studies of 18 interventions, met all the inclusion criteria. A further 43 studies were relevant, but did not meet all of the inclusion criteria. Studies were organised according to the type of emotional abuse targeted: emotionally abusive parenting; parents of infants with faltering growth; missocialisation: parenting interventions with substance-abusing mothers. Twelve included studies had quantitative designs. Of these, 6 comprised randomised controlled trials; 1 comprised a follow-up of a randomised controlled trial; 2 were controlled studies; and 3 had one-group pre- and post-designs. The remaining 9 were case studies.
Included studies involved a wide range of interventions. The 8 studies for parents which address emotionally abusive parenting (rejection, misattribution, parent-child role reversal and anger management) involved evaluations of cognitive-behavioural training (CBT), behavioural training and parent-infant psychotherapy. Two further case studies involved cognitive-behavioural training, mentalisation and family-based therapy. The 9 interventions with parents of infants with faltering growth evaluated CBT, behavioural training, parent infant psychotherapy and interaction guidance; lay home visitors, and a range of therapeutic options based on the diagnostic condition of the parents. The 3 studies of interventions for substance abusing mothers evaluated a relational psychotherapy group for mothers, and a residential treatment for substance abuse with a parenting component. The sample sizes for quantitative studies were small and ranged from 17 to 98 participants. Ten interventions involved mothers alone, while a further 11 included fathers, either at the outset or at a later stage, and in 3 cases extended family members.
Interventions for emotionally abusing parents
The findings from the 8 included studies evaluating CBT, psychotherapy, and behavioural approaches suggest that group-based CBT may be an effective means of intervening with this group of parents, although it cannot currently be recommended with parents experiencing symptoms of severe psychopathology. While one comparative study showed a psychotherapeutic intervention to be more effective than a CBT focused intervention, the outcomes measured in this study (i.e. parent and child representations) favoured the former. Behavioural case work involving the use of problem-solving techniques may also have a role to play with some parents, although further research is still needed.
Interventions to enhance parental sensitivity
The findings from a systematic review of 81 interventions that aimed at enhancing parental sensitivity and / or infant attachment found strong evidence that short term (less than 16 sessions) interventions, with a behavioural focus and aimed exclusively at enhancing maternal sensitivity were also most effective in enhancing infant attachment security. This supports the notion of a causal role of sensitivity in shaping attachment. Interventions that included fathers as well as mothers showed higher effect sizes but results are tentative since they are based on a small number of small scale trials.
Parental behaviours associated with faltering growth
Nine studies evaluated a range of interventions with parents of babies with faltering growth including interaction guidance, home visiting; parent-child psychotherapy, behavioural casework and multi-component interventions. The findings show that interaction guidance and parent-infant psychotherapy may be potentially effective means of working with this group of clients along with behavioural casework, but that further research is needed before these can be recommended.
Missocialisation: Parenting interventions for substance-abusing parents
5 studies (one of which was a 6-month follow-up) evaluated interventions for substance abusing mothers, including a relational psychotherapy group and a residential treatment for substance abusing adults with a parenting component. The findings show that initial gains made in the former were not sustained at 6-months and few benefits from residential intervention.
Conclusions
Emotional abuse is a complex issue resulting in part from learned behaviours, psychopathology and/or unmet emotional needs in the parents, and often compounded by factors in the familiesā immediate and wider social environment. As such, a āone-approach-fits-allā is unlikely to lead to sustained change.
The evidence base is weak, but suggests that some caregivers respond well to cognitive behavioural therapy. However, the characteristics that define these parents are not clear. There is currently no evidence to support the use of this intervention alone in the treatment of severely emotionally abusive parents. Some of the evidence suggests that a certain form of emotional abuse (for example, highly negative parent affect, which may be expressed as frightened and frightening behaviours in the parent) stemming from unresolved trauma and loss, is less amenable to CBT. There is some evidence that interaction guidance and psychotherapeutic approaches can generate change in parents with more severe psychopathology.
Further research is urgently needed to evaluate the benefits of both psychotherapeutic and cognitive behavioural interventions, including those which take the form of family therapy, with parents at the more severe end of the spectrum, with fathers, and with older children. There is also a need to gain further understanding about which forms of emotional abuse respond best to different treatments
Knowledge and information needs of informal caregivers in palliative care : a qualitative systematic review
Objectives: To review current understanding of the knowledge and information needs
of informal caregivers in palliative settings. Data sources: Seven electronic databases
were searched for the period January 1994āNovember 2006: Medline, CINAHL, PsychINFO,
Embase, Ovid, Zetoc and Pubmed using a meta-search engine (MetalibĀ®).
Key journals and reference lists of selected papers were hand searched. Review methods:
Included studies were peer-reviewed journal articles presenting original research.
Given a variety of approaches to palliative care research, a validated systematic review
methodology for assessing disparate evidence was used in order to assign scores to
different aspects of each study (introduction and aims, method and data, sampling,
data analysis, ethics and bias, findings/results, transferability/generalizability, implications
and usefulness). Analysis was assisted by abstraction of key details of study into
a table. Results: Thirty-four studies were included from eight different countries. The
evidence was strongest in relation to pain management, where inadequacies in caregiver
knowledge and the importance of education were emphasized. The significance
of effective communication and information sharing between patient, caregiver and
service provider was also emphasized. The evidence for other caregiver knowledge
and information needs, for example in relation to welfare and social support was
weaker. There was limited literature on non-cancer conditions and the care-giving
information needs of black and minority ethnic populations. Overall, the evidence
base was predominantly descriptive and dominated by small-scale studies, limiting
generalizability. Conclusions: As palliative care shifts into patientsā homes, a more rigorously
researched evidence base devoted to understanding caregivers knowledge
and information needs is required. Research design needs to move beyond the current
focus on dyads to incorporate the complex, three-way interactions between patients,
service providers and caregivers in end-of-life care setting
Acute Chagas Disease in a Returning Traveler
Acute Chagas disease is rarely recognized, and the risk for acquiring the disease is undefined in travelers to Central America. We describe a case of acute Chagas disease in a traveler to Costa Rica and highlight the need for increased awareness of this infection in travelers to Chagas-endemic areas
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