99 research outputs found

    Empirical approaches to improving the use of DNA in crime scene investigative practice

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    This article reports on a collaborative project that explored the targeted use of swabbing evidence sources which, up until now, have not been routinely recovered or utilised for DNA analysis. All genres of the forensic portfolio have undergone significant changes driven by economic, political and technological influencers, which have resulted in an array of interpretations on its frontline delivery, often based on local requirements. The approach reported here pertains to a research project bringing together a collaborative team of researchers, representing practitioners and academics, working in conjunction with forensic service providers. The project reviewed the process of swabbing glove marks at crime scenes, comparing the methods used with DNA profiling outcomes. The findings showed significant benefits in regards to DNA outcomes, providing six detections over a four-month period that were attributable to the swabbing of the glove marks. Furthermore, the study provided key data to guide practice and crime scene methods to meet new operational requirements

    Empirical approaches to improving the use of DNA in crime scene investigative practice

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    At the beginning of the 21st century, rural policy remains one of the most important areas of public policy; huge financial and human resources are devoted to the implementation of this policy measures. The aim of the article is to provide holistic evaluation of the goals, means and key achievements of Lithuanian agricultural policy and to identify possible areas and ways of improvement. The diversity of agricultural policy measures applied in Lithuania after the restoration of independence in 1990 and achievements of the policy are analysed on the basis of new approach ÔÇô the theory of qualitative structures. The study explores how policy measures to accelerate the process of industrialization in Lithuanian agriculture after the privatization of kolkhozes and sovkhozes have encouraged and supported private farms to implement extensive growth, intensification, specialization, risk management, collaboration and innovation production strategies, and what results they have achieved.XXI a. prad┼żioje kaimo politika i┼ílieka viena i┼í svarbiausi┼│ vie┼íosios politikos sri─Źi┼│. ┼áios politikos priemon─Śms diegti skiriama labai daug finansini┼│ ir ┼żmogi┼ík┼│j┼│ i┼ítekli┼│. Straipsnio tikslas ÔÇô holisti┼íkai ─»vertinti Lietuvos ┼żem─Śs ┼źkio politikos tikslus, priemones ir pasiekimus, identifikuoti galimas tobulinimo kryptis. ┼Żem─Śs ┼źkio politikos priemoni┼│, taikyt┼│ Lietuvoje po nepriklausomyb─Śs atgavimo 1990 m., ─»vairov─Ś ir pasiekimai analizuojami remiantis kokybini┼│ strukt┼źr┼│ analiz─Śs metodu. Aptariama, kaip politikos priemon─Śmis, siekiant paspartinti industrializacijos proces─ů Lietuvos ┼żem─Śs ┼źkyje, ┼źkininkai buvo skatinami panaudoti ┼íi┼│ priemoni┼│ kokybin─Śs strukt┼źros galimybes, kad b┼źt┼│ ─»gyvendinamos ekstensyvaus augimo, intensifikacijos, specializacijos, rizikos valdymo, bendradarbiavimo ir inovacij┼│ strategijos

    Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness

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    PublishedObjective More than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness. Method 1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire. Results The number of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital; having no partner OR 1.49 (95% CI 1.04 to 2.15); having ischaemic heart disease OR 1.60 (95% CI 1.04 to 2.46); having a threatening experience OR 1.16 (95% CI 1.04 to 1.29) per experience; depression OR 1.58 (95% CI 1.04 to 2.40); emergency hospital admission in year prior to questionnaire completion OR 3.41 (95% CI (1.98 to 5.86). Conclusion To prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and who have had a recent emergency hospital admission.National Institute for Health Research (NIHR

    Late-Onset Erythropoietic Porphyria Caused by a Chromosome 18q Deletion in Erythroid Cells

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    The erythropoietic porphyrias, erythropoietic protoporphyria and congenital erythropoietic porphyria, result from germline mutations in the ferrochelatase gene and uroporphyrinogen III synthase gene, respectively. Both conditions normally present in childhood but rare cases with onset past the age of 40 y have been reported. Here we show that late-onset erythropoietic protoporphyria can be caused by deletion of the ferrochelatase gene in hematopoietic cells with clonal expansion as part of the myelodysplastic process. This is the first direct demonstration of porphyria produced by an acquired molecular defect restricted to one tissue. Some other cases of late-onset erythropoietic porphyria may be explained by a similar mechanism

    Implementing resources to support the diagnosis and management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) in primary care: a qualitative study

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    BACKGROUND: Previous research has highlighted that many GPs lack the confidence and knowledge to diagnose and manage people with CFS/ME. Following the development of an online training module for GPs, and an information pack and DVD for patients, this study explored the extent to which these resources can be implemented in routine primary care.METHODS: Semi structured qualitative interviews were completed with patients and GPs across North West England. All interviews were transcribed and analysed using open exploratory thematic coding. Following this thematic analysis, the authors conducted a further theory-driven analysis of the data guided by Normalisation Process Theory.RESULTS: When used in line with advice from the research team, the information resource and training were perceived as beneficial to both patients and GPs in the diagnosis and management of CFS/ME. However, 47 % of patients in this study did not receive the information pack from their GP. When the information pack was used, it was often incomplete, sent in the post, and GPs did not work with patients to discuss the materials. Only13 out of 21 practices completed the training module due to time pressures and the low priority placed on low prevalence, contentious, hard to manage conditions. When the module was completed, many GPs stated that it was not feasible to retain the key messages as they saw so few patients with the condition. Due to the complexity of the condition, GPs also believed that the diagnosis and management of CFS/ME should take place in a specialist care setting.CONCLUSION: While barriers to the implementation of training and resources for CFS/ME remain, there is a need to support CFS/ME patients to access reliable, evidence based information outside primary care. Our findings suggest that future research should develop an online resource for patients to support self-management

    Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies

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    Background The NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition. Methods A meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum. Results Twenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care. Conclusions In order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input

    Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease

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    PublishedOpen Access ArticleObjective To test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions. Design Cluster randomised controlled trial. Setting 36 general practices in the north west of England. Participants 387 patients with a record of diabetes or heart disease, or both, who had depressive symptoms (Ôëą10 on patient health questionaire-9 (PHQ-9)) for at least two weeks. Mean age was 58.5 (SD 11.7). Participants reported a mean of 6.2 (SD 3.0) long term conditions other than diabetes or heart disease; 240 (62%) were men; 360 (90%) completed the trial. Interventions Collaborative care included patient preference for behavioural activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse. Usual care was standard clinical practice provided by general practitioners and practice nurses. Main outcome measures The primary outcome was reduction in symptoms of depression on the self reported symptom checklist-13 depression scale (SCL-D13) at four months after baseline assessment. Secondary outcomes included anxiety symptoms (generalised anxiety disorder 7), self management (health education impact questionnaire), disability (Sheehan disability scale), and global quality of life (WHOQOL-BREF). Results 19 general practices were randomised to collaborative care and 20 to usual care; three practices withdrew from the trial before patients were recruited. 191 patients were recruited from practices allocated to collaborative care, and 196 from practices allocated to usual care. After adjustment for baseline depression score, mean depressive scores were 0.23 SCL-D13 points lower (95% confidence interval Ôłĺ0.41 to Ôłĺ0.05) in the collaborative care arm, equal to an adjusted standardised effect size of 0.30. Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care. There were no significant differences between groups in quality of life, disease specific quality of life, self efficacy, disability, and social support. Conclusions Collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity. The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity. Trial registration ISRCTN80309252.National Institute for Health ResearchCollaboration for Leadership in Applied Health ResearchCare for Greater Mancheste

    Update on the collaborative interventions for circulation and depression (COINCIDE) trial: changes to planned methodology of a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease.

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    Published onlineJournal ArticleRandomized Controlled TrialResearch Support, Non-U.S. Gov'tBACKGROUND: The COINCIDE trial aims to evaluate the effectiveness and cost-effectiveness of a collaborative care intervention for depression in people with diabetes and/or coronary heart disease attending English general practices. DESIGN: This update details changes to the cluster and patient recruitment strategy for the COINCIDE study. The original protocol was published in Trials (http://www.trialsjournal.com/content/pdf/1745-6215-13-139.pdf). Modifications were made to the recruitment targets in response to lower-than-expected patient recruitment at the first ten general practices recruited into the study. In order to boost patient numbers and retain statistical power, the number of general practices recruited was increased from 30 to 36. Follow-up period was shortened from 6 months to 4 months to ensure that patients recruited to the trial could be followed up by the end of the study. RESULTS: Patient recruitment began on the 01/05/2012 and is planned to be completed by the 30/04/2013. Recruitment for general practices was completed on 31/10/2012, by which time the target of 36 practices had been recruited. The main trial results will be published in a peer-reviewed journal. CONCLUSION: The data from the trial will provide evidence on the effectiveness and cost-effectiveness of collaborative care for depression in people with diabetes and/or coronary heart disease. TRIAL REGISTRATION: TRIAL REGISTRATION NUMBER: ISRCTN80309252.NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Mancheste
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