Implementing low intensity CBT in case management of clients with severe mental illness

In a previous chapter (Dean and Kavanagh, Chapter 37), the authors made a case for applying low intensity (LI) cognitive behaviour therapy (CBT) to people with serious mental illness (SMI). As in other populations, LI CBT interventions typically deal with circumscribed problems or behaviours. LI CBT retains an emphasis on self-management, has restricted content and segment length, and does not necessarily require extensive CBT training. In applying these interventions to SMI, adjustments may be needed to address cognitive and symptomatic difficulties often faced by these groups. What may take a single session in a less affected population may require several sessions or a thematic application of the strategy within case management. In some cases, the LI CBT may begin to appear more like a high-intensity (HI) intervention, albeit simple and with many LI CBT characteristics still retained. So, if goal setting were introduced in one or two sessions, it could clearly be seen as an LI intervention. When applied to several different situations and across many sessions, it may be indistinguishable from a simple HI treatment, even if it retains the same format and is effectively applied by a practitioner with limited CBT training. ----- ----- In some ways, LI CBT should be well suited to case management of patients with SMI. treating staff typically have heavy workloads, and find it difficult to apply time-consuming treatments (Singh et al. 2003). LI CBT may allow provision of support to greater numbers of service users, and allow staff to spend more time on those who need intensive and sustained support. However, the introduction of any change in practice has to address significant challenges, and LI CBT is no exception. ----- ----- Many of the issues that we face in applying LI CBT to routine case management in a mnetal health service and their potential solutions are essentially the same as in a range of other problem domains (Turner and Sanders 2006)- and, indeed, are similar to those in any adoption of innovation (Rogers 2003). Over the last 20 years, several commentators have described barriers to implementing evidence-based innovations in mental health services (Corrigan et al. 1992; Deane et al. 2006; Kavanagh et al. 1993). The aim of the current chapter is to present a cognitive behavioural conceptualisation of problems and potential solutions for dissemination of LI CBT.

Identity, forgiveness and power in the management of child sexual abuse by personnel in Christian Institutions

The ongoing crises of child sexual abuse by Christian institutions leaders across the Anglophone world continue to attract public attention and public inquiries. The pervasiveness of this issue lends credence to the argument that the prevailing ethos functioning within some Christian Institutions is one which exercises influence to repeatedly mismanage allegations of child sexual abuse by Church leaders. This work draws on semistructured interviews conducted with 15 Personnel in Christian Institutions (PICIs) in Australia who were identified as being pro-active in their approach to addressing child sexual abuse by PICIs. From these data, themes of power and forgiveness are explored through a Foucaultian conceptualising of pastoral power and ‘truth’ construction. Forgiveness is viewed as a discourse which can have the power effect of either silencing or empowering victim/survivors. The study concludes that individual PICIs’ understandings of the role ofpower in their praxis influences outcomes from the deployment of forgiveness.

Part 1. Chemical and Physical Restraints in the Management of Mechanically Ventilated Patients in the ICU: Contributing Factors

Chemical and physical restraints are frequently used in the intensive care unit (ICU) to control agitated patients and to prevent self-harm and unplanned extubations. Published work relating to the numerous issues of the care and treatment strategies for these patients remains conflicting and unclear. Literature regarding sedation and chemical restraint reveals a trend towards management with lighter sedation, use of sedation assessment tools and sedation protocols. It remains unclear which treatment is best for agitated and delirious patients, and the evidence on the effect of sedation is conflicting. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. The purpose of this paper is to provide a summary of the existing literature on the use of physical and chemical restraints in the ICU setting. In Part 1 of this two-part paper, the evidence on chemical and physical restraints is explored with specific focus on definition of terms, unplanned

Part 2. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: A patient perspective

An important goal of the care for the mechanically ventilated patient is to minimize patient discomfort and anxiety. This is partly achieved by frequent use of chemical and physical restraints. The majority of patients in intensive care will receive some form of sedation. The goal and use of sedation has changed considerably over the past few decades with literature evidencing trends toward overall lighter sedation levels and daily interruption of sedation. Conversely, the use of physical restraint for the ventilated patient in ICU differs considerably between nations and continents. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. Recent literature suggests minimal use of physical restraint in the ICU, and that reduction programmes have been initiated. However, very few papers illuminate the patient's experience of physical and chemical restraints as a treatment strategy. In Part 1 of this two-part review, the evidence on chemical and physical restraints was explored with specific focus on definitions of terms, unplanned extubation, agitation, delirium as well as the impact of nurse–patient ratios in the ICU on these issues. This paper, Part 2, examines the evidence related to chemical and physical restraints from the mechanically ventilated patient's perspective.

An assessment of the potential of family day care as a nutrition promotion setting in South Australia

Articles > Journals > Health journals > Nutrition & Dietetics: The Journal of the Dieticians Association of Australia articles > March 2003 Article: An assessment of the potential of Family Day Care as a nutrition promotion setting in South Australia. (Original Research). Article from:Nutrition & Dietetics: The Journal of the Dieticians Association of Australia Article date:March 1, 2003 Author:Daniels, Lynne A.; Franco, Bunny; McWhinnie, Julie-Anne CopyrightCOPYRIGHT 2006 Dietitians Association of Australia. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights or concerns about this content should be directed to customer service. (Hide copyright information) Related articles Ads by Google TAFE Child Care Courses Government accredited courses. Study anytime, anywhere. www.seeklearning.com.au Get Work in Child Care Certificate III Children's Services 4 Day Course + Take Home Assessment HBAconsult.com.au Abstract Objective: To assess the potential role of Family Day Care in nutrition promotion for preschool children. Design and setting: A questionnaire to examine nutrition-related issues and practices was mailed to care providers registered in the southern region of Adelaide, South Australia. Care providers also supplied a descriptive, qualitative recall of the food provided by parents or themselves to each child less than five years of age in their care on the day closest to completion of the questionnaire. Subjects: 255 care providers. The response rate was 63% and covered 643 preschool children, mean 4.6 (SD 2.8) children per carer. Results: There was clear agreement that nutrition promotion was a relevant issue for Family Day Care providers. Nutrition and food hygiene knowledge was good but only 54% of respondents felt confident to address food quality issues with parents. Sixty-five percent of respondents reported non-neutral approaches to food refusal and dawdling (reward, punishment, cajoling) that overrode the child's control of the amount eaten. The food recalls indicated that most children (> 75%) were offered fruit at least once. Depending on the hours in care, (0 to 4, 5 to 8, greater than 8 hours), 20%, 32% and 55%, respectively, of children were offered milk and 65%, 82% and 87%, respectively, of children were offered high fat and sugar foods. Conclusions: Questionnaire responses suggest that many care providers are committed to and proactive in a range of nutrition promotion activities. There is scope for strengthening skills in the management of common problems, such as food refusal and dawdling, consistent with the current evidence for approaches to early feeding management that promote the development of healthy food preferences and eating patterns. Legitimising and empowering care providers in their nutrition promotion role requires clear policies, guide lines, adequate pre- and in-service training, suitable parent materials, and monitoring.

Strengthening and formally verifying privacy in identity management systems

In a digital world, users’ Personally Identifiable Information (PII) is normally managed with a system called an Identity Management System (IMS). There are many types of IMSs. There are situations when two or more IMSs need to communicate with each other (such as when a service provider needs to obtain some identity information about a user from a trusted identity provider). There could be interoperability issues when communicating parties use different types of IMS. To facilitate interoperability between different IMSs, an Identity Meta System (IMetS) is normally used. An IMetS can, at least theoretically, join various types of IMSs to make them interoperable and give users the illusion that they are interacting with just one IMS. However, due to the complexity of an IMS, attempting to join various types of IMSs is a technically challenging task, let alone assessing how well an IMetS manages to integrate these IMSs. The first contribution of this thesis is the development of a generic IMS model called the Layered Identity Infrastructure Model (LIIM). Using this model, we develop a set of properties that an ideal IMetS should provide. This idealized form is then used as a benchmark to evaluate existing IMetSs. Different types of IMS provide varying levels of privacy protection support. Unfortunately, as observed by Jøsang et al (2007), there is insufficient privacy protection in many of the existing IMSs. In this thesis, we study and extend a type of privacy enhancing technology known as an Anonymous Credential System (ACS). In particular, we extend the ACS which is built on the cryptographic primitives proposed by Camenisch, Lysyanskaya, and Shoup. We call this system the Camenisch, Lysyanskaya, Shoup - Anonymous Credential System (CLS-ACS). The goal of CLS-ACS is to let users be as anonymous as possible. Unfortunately, CLS-ACS has problems, including (1) the concentration of power to a single entity - known as the Anonymity Revocation Manager (ARM) - who, if malicious, can trivially reveal a user’s PII (resulting in an illegal revocation of the user’s anonymity), and (2) poor performance due to the resource-intensive cryptographic operations required. The second and third contributions of this thesis are the proposal of two protocols that reduce the trust dependencies on the ARM during users’ anonymity revocation. Both protocols distribute trust from the ARM to a set of n referees (n > 1), resulting in a significant reduction of the probability of an anonymity revocation being performed illegally. The first protocol, called the User Centric Anonymity Revocation Protocol (UCARP), allows a user’s anonymity to be revoked in a user-centric manner (that is, the user is aware that his/her anonymity is about to be revoked). The second protocol, called the Anonymity Revocation Protocol with Re-encryption (ARPR), allows a user’s anonymity to be revoked by a service provider in an accountable manner (that is, there is a clear mechanism to determine which entity who can eventually learn - and possibly misuse - the identity of the user). The fourth contribution of this thesis is the proposal of a protocol called the Private Information Escrow bound to Multiple Conditions Protocol (PIEMCP). This protocol is designed to address the performance issue of CLS-ACS by applying the CLS-ACS in a federated single sign-on (FSSO) environment. Our analysis shows that PIEMCP can both reduce the amount of expensive modular exponentiation operations required and lower the risk of illegal revocation of users’ anonymity. Finally, the protocols proposed in this thesis are complex and need to be formally evaluated to ensure that their required security properties are satisfied. In this thesis, we use Coloured Petri nets (CPNs) and its corresponding state space analysis techniques. All of the protocols proposed in this thesis have been formally modeled and verified using these formal techniques. Therefore, the fifth contribution of this thesis is a demonstration of the applicability of CPN and its corresponding analysis techniques in modeling and verifying privacy enhancing protocols. To our knowledge, this is the first time that CPN has been comprehensively applied to model and verify privacy enhancing protocols. From our experience, we also propose several CPN modeling approaches, including complex cryptographic primitives (such as zero-knowledge proof protocol) modeling, attack parameterization, and others. The proposed approaches can be applied to other security protocols, not just privacy enhancing protocols.

Do students and lecturers actively use collaboration tools in learning management systems?

In recent years there has been a large emphasis placed on the need to use Learning Management Systems (LMS) in the field of higher education, with many universities mandating their use. An important aspect of these systems is their ability to offer collaboration tools to build a community of learners. This paper reports on a study of the effectiveness of an LMS (Blackboard©) in a higher education setting and whether both lecturers and students voluntarily use collaborative tools for teaching and learning. Interviews were conducted with participants (N=67) from the faculties of Science and Technology, Business, Health and Law. Results from this study indicated that participants often use Blackboard© as an online repository of learning materials and that the collaboration tools of Blackboard© are often not utilised. The study also found that several factors have inhibited the use and uptake of the collaboration tools within Blackboard©. These have included structure and user experience, pedagogical practice, response time and a preference for other tools.

People capabilities for promoting sustainability in facilities management practices

Sustainability needs to be embedded throughout the life-cycle of a construction project. From project conception, planning, design, construction stage, operation and maintenance to demolition, each phase of development should embrace principles of sustainability and the stakeholder involved should be empowered with the necessary skills. Past research explored the importance of ensuring sustainability measures during the occupancy phase based on considerations of Life-Cycle Cost Analysis and a project’s long-term detrimental impact on the environment. Facility managers are in a unique position to promote sustainability over longer periods of project engagement and can apply a high level of influence on the built assets through management and upgrades. There is growing interest among facility managers in incorporating sustainability measures into day-to-day practice. More, however, needs to be done. Previous studies have identified barriers such as the lack of sustainability knowledge and skills, poor access to information, and unwillingness to change among facility management (FM) practitioners and stakeholders. This inhibits proper implementation of sustainable practices in the FM sector. A number of key factors, such as knowledge discrepancy, time constraints, diversity of FM functions and a lack of incentives, require urgent remedy. The capability of FM professionals and stakeholders will be a key enabler in managing the sustainability agenda, as it is central to the improvement of competency and innovation in an organization. Compared to the attempts at developing sustainability guidelines and performance measurement, research efforts relating to people capabilities and skills are still lagging behind. This paper discusses the progress to date of a research project aimed at formulating a people capabilities framework for sustainable FM practices based on expert opinions and industry feedback. Through literature review, the paper explores the challenges of incorporating sustainability principles into general FM practices before focusing specifically on FM personnel capabilities that may impact on the implementation of a holistic sustainability agenda in real life practice. The results of an industry survey are used to propose an action framework to identify, promote and utilise people capabilities in order to promote sustainability integration in FM practices. The paper provides a useful information source for FM personnel and organizations to bridge the gap between extensive tools on sustainable design and construction assessment at the front end and the need to maintain focus throughout the project life-cycle.

Cisplatin and gemcitabine in the management of metastatic penile cancer

Penile cancer is rare and receives little public attention. There are few treatment options for advanced disease. The most active regimen to date is a combination of bleomycin, methotrexate, and cisplatin. However the treatment-related mortality is 11% and hence this combination has not been adapted as a standard of care. We report two cases of advanced penile cancer where a sustained palliative response was observed with combination chemotherapy using cisplatin and gemcitabine. Our experience demonstrates that this is a well tolerated regimen active in this setting. © 2009 Elsevier Inc. All rights reserved.

Using virtual reality modelling in cultural management, archiving and research

This paper outlines how the Ortelia project’s 3D virtual reality models have the capacity to assist our understanding of sites of cultural heritage. The VR investigation of such spaces can be a valuable tool in 'real world' empirical research in theatre and spatiality. Through a demonstration of two of Ortelia's VR models (an art gallery and a theatre), we suggest how we might consider interpreting cultural space and sites as contributing significantly to cultural capital. We also introduce the potential for human interaction in such venues through motion-capture to discuss the potential for assessing how humans interact in such contexts.