Pathway to clozapine use:a comparison between a patient cohort from New Zealand and a cohort from the United Kingdom

Background and Objective: Clozapine has been available since the early 1990s. Studies continue to demonstrate its superior efficacy in treatment-resistant schizophrenia. Despite this, numerous studies show under-utilisation, delayed access and reluctance by psychiatrists to prescribe clozapine. This retrospective cross-sectional study compared the prescribing of clozapine in two adult cohorts under the care of large public mental health services in Auckland (New Zealand) and Birmingham (United Kingdom) on 31 March 2007. Method: Time from first presentation to clozapine initiation, prior antipsychotics trialled and antipsychotic co-prescribing were compared. Data included demographics, psychiatric diagnosis, co-morbid conditions, year of first presentation, admissions and pharmacological treatment (clozapine dose, start date, prior antipsychotics, co-prescribed antipsychotic). Results: Overall, 664 people were prescribed clozapine (402 Auckland; 262 Birmingham); mean daily dose of 384 mg (Auckland) and 429 mg (Birmingham). 53 % presented after 1990 and the average duration of time before starting clozapine was significantly longer in the Birmingham cohort (6.5 vs. 5.3 years) but this reduced in both cohorts to a 1-year mean in those presenting within the last 3 years. The average number of antipsychotics trialled pre-clozapine for those presenting since 1990 was significantly higher in the Birmingham cohort (4.3 vs. 3.1) but in both cohorts this similarly reduced in those presenting within the last 3 years. Antipsychotic co-prescribing was significantly higher in the Birmingham cohort (22.9 vs. 10.7 %). Conclusions: There is evidence that access to clozapine has improved over time in both cohorts, with a reduction in the duration between presentation and initiation of clozapine and number of different antipsychotics trialled pre-clozapine. These are very positive findings in terms of optimising outcomes with clozapine and are possibly due to the impact of guideline recommendations, increasing clinician, consumer and carer knowledge, and experience with clozapine and funding changes. © 2014 Springer International Publishing.

Improving the management of behaviour that challenges associated with dementia in care homes:protocol for pharmacy-health psychology intervention feasibility study

INTRODUCTION: The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia. METHODS/ANALYSIS: 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study. ETHICS/DISSEMINATION: The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences.

Medication review of children on long term medications:a review of the literature

INTRODUCTION: Children on long term medication may be under the care of more than one medical team including the patients GP. Children on chronic medication should be supported and their medications reviewed, especially in cases of polypharmacy. Medicines Use Reviews (MURs) were introduced into the pharmacy contract in 2005. The service was designed for community pharmacists to review patients on long term medication. The service specified that MURs were done on patients who can give consent and cannot be conducted with a parent or carer. Hence the service may be inaccessible to paediatric patients. This review aims to find studies that identify medication review services in primary care that cater for children on long term medication. METHODS: A literature search was conducted on 6th June 2015 using the keywords, ("Medication" or "review" or "Medication Review" or "Medicines use review" or "Medication use review" or "New Medicine Service") AND ("community pharmacy" OR "community pharmacist" OR "primary care" OR "General practice" OR "GP" OR "community paediatrician" OR "community pediatrician" OR "community nurse"). Bibliographic databases used were AMED, British Nursing Index, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO and Health Business Elite. Inclusion criteria were: paediatric specific medication review in primary care, for example by either a GP, community paediatrician, community nurse or community pharmacist. Exclusion criteria were studies of medication review in adults/unclear patient age and secondary care medication reviews. RESULTS: From the 417 articles, 6 relevant articles were found after abstract and full text review. 235 articles were excluded after title and abstract review (11 did not have full text in English); 96 were adult or non-age specified medication review/MUR/New Medicine Service studies; 63 referred to observational, evaluative studies of interventions in adults; 6 were non-paediatric specific systematic reviews and 17 were protocols, commentaries, news, and letters.The 6 relevant articles consisted of 1 literature review (published 2004), 3 research articles and 1 published protocol. The literature review[1] recommended that children's long term medication should be reviewed. The published protocol stated that the NMS minimum age for inclusion in the trial was for children aged over 13 years of age. The four studies were related to psychiatrists reviewing paediatric mental health patients in the USA, a pharmacist using Drug Related Problem to review patients in GP practices in Australia, a UK study based on an information prescription concept by providing children dispensed medications in community pharmacy with signposting them to health information and one GP practice based study observing pharmaceutical care issues in children and adults. CONCLUSION: The results show that there are currently no known studies on medication use reviews specific to children, whereas in adults, published evaluations are available. The terms of the MUR policy restrict children's access to the service and so more studies are necessary to determine whether children could benefit from such access.

‘I don’t think I’d be frightened if the statins went’: a phenomenological qualitative study exploring medicines use in palliative care patients, carers and healthcare professionals

Background

Comparing long-term placements for young children in care: Does type of placement really matter?

This paper presents findings from the third phase of a longitudinal study, entitled Care Pathways and Outcomes, which has been tracking the placements and measuring outcomes for a population of children (n = 374) who were under the age of five and in care in Northern Ireland on the 31st March 2000. It explores how a sub-sample of these children at age nine to 14 years old were getting on in the placements provided for them, in comparative terms across five placement types: adoption; foster care; kinship foster care (with relatives); on Residence Order; and living with birth parents. This specifically focused on the development of attachment and self-concept from the perspective of the children, and behavioural and emotional function, and parenting stress, from the perspective of parents and carers. Findings showed no significant placement effect from the perspective of children, and a statistically weak, but descriptively compelling, effect from the perspective of parents. The findings challenge the notion of adoption as the gold standard in long-term placements, specifically from the perspective of children in terms of their parent/carer attachments and self-concept, and highlight what appears to be the central importance of placement longevity for delivering positive longer-term outcomes for these children, irrespective of placement type.

Palliative Care for People with Dementia: a Literature Review

With growing numbers of people dying with, and from, dementia there is a need for professionals and health-care organisations to review the access to and provision of palliative care. This literature review has identified several key themes in relation to the person dying with dementia including: diagnosis of the dying phase, appropriate timing of referral to specialist palliative care services; ethical decisions in relation to medication and nutrition; the environment; under treatment especially, for pain relief; over and burdensome treatment interventions; carer involvement; collaborative working and advance decision making.

Tackling Ageing Continence through Theory, Tools & Technology (TACT3)

The complexity of issues surrounding continence management, have been investigated by a UK multi-disciplinary research team working under the project title Tackling Ageing Continence through Theory Tools and Technology (TACT3). The team comprising engineers, chemists, health researchers, designers and social anthropologists is funded by the New Dynamics of Ageing Programme, ‘a seven year multidisciplinary research initiative with the ultimate aim of improving quality of life of older people. The programme is a unique collaboration between five UK Research Councils , and is the largest and most ambitious research programme on ageing ever mounted in the UK’ (www.newdynamics.group.shef.ac.uk). The TACT3 project comprises four work packages that are individually managed by members of the research team. One work package focuses solely on knowledge transfer of the research outputs and the management of the overall project. Another work package, entitled ‘Challenging Environmental Barriers’ has focused on the barriers in the built environment that prevent older people with continence concerns from participating in wider social life, namely access to publicly available toilet facilities. We also have a work package entitled ‘Improving Continence Interventions and Services’ which is exploring patient, carer and service providers experiences in receiving and delivering National Health Service (NHS) continence management treatments. The fourth workpackage ‘Developing Assistive Technologies’ has worked with users to develop devices that promote confidence, improve health and therefore may facilitate greater social interaction for older people with continence management concerns.

Klaus Prange: Erziehung als Handwerk, Studien zur Zeigestruktur der Erziehung, Paderborn / München / Wien / Zürich: Schöningh 2012 [Rezension]

Rezension von: Klaus Prange: Erziehung als Handwerk, Studien zur Zeigestruktur der Erziehung, Paderborn / München / Wien / Zürich: Schöningh 2012 (192 S.; ISBN 978-3-506-77547-4; 24,90 EUR)

Sprachförderung im Alltag: Umsetzung in Kindergarten, Kita und Spielgruppe. Videobasierte Fallanalysen

Hohe Erwartungen werden gegenwärtig an verschiedene Initiativen zur Sprachförderung in der frühkindlichen Bildung gestellt. Wirkungsanalysen verweisen auf die Bedeutung der Sprachförderung als Querschnittsaufgabe und damit auf die Sprachförderkompetenz der Fachkräfte, Kinder in ihrem Spracherwerb adaptiv zu unterstützen. Die hier diskutierte Interventionsstudie umfasst eine Weiterbildung für frühpädagogische Fachkräfte aus Spielgruppe, Kita und Kindergarten in Deutschland und der Schweiz, die fünf ausgewählte Strategien der Sprachförderung im Alltag thematisiert. Es werden die Strategien und ihre Umsetzung durch die Fachkräfte anhand von Fallstudien auf der Basis der Videoanalyse aufgezeigt. (DIPF/Orig.)

Stand-Punkte beziehen – multimodale Unterstützung des Erwerbs sprachlich-kognitiver Fähigkeiten im Kindergarten

Im Forschungsprojekt "Prozesse der Sprachförderung im Kindergarten – ProSpiK" werden Gespräche zwischen Lehrpersonen und Kindern gefilmt und sequenzanalytisch ausgewertet, um ihre Potenziale für den Erwerb und die Förderung bildungssprachlicher Fähigkeiten zu untersuchen. Ziel ist es, Grundlagen für eine stufengerechte (integrierte, situations- und themenorientierte) Sprachdidaktik zu erarbeiten, die Bildungsungleichheit abbauen hilft, anstatt sie zu reproduzieren. In der Nummer 3/2014 der Schweizerischen Zeitschrift für Bildungswissenschaften wurden die Anlage des Projekts und erste Auswertungsergebnisse (zum Phänomen «Wechsel von Referenzräumen») vorgestellt (Isler, Künzli, & Wiesner, 2014). Der vorliegende Beitrag befasst sich weiter vertiefend mit der Ausgestaltung von pädagogischen Gesprächen: Es wird untersucht, mit welchen kommunikativen Mitteln die Kinder beim Erwerb von Fähigkeiten des Argumentierens (Beziehen und Begründen eigener Positionen) unterstützt werden können.2 Im ersten Abschnitt geht es um die Bedeutung der Prozessqualität in der frühen Bildung und um Gespräche als Erwerbskontexte sprachlicher Fähigkeiten. Im zweiten Abschnitt werden zentrale theoretische Konzepte dargestellt, die unseren Analysen zugrunde liegen. Der dritte Abschnitt gibt einen exemplarischen Einblick in das Datenmaterial und die Auswertungsarbeiten. Im vierten Abschnitt wird anhand einer exemplarischen Analyse gezeigt, wie im Kindergarten multimodal gelernt werden kann. Abschliessend werden die Ergebnisse mit Bezug auf die Forschungsfragen des Projekts diskutiert. (DIPF/Orig.)

Elementi contestuali nella costruzione del benessere degli insegnanti in due casi studio italiani

L’articolo propone una riflessione su alcuni elementi critici della costruzione del benessere professionale degli insegnanti mettendo in luce, accanto alle note cause di insorgenza della sindrome del burnout quali fattori individuali, emotivi e relazionali, anche gli effetti che sembrano riconducibili alla condizione lavorativa nel suo complesso e dunque al sistema di attività nel quale viene svolto questo mestiere. Per dar conto di tali effetti l’articolo discute i risultati di due contributi empirici, realizzati in modo indipendente, a distanza di dieci anni l’uno dall’altro, nel Sistema scolastico italiano. In particolare i due studi fanno riferimento alla condizione di benessere socio professionale di insegnanti di scuola dell’infanzia e primaria in due fasi distinte dell’evoluzione del sistema scolastico italiano (che nell’arco dei dieci anni intercorsi fra i due studi è stato interessato da continui tentativi di riforme, da un crescente precariato, da un progressivo indebolimento del riconoscimento della professione, dalla presenza diffusa in classe di bambini di differenti culture, dall’introduzione, largamente approssimativa, di nuove tecnologie, dalla scarsa corrispondenza tra lavoro effettivo ed aspettative dei futuri insegnanti). Senza la pretesa di fornire risposte definitive ad un problema evidentemente complesso la ri-lettura dei due studi sul burnout, realizzati in due distinte fasi dell’evoluzione del sistema scolastico, pur confermando, in parte, i risultati di altri lavori simili, solleva il problema complementare della contestualizzazione delle modalità di espressione del disagio degli insegnanti in relazione al più ampio tessuto identitario professionale nel quale essi operano. Tessuto che sembra mutare al mutare del posizionamento sociale e culturale dell’insegnamento. (DIPF/Orig.)

Vivências de cuidado familiar à criança dependente de tecnologias: subsídios para a enfermagem

Crianças dependentes do uso de tecnologias para viver necessitam de cuidados diferenciados, tanto dos profissionais da saúde como de sua família. Para o enfermeiro atuar junto à família da criança dependente do uso de tecnologias é necessário que compreenda quais são os recursos importantes para o enfrentamento de situações estressantes que envolvem, necessariamente, o conviver com a doença e o cuidado. Ao vivenciar a relação com essa família, o enfermeiro estuda e desenvolve sua prática de aprendizado e de ensino sobre o cuidado humano, criando o fazer profissional e, nesse processo de aprender/ensinar/criar, ele concebe, organiza e expressa ações de cuidado. A compreensão da experiência da família no processo de cuidar da criança em seu cotidiano pode subsidiar as intervenções da enfermagem nessas situações. Assim, objetivou-se conhecer as vivências de famílias no cuidado às crianças dependentes de tecnologias. Realizou-se uma pesquisa qualitativa, descritiva e exploratória no primeiro semestre de 2014. Os dados foram coletados por meio de entrevistas semiestruturadas com treze familiares cuidadores de crianças dependentes de tecnologias atendidas em uma Unidade de Pediatria de um hospital universitário do sul do país e submetidos à análise temática. Encontraram-se como categorias: caracterização da população do estudo; identificação da percepção do familiar cuidador a cerca do cuidado à criança dependente de tecnologia; recepção do diagnóstico da criança; mudanças do cotidiano familiar em função do cuidado à criança; profissionais de saúde e a enfermagem: contribuições para a instrumentalização do familiar cuidador; facilidades e dificuldades encontradas pelo familiar cuidador durante o cuidado à criança dependente de tecnologia; recebimento de ajuda da rede de apoio social para o cuidado à criança. Acredita-se que este estudo possibilitou a compreensão da experiência de famílias no processo de cuidar da criança dependente de tecnologias em seu cotidiano, subsidiando as intervenções da enfermagem nessas situações.

Männer in Kitas: Zwischen Idealisierung und Verdächtigung

Der Autor verweist in seinem Beitrag auf ein zentrales Spannungsverhältnis in der aktuellen Diskussion über Männer in Kindertageseinrichtungen. Auf der einen Seite werden männliche Erzieher in Kindertageseinrichtungen begrüßt, sie werden als Bereicherung angesehen und ihr ‚geschlechtsspezifischer‘ Beitrag zur frühkindlichen Bildung idealisiert. Wie der Autor hervorhebt, wird dieses ‚Andere‘, das Männer in die Kindererziehung einbringen sollen, dabei mit geschlechterstereotypen Erwartungen verknüpft. Männliche Erzieher können hier offenbar auf eine patriarchale Dividende (Connell) zurückgreifen, die ihnen in erster Linie qua Geschlecht und weniger qua Professionalität zuerkannt wird. Gleichzeitig werden männliche Erzieher als potentiell pädophile Täter unter einen ‚Generalverdacht‘ gestellt. Dieser Generalverdacht, so der Autor, verunsichert insbesondere Männer in der Phase der Berufsorientierung, der Berufsausbildung und des Berufseinstiegs. Als Bewältigungsstrategien macht der Autor zwei Muster aus: zum einen die Strategie der Neutralisierung, die mit einer Dethematisierung bzw. Entdramatisierung von Geschlechtsunterschieden einhergeht, zum anderen die Strategie der Resouveränisierung, bei der männliche Fachkräfte auf traditionelle Männlichkeitsmuster zurückgreifen. Hier versuchen männliche Erzieher in einer als weiblich wahrgenommenen Institution, den Anspruch männlicher Überlegenheit wieder herzustellen. Der Autor stellt mit seinem Beitrag somit die Widersprüche von Männlichkeitskonstruktionen in pädagogischen Institutionen heraus. (DIPF/Orig.)

Heilsbringer oder Erlösungssucher? Befunde und Thesen zur Problematik von Männern in frühpädagogischen Institutionen

Die Autorinnen schließen in ihrem Beitrag Befunde und Thesen zur Problematik von Männern in frühpädagogischen Institutionen an die Diskurse um die Steigerung des Anteils männlicher Erzieher an, mit denen häufig die Vermutung einer Qualitätssteigerung verbunden ist. Sie fragen anhand von Interviews nach „Auffassungen und Ausgestaltungen der männlichen Geschlechtszugehörigkeit durch Erzieher in ihrer frühpädagogischen Arbeit“. Dabei schildern die Autorinnen große Akzeptanz im Feld und positive Zuschreibungen seitens der Institutionen. Die Erzieher explizieren dabei ihre Funktion als männliche Vorbilder in Form von Varianten wie ‚neue‘ Männer und ‚bessere‘ Väter, nicht zuletzt in Abgrenzung gegenüber den tatsächlichen Vätern der Kindergartenkinder. Augenfällig seien, so die Autorinnen, dass negative eigene Kindheitserfahrungen durch eine Romantisierung und stark emotionalisierende Aufladung der Beziehung zu den Kindern kompensiert werden und dies die notwendige generationale Differenz verwischt. Insgesamt stehen diese vergeschlechtlichten Positionierungen der Erzieher einer vertieften biographischen Selbstreflexion als Kernelement von institutionell zu fordernder Professionalisierung eher im Wege. (DIIPF/Orig.)

Beiträge zum Mathematikunterricht 2015. Vorträge auf der 49. Tagung für Didaktik der Mathematik vom 09.02.2015 bis 13.02.2015 in Basel [Band 2]

Die Jahrestagung der Gesellschaft für Didaktik der Mathematik fand im Jahr 2015 zum dritten Mal in der Schweiz statt. [...] Mit rund 300 Vorträgen, 16 moderierten Sektionen, 15 Arbeitskreistreffen und 21 Posterpräsentationen eröffnete sich ein breites Spektrum an Themen und unterschiedlichen Zugangsweisen zur Erforschung von Fragen rund um das Lernen und Lehren von Mathematik. (DIPF/Orig.)