Attitudes of young people with diabetes to an Internet-based virtual clinic

We assessed the feasibility of developing a virtual diabetes clinic for young people, using the Internet. The proposed content of the site would be based on self-efficacy theory, aiming to develop confidence in self-management of diabetes. A questionnaire about the proposed Website was delivered to 72 patients who attended a young person’s outpatient clinic in a district hospital. Thirty-nine replies were received, a response rate of 54%. The mean age of the respondents was 13 years. A positive attitude to the potential clinic was reported by 95% of respondents. The items rated as most useful were: quick and easy access to up-todate information about diabetes; the opportunity to ask an expert; good graphics; easy navigation; interactivity. Responses to open questions indicated that 24-hour access and anonymity in asking questions were also valued. A virtual clinic appears to be a possible method of health-care delivery to young people with diabetes.

How do older people with sight loss manage their general health? A qualitative study

Purpose: Older people with sight loss experience a number of barriers to managing their health. The purpose of this qualitative study was to explore how older people with sight loss manage their general health and explore the techniques used and strategies employed for health management. Methods: Semi-structured face-to-face interviews were conducted with 30 participants. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Health management challenges experienced included: managing multiple health conditions; accessing information; engaging in health behaviours and maintaining wellbeing. Positive strategies included: joining support groups, clubs and societies; using low vision aids; seeking support from family and friends and accessing support through health and social care services. Conclusion: Healthcare professionals need to be more aware of the challenges faced by older people with sight loss. Improved promotion of group support and charity services which are best placed to share information, provide fora to learn about coping techniques and strategies, and give older people social support to prevent isolation is needed. Rehabilitation and support services and equipment can only be beneficial if patients know what is available and how to access them. Over-reliance on self-advocacy in current healthcare systems is not conducive to patient-centred care. Implications for Rehabilitation Sight loss in older people can impact on many factors including health management. This study identifies challenges to health management and highlights strategies used by older people with sight loss to manage their health. Access to support often relies on patients seeking information for themselves. However, self-advocacy is challenging due to information accessibility barriers. Informal groups and charities play an important role in educating patients about their condition and advising on available support to facilitate health management.

Democratization of local government in Brazil : decentralisation and people's councils

This research studies two cases of implementation of alternative strategies for municipal government reform in Brazil, decentralisation and People's Councils. The aim is to answer the following general question: `Can decentralisation and People's Councils be a means for democratization of municipal government in Brazil?'. The hypothesis is that initiatives to reform Brazilian municipal governments face problems that are characteristic of the Brazilian political and administrative reality. These problems are considered obstacles for the development of those initiatives and accordingly, for democratization of municipal government in Brazil. After an introduction and outline in Chapter One, Chapter Two discusses four main theories concerning local government. Chapter Three discusses decentralisation and People's Councils are discussed in Chapter Four. Chapter Five presents a historical, political and economic overview of Brazil. Chapter Six deals with Brazilian Federalism and Municipal Government. The main aspects of the Municipal Government are presented as well as the development of municipal autonomy through the various Federal Constitutions and cases of People's Councils and decentralisation in municipalities in Brazil. Chapter Seven presents the political parties responsible for the initiatives, the PSDB (Brazilian Social Democratic Party) in the case of decentralisation, and the PT (Workers' Party) in the case of People's Councils. In Chapter Eight the research strategy and the data collection techniques are described. Chapters Nine and Ten present decentralisation implemented by the PSDB in Belo Horizonte, the Minas Gerais state capital and People's Councils introduced by the PT in the town of Ipatinga in the same state. Conclusions are presented in Chapter Eleven and include a comparison and discussion of the two cases. The thesis shows that these experiments with alternative strategies of local government face problems that are generally current in Brazilian political and administrative reality. Those problems are concerned with unwillingness to decentralise power, clientelism, low levels of participation of civil society and the `political' use of the structures implemented.

Medication errors in older people with mental health problems:a review

Objective - To review and summarise published data on medication errors in older people with mental health problems. Methods - A systematic review was conducted to identify studies that investigated medication errors in older people with mental health problems. MEDLINE, EMBASE, PHARMLINE, COCHRANE COLLABORATION and PsycINFO were searched electronically. Any studies identified were scrutinized for further references. The title, abstract or full text was systematically reviewed for relevance. Results - Data were extracted from eight studies. In total, information about 728 errors (459 administration, 248 prescribing, 7 dispensing, 12 transcribing, 2 unclassified) was available. The dataset related almost exclusively to inpatients, frequently involved non-psychotropics, and the majority of the errors were not serious. Conclusions - Due to methodology issues it was impossible to calculate overall error rates. Future research should concentrate on serious errors within community settings, and clarify potential risk factors.

Designing mobile technologies for individuals with disabilities

While mobile devices offer many innovative possibilities to help increase the standard of living for individuals with disabilities and other special needs, the process of developing assistive technology, such that it will be effective across a group of individuals with a particular disability, can be extremely challenging. This chapter discusses key issues and trends related to designing and evaluating mobile assistive technology for individuals with disabilities. Following an overview of general design process issues, we argue (based on current research trends) that individuals with disabilities and domain experts be involved throughout the development process. While this, in itself, presents its own set of challenges, many strategies have successfully been used to overcome the difficulties and maximize the contributions of users and experts alike. Guidelines based on these strategies are discussed and are illustrated with real examples from one of our active research projects.

A pharmacy led program to review anti-psychotic prescribing for people with dementia

Background: Anti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics. Methods: This project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search. Results: Data were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (p?people with dementia prescribed low-dose anti-psychotics, 91 were receiving on-going treatment from local secondary care mental health services or Learning Disability Teams. Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review. Conclusions: In total 15.3% of people on the dementia register were receiving a low-dose anti-psychotic. However, such data, including the recent national audit may under-estimate the usage of anti-psychotics in people with dementia. Anti-psychotics were used more commonly within care home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.

Designing mobile technologies for individuals with disabilities

While mobile devices offer many innovative possibilities to help increase the standard of living for individuals with disabilities and other special needs, the process of developing assistive technology, such that it will be effective across a group of individuals with a particular disability, can be extremely challenging. This chapter discusses key issues and trends related to designing and evaluating mobile assistive technology for individuals with disabilities. Following an overview of general design process issues, we argue (based on current research trends) that individuals with disabilities and domain experts be involved throughout the development process. While this, in itself, presents its own set of challenges, many strategies have successfully been used to overcome the difficulties and maximize the contributions of users and experts alike. Guidelines based on these strategies are discussed and are illustrated with real examples from one of our active research projects.

'Listen to my madness':understanding the experiences of people with serious mental illness

This article explores the salience of disability theory for understanding the experiences of people with serious mental illness. Drawing on data from a focus group study, we suggest that users experience both impairment (as embodied irrationality) which can, in itself, be oppressive, and also have to manage their lives within a largely disabling society. We outline some of the strategies adopted by users to manage their situation and ensure they access and receive health services, and illustrate how these are a result of the complex relationship between disability and impairment. We suggest that using a framework of the social model of disability provides a useful way of understanding and making sense of the experience of users with serious mental illness. © Blackwell Publishing Ltd/Foundation for the Sociology of Health & Illness 2005.

Managing crisis:the role of primary care for people with serious mental illness

Background and Objectives: More than 30% of patients with serious mental illness in the United Kingdom now receive all their health care solely from primary care. This study explored the process of managing acute mental health crises from the dual perspective of patients and primary care health professionals. Methods: Eighteen focus groups involving 45 patients, 39 general practitioners, and eight practice nurses were held between May and November 2002 in six Primary Care Trusts across the British West Midlands. The topic guide explored perceptions of gold standard care, current issues and critical incidents in receiving/providing care, and ideas on improving services. Results: Themes relevant to the management of acute crisis included issues of process, such as access, advocacy, communication, continuity, and coordination of care; the development of more structured care that might reduce the need for crisis responses; and issues raised by the development of a more structured approach to care. Conclusions: Access to services is a complicated yet crucial feature of managing care in a crisis, with patients identifying barriers at the level of primary care and health professionals at the interface with secondary care. The development of more structured systems as a solution may generate its own ethical and pragmatic challenges.