Anna Luce

Rivastigmine in the treatment of parkinsonian psychosis and cognitive impairment: preliminary findings from an open trial.

This open study assessed the ability of rivastigmine to treat the neuropsychiatric complications of advanced Parkinsons disease. In a group of 12 patients, hallucinations, sleep disturbance, and carer distress were all improved and cognitive performance significantly enhanced by the drug.

After the Omagh Bomb: Posttraumatic Stress Disorder in Health Service Staff

In this postal survey of 1064 health service staff working closest to the Omagh bombing in Northern Ireland, approximately half reported having professional or civilian involvement. Types of involvement and posttraumatic stress disorder (PTSD) levels varied between staff groups. Staff involved both professionally and as a civilian, particularly those who witnessed the trauma, or those who had experienced previous emotional problems and trauma, had the highest levels of symptomatology. Although staff with higher PTSD symptoms were more likely to seek professional help, only a minority contacted professionals for support.

DEVELOPMENT OF A TREATMENT VERSION OF THE READINESS TO CHANGE QUESTIONNAIRE

A treatment version of the Readiness to Change Questionnaire (the RCQ[TV]) was developed among a sample of 263 clients attending treatment for alcohol problems. The psychometric properties of this new instrument were shown to be adequate for research and clinical purposes, although further work is needed to strengthen the internal consistency and test-retest reliability of the Contemplation scale. It was not found possible to include a Preparation or a Maintenance stage in the RCQ|TV| and subjects are therefore allocated to Precon-templation. Contemplation or Action stages of change. Significant relationships were found between allocated stage of change and level of alcohol consumption, items measuring motivation to change drinking habits, length of time in treatment and whether or not the subject has previously received treatment for an alcohol problem. Subjects allocated to the Contemplation stage at initial assessment were less likely to show a good treatment outcome at six months follow-up than those ...

What might encourage later retirement among general practitioners

More GPs are needed, but there are concerns about retaining the existing workforce quite apart from recruiting new doctors. This survey of GP principals in the Northern deanery aged over 45, identified factors potentially encouraging them to take early retirement (before 60) or to work on beyond 60. Over a third of those with retirement plans intended to retire early. Perceived undesirable changes in the NHS and workload were the main factors influencing intentions to retire. Reducing hours and administrative duties, and improving managerial support were factors that may encourage later retirement. Financial incentives in the form of increased pensions were most attractive to those already planning later retirement. A total of 35 per cent scored above threshold for significant psychological distress, and the higher psychological distress the earlier GPs wanted to retire. Interventions encouraging later retirement should be targeted at reducing workload and administration. Interventions to reduce stress could also encourage later retirement.

Reframing risk management in dementia care through collaborative learning

Risk management is a complex aspect of practice which can lead to an emphasis on maintaining physical safety, which impacts on the well-being of people with dementia. Education for practitioners in risk management is particularly challenging because of its conceptual nature and diverse perceptions of risk between and within professional groups. The practice development research reported here formed one part of a multisite study and contributed to developing a risk assessment and management framework for use by practitioners in partnership with people with dementia and their families. Practice development research uses learning theories in the process of the research, and in so doing its intent is to not only create new knowledge but to view the research process as also a process of learning for those involved. Twenty practitioners from varying professions participated in five Collaborative Learning Groups, each of at least 2 hours duration, which were held over a 7-month period. Data analysis highlighted contradictions in the care system and in the professionals intention to practice in a person-centred way. These were expressed through the themes of: Seeking Certainty; Making Judgements; Team Working; Managing Complexity; Gathering and Using Information.

Alcohol-related brain damage: Narrative storylines and risk constructions

To date, the voice and experience of people with alcohol-related brain damage has been silent in the literature. Using narrative research methodology and a focus on risk and quality of life, this paper outlines the analysis of interviews with six people with alcohol-related brain damage who were resident on a specialist care unit for the condition. Of the six participants, four were interviewed twice in line with the study protocol and separate interviews were conducted with a key worker on the unit, a social worker and a relative of one of the female participants. Analysis of the interviews revealed three dominant, narrative storylines: Five Minute Memory; Fractured Lives; and Believing in Recovery. Risk was constructed and experienced in a variety of ways under each of these narrative storylines, but each participant was particularly vulnerable to the assimilation of alcohol-related brain damage as a component and projection of self and identity. In addition, the process of ‘prompting’ emerged as a way that care staff constructed and discharged their rehabilitative function on the care unit and worked to minimise risk factors. A more co-ordinated, robust and transparent funding, policy, education and service structure for people with alcohol-related brain damage is called for.

National census of UK alcohol treatment agencies: I. Characteristics of clients, treatment and treatment providers

A national census of all UK specialist alcohol treatment agencies was carried out in order to enquire about client characteristics and the broad features of the treatment service received by clients on a specific day (4 December 1996). A total of 728 agencies were eligible for the census and the overall response rate was 41 %. When the effects of response bias were examined, correcting for under- and over-representations of different types of agencies made very little difference to findings. A rough estimate from the census is that 10,000 individuals were seen for treatment or advice regarding an alcohol problem on census day in the UK. Treatment services are dominated by the non-statutory sector, which accounted for almost two-thirds of all clients seen on census day. Despite demographic changes in drinking patterns over the last 10-20 years, the ‘typical’ client attending treatment services is still a middle-aged man and the client sample as a whole showed evidence of major social disadvantage and dislocation. Compared with national figures, the sample showed an over-representation of ‘Irish’ clients in English agencies but there was no under-representation of other ethnic groups. The most common category of staff providing treatment was ‘counsellors’, and the complaint most often presented by clients concerned ‘psychological well-being’. Twenty-eight per cent of clients were recorded as being in residential treatment. The most common form of treatment received was therapy or counselling on a one-to-one basis, which accounted for two-thirds of clients receiving some form of psychosocial treatment. The majority of clients in detoxification (60%) received it as in-patients. Forty-two per cent of treatment episodes were estimated to have lasted for more than 3 months and 18% had continued for over a year. The most commonly cited use of other services was for Alcoholics Anonymous (AA), although AA was mentioned in relation to only 9% of all clients. Excluding cannabis, 85% of clients were recorded as having no illicit drug use. Suggestions are made as to how the response rate and other features of the census could be improved if the exercise were to be repeated.

National census of UK alcohol treatment agencies: III. Differences between countries of the United Kingdom

From data provided by a national census of treatment for alcohol problems in 1996, this paper reports findings on differences between three countries of the UK (England, Northern Ireland and Scotland). Wales and the Channel Islands were not included in this analysis because of especially low response rates. Countries did not differ in the numbers of clients seen per day or the gender balance of clients. Mean age of clients was highest in Scotland (44 years) and lowest in Northern Ireland (39 years). A higher proportion of clients seen in Northern Ireland were friends or relatives of problem drinkers seeking help than in the other countries. English agencies reported much larger proportions of ‘Irish’ clients than those in Scotland. Northern Irish agencies showed the highest proportion of married clients and also the lowest proportion of those divorced, separated or widowed, the highest proportion of whom was found in Scotland. The country recording the highest proportion of clients in insecure accommodation was England. Northern Irish agencies had the highest proportion of clients in employment and the lowest proportion on sickness or invalidity benefits. The highest proportion of professional staff delivering treatment on census day was recorded in Northern Ireland. Clients in Northern Ireland were less likely to complain about physical health consequences of drinking and more likely to complain about psychological consequences. The highest proportion of clients simultaneously attending Alcoholics Anonymous (AA) meetings was found in Northern Ireland. Known drug use was higher in agencies in Northern Ireland than in England and Scotland. Clients seen by agencies in Northern Ireland appear to form a distinct group from those seen in Scotland and England. These current differences in treatment provision may become especially relevant if increased devolution leads to greater divergence in the nature of treatment provision in the countries of the UK.

National census of UK alcohol treatment agencies: II. Differences between types of treatment agencies in England and Wales

From data provided by a national census of treatment for alcohol problems in 1996, this paper reports findings on differences between types of treatment agencies in England and Wales. The overall response rate was 44% but no significant differences were found between responding and non-responding agencies in size and composition of staff. The highest mean number of clients per day was seen in NHS trust services and charitable organizations. Private (for profit) agencies showed both the highest mean age of clients and the highest proportion of men among agency types, while NHS trusts saw the highest proportion of women. Charities and voluntary organizations reported higher than average proportions of clients living in insecure accommodation. Private (for profit) agencies showed both the lowest proportion of unemployed clients and the highest proportion of those on sickness or invalidity benefits. Seventy-three per cent of clients attending NHS trust services were seen by nurses, medical or non-medical professionals; only 8% of clients attending private (for profit) agencies were seen by these professional groups. Worries about physical health were far more common among clients attending private (for profit) agencies and legal/financial problems occurred much more often among those attending voluntary/ statutory partnerships. The highest proportion of clients in residential treatment was shown in private (for profit) agencies and the lowest in voluntary/statutory partnerships and NHS trusts. Nearly all (90%) treatment carried out by voluntary/ statutory partnerships was in the form of ‘counselling’, while approximately half the clients seen by charities and independent (non-profit) organizations were in day or residential treatment. While in the overall sample, the mean percentage of clients also attending Alcoholics Anonymous (AA) was 9%, this rose to 23% of clients attending independent (non-profit) agencies. The highest proportions of clients with reported illicit drug use was in voluntary/statutory partnerships and the lowest in independent (non-profit) agencies. This paper provides a ‘snapshot’ of the variation in treatment services for alcohol problems in England and Wales, which can be used to detect trends in treatment provision in the future.