Desmond Ryan

Spiritual issues and needs: Perspectives from patients with advanced cancer and nonmalignant disease. A qualitative study

OBJECTIVEnHealth care professionals and policy makers acknowledge that spiritual needs are important for many patients with life-limiting illnesses. We asked such patients to describe their spiritual needs and how these needs may impinge on their physical, psychological, and social well-being. Patients were also encouraged to explain in what ways their spiritual needs, if they had any, could be addressed.nnnMETHODSnWe conducted two qualitative interviews, 3 months apart, with 20 patients in their last year of life: 13 patients with advanced cancer and 7 with advanced nonmalignant illness. We also interviewed each patients general practitioner. Sixty-six interviews were tape-recorded, transcribed, and analyzed.nnnRESULTSnPatients spiritual needs centered around their loss of roles and self-identity and their fear of dying. Many sought to make sense of life in relation to a nonvisible or sacred world. They associated anxiety, sleeplessness, and despair with such issues, which at times resulted in them seeking support from health professionals. Patients were best able to engage their personal resources to meet these needs when affirmed and valued by health professionals.nnnSIGNIFICANCE OF RESULTSnEnabling patients to deal with their spiritual needs through affirmative relationships with health professionals may improve quality of life and reduce use of health resources. Further research to explore the relationship between spiritual distress and health service utilization is indicated.

Allergen Immunotherapy (AIT): a prototype of Precision Medicine

Precision medicine is a medical model aiming to deliver customised healthcare - with medical decisions, practices, and/or products tailored to the individual patient informed but not directed by guidelines. Allergen immunotherapy has unique immunological rationale, since the approach is tailored to the specific IgE spectrum of an individual and modifies the natural course of the disease as it has a persistent efficacy after completion of treatment. In this perspective Allergen Immunotherapy - AIT has to be presently considered a prototype of Precision Medicine.Precise information and biomarkers provided by systems medicine and network medicine will address the discovery of Allergen immunotherapy biomarkers for (i) identification of the causes, (ii) stratification of eligible patients for AIT and (iii) the assessment of AIT efficacy.This area of medical technology is evolving rapidly and, compelemented by e-health, will change the way we practice medicine. It will help to monitor patients’ disease control and data for (i) patient stratification, (ii) clinical trials, (iii) monitoring the efficacy and safety of targeted therapies which are critical for reaching an appropriate reimbursement. Biomarkers associated with e-health combined with a clinical decision support system (CDSS) will change the scope of Allergen immunotherapy.The cost/effectiveness of Allergen immunotherapy is a key issue for successful implementation. It should include the long-term benefits in the pharmaco-economic evaluation, since no other allergy treatment has this specific characteristic.AIT is the prototype of current and future precision medicine.

Improving allergy management in the primary care network - a holistic approach

The incidence, prevalence and costs of allergy have increased substantially in recent decades in many parts of Europe. The dominant model of allergy care within Europe is at the moment specialist‐based. This model will become unsustainable and undeliverable with increasing disease prevalence. One solution to increase provision of allergy services is to diversify the providers. A new model for the provision of allergy care in the community with the general practitioner at the forefront is proposed. Pre‐ and postgraduate allergy education and training, implementation of pathways of care, allergy specialization and political will to generate resources and support are essential to achieve this new model. In parallel the holistic view of allergic diseases should be maintained, including assessment of severity and risk, psychological factors and health‐care related costs in the context of the patient‐centered decision making process.

Spiritual Issues in Health and Social Care: Practice Into Policy?

SUMMARY The paper introduces an action research initiative called Spirited Scotland, an embryonic movement seeking to restore spirituality to an appropriate place in health and social care. It locates the initiative in the changing social and spiritual circumstances of post-industrial Scotland and identifies some challenges it faces associated with the prevailing understandings of health, becoming ill, and successful ageing. The paper also considers some policy and practice challenges raised by Spirited Scotland, in terms both of content and process.

The Allergic Rhinitis and its Impact on Asthma (ARIA) score of allergic rhinitis using mobile technology correlates with quality of life: The MASK study

Mobile technology has been used to appraise allergic rhinitis control, but more data are needed. To better assess the importance of mobile technologies in rhinitis control, the ARIA (Allergic Rhinitis and its Impact on Asthma) score ranging from 0 to 4 of the Allergy Diary was compared with EQ‐5D (EuroQuol) and WPAI‐AS (Work Productivity and Activity Impairment in allergy) in 1288 users in 18 countries. This study showed that quality‐of‐life data (EQ‐5D visual analogue scale and WPA‐IS Question 9) are similar in users without rhinitis and in those with mild rhinitis (scores 0‐2). Users with a score of 3 or 4 had a significant impairment in quality‐of‐life questionnaires.

Reviewing the literature constructing the field: Accounting for the CPN in practice and research

Making health practice and policy evidence-based politicises clinical research, by making proof of effectiveness the key to resources. In this paper we revisit a literature review of clinical effectiveness in psychiatric nursing in order to demonstrate how, in a multi-professional health system, scientific publications can also function as claims in the competition for resources. We consider the rhetorical dimension both of the literature reviewed, and of the act of literaturereviewing itself. Each genre comprising the literature constructs a version of the field of mental health care and a version of the CPN within the field. Each genre thereby constructs effectiveness differently. We therefore recast the problem of determining the effectiveness of Community Psychiatric Nurses (CPNs) as the problem of determining how the problem of CPN effectiveness is constructed as a problem in different discursive contexts, i.e. by different professional and non-professional discourse communities. In reconstructing the problem of effectiveness as one part of the wider struggle for definition of the field of mental health care, the genres we consider are: • care studies, in which CPNs report on their own work; • qualitative studies related to CPN effectiveness; • users reports on their mental health experiences; • the hidden CPN- loss of information in studies of services; • the disappearing CPN- loss of role specificity in community psychiatric projects. Concluding with a case study of the literature as political remote control (negotiating the CPN as a resource in community mental health care), we show how, if the field can be seen as a field of interests, sometimes openly displayed, sometimes not, a basic game being played in the literature is that of differently placed social groups seeking control of mental health services in the community through the production of legitimating accounts of practice.

The socialisation of nurses in clinical settings: a dual focus critique of a research study.

This is a two-pronged critique of a study of the socialisation of neophyte nurses in a neonatal intensive care unit in the USA. The authors, respectively an educationalist and a nurse researcher experienced in neonatal intensive care, agreed in finding that the study fell short of what it promised, but differed as to their reasons. They decided to publish their critiques as a complementary pair, in the hope that those supervising research students would benefit from seeing a disappointing study simultaneously in two perspectives, educational and clinical.