Dorothy Horsburgh

A review of the literature relating to psychological interventions and people with intellectual disabilities: Issues for research, policy, education and clinical practice

The aim of this review is to identify and analyse the published evidence base and wider literature in relation to psychological interventions for adults with intellectual disabilities. The review suggests that the evidence base regarding psychological interventions is sparse yet growing, and if the therapeutic approaches are modified and adapted to meet the distinct needs of people with intellectual disabilities these may be life enhancing. The lack of access to psychotherapies for people with intellectual disabilities has led to their exclusion from mainstream research, thereby limiting the evidence base on effective interventions and treatment approaches. This has significant implications for research, policy, education and clinical practice and is an area requiring strategic and local attention and development in the future.

A pilot study to assess if urine specific gravity and urine colour charts are useful indicators of dehydration in acute stroke patients

AIM The purpose of this pilot study was to examine whether urine specific gravity and urine colour could provide an early warning of dehydration in stroke patients compared with standard blood indicators of hydration status. BACKGROUND Dehydration after stroke has been associated with increased blood viscosity, venous thrombo-embolism and stroke mortality at 3-months. Earlier identification of dehydration might allow us to intervene to prevent significant dehydration developing or reduce its duration to improve patient outcomes. METHODS We recruited 20 stroke patients in 2007 and measured their urine specific gravity with urine test strips, a refractometer, and urine colour of specimens taken daily on 10 consecutive days and compared with the routine blood urea:creatinine ratios over the same period to look for trends and relationships over time. The agreement between the refractometer, test strips and urine colour were expressed as a percentage with 95% confidence intervals. RESULTS Nine (45%) of the 20 stroke patients had clinical signs of dehydration and had a significantly higher admission median urea:creatinine ratio (P = 0·02, Mann-Whitney U-test). There were no obvious relationships between urine specific gravity and urine colour with the urea:creatinine ratio. Of the 174 urine samples collected, the refractometer agreed with 70/174 (40%) urine test strip urine specific gravity and 117/174 (67%) urine colour measurements. CONCLUSIONS Our results do not support the use of the urine test strip urine specific gravity as an early indicator of dehydration. Further research is required to develop a practical tool for the early detection of dehydration in stroke patients.

The Isolating and Insulating Effects of Hepatitis C A Substantive Grounded Theory

Hepatitis C has a global prevalence of 3%, causing chronic infection in 75% of cases, and is currently the main cause of liver transplant in the United Kingdom. This study reviewed patients’ and service providers’ perspectives on hepatitis C as an enduring condition, using a constructivist grounded theory approach. A constant comparative approach to data collection and analyses incorporating a coding paradigm was applied to semistructured interviews, focus groups, and memos. Sixteen patients and three focus groups of staff (n = 17) were recruited via purposive theoretical sampling (February through August 2008). A negative synergistic relationship between the condition hepatitis C, patients, and service providers that creates isolating and insulating effects for the relevant parties emerged from the data as a middle-range theory. Stigma and contagion create a “real” or perceived sense of isolation for hepatitis C comorbid and itinerant patients, who require the right support at the right time. Healthcare staff adhere to professional demarcation lines to manage potentially untenable patient caseloads. In turn, patients and professionals perceive that a crisis may be required to bring about successful therapeutic intervention. A service that incorporates seamless outreach services and facilitates interdisciplinary working is needed to manage complex patients with this enduring condition.

Paid- and family-carers' views on supporting women with intellectual disability through breast screening

The cancer needs of people with intellectual disabilities are increasingly being debated. This paper explores the views and experiences of paid- and family-carers when supporting women with intellectual disabilities through breast screening. An ethnographic approach was drawn on and purposive sampling methods were employed. One-to-one semi-structured interviews with 13 carers (10 paid-carers, three family-carers) were undertaken and supported by periods of focused observation on behaviour related to breast awareness and breast screening. Findings indicated that most women with intellectual disabilities needed some support but the quality and quantity of support depended upon both the womans level of intellectual disability and who was supporting them. In terms of breast screening, the findings suggested that the women were potentially being let down at all the different stages of the breast screening process, from the arrival of the invitation letter to the experience of having a mammogram. The conclusion drawn was that there was evidence of equality of service provision but inequality of service delivery and uptake.

How women manage their type 1 diabetes during the menopausal transition: a qualitative study using a grounded theory approach

This study aimed to explore the experiences of women with type 1 diabetes during the menopausal transition using a grounded theory approach and, from the data, develop a substantive theory with implications for service users and service providers. A qualitative exploratory research framework was employed using a grounded theory approach. Data were collected from 10 participants using transcribed audiotaped semistructured interviews and field notes. The transcripts, audio recordings and field notes were reviewed and a coding process facilitated data analysis. This approach enabled themes to emerge from the data and ultimately a theory. A wide range of conceptions was revealed. Data are presented in seven categories that reflect the experience of the subjects: ‘Blank wall’ (relates to the lack of information regarding menopause and diabetes); ‘Juggling game’ (relates to glycaemic control); Anxiety and fear; ‘Haywire’ (relates to the signs and symptoms of menopausal transition); Treating symptoms; Depression and mood; and ‘I’m old’ (relates to ageing and mortality). A substantive theory emerged. Absence of information regarding the menopause and its impact on type 1 diabetes (‘Blank wall’) was identified as the main problem facing women with type 1 diabetes during their menopausal transition. The findings could enable practitioners to identify the types of information, advice and support that should be made available to these women, and contribute to the limited knowledge base currently available. The findings indicate also that further research into this under-studied but important area of diabetes care is required. Copyright