Professional development for radiographers and post graduate nurses in radiological interventions: Building teamwork and collaboration through drama.

INTRODUCTION: The rapid development within Interventional Radiology presents new challenges. Hybrid operating rooms consist of interventional radiology, open surgery, computed tomography, magnetic resonance imaging and other techniques. This means that several disciplines and professionals need to work in new constellations creating a multidisciplinary team around the patient. In accordance with this development, higher professional education must provide new pedagogic strategies to successfully address the knowledge expected in today's complex working life. AIM: To explore the use of Applied Drama as a learning medium, focusing on the use of Forum Theatre, to foster team work and collaboration in the field of radiography and learning. METHODS: A qualitative approach, closely related to Ethnography, was utilized. RESULT: The Drama Workshop utilising Forum Theatre created a dynamic learning environment and enabled the participants from three professions to understand each other's priorities better. The use of drama within health care education allows the students to take different roles in order to find the best way to co-operate. CONCLUSION: Forum Theatre is a useful learning medium in order to promote teamwork and collaboration in the radiological intervention field. By choosing a personal working experience, Forum Theatre seem to engage the participants at a deeper level and to experience various communication strategies and how the outcome changed depending on the approach. This can lead to improved teamwork and collaboration.

Adolescents' experiences of using removable functional appliances.

OBJECTIVES: The aim of this qualitative study was to explore and describe adolescents' experiences of treatment with removable functional appliances. SETTING AND SAMPLE POPULATION: Public Dental Service, Gothenburg, Sweden. MATERIAL AND METHODS: Individual interviews focusing on adolescents' experiences of using a removable functional appliance were held with 21 adolescents (12 girls and nine boys). The mean age of the participants was 13.2 years (range 11-15, SD 1.25) at the interview occasion. Interviews were transcribed verbatim and analysed according to a qualitative research approach, phenomenography. RESULTS: Outcomes of data analysis emerged in five categories with totally 12 subcategories that describe the adolescents' various conceptions of the treatment. The adolescent's experiences of using removable functional appliance appeared to have a large variation, comprising of the individual approach, feelings and strategies, the dentist role and receiving external support. CONCLUSION: Participants developed their own strategies of measurement to see improvement. An active involvement of the adolescents' in the treatment seems to be needed, supported by the dentist at coming appointments, using overjet measurement as a tool for motivation. Furthermore, efforts should be made by clinicians to listen and understand adolescents' needs and requirement before the treatment start.

Adolescents' experiences of a two-year oral health intervention programme in two Swedish secondary schools.

OBJECTIVES: To describe adolescents' experiences of participating in a school-based oral health intervention programme for 2 years containing education about oral health and fluoride varnish treatment at the school clinic. METHODS: Sixteen adolescents aged 13-16 were interviewed in three focus group sessions. A phenomenographic approach was used for analysis. RESULTS: The results are presented as three themes and seven descriptive categories. The three themes were 'Seeing the dental hygienist', 'Treatments at the dental hygiene clinic' and 'Education about oral health in class'. The results demonstrate satisfaction with the intervention, such as accessibility, time gain and expanding knowledge. On the other hand, feelings of vulnerability in the treatment sessions were expressed. The fluoride varnish treatment was given both positive and negative reviews. The contact between the participants and the dental hygienist was important, and the opportunity to ask questions about oral health issues was emphasized. CONCLUSIONS: Both positive and negative experiences of the programme were found. Adolescence is a transitional period of life, and for this reason, it is important to create a good working alliance between students and the dental hygienist in future school-based oral health interventions.

Students' learning as the focus for shared involvement between universities and clinical practice: a didactic model for postgraduate degree projects.

In an academic programme, completion of a postgraduate degree project could be a significant means of promoting student learning in evidence- and experience-based practice. In specialist nursing education, which through the European Bologna process would be raised to the master's level, there is no tradition of including a postgraduate degree project. The aim was to develop a didactic model for specialist nursing students' postgraduate degree projects within the second cycle of higher education (master's level) and with a specific focus on nurturing shared involvement between universities and healthcare settings. This study embodies a participatory action research and theory-generating design founded on empirically practical try-outs. The 3-year project included five Swedish universities and related healthcare settings. A series of activities was performed and a number of data sources secured. Constant comparative analysis was applied. A didactic model is proposed for postgraduate degree projects in specialist nursing education aimed at nurturing shared involvement between universities and healthcare settings. The focus of the model is student learning in order to prepare the students for participation as specialist nurses in clinical knowledge development. The model is developed for the specialist nursing education, but it is general and could be applicable to various education programmes.

Parents' views of their child's health and family function in paediatric inflammatory bowel disease.

AIM: The aim of this study was to explore parents' views and agreement of their child's current and future health, as well as the family's functioning in daily life with inflammatory bowel disease (IBD). METHODS: In this study, 119 parents (65 mothers and 54 fathers) of 66 adolescents (11-16 years) with IBD completed a questionnaire regarding their views of their child's IBD and health-related behaviour. RESULTS: The majority of the parents held a positive view of their child's current health status. However, the parents voiced a range of worries about their children's future health and life situation such as fear about the side effects of medication, concerns for future schooling, social life and employment options. Within the families, the parental pairs had more similar views about their child's current health status than about their future health. Factors that affected the parents' views consisted of cohabitation status, i.e. parents not living together, and severe disease course, both correlated with a more negative view of the child's current health and family functioning. CONCLUSION: The majority of the parents in this study had a largely positive view of their child's current health status, but they expressed concerns about their child's future health. Knowledge about parents' thoughts may be of importance for healthcare teams supporting families with IBD.

Experiences by patients with asthma-like symptoms of a problem-based learning health education programme.

BACKGROUND: Eighteen patients with asthma-like symptoms but negative asthma tests, randomly selected, participated in a problem-based learning health education programme. The programme had a multidisciplinary approach and included exercises inspired by cognitive behavioural therapy. OBJECTIVE: The aim of this study was to describe how the patients experienced the programme. METHODS: After termination of the programme, semi-structured interviews with a phenomenographic approach were conducted with 15 of the participants. RESULTS: Two categories emerged, with three sub-categories each. In these, the informants described how they felt solidarity with the group, received confirmation from the other participants and had increased their self-confidence. They had started to look upon themselves and the disorder from a different perspective, they could describe the disorder in words and they had started to use new, conscious coping strategies. CONCLUSIONS: Patients with asthma-like symptoms benefit from taking part in a problem-based learning health education programme. It helps them to reflect upon themselves and the disorder and to use new strategies to cope with it.

Schizophrenic relapse after drug withdrawal is predictable.

Thirty-two patients in remission were followed by regular ratings during a prospective neuroleptic withdrawal study. They were outpatients who fulfilled the DSM-III criteria of schizophrenia and who were motivated for drug withdrawal. The relapse rate was 81%. The results from the rating scales confirm the hypothesis that a symptom increase occurs before psychotic relapse. In the order statistical differences occurred, the factors predicting relapse were those concerned with positive psychopathology, motor dysfunction, impaired affects and sleep disturbances. The corresponding symptoms and signs were mainly concerned with thought disorders, paranoid ideation, overactivity, depression and insomnia middle, all of nonpsychotic degree of severity. If prodromes appear, the patient should resume his neuroleptic treatment, or other preventive measures should be taken. By such therapeutic interactions, psychotic relapse may be prevented, or can be dealt with in an outpatient setting.

Clopenthixol and flupenthixol depot preparations in outpatient schizophrenics. I. A one year double-blind study of clopenthixol decanoate and flupenthixol palmitate.

Clopenthixol decanoate and flupenthixol palmitate, both depot neuroleptics belonging to the thioxanthene group, were studied during double-blind conditions for 12 months using four week intervals between injections. The 60 patients included in the study were chronic schizophrenics and treated as outpatients after earlier admission to hospital and rehabilitation training periods. They had all been treated with depot neuroleptics in the last three years and they had been free from relapse for at least 15 months. The main aim with this trial was to study the two depot drugs during maintenance treatment conditions in an outpatient setting. Ten patients dropped out, 7 because of unsatisfactory effect, mainly because only limited dose levels were accepted according to the design. In spite of the earlier long lasting neuroleptic treatment and the good social adaptation in this schizophrenic subgroup there was observed a symptom decrease in all the rating scales even in these symptom poor patients. This improvement in psychopathology with optimal results after half a year seems to be a combined result of the efficient neuroleptics tested and careful monitoring of the drug.

Do schizophrenics well adapted in the community need neuroleptics? A depot neuroleptic withdrawal study.

Two depot neuroleptics (flupenthixol plamitate and clopenthixol decanoate) used for at least 15 months were withdrawn in 32 schizophrenic outpatients belonging to the most symptom-free and social cohort of a total patient population. They all had only slight schizophrenic symptoms, were well adapted in the community, and had been free from relapse for at least 2 years before the study. They were assessed by means of rating scales every month during the first six months and then after 9 and 12 months. After the one-year trial 26 patients had relapsed. Moreover, after the control period further 4 out of 6 patients relapsed during the following drug-free year. These results indicate the necessity of a long follow-up period after withdrawal of depot neuroleptics. Moreover, the results suggest that periodical drug-free periods of about 3 months are appropriate in symptom-poor patients during long-term treatment with long-acting antipsychotic drugs.

A controlled long-term study of flunitrazepam, nitrazepam and placebo, with special regard to withdrawal effects.

The hypnotic effect of flunitrazepam (Ro 5-4200), nitrazepam and a placebo was studied in 117 outpatients using hypnotics for at least 3 months prior to the study. They obtained various neurotropic drugs and this and other treatments were unchanged throughout the trial period of 13 weeks. This consisted of 3 weeks on the previously used hypnotic, 3 weeks on a test drug (during the first of these a doubling of the dose was permitted if the initial dose of 1 mg flunitrazepam, 5 mg nitrazepam or one tablet of placebo was not satisfactory) and 4 weeks' observation after a request to stop medication with the test drug. The effects were evaluated every week by self-ratings. Also noted were: the frequency of dose increase after 1 week of the test period, number of drop-outs in the test period, and failure in the attempt to stop taking the test drug. A "psychological concentration test" was done, as was a follow-up interview. The self-ratings had a good reliability and showed that more patients experienced shorter sleep induction, longer sleep time, better sleep quality and a subjective feeling of having had a better rest with flunitrazepam than with either nitrazepam or placebo. There were no differences between the nitrazepam and the placebo groups. Tiredness was the most common side effect and appeared in the same frequency in all groups. The number of patients who increased the dose after 1 week's medication, as well as the number of drop-outs, was significantly higher in the nitrazepam and placebo groups than in the flunitrazepam group. There was no difference in the ability to discontinue the medication between the test groups or between groups having previously used different hypnotics. The "psychological concentration test" did not reveal any differences between groups. It was concluded that withdrawal of a hypnotic in chronic users was not facilitated by the use of a placebo. This was interpreted as due to a strong psychological dependence upon the hypnotics and their lack of pharmacological effects during long-term treatment.

Three years' maintenance neuroleptic treatment in schizophrenia--before and beyond.

A group of patients with schizophrenia, initially 67 patients, was studied over a period of 3 years. After three years 36 out of 67 patients were still on the same depot neuroleptic. The main aim was to describe and compare maintenance neuroleptic therapy using two depot neuroleptics, fluphenazine decanoate and pipotiazine palmitate, given monthly. Before the outpatient care the patients had participated in the department's comprehensive hospital treatment including depot neuroleptic medication. After a 1-year clinical trial with frequent assessments of the patients, significant symptom reductions were found on all rating scales. During the last 2 years of the study only drug therapy was given. Improvement concerning social function in the community and work level as well as the low-rated psychopathology noted at the start of study also persisted at the 3-year follow-up. The side effects were low in frequency and quality. These results show the clinical value of long-term maintenance treatment with depot neuroleptics. The results also confirm that the favourable effects of the hospital treatment demonstrated before the start of the clinical trial could be maintained. The possibilities of further improving aftercare and outpatient treatment beyond medication alone are discussed.

How schizophrenic patients change during 3 years' treatment with depot neuroleptics.

A group of patients, initially 67 individuals, with chronic schizophrenia were studied on repeated occasions during 1 year and followed up after 3 years. The patients were given depot neuroleptics, either fluphenazine decanoate or pipotiazine palmitate, at intervals of 1 month. The symptom scores from three rating scales were subjected to factor analysis. Four factors were found to explain the variance satisfactorily: one comprising psychopathological symptoms specific for schizophrenia, one relating to contact disturbances, one psychomotor activity and one representing neurotic symptoms. Analysis of these factors revealed certain differences between the treatment groups over time and demonstrated the effect of combination of psychotherapy and neuroleptic drugs in a subgroup of patients. This type of analysis of treatment results might contribute to improving our knowledge of rehabilitation of schizophrenic patients and help us to draw up giudelines for selection of suitable measures.