Difficulties in conducting a randomized controlled trial of health service interventions in intellectual disability: implications for evidence-based practice.

BACKGROUND: In an era of evidence-based medicine, practice is constantly monitored for quality in accordance with the needs of clinical governance (Oyebode et al. 1999). This is likely to lead to a dramatic change in the treatment of those with intellectual disability (ID), in which evidence for effective intervention is limited for much that happens in ordinary practice. As Fraser (2000, p. 10) has commented, the word that best explains "the transformation of learning disability practice in the past 30 years is 'enlightenment'." This is not enough to satisfy the demands of evidence, and Fraser exhorted us to embrace more research-based practice in a subject that has previously escaped randomized controlled trials (RCTs) of treatment because of ethical concerns over capacity and consent, which constitute a denial of opportunity which "is now at last regarded as disenfranchising". CONCLUSIONS: The present paper describes the difficulties encountered in setting up a RCT of a common intervention, i.e. assertive community treatment, and concludes that a fundamental change in attitudes to health service research in ID is needed if proper evaluation is to prosper.

Assessing the side-effects of antipsychotic drugs: a survey of CPN practice.

The provision of community-based care for people with serious and enduring mental health problems requires an approach that combines drug therapy, psychological interventions and skills training. Mental health nurses are being required to place more emphasis on their work with this client group. It has been suggested that community psychiatric nurses (CPNs) will require training in appropriate skills to work with the seriously mentally ill. While the training of CPNs to use psychological intervention strategies has received limited attention, the area of medication management, including the detection of side-effects, is relatively unexplored. Community psychiatric nurses' practice with clients on antipsychotic medication was investigated. This paper reports selected findings on the assessment of medication side-effects and CPNs' attitude to this aspect of their role. Fifty CPNs in three health districts completed a self-administered questionnaire. The results showed that the CPNs were supervising the medication of large numbers of clients. They reported that their training had adequately prepared them to assess clients for medication side-effects and that this was being done frequently. They also felt that their reports of side-effects influence the prescribers' decisions on medication when clients are reviewed. However, the data also suggested that CPNs were only monitoring their clients for three to four side-effects and that they held an unfavourable attitude towards their involvement with medication.

Porcine cytomegalovirus (PCMV) in early gestation.

Following intranasal exposure to PCMV at or within 48 h of coitus transplacental infection occurred in two groups of gilts. Five out of 22 embryos were infected in the first group but only 2 out of 63 in the second. A more rapid immune response as measured by circulating antibody was probably instrumental in abrogating infection in the second group. In the infected embryos the virus localized in leptomeningeal cells, hepatic sinusoidal cells, peritoneal macrophages, periosteal cells and occasional alveolar cells, but the placenta did not appear to be a primary site of viral replication.