Effect of ethyl alcohol on lonic calcium and prolactin in man.

Earlier animal studies suggested that there might be physiologically significant changes in serum calcium following administration of ethyl alcohol. Ionized and total calcium were measured in five normal male subjects following the oral ingestion of 200cm3 of 50% ethyl alcohol. Although blood alcohols reached intoxication levels in all subjects, no significant change in ionized calcium or total calcium occurred. It is unlikely that alcohol contributes to the risks of hypocalcemia or hyperventilation and anxiety in individuals performing in adverse environments, although there is little question it contributes to other risks. Even though two-fold elevations in plasma prolactin have been described in men with chronic alcoholism, no significant changes in plasma prolactin occurred during acute alcohol ingestion. Awareness of the significant increase in plasma osmolality, which has been demonstrated with alcohol, is important to avoid inappropriate therapy, since individuals performing in adverse environments are at risk of becoming dehydrated.

Survey evaluation of the National Patient Safety Agency's Root Cause Analysis training programme in England and Wales: knowledge, beliefs and reported practices.

BACKGROUND: Root Cause Analysis (RCA) is a systematic approach to investigations, and is applied in many healthcare settings within comprehensive patient safety systems. The National Patient Safety Agency (NPSA) in England and Wales commissioned a survey evaluation of its national training programme which consisted of 3-day workshops and internet support materials. METHODS: Anonymous survey of 374 health professionals immediately after they attended the programme (T1), and a further 350 participants 6 months after the programme (T 2), who had attended courses in England and Wales in 2005. RESULTS: T1 knowledge tests showed a greater understanding of the frameworks and techniques of RCA but with less accuracy in application to scenarios. Personal beliefs about conducting RCAs were consistently positive at both times, but many participants experienced personal barriers to conducting RCA in their current role and trust context, and some felt low confidence in undertaking cascade training of other staff in their trust. There was also low confidence in implementing RCA as standard practice at both times. At T2, 76.7% were confident the outcomes from their RCA had been implemented, but only 12.1% were aware if improvements had been shared outside the local organisation. Barriers to RCA at both times most often concerned time and resources to apply RCA. At T1, there was particular concern for personal development, at T2 greater concern for organisational impediments. CONCLUSIONS: The RCA programme enhanced knowledge of RCA, and participants valued the programme, but further personal development and organisational support are required to achieve continued improvement in practice and sustained organisational learning.

Psychological care of the chronically physically ill.

Disease prevalence and health priorities have changed, with increasing emphasis on chronic degenerative problems. Health care for the chronically physically ill needs to focus on realistic and often modest goals. This article presents the case for greater consideration of psychological factors, and outlines an example of a system of psychological care.

Clinical psychology in general practice: a controlled trial evaluation.

A controlled trial study is described in which 50 consecutive potential referrals for psychological treatment from one general practice were randomly allocated either to behavioural treatment or no-treatment conditions. Treatment-group patients received treatment from a clinical psychologist working within the practice; the control-group patients continued to be managed by their general practitioner. The patients' use of NHS resources was assessed during the treatment period (or its equivalent for the control group) and at a follow-up comparison point, when the patients' subjective ratings of their progress were also obtained. Between referral and the end of treatment the treated group received significantly less psychotropic medication than the control group. This difference was not, however, maintained at the longer-term follow-up. No differences in general practice consultation rates, in the subjective ratings of psychological distress, in control orientation or life satisfaction were found between the two groups, but the level of patient satisfaction was high. Implications for the design of future studies and for psychological health care delivery systems are discussed.

Coping with motor neurone disease--an analysis using self-regulation theory.

Medicine and environmental changes have had tremendous success in controlling the infectious diseases that were the major causes of death in the last century. However, the consequential extension of life has been accompanied by an increase in the number of persons living with and dying of chronic illness. Despite these changes and their implications, the means by which people cope with such illnesses has only recently begun to receive the attention the subject warrants. Such diseases have a high prevalence in the population and self-detection and self-management are critical to the treatment and control of chronic disease and disability. This paper examines how people cope with motor neurone disease and sets this in the context of earlier research on psychological aspects of chronic disease and current theoretical approaches to coping with long-term ill health.

Communicating the diagnosis of motor neurone disease.

Communication of the diagnosis of motor neurone disease (MND) is a particularly difficult task for doctors in view of the poor prognosis and the lack of significant treatment. This study examined patients' views of being given the diagnosis and of how it was communicated. Fifty people who had been diagnosed with MND more than six months previously were interviewed about their experience of the diagnosis. The majority reported positive aspects of being told, especially having a label for their condition. The most frequently mentioned critical aspect of how they were told was the directness and clarity with which they were given the information. Patients were more critical if the diagnosis was worse than expected (as it was for most patients) and more satisfied if they felt they had been able to ask questions. There was no evidence that unsatisfactory communications were associated with later mood disturbance. A longitudinal study is recommended to overcome limitations in this cross-sectional design.