Abstract

OBJECTIVE: This study aimed to assess the performance, in terms of sensitivity and precision, of different approaches to searching MEDLINE and EMBASE to identify studies of adverse effects.

METHODS: Five approaches to searching for adverse effects evidence were identified: approach 1, using specified adverse effects; approach 2, using subheadings/qualifiers; approach 3, using text words; approach 4, using indexing terms; approach 5, searching for specific study designs. The sensitivity and precision of these five approaches, and combinations of these approaches, were compared in a case study using a systematic review of the adverse effects of seven anti-epileptic drugs.

RESULTS: The most sensitive search strategy in MEDLINE (97.0%) required a combination of terms for specified adverse effects, floating subheadings, and text words for 'adverse effects'. In EMBASE, a combination of terms for specified adverse effects and text words for 'adverse effects' provided the most sensitive search strategy (98.6%). Both these search strategies yielded low precision (2.8%).

CONCLUSIONS: A highly sensitive search in either database requires a combination of approaches, and has low precision. This suggests that better reporting and indexing of adverse effects is required and that an effective generic search filter may not yet be feasible.

Abstract

BACKGROUND: Drug strategies internationally recognize link between drug use and crime. This review consider interventions for drug-using offenders
under the care of the criminal justice system.

OBJECTIVES: To assess the effectiveness of interventions for drug-using offenders in reducing criminal activity and drug use in the courts, secure
establishments and community-based settings.

SEARCH METHODS: Twenty two electronic databases were searched (1980 to 2004). Internet sites and experts in the field were contacted for further
information.

SELECTION CRITERIA: Randomised Controlled Trials designed to reduce, eliminate or prevent relapse in drug using offenders

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trials for inclusion. Data were extracted by one author and double checked.

MAIN RESULTS: Twenty four studies, 8936 participants, met the inclusion criteria. Results show that comparing a court-based community pre-trial
release with drugs testing and sanctions versus routine pre-trial, for arrest at 90 days results favoured the comparison group OR 1.33
(95% CI 1.04 to 1.70). Comparing therapeutic community with aftercare with a mental health programme with a waiting list control,
considering incarceration at 12 months OR 0.37 (95% CI 0.16 to 0.87), results in favour of the treatment Comparing intensive
supervision with routine parole/probation, for recidivism OR 1.98 (95% CI 1.01 to 3.87) results in favour of comparison group, no

Abstract

AIMS AND OBJECTIVES: We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs' views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient satisfaction and in linking qualitative findings with trial results are explored.

DESIGN: A sample of 13 patients randomized to the community hospital arm of the RCT joined the qualitative study. Official documentation from the hospital were accessed and six staff interviewed to identify assumptions underlying practice.

RESULTS: Analysis of interviews identified a complex picture concerning expectations These could be classified as ideal, realistic, normative and unformed. The hospital philosophy and staff views about service delivery were closely in harmony, they delivered rehabilitation in a home-based atmosphere. The formal, or 'hard', process of rehabilitation was not well understood by patients. They were primarily concerned with 'soft' or process issues--where and how care was delivered.

CONCLUSIONS: We identify a model of community hospital care that incorporates technical aspects of rehabilitation within a human approach that is welcomed by patients. If patients are to be able to participate in making informed decisions about care, the rationale for the activities of staff need to be more clearly explained. Recommendations are made about the appropriate scope of qualitative findings in the context of trials and about techniques to access patient views in areas where they have difficulty in expressing critical impressions.

Abstract

No abstract available

Abstract

BACKGROUND: Concerns about recent changes in acute in-patient mental health care environments have led to fears about staff stress and poor morale in acute in-patient mental health care staff.

AIM: To review the prevalence of low staff morale, stress, burnout, job satisfaction and psychological well-being amongst staff working in in-patient psychiatric wards.

METHOD: Systematic review.

RESULTS: Of 34 mental health studies identified, 13 were specific to acute in-patient settings, and 21 were specific to other non-specified ward-based samples. Most studies did not find very high levels of staff burnout and poor morale but were mostly small, of poor quality and provided incomplete or non-standardised prevalence data.

CONCLUSIONS: The prevalence of indicators of low morale on acute in-patient mental health wards has been poorly researched and remains unclear. Multi-site, prospective epidemiological studies using validated measures of stress together with personal and organizational variables influencing staff stress in acute in-patient wards are required.

Abstract

Economic evaluation databases have been developed to assist in setting priorities and facilitating research within the healthcare sector. This paper presents an overview of the major databases of economic evaluations currently available (HEED, NHS EED, the CEA Registry, CODECS, PEDE, EURONHEED and JEED). It describes the key features of each database and the main user groups. It also presents evidence of the value of access to economic evaluation databases, particularly for the researchers and decision makers who form their main target audience. The research available shows that both decision makers and researchers find economic evaluation databases helpful as a source of information. However, database producers may also need to better understand the requirements of their users and consider adaptations to their products.

Abstract

OBJECTIVE: To determine the effects on independence in older people needing rehabilitation in a locality based community hospital compared with care on a ward for elderly people in a district general hospital.

DESIGN: Randomised controlled trial.

SETTING: Care in a community hospital and district general hospital in Bradford, England.

PARTICIPANTS: 220 patients needing rehabilitation after an acute illness that required hospital admission.

INTERVENTIONS: Patients were randomly allocated to a locality based community hospital or to remain within a department for the care of elderly people in a district general hospital.

MAIN OUTCOME MEASURES: Primary outcomes were Nottingham extended activities of daily living scale and general health questionnaire 28 (carer). Secondary outcomes were activities of daily living (Barthel index), Nottingham health profile, hospital anxiety and depression scale, mortality, destination after discharge, satisfaction with services, carer strain index, and carer's satisfaction with services.

RESULTS: The median length of stay was 15 days for both the community hospital and the district general hospital groups (interquartile range: community hospital 9-25 days; district general hospital 9-24 days). Independence at six months was greater in the community hospital group (adjusted mean difference 5.30, 95% confidence interval 0.64 to 9.96). Results for the secondary outcome measures, including care satisfaction and measures of carer burden, were similar for both groups.

CONCLUSIONS: Care in a locality based community hospital is associated with greater independence for older people than care in wards for elderly people in a district general hospital.