ABSTRACT
WHAT IS KNOWN ON THE SUBJECT?: Nationally and internationally there has been a movement away from the traditional medical model towards a more holistic recovery-oriented approach to mental health care delivery. At every level of service provision the emphasis is firmly on recovery and on facilitating active partnership working and involvement of service users, their carers and family members. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to identify on a national level specific areas of care that are addressed most or least by psychiatric and mental health nurses in care planning for mental health service users in Ireland. In addition, this is the first study to identify nationally how the recovery approach is being implemented by psychiatric and mental health nurses in relation to current recovery-orientated policy. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare staff require more education on the recovery concept and this needs to be multidisciplinary team wide. Further research is required to establish how best to develop a shared approach to working with service users and their families within the mental healthcare environment. Further investigation is required to help determine how funding could be allocated appropriately for education and training and service development nationally. ABSTRACT: Introduction The restructuring of national mental health policy to an integrated recovery ethos demands a clarification in the psychiatric/mental health nurse's role, skills and competencies. Aim/Question To explore the psychiatric/mental health nurse's role and identify skills, competencies and supports required to adopt recovery-orientated policy in practice. Method An exploratory mixed methods study in multiple health services in Ireland with N = 1249 psychiatric/mental health nurses. Data collection used a survey, focus groups and written submissions. Data analysis used descriptive statistics and thematic analysis. Results The medical profession use a symptom-focused approach to mental healthcare delivery. Nurses viewed this as a primary inhibitor to recovery-orientated practice. Professional development in prevention and earlier intervention within primary care environments requires development. Nurses require research support to measure the effectiveness of the mental health interventions they provide. Implications and conclusion The effective implementation of the recovery approach requires a multitude of strategies and narrative threads in an overall medical assessment. Nurses need support from medics in providing consistency of assessments/documentation of required psychosocial interventions. A greater range of specialist services provided by nurses including psychosocial interventions and health promotion is fundamental to quality care and improving service user outcomes in primary care.
Subject(s)
Clinical Competence , Nurse's Role , Psychiatric Nursing/methods , Psychiatric Nursing/standards , Adult , Female , Humans , Ireland , Male , Middle Aged , Psychiatric Nursing/statistics & numerical dataABSTRACT
We describe a library of two-chain molecular complementation mutants of staphylococcal alpha-hemolysin that features a combinatorial cassette encoding thousands of protease recognition sites in the central pore-forming domain. The cassette is flanked by a peptide extension that inactivates the protein. We screened the library to identify alpha-hemolysins that are highly susceptible to activation by cathepsin B, a protease that is secreted by certain metastatic tumor cells. Toxins obtained by this procedure should be useful for the permeabilization of malignant cells thereby leading directly to cell death or permitting destruction of the cells with drugs that are normally membrane impermeant.
Subject(s)
Bacterial Toxins/metabolism , Cathepsin B/metabolism , Cysteine Endopeptidases/metabolism , Exotoxins/metabolism , Hemolysin Proteins/metabolism , Neoplasms/enzymology , Peptide Library , Amino Acid Sequence , Bacterial Toxins/chemistry , Bacterial Toxins/genetics , Base Sequence , DNA Primers , Exotoxins/chemistry , Exotoxins/genetics , Hemolysin Proteins/chemistry , Hemolysin Proteins/genetics , Humans , MutagenesisABSTRACT
The records of 16 early-treated children with phenylketonuria (PKU) whose low-phenylalanine diets had been discontinued at an average age of 5.5 years were reviewed for evidence of deterioration in functioning. Measures of their medical and social status, namely, serum phenylalanine levels and Vineland Social Quotients, before and after diet discontinuation were investigated via repeated measures analyses of variance. Social quotients decreased significantly following discontinuation and were inversely correlated with serum phenylalanine levels.
