Introducing the New England 4G framework of guided self-health for people in rural areas with physical and psychological conditions
The New England Framework, based on 50 years combined clinical practice, has been recently consolidated as an adaptation of the United Kingdom's 'Improving Access to Psychological Therapies' to include physical conditions. Founded on a collaborative approach in helping, health workers assist individuals to select and use self-administered cognitive and behaviourally based (CB) interventions specific to health problems. Heart disease and depression are the leading causes of disability worldwide. Obesity, diabetes, renal disease, respiratory conditions, chronic pain and addictions constitute another large percentage of suffering. Cognitive behavioural therapy (CBT) is the most effective non-pharmacological evidence-based treatment for most of all mental disorders and a wide range of physical health conditions. While CBT was originally developed as a self management tool to help reduce the negative impact that particular thinking and behaving patterns have on health, it evolved into a specific domain practice of professionals. Because of this, access to CBT has been impeded because of lack of available help, cost of treatment and time required - issues compounded for rural populations. With the rapid expansion of freely available online, virtual and print-based CBT, the value of self-directed minimal-assisted first-line treatments has been established.
The Development of ICD Adaptations and Modifications as Background to a Potential Saudi Arabia's National Version
Modified national versions of the WHO’s International Statistical Classification of Diseases, current version ICD-10 with ICD-11 coming into effect in January 2022, have become the standard in many countries for diagnosis and procedure coding to facilitate the submission of medical billing and reimbursement by health insurers. The WHO ICD-10 exists purely as a coded classification of disease. It has no related classification of procedures and lacks the clinical level of diagnostic specificity necessary for the documentation of individual clinical cases and the associated prescribed therapies and interventions, particularly surgical cases. Historically, the US clinical modification of ICD-9, known as ICD-9-CM, established the trend. Australia adopted ICD-9-CM, later adapted it to Australian clinical specifications, and after the launch of the WHO ICD-10 produced the current Australian modification ICD-10-AM, used under license by many other countries. This paper examines a work in progress, rather than offering an academic critique, to illustrate the evolution of national clinical modications with particular reference to those of the United States, Australia and Thailand. The selection is based on the historical ICD-9-CM connection of the US and Australia, and the fact that Thailand is a more advanced developing nation like Saudi Arabia. The study parameters include the Saudi national healthcare system which has not previously employed a classification clinical coding, despite the wealthy developing healthcare system. Nations using their own modification face the burden of upgrading. Saudi Arabia plans to implement the national Australian modification, rather than creating a Saudi national modification.
A comparative study of men and women gamblers in Victoria
This study was funded by the Victorian Responsible Gambling Foundation to extend the analyses conducted for A Study of Gambling in Victoria (Hare, 2009) to provide detailed analyses of similarities and differences between male and female gamblers in Victoria Australia. The research objectives were to: 1. Analyse the similarities and differences between male and female gamblers in Victoria in terms of gambling preferences, activities and styles of play; gambling motivations and attitudes; physical and mental health; family and early gambling influences; and help-seeking behaviour; and 2. Analyse the similarities and differences between male and female gamblers in Victoria in terms of risk factors associated with problem/moderate risk gambling and protective factors associated with low risk/non-problem gambling.
Developing a student-led community health and wellbeing clinic in an under-served community: collaborative learning, health outcomes and cost savings
The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. 'Methods': Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. 'Results': Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. 'Conclusions': The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable and sustainable link between students, health care professionals, community based organisations, the university, and the community. The community benefits from the clinic by learning to self-manage health and wellbeing issues. The benefits for students are that they gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs.
The Impact of Gambling on Rural Communities Worldwide: A Narrative Literature Review
Gambling has become a popular activity in both urban and rural settings. Although the prevalence and participation of gambling is well known, little has been reported regarding the impacts of gambling on rural communities. Therefore, a narrative literature review approach was adopted to examine what is known regarding gambling in rural communities. This article describes the prevalence and types of gambling that are popular in rural communities around the world. It identifies the benefits and highlights the potential harm caused by a person's gambling and the impact this has on families and the wider rural community. There are both benefits and risks associated with increased availability of gambling opportunities. Specific vulnerable groups within rural populations are identified within this context and how different countries respond to rural gambling is explored. A number of strategies based on a public health approach are recommended to ensure that gambling remains as harmless an activity as possible in rural communities.
The South East Essex model for Integrated COPD care: A collaborative scheme involving PCT, Hospital, Community Service, General Practice, University and Breathe Easy
South East Essex PCT has commissioned an integrated COPD service. At the core is the philosophy of patient centered care to achieve high quality care, equality of care for all patients with COPD, ease of access so patients receive the appropriate care, producing an educational programme which ensures a sustainable service, improved patient information and patient involvement. The aims are also to reduce hospital follow up attendances and hospital admissions. This service has been planned through the local COPD network group where all stakeholders are involved. It was agreed that the Respiratory Consultants would provide clinical leadership for the whole COPD service across boundaries. The network has developed guidelines for managing COPD, a self-management plan and patient pathway. The agreed patient pathway is particularly important in developing the philosophy of the service. A manager has taken on the role of Project manager. The job plans of the Respiratory Consultants have changed and they have started doing clinics in the community. Two thirds of the clinics are conventional and the other thirds are multidisciplinary clinics where staff (usually Community Matrons) bring cases to be discussed without the patients having to attend. This arrangement is outside of tariff and operates through a contract variation. Both these initiatives have moved care closer to home. Community Matrons see many of the patients with severe COPD at home, protocols have been agreed as to whether patients remain on the active case load. Integrated services include the hospital at home service. This is both a prevention of admission and early discharge scheme service.
Health information literature across the cultural evolutionary divide
This paper details the process involved in developing the theoretical framework of factors for a major study entitled “Factors influencing the implementation of ICD-10 in Saudi public hospitals”. An original systematic review strategy, together with specific features of Endnote bibliographic manager software, were used to classify the global literature, separating it into the categories of developed nations and developing nations and, again, nationally according to the national modifications of ICD-10. Finally, the separated literature was examined under three categories, namely Health information, Organization, and National, in order to cast light on how such a process could be implemented in Saudi public hospitals. The issue has not been previously discussed in the Saudi literature. Saudi Arabia is attempting to implement ICD-10 from scratch without the background of a history of earlier ICD version usage. The results of the systematic review indicate a combination of barriers facing healthcare organizations in implementing ICD-10, including a lack of training, specialists, awareness, technology, resources, and some administration barriers. However, in terms of the reality of developing nations, more applicable practical advice was found in the healthcare literature of Thailand, rather than in that of the OECD nations. As ICD-10 is a new phenomenon in Saudi public hospitals and, based on the findings of this paper, it is possible that implementation may best be underpinned by Rogers’ Theory of Diffusion of Innovations, although certain factors that are essential for its success illustrate that an organizational application Maslow’s Triangle applies in dealing with these factors first.
Treatment Completion in a Cognitive Behaviour Therapy Service for Problem Gamblers: Clinical Outcome Study
Increased access to gambling is proving to be a great burden on the individuals who partake, their families and society in general. Despite growing evidence for the use of Cognitive-Behaviour Therapy (CBT) with problem gamblers, important questions remain unanswered regarding those individuals who do not respond to CBT. This paper compares gamblers who are considered 1) treatment completers, 2) drop-out following an initial assessment and, 3) drop-out after commencing treatment from a specialized CBT service. The results indicate a number of differences between the groups in regard to gambling severity and behaviour, demographic profile and variations in overall psychopathology.
Suicide Ideation and Behaviour in People with Pathological Gambling Attending a Treatment Service
This study aimed to describe the 12-month period prevalence and risk factors for suicidal ideation and behaviour in a cohort of patients with pathological gambling attending a treatment service. Seventy-nine people with a diagnosis of pathological gambling received a mail out survey that included questions on postulated risk factors for suicidal ideation and behaviour, the modified Suicide Ideation Scale (SIS), the South Oaks Gambling Screen (SOGS), the Beck Depression Inventory (BDI) and the CAGE. A total of 54.4% of the surveys were returned completed. There were 81.4% who showed some suicidal ideation and 30.2% reported one or more suicide attempts in the preceding 12 months. Suicidal ideation and behaviours were positively correlated with the gambling severity (SOGS scores), the presence of debt attributed to gambling, alcohol dependence and depression (BDI). Suicidal ideation/behaviour was not significantly associated with gender and living arrangements, nor a history of receiving treatment for depression during the preceding 12 months. People with pathological gambling attending a treatment service had higher levels of suicidal ideation and behaviour than previous studies. Pathological gambling should be seen as a chronic condition with a similar risk for suicidal ideation and behaviour as other mental illnesses. Counselling services, general practitioners and mental health services should screen for gambling problems when assessing risk after suicide attempts and for suicide risk in patients presenting with gambling problems and co-morbid depression, alcohol abuse and a previous suicide attempt.
Computer-Assisted CBT for Depression and Anxiety: Increasing Accessibility to Evidence-Based Mental Health Treatment
Cognitive-behavioral therapy (CBT) is the most effective nonpharmacological treatment for almost all mental disorders, especially anxiety and depression. The treatment is time limited, encourages self-help skills, is problem focused, is inductive, and requires that individuals develop and practice skills in their own environment through homework. However, most of those with mental health issues are unable to seek help because of factors related to treatment availability, accessibility, and cost. CBT is well suited to computerization and is easy to teach to nurses. In this article we describe outcome studies of computer-assisted CBT (cCBT), outline the current technologies available, discuss concerns and resistance associated with computerized therapy, and consider the role of nurses in using cCBT.