The impact of community nurse-led interventions on the need for hospital use among older adults: An integrative review.

Background: Hospital avoidance services are important for older people who risk deteriorating health and independence when in hospital. However, the evidence base for nurse-led community services is equivocal.

Objectives: To determine the impact of community nurse-led interventions on the need for hospital use among older adults.

Tool to assess the cost and quality benefits of nursing innovation.

Understanding the economic value of nursing services in a time of unprecedented public sector cuts is a challenge. The economic assessment tool (EAT) (RCN 2011) has been designed by the authors of the article for this purpose and generates return on investment dividends for nursing innovations and services. The EAT, which is built on the discipline of improvement and uses many of its tools and techniques, involves four stages: mapping, costing, calculating and reporting.

Characteristics of teams, staff and patients: associations with outcomes of patients in assertive outreach.

Background: Little is known about what characteristics of teams, staff and patients are associated with a favourable outcome of severe mental illness managed by assertive outreach.

Aims: To identify predictors of voluntary and compulsory admissions in routine assertive outreach services in the UK.

Method: Nine features of team organisation and policy, five variables assessing staff satisfaction and burn-out and eleven patient characteristics taken from the baseline data of the Pan-London Assertive Outreach Study were tested as predictors of voluntary and compulsory admissions within a 9-month follow-up period.

Assertive outreach teams in London: patient characteristics and outcomes. Pan-London Assertive Outreach Study, part 3.

Background: Although the model of assertive outreach has been widely adopted, it is unclear who receives assertive outreach in practice and what outcomes can be expected under routine conditions.

Aims: To assess patient characteristics and outcome in routine assertive outreach services in the UK.

Method: Patients (n=580) were sampled from 24 assertive outreach teams in London.

Assertive outreach teams in London: staff experiences and perceptions. Pan-London Assertive Outreach Study, part 2.

Background: The job satisfaction, burn-out and work experiences of assertive outreach team staff are likely to be important to the model's sustainability.

Aims: To describe self-reported views and work experiences of staff in London's 24 assertive outreach teams and to compare these with staff in community mental health teams (CMHTs) and between different types of assertive outreach team.

Method: Confidential staff questionnaires in London's assertive outreach teams (n=187, response rate=89%) and nine randomly selected CMHTs (n=114, response rate=75%).

Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, part 1.

Background: Assertive outreach teams have been introduced in the UK, based on the assertive community treatment (ACT) model. It is unclear how models of community care translate from one culture to another or the degree of adaptation that may result.

Aims: To characterise London assertive outreach teams and determine whether there are distinct groups within them.

Mental health. Reach out and join up.

The NHS plan proposed the establishment of 220 specialist assertive outreach teams for people with serious mental illness by 2003. Research on the development of these teams in London shows that diverse models are in operation. Some focus on medication administration, others on psychosocial needs.

A comprehensive package of support to facilitate the treatment of problem drug users in primary care: an evaluation of the training component.

Since the early 1980s, government policy documents and specialist reports have encouraged the involvement of general practitioners (GPs) in the treatment of problem drug users. In spite of such policy initiatives, their involvement has been patchy and slow. In response to this apparent reluctance, the London Boroughs of Brent and Harrow established the substance misuse management project (SMP) to support and train GPs in the management of substance misuse.

Recognising advancing nursing practice: evidence from two observational studies.

Debates over title, grades and relationships across the profession has tended to dominate the literature in advancing nursing practice. Fewer research projects have attempted to study the activities of nurses who are designated as undertaking advancing nursing roles. One study evaluating Masters courses for Clinical Nursing Practice and a second addressing the impact of the 'Scope of Professional Practice' (United Kingdom Central Council for Nursing, Midwifery & Health Visiting, 1992) document by this team of authors afforded these research opportunities.

Staff perceptions of substance use among acute psychiatry inpatients.

This paper reports on a small-scale study undertaken in two inner city acute psychiatric wards to identify the proportion of patients known to use drugs or alcohol and the perceptions of staff regarding these patients. Data collection involved a retrospective audit of patient notes and the administration of a questionnaire to nursing staff. The findings were broadly consistent with other research studies.

A survey of psychiatric nursing practice in two inner city acute admission wards.

In response to the British government's Review of Mental Health Nursing this paper reports on a study which examined nursing practice in two inner city acute admission wards. Eight nursing staff maintained a record of their activities over a 7-day period according to four operationalized variables. Qualitative detail was also collected to enable the specification of activities.

Liaison psychiatric nursing in an inner city accident and emergency department.

The Mental Health Nursing Review Team recommend research to examine the potential of liaison mental health nursing. This paper describes a study into the work of two emergency psychiatric nurses (EPN) attached to a central London accident and emergency (A&E) department. A semi-structured interview schedule was employed to generate data on role development and purpose, and a retrospective survey of clinical activity was carried out over a 94-day period.

Evaluation of a low-threshold clinic for opiate-dependent drug users.

This study reports on the development and outcome of a Low Threshold Clinic (LTC) for opiate-dependent drug users. The service originated as a nursing initiative within an inner city Drug Dependency Centre (DDC) and its rationale and treatment approach are explored in relation to the literature and local circumstances. Client baseline and outcome data were systematically gathered to assess service uptake and service efficacy in terms of client outcome.

Caring for the carers of people with mental health problems.

A ward manager has set up a forum where carers of relatives or friends with mental health problems can discuss and find solutions to their problems. In 1994, relatives and carers were invited to join the special hospital-based group, which met every fortnight. The ward manager was present in a facilitative role, but a 'bottom-up' approach focused on the needs and wishes of participants.

Investigations of the role of the main light-harvesting chlorophyll-protein complex in thylakoid membranes. Reconstitution of depleted membranes from intermittent-light-grown plants with the isolated complex.

The functions of the light-harvesting complex of photosystem II (LHC-II) have been studied using thylakoids from intermittent-light-grown (IML) plants, which are deficient in this complex. These chloroplasts have no grana stacks and only limited lamellar appression in situ. In vitro the thylakoids showed limited but significant Mg2+-induced membrane appression and a clear segregation of membrane particles into such regions.

Freeze-fracture analysis of membrane appression and protein segregation in model membranes containing the chlorophyll-protein complexes from chloroplasts.

Cation-induced membrane appression and lateral segregation of chlorophyll-protein complexes have been investigated by freeze-fracture analysis of model membranes containing photosystem 1 and the light-harvesting complex of photosystem 2. In light-harvesting complex proteoliposomes, cations caused extensive membrane adhesion and a segregation of protein into appressed regions. A marked flattening of the appressed membranes, sometimes together with a co-alignment of the particles on the opposing membrane faces, strongly suggests a direct transmembrane attraction between the protein particles.

Immunological evidence for apoproteins of the light-harvesting chlorophyll-protein complex in a mutant of barley lacking chlorophyll b.

A barley mutant lacking chlorophyll b and the pigmented light-harvesting chlorophyll-protein of photo-system 2 is shown by several criteria to contain functional apoproteins of the light-harvesting complex. 1. Electrophoretic comparison of thylakoid polypeptide patterns, and the effects of trypsin treatment on these, suggests that the mutant contains several polypeptides equivalent in mobility to those of the wild-type complex.

Transbilayer organization of the chlorophyll-proteins of spinach thylakoids.

To investigate the transverse bilayer organization of the chlorophyll-proteins of the three intrinsic chlorophyll-protein complexes, the effects of proteolytic enzymes, and an antibody against the light-harvesting complex were compared using right-side-out and inside-out thylakoid vesicles. The vesicles were isolated by aqueous polymer phase partitioning following the fragmentation of spinach thylakoids by passage through a Yeda press. Both vesicle types were agglutinated by an antiserum specific for the light-harvesting complex, although proteolytic degradation of the complex occurred only in right-side-out vesicles.

The role of the light-harvesting chlorophyll a/b protein complex in chloroplast membrane stacking. Cation-induced aggregation of reconstituted proteoliposomes.

The major intrinsic protein from spinach chloroplast membranes, the light-harvesting chlorophyll a/b-protein complex, contains two distinct polypeptides of Mr 23,500 and 26,000 and 31% lipid by weight, comprising five diacyl lipids and seven chlorophylls, together with some carotenoids, per 26,000-Mr polypeptide. The chlorophyll a/b ratio is 1.1.