Skin care: an essential component of hand hygiene and infection control.

Skin care is an important component of hand hygiene and also infection prevention education programmes relating to hand hygiene (Bissett, 2007a,b). Hand hygiene is the term commonly used to describe hand washing using plain soap or antiseptic soaps and hand rubbing using waterless antiseptic products or alcohol-based products. The importance of effective hand hygiene is well documented (Larson, 1997; Boyce et al, 2002; Horton and Parker, 2002) and can be achieved by following the six-step technique used for hand washing as illustrated by the Royal College of Nursing (2000).

ESBL-producing Enterobacteriaceae: controlling the spread of infection.

Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae were first reported in Europe in the 1980s and have since become a worldwide problem. This has resulted in increased morbidity, mortality and cost in treating the infections they cause (Paterson et al, 2001; Bisson et al, 2002). In the UK the prevalence of ESBL rose from 5.

Hand inspection cabinets as an aid to washing technique.

Aim: The study aimed to discover if self-assessment of handwashing techniques would help staff to improve practice.

Method: A rolling programme of self-assessment of handwashing technique was carried out over a period of three months using hand inspection cabinets (glow-and-tell boxes). A simple questionnaire was then used to establish opinions on the glow-and-tell box as an aid to self-assessment in handwashing technique.

Memantine (Ebixa) in the later stages of dementia.

Memantine is the first agent licensed for the treatment of moderate to severe Alzheimer's disease. It is an N-methyl D-aspartate (NMDA) receptor antagonist which reduces glutamatergic excitotoxicity. Benefits are seen in cognitive, functional and global measures in both outpatients and nursing home residents.

High service users: does the clinical psychologist have a role?

Objective: To assess the impact of psychological intervention on high users of the GP service.

Design: A sample of high-attenders was offered the opportunity to attend an interview with a clinical psychologist. A three-year (one year before and two years after psychological intervention) survey of patient records was carried out to determine the pattern of patient attendances.

The willingness to continue caring in family supporters of older people.

Research has revealed the importance of characteristics of the supporter, the care-recipient, and circumstances of caregiving in the success or failure of community-based care of older people. The Dundee Study of Carers and Dementia examined factors associated with the maintenance and care of older people in the community, and with the impact of dementia on family supporters. Two hundred and twenty-eight family supporters of community-resident older people (>/=65) (50% with dementia, 50% without, matched for age and sex) were interviewed.

Burnout in psychiatric nursing.

Introduction: Burnout in nursing is of both individual and organizational concern with ramifications for well-being, job performance, absenteeism and turnover. Burnout is rarely assessed as part of a comprehensive model of occupational stress, a short-coming which this paper attempts to redress.

Method: A randomly selected sample of 510 psychiatric nurses from one Scottish Trust completed a questionnaire based on a psychological model of occupational stress which included the Maslach Burnout Inventory (MBI) as the dependent variable.

Death of a psychiatric patient during physical restraint. Excited delirium--a case report.

We report the case of a young man with a diagnosis of paranoid schizophrenia and multiple drug abuse who died in hospital following a period of prolonged physical restraint. The literature is reviewed, possible factors contributing to death discussed and measures which may reduce the incidence of such deaths in the future highlighted.

Delusional misidentification secondary to perceptual abnormality: An unusual case of Capgras syndrome.

Capgras syndrome is the commonest of the delusional misidentification syndromes, occurring in 1 - 5% of psychotic patients. This case of a Capgras syndrome was secondary to an abnormal percept (auditory hallucination). Capgras syndrome is not a symptom specific to abnormalities of face recognition.

Health visitor-run adult sleep clinics.

Two sleep clinics run by health visitors were set up in Dundee to provide a brief, time-limited programme of advice and treatment for adults with insomnia and referred by their GPs. This article describes the clinics and reports the clinical features and outcome of the first 100 patients referred.

The Chief Scientist reports... A controlled investigation of changes following a programme of community living, skills training and the validation of these changes through relocation.

Fifty-seven adults with mild to moderate learning disabilities served as subjects in a community living skills training project. Twenty-nine subjects were trained using in vivo techniques, 13 were taught using classroom techniques and 15 subjects acted as a no-treatment control group. The effects of the training programme were assessed using videotaped assessments rated by independent observers and the in vivo techniques were found to be significantly superior to the teaching and no-treatment control conditions.

On predicting improvement and relapse in generalized anxiety disorder following psychotherapy.

This paper concerns an investigation of outcome predictors in a clinical trial of psychological therapies for generalized anxiety disorder. A variety of information of potential predictive value was obtained at three stages of patient contact: the initial referral, a screening interview and early sessions of therapy. Three measures of the clinical significance of change over a 12-month follow-up period were used to construct a composite measure which categorized outcome in terms of sustained improvement, relapse and no consistent change.

The effect of methadone prescribing in a clinic setting on the criminal activity of drug users.

The objective was to examine the impact of clinic attendance and methadone prescribing on drug user criminality. Fifty-four consecutive attenders at a Drug Problem Clinic were interviewed by questionnaire. An objective assessment of the criminality on 49(91%) of the above was made by examining their conviction details, before and after clinic attendance.

Neuroticism and sense of coherence.

The relationship of scores on sense of coherence with measures of personality traits was assessed using the 29-item Orientation to Life Questionnaire and the Eysenck Personality Inventory. In one group of 95 mixed-sex students scores on Neuroticism bore a highly negative relationship with scores on sense of coherence. Findings support the current literature that health questionnaires may indirectly measure Neuroticism and that personality variables play an important role in general health.

Behaviour symptoms among severely and profoundly mentally retarded patients. A 16-18 year follow-up study.

Background: Little is known about the natural history and evolution of behaviour symptoms and patterns in severely and profoundly mentally retarded adults. This paper reports a cohort study of 100 such adults.

Method: Abnormal behaviour symptoms and patterns have been followed, using a carer rating scale and the modified Manifest Abnormality Scale of Goldberg's Clinical Interview Schedule (1970) by the same two consultant psychiatrists in 1975, 1981 and 1992.

Irregular distortion of the erythrocytes (acanthocytes, spur cells) in senile dementia.

An excess of irregularly distorted red cells with spiked forms (acanthocytes, spur cells) has been found in a substantial minority of patients with senile dementia of Alzheimer type (7 of 50 patients, 3 of 21 men and 4 of 29 women). Of 100 control patients, 42 men and 58 women), 5 (3 men and 2 women) showed comparable distortion, but, of these, one man may well have incipient dementia and the others had serious organic diseases which may be associated with comparable erythrocytic changes. The cause of the distortion is not yet clear, but the presence of occasional giant erythrocytes in the absence of general macrocytosis suggests a possible abnormality of cell-membrane synthesis.

Neuroleptic medication for dystonia. Reciprocal relationship between effects on motor function and mood.

Background: The presence of dysphoric symptoms associated with neuroleptic medication is commonly reported.

Method: Neuroleptic treatment of a segmental dystonia resulted in a disabling depressive illness, which when treated with antidepressants led to the return of the involuntary movements.

Results: The use of several different antidepressants and neuroleptics confirmed the association between drugs and symptoms.

Cognitive therapy, analytic psychotherapy and anxiety management training for generalised anxiety disorder.

Background: We test the hypotheses that (a) cognitive therapy is of comparable efficacy to psychodynamic psychotherapy, (b) 8-10 sessions of therapy is as effective as 16-20 sessions, and (c) brief therapist training is as effective as intensive training.

Method: Of 178 out-patients referred to a clinical trial of psychological treatment for generalised anxiety, 110 patients met DSM-III-R criteria for generalised anxiety disorder and were randomly assigned to three different forms of psychotherapy. The main comparison was between cognitive therapy and analytic psychotherapy, delivered by experienced therapists at weekly or fortnightly intervals over six months.

Psychological treatment of generalised anxiety disorder. A review of the clinical significance of results in outcome studies since 1980.

Comparative outcome studies of generalised anxiety disorder suggest that psychological therapy is a potentially valuable alternative to anxiolytic medication. However, on average psychological therapy results in modest improvements in symptoms, with about 50% of patients achieving normal functioning. Limited follow-up data indicate that these changes are maintained over six months.

Erythrocyte membrane cation carrier in Down syndrome.

Erythrocyte sodium pump was estimated in subjects with Down syndrome and in matched mentally handicapped controls: there was no significant difference in measures of sodium pump between the two groups.