The authors describe a method of systematically reviewing research from different paradigms. They draw on the methods adapted, developed, and designed during a study concerned with the delivery of care across professional boundaries. Informed by the established method of systematic review, the authors undertook the review in distinct stages. They describe the methods developed for each stage and outline the difficulties encountered, the solutions devised, and the appraisal tools developed. Although many of the problems encountered were related to the critical assessment of qualitative research, the authors argue that the method of systematic review can be adapted for use with different data andacross disciplines.
We identified the population of schizophrenic patients under 65 in a geographically defined area. The number using psychiatric services based on a new District General Hospital unit in the course of one year was 364, a prevalence of 2.2 per 1000 adult population. Half the patients lived in supportive private households, most often with spouses or mothers. More women than men married and retained supporters. Patients and their primary supporters were interviewed separately. The PSE Catego programme classed 47 per cent of patients as psychotic. Supporters reported disturbed behavior in 65 per cent of patients, and restricted social performance in 78 per cent. There was evidence of hardship (emotional and physical ill-health, problems with children) in 90 per cent of households. Supporters' subjective distress was directly related to the presence of psychosis and disturbed behaviour and inversely related to the duration of the illness. Drop-out and failure to take medication appeared to be causes of the relatively high prevalence of psychosis.
raised awareness and the establishment of common goals are the first steps needed to bridge the divide between health and social care staff in hospital and the community.
This care pathway was associated with longer hospital stay and improved clinical outcomes. Care pathways for hip fracture patients can be a useful tool for raising care standards but may require additional resources.
We report a study that facilitated and evaluated two multiagency Communities of Practice (CoPs) working on improving specific aspects of health and social services for older people, and analysed how they processed and applied knowledge in formulating their views. Data collection included observing and tape-recording the CoPs, interviewing participants and reviewing documents they generated and used. All these sources were analysed to identify knowledge-related behaviours. Four themes emerged from these data: (1) the way that certain kinds of knowledge became privileged and accepted; (2) the ways in which the CoP members transformed and internalized new knowledge; (3) how the haphazard processing of the available knowledge was contingent upon the organizational features of the groups; and (4) the ways in which the changing agendas, roles and power-relations had differential effects on collective sense making. We conclude by recommending ways in which the process of evidence-based policy development in such groups may be enhanced.
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