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Stigma of mental health conditions hinders recovery and well-being. The Honest, Open, Proud (HOP) program shows promise in reducing stigma but there is uncertainty about the feasibility of a randomized trial to evaluate a peer-delivered, individual adaptation of HOP for psychosis (Let's Talk).
Methods
A multi-site, Prospective Randomized Open Blinded Evaluation (PROBE) design, feasibility randomised controlled trial (RCT) comparing the peer-delivered intervention (Let's Talk) to treatment as usual (TAU). Follow-up was 2.5 and 6 months. Randomization was via a web-based system, with permuted blocks of random size. Up to 10 sessions of the intervention over 10 weeks were offered. The primary outcome was feasibility data (recruitment, retention, intervention attendance). Primary outcomes were analyzed by intention to treat. Safety outcomes were reported by as treated status. The study was prospectively registered: https://doi.org/10.1186/ISRCTN17197043.
Results
149 patients were referred to the study and 70 were recruited. 35 were randomly assigned to intervention + TAU and 35 to TAU. Recruitment was 93% of the target sample size. Retention rate was high (81% at 2.5 months primary endpoint), and intervention attendance rate was high (83%). 21% of 33 patients in Let's talk + TAU had an adverse event and 16% of 37 patients in TAU. One serious adverse event (pre-randomization) was partially related and expected.
Conclusions
This is the first trial to show that it is feasible and safe to conduct a RCT of HOP adapted for people with psychosis and individual delivery. An adequately powered trial is required to provide robust evidence.
Edited by
Sattar Alshryda, Al Jalila Children’s Specialty Hospital, Dubai Academic Health Corporation, Dubai UAE,Stan Jones, Al Ahli Hospital, Qatar,Paul A. Banaszkiewicz, Queen Elizabeth Hospital, Gateshead
A limb deformity can be defined as distortion from the normal form and this may be in the form of leg length discrepancy (LLD), angular deformity, rotational deformity, or a combination of these. Untreated substantive limb deformity can cause symptoms and affect limbs functions. An accurate assessment and appropriate treatment are the key to success in managing these patients.
Edited by
Sattar Alshryda, Al Jalila Children’s Specialty Hospital, Dubai Academic Health Corporation, Dubai UAE,Stan Jones, Al Ahli Hospital, Qatar,Paul A. Banaszkiewicz, Queen Elizabeth Hospital, Gateshead
The foot has 26 bones, 33 joints, and over 100 muscles and tendons; therefore, it is not a surprise that it is one of the commonest causes for parents to see a paediatric orthopaedic surgeon. At birth, the talus, calcaneus, cuboid, metatarsals, and phalanges are ossified, whereas the navicular and three cuneiforms are not (see Chapter 3, Figure 3.11). The lateral cuneiform ossifies at 1 year, the medial cuneiform at 2 years, and the intermediate cuneiform at 3 years. The navicular bone ossifies between 2 and 5 years [1].
Background: Statistically significant decreases in methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) occurred in Veterans Health Administration (VA) facilities from 2007 to 2019 using active surveillance for facility admissions and contact precautions for patients colonized (CPC) or infected (CPI) with MRSA, but the value of these interventions is controversial. Objective: To determine the impact of active surveillance, CPC, and CPI on prevention MRSA HAIs, we conducted a prospective cohort study between July 2020 and June 2022 in all 123 acute-care VA medical facilities. In April 2020, all facilities were given the option to suspend any combination of active surveillance, CPC, or CPI to free up laboratory resources for COVID-19 testing and conserve personal protective equipment. We measured MRSA HAIs (cases per 1,000 patient days) in intensive care units (ICUs) and non-ICUs by the infection control policy. Results: During the analysis period, there were 917,591 admissions, 5,225,174 patient days, and 568 MRSA HAIs. Only 20% of facilities continued all 3 MRSA infection control measures in July 2020, but this rate increased to 57% by June 2022. The MRSA HAI rate for all infection sites in non-ICUs was 0.07 (95% CI, 0.05–0.08) for facilities practicing active surveillance plus CPC plus CPI compared to 0.12 (95% CI, 0.08–0.19; P = .01) for those not practicing any of these strategies, and in ICUs the MRSA HAI rates were 0.20 (95% CI, 0.15–0.26) and 0.65 (95% CI, 0.41–0.98; P < .001) for the respective policies. Similar differences were seen when the analyses were restricted to MRSA bloodstream HAIs. Accounting for monthly COVID-19 admissions to facilities over the analysis period using a negative binomial regression model did not change the relationships between facility policy and MRSA HAI rates in the ICUs or non-ICUs. There was no statistically significant difference in monthly facility urinary catheter-associated infection rates, a nonequivalent dependent variable, in the categories during the analysis period in either ICUs or non-ICUs. Conclusions: In Veterans Affairs medical centers, there were fewer MRSA HAIs when facilities practiced active surveillance and contact precautions for colonized or infected patients during the COVID-19 pandemic. The effect was greater in ICUs than non-ICUs.
The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.
Our aim was for 80% of new referrals for behaviours that challenge within Tower Hamlets Community Learning Disability service to have an MDT coordinated approach by July 2022. This followed concerns about disjointed care and long waits for therapeutic support when being referred between different MDT branches within the service having a negative impact on patient care.
Methods
An MDT project team was formed and weekly meetings were arranged. A driver diagram was created. Our primary outcome measure was determined: percentage of referred patients per week that had MDT coordinated assessments, with data being collected manually from electronic progress notes and MDT meeting minutes. Number of referrals per week was recorded as a process measure. Baseline data were added to the Life QI web platform upon collection, allowing generation of run charts for outcome and process measures. The time-frame over which referrals were recorded was changed from weekly to fortnightly, to help differentiate graphically between zero values resulting from the absence of MDT coordination and those resulting from no referrals being received on a given week. Attempts were made to obtain service user input via easy-read questionnaires and subsequent discussion in a service user participation group. A weekly Positive Behavioural Support meeting was set up and a Positive Behavioural Support database was established, and the combination of these changes simplified data collection and gave a focus to MDT working and collaboration for these service users. Data were recorded from 28/06/2021 to 03/07/2022 initially and subsequently extended to 06/11/2022 as part of a further PDSA cycle.
Results
A shift in proportion of service users referred with behaviour that challenges who had MDT involvement at the point of allocation was observed, to above the mean value of 0.5, commencing 07/02/2022, this shift was sustained until the project's endpoint. In terms of our process measure, the median number of new behaviour that challenges referrals per fortnightly period to psychiatry and psychology was one. This ranged from 0-4 referrals per fortnightly period, but no sustained change in this value was observed over the course of the project.
Conclusion
Implementing a new behaviour that challenges database and weekly meeting to focus on MDT coordinated working in those newly referred with behaviour that challenges has been successful in leading to a measurable and sustained improvement in the proportion of those service users receiving timely MDT coordinated care.
The research of this paper provides a useful insight into the many barriers leading to building services overdesign, within the context of NHS hospitals. The issue of overdesign in building services is a systemic problem, whereby numerous contributing factors manifest into an issue that inevitably leads to poor system performance and excess costs. A key factor leading to oversizing is the excessive and uncoordinated application of design margins across the various stages of a building services project. Poor communication between project stakeholders is another significant barrier that inhibits the distribution of information between design groups; unknown requirements, system redundancy and poor system specifications further add to the problem. There are many complex interrelationships associated with the building service design process in hospitals, with external stakeholders adding to the complexity. This points to the importance of effective communication between stakeholders and clear contractual terms between NHS Trusts and external private sector organisations. Many of the barriers identified within this paper are by no means limited to building service systems but also impact on a range of other engineering disciplines.
It is known that the water entry of a body with a recessed, cupped nose can suppress the splash and air cavity typically observed for solid body entry (Mathai, Govardhan & Arakeri, Appl. Phys. Lett., vol. 106, 2015, 064101). However, the interplay between the captive gas in the cup, the cavity and the splash is quite subtle and has not been thoroughly explored. Here we study the cavity and splash dynamics associated with the vertical water entry of cups and find a variety of regimes over a range of Weber numbers ($We_D$) and dimensionless cup depths. Our parameter space spans a transition between slow-developing cavities with long closure times (low $We_D$) to fast-sealing cavities (high $We_D$). An important dynamic event is the evacuation of trapped gas from within the cup, which drives the ensuing cavity and splash behaviour. Through modelling, we predict the conditions for which the evacuating gas inflates a cavity that opens to the atmosphere versus inflating a submerged cavity that suppresses air entrainment from above the surface. We also compare our cup water entry findings to the impact phenomena observed for flat disks, which entrap gas on the front surface similar to cups. In doing so, we reveal the sensitivity of disk splash and cavity behaviour to impact angle, and show that disks share a common regime with cups, in which a thin splash quickly seals on the body. We deduce the mechanisms by which increasing cup depth delays the cavity seal time in this regime. These findings reveal that cups may in fact promote or suppress cavity growth, depending on the cup depth and impact conditions.
Mate preferences and mating-related behaviours are hypothesised to change over the menstrual cycle to increase reproductive fitness. Recent large-scale studies suggest that previously reported hormone-linked behavioural changes are not robust. The proposal that women's preference for associating with male kin is down-regulated during the ovulatory (high-fertility) phase of the menstrual cycle to reduce inbreeding has not been tested in large samples. Consequently, we investigated the relationship between longitudinal changes in women's steroid hormone levels and their perceptions of faces experimentally manipulated to possess kinship cues (Study 1). Women viewed faces displaying kinship cues as more attractive and trustworthy, but this effect was not related to hormonal proxies of conception risk. Study 2 employed a daily diary approach and found no evidence that women spent less time with kin generally or with male kin specifically during the fertile phase of the menstrual cycle. Thus, neither study found evidence that inbreeding avoidance is up-regulated during the ovulatory phase of the menstrual cycle.
Posttraumatic stress symptoms (PTSS) are common following traumatic stress exposure (TSE). Identification of individuals with PTSS risk in the early aftermath of TSE is important to enable targeted administration of preventive interventions. In this study, we used baseline survey data from two prospective cohort studies to identify the most influential predictors of substantial PTSS.
Methods
Self-identifying black and white American women and men (n = 1546) presenting to one of 16 emergency departments (EDs) within 24 h of motor vehicle collision (MVC) TSE were enrolled. Individuals with substantial PTSS (⩾33, Impact of Events Scale – Revised) 6 months after MVC were identified via follow-up questionnaire. Sociodemographic, pain, general health, event, and psychological/cognitive characteristics were collected in the ED and used in prediction modeling. Ensemble learning methods and Monte Carlo cross-validation were used for feature selection and to determine prediction accuracy. External validation was performed on a hold-out sample (30% of total sample).
Results
Twenty-five percent (n = 394) of individuals reported PTSS 6 months following MVC. Regularized linear regression was the top performing learning method. The top 30 factors together showed good reliability in predicting PTSS in the external sample (Area under the curve = 0.79 ± 0.002). Top predictors included acute pain severity, recovery expectations, socioeconomic status, self-reported race, and psychological symptoms.
Conclusions
These analyses add to a growing literature indicating that influential predictors of PTSS can be identified and risk for future PTSS estimated from characteristics easily available/assessable at the time of ED presentation following TSE.
'STOMP stands for stopping over medication of people with a learning disability, autism or both with psychotropic medicines. It is a national project involving many different organizations which are helping to stop the over use of these medicines. STOMP is about helping people to stay well and have a good quality of life'. Our aim was to reduce the percentage of psychotropic burden on the LD and/or autism caseload in Tower Hamlets.
Methods
We reviewed the internal LD caseload that fit STOMP eligibility criteria (prescribed antipsychotics without an indicated mental health diagnosis).
We calculated the% of BNF maximum dose for individual service users, aimed to reduced this, and reviewing the cumulative dose reduction achieved across the service, before and after an intervention.
The primary intervention was the introduction of a pharmacy led clinic for service users meeting the criteria. This allowed closer f/u from LD pharmacist, thorough medication histories independent of their routine psychiatric reviews, and using GASS and BAI scales to quantify change achieved to their quality of life.
We used early and rigourous people participation to consider the role medications (and their overprescription) in service users quality of life, and asked what service users want out of these medication reviews. Several focus groups were ran without People Participation Lead.
Results
Prior to starting of clinic - Of 29 STOMP eligible patients within TH CLDS, we have reduced antipsychotics in 8 of them through general raising awareness of STOMP (presentations to staff, reviews of GP letters to identify service users within the caseload who are likely to benefit and/or be receptive to dose reductions etc). So far total reduction of 45.4%, (and a total of three patients have been stopped all together).
Conclusion
The majority of the results and intervention are yet to be collated, and we are collecting these over the next 2 months, but provisionally we hope to conclude that by reducing the quantity of psychotropic medication we prescribe will improve the quality of life for our service users
Automated virtual reality therapies are being developed to increase access to psychological interventions. We assessed the experience with one such therapy of patients diagnosed with psychosis, including satisfaction, side effects, and positive experiences of access to the technology. We tested whether side effects affected therapy.
Methods
In a clinical trial 122 patients diagnosed with psychosis completed baseline measures of psychiatric symptoms, received gameChange VR therapy, and then completed a satisfaction questionnaire, the Oxford-VR Side Effects Checklist, and outcome measures.
Results
79 (65.8%) patients were very satisfied with VR therapy, 37 (30.8%) were mostly satisfied, 3 (2.5%) were indifferent/mildly dissatisfied, and 1 (0.8%) person was quite dissatisfied. The most common side effects were: difficulties concentrating because of thinking about what might be happening in the room (n = 17, 14.2%); lasting headache (n = 10, 8.3%); and the headset causing feelings of panic (n = 9, 7.4%). Side effects formed three factors: difficulties concentrating when wearing a headset, feelings of panic using VR, and worries following VR. The occurrence of side effects was not associated with number of VR sessions, therapy outcomes, or psychiatric symptoms. Difficulties concentrating in VR were associated with slightly lower satisfaction. VR therapy provision and engagement made patients feel: proud (n = 99, 81.8%); valued (n = 97, 80.2%); and optimistic (n = 96, 79.3%).
Conclusions
Patients with psychosis were generally very positive towards the VR therapy, valued having the opportunity to try the technology, and experienced few adverse effects. Side effects did not significantly impact VR therapy. Patient experience of VR is likely to facilitate widespread adoption.
Many patients with mental health disorders become increasingly isolated at home due to anxiety about going outside. A cognitive perspective on this difficulty is that threat cognitions lead to the safety-seeking behavioural response of agoraphobic avoidance.
Aims:
We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess a wide range of cognitions likely to lead to agoraphobic avoidance. We also included two additional subscales assessing two types of safety-seeking defensive responses: anxious avoidance and within-situation safety behaviours.
Method:
198 patients with psychosis and agoraphobic avoidance and 1947 non-clinical individuals completed the item pool and measures of agoraphobic avoidance, generalised anxiety, social anxiety, depression and paranoia. Factor analyses were used to derive the Oxford Cognitions and Defences Questionnaire (O-CDQ).
Results:
The O-CDQ consists of three subscales: threat cognitions (14 items), anxious avoidance (11 items), and within-situation safety behaviours (8 items). Separate confirmatory factor analyses demonstrated a good model fit for all subscales. The cognitions subscale was significantly associated with agoraphobic avoidance (r = .672, p < .001), social anxiety (r = .617, p < .001), generalized anxiety (r = .746, p < .001), depression (r = .619, p < .001) and paranoia (r = .655, p < .001). Additionally, both the O-CDQ avoidance (r = .867, p < .001) and within-situation safety behaviours (r = .757, p < .001) subscales were highly correlated with agoraphobic avoidance. The O-CDQ demonstrated excellent internal consistency (cognitions Cronbach’s alpha = .93, avoidance Cronbach’s alpha = .94, within-situation Cronbach’s alpha = .93) and test–re-test reliability (cognitions ICC = 0.88, avoidance ICC = 0.92, within-situation ICC = 0.89).
Conclusions:
The O-CDQ, consisting of three separate scales, has excellent psychometric properties and may prove a helpful tool for understanding agoraphobic avoidance across mental health disorders.
Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of avoidance and in situ anxiety but are challenging to administer and lack standardisation. Our aim was to draw on the principles of BATs to develop a self-report measure of agoraphobia symptoms.
Method
The scale was developed with 194 patients with agoraphobia in the context of psychosis, 427 individuals in the general population with high levels of agoraphobia, and 1094 individuals with low levels of agoraphobia. Factor analysis, item response theory, and receiver operating characteristic analyses were used. Validity was assessed against a BAT, actigraphy data, and an existing agoraphobia measure. Test–retest reliability was assessed with 264 participants.
Results
An eight-item questionnaire with avoidance and distress response scales was developed. The avoidance and distress scales each had an excellent model fit and reliably assessed agoraphobic symptoms across the severity spectrum. All items were highly discriminative (avoidance: a = 1.24–5.43; distress: a = 1.60–5.48), indicating that small increases in agoraphobic symptoms led to a high probability of item endorsement. The scale demonstrated good internal reliability, test–retest reliability, and validity.
Conclusions
The Oxford Agoraphobic Avoidance Scale has excellent psychometric properties. Clinical cut-offs and score ranges are provided. This precise assessment tool may help focus attention on the clinically important problem of agoraphobic avoidance.
Energy consumed in buildings is a main contributor to CO2 emissions, there is therefore a need to improve the energy performance of buildings, particularly commercial buildings whereby building service systems are often substantially over-designed due to the application of excess margins during the design process.
The cooling system of an NHS Hospital was studied and modelled in order to identify if the system was overdesigned, and to quantify the oversizing impact on the system operational and embodied carbon footprints. Looking at the operational energy use and environmental performance of the current system as well as an alternative optimised system through appropriate modelling and calculation, the case study results indicate significant environmental impacts are caused by the oversizing of cooling system.
The study also established that it is currently more difficult to obtain an estimate of the embodied carbon footprint of building service systems. It is therefore the responsibility of the machine builders to provide information and data relating to the embodied carbon of their products, which in the longer term, this is likely to become a standard industry requirement.
The Scaling-up Health-Arts Programme: Implementation and Effectiveness Research (SHAPER) project is the world's largest hybrid study on the impact of the arts on mental health embedded into a national healthcare system. This programme, funded by the Wellcome Trust, aims to study the impact and the scalability of the arts as an intervention for mental health. The programme will be delivered by a team of clinicians, research scientists, charities, artists, patients and healthcare professionals in the UK's National Health Service (NHS) and the community, spanning academia, the NHS and the charity sector. SHAPER consists of three studies – Melodies for Mums, Dance for Parkinson's, and Stroke Odysseys – which will recruit over 800 participants, deliver the interventions and draw conclusions on their clinical impact, implementation effectiveness and cost-effectiveness. We hope that this work will inspire organisations and commissioners in the NHS and around the world to expand the remit of social prescribing to include evidence-based arts interventions.
The effectiveness of Emergency Medical Teams (EMTs) is strongly related to their time of arrival, and usually only few teams arrive within 24-48 h postdisaster. The decision to deploy and the scale of deployment rely heavily on context and nature of the event and consequently a rapid assessment of needs/gaps is critical to an appropriate and customized response.
Methods:
In this study, we describe a desk-based study that provides: (1) knowledge about the medical needs that can be anticipated according to the phases of the disaster that is not rich in literature; and (2) a decision support framework for the deployment of EMTs to earthquakes that combines the results of a literature research and a Delphi study involving the opinion of 12 experts in the field.
Results:
The resulting framework is a tool that will help better mapping the configuration to the needs on the ground at the time the team becomes operational in the field and will assist those responsible for deploying and/or accepting EMTs in making informed decisions on deployment after an earthquake.
Conclusions:
With additional research the framework approach may be adapted to other types of international relief such as to deploy a Search And Rescue (SAR) team.
The neurodevelopmental model of schizophrenia includes the etiological impact of fetal brain stressors possibly connected with birth seasonality. Specification of social class of origin (SES) as a related risk factor remains unexamined as does type of schizophrenia as an outcome variable. The objective of this study was to test for an interconnection between SES, type of schizophrenia and seasonality of birth.
Methods
Patients (N = 436) from a United States psychiatric hospital were separated into deficit/nondeficit presentation and bifurcated into poor/nonpoor SES. Birth seasonality was assessed by months hypothetically connected with winter-related trimesters of gestation.
Results
Results showed that there is a significant difference (p = 0.0411) in the monthly birth patterns of poor vs. nonpoor patients and that the difference connects with the likelihood of deficit vs. nondeficit schizophrenia. Specifically, an elevated proportion of patients with deficit schizophrenia were born to impoverished women who likely conceived in January. Findings were confirmed by multiple levels of statistical assessment including log linear analysis.
Conclusion
The resultant model suggests the environmental location (lower SES) and timing (winter conception) of adult schizophrenia with poor outcome (deficit).