This paper describes the 9-step Collaborative Care Pathway (CCP-9), an innovative approach to delivering recovery-focused community mental health care which has been piloted and implemented in a community-based secondary level service in Ireland over the past 14 years. Care planning is mandated in the Republic of Ireland by the Mental Health Act (2001). Subsequent public policy documents require care planning to have a recovery focus, as outlined in the Quality Framework Document (Mental Health Commission 2023). The CCP-9 is a novel approach to delivering community mental health care in which care planning is embedded as one of a sequence of nine steps in a complete pathway of care from referral to discharge, and which has been adapted over time in line with evolving public policy. The CCP-9 is innovative in explicitly taking a graded approach to assessment, in the emphasis placed on collaborative engagement of service users (SUs) and their families, in the detailed psychosocial assessment undertaken in parallel with diagnostic assessment and in the degree of multidisciplinary team (MDT) involvement. The CCP-9 is coordinated by a key worker, involves prospective identification of personal needs and goals by the SU and enhanced MDT involvement in review of assessments, case formulation, care planning and feedback to SUs and families. The CCP-9 emphasises sharing information, documentation and mental health education with SUs and family members throughout the process, as a necessary support for shared decision-making in developing and implementing the care plan. Challenges to the sustainability of the CCP-9 includes the significant time investment to complete the assessment, care planning and feedback.

Background: Presence and documentation of clinical symptoms of Clostridioides difficile infection (CDI) prior to diagnostic testing is not well-described. The Infectious Diseases Society of America (IDSA) guidelines recommend that patients have ≥3 episodes of unexplained loose stool in the previous 24 hours before testing. In populations predisposed to chronic non-infectious diarrhea, such as those undergoing chemotherapy or with chronic gastrointestinal (GI) illness, more explicit signs of infection may be needed. Our objective was to evaluate CDI symptoms that proceeded testing in a cohort of inpatient Veterans with chronic GI illness or undergoing chemotherapy. Methods: This retrospective cohort study included Veterans hospitalized at 8 VA facilities from January 1st, 2019-December 31st, 2022, who were tested for CDI, and were receiving chemotherapy or had chronic GI illness. Charts reviewed identified the following symptoms in the 24 hours prior to testing: greater than 3 loose stools in 24 hours, bloody stool, nausea, vomiting, abdominal pain, fever (temperature ≥100.4°F), and white blood cell count >10,000/mm3. The presence of 3 loose stools in 24 hours alone was deemed the minimal indication for CDI testing, while the presence of any additional symptoms was considered high indication for testing. CDI treatment was defined as at least one dose of metronidazole, oral vancomycin, or fidaxomicin ±7 days from testing. Chi-square tests assessed the association between indication for CDI testing and test positivity. Results: A total of 676 tests for 577 unique patients were reviewed (69.1% White, 94.5% male, mean age=68.3 years). Most had a chronic GI illness (90%); colitis, and presence of a gastrostomy were the most frequently reported. Only 14% of CDI tests were positive. The minimal indication for CDI testing was present for 243 tests (36%). 190 tests (28%) were ordered for patients with symptoms highly indicative of CDI. Of the negative tests, 55% were associated with at least one dose of CDI treatment. There was no association between test indication and test positivity (p-value=0.82). Conclusion: In a population predisposed to chronic non-infectious diarrhea, nearly two thirds (64%) of those tested did not meet the minimum requirement (3 documented loose stools in 24 hours). This may partly explain the low-test positivity rate of 14%. Over half of negative tests were associated with CDI treatment. Future work should focus on diagnostic stewardship to improve documentation of loose stool and other CDI symptoms prior to testing to reduce unnecessary testing and overtreatment.

Clinical outcomes of repetitive transcranial magnetic stimulation (rTMS) for treatment of treatment-resistant depression (TRD) vary widely and there is no mood rating scale that is standard for assessing rTMS outcome. It remains unclear whether TMS is as efficacious in older adults with late-life depression (LLD) compared to younger adults with major depressive disorder (MDD). This study examined the effect of age on outcomes of rTMS treatment of adults with TRD. Self-report and observer mood ratings were measured weekly in 687 subjects ages 16–100 years undergoing rTMS treatment using the Inventory of Depressive Symptomatology 30-item Self-Report (IDS-SR), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item, and Hamilton Depression Rating Scale 17-item (HDRS). All rating scales detected significant improvement with treatment; response and remission rates varied by scale but not by age (response/remission ≥ 60: 38%–57%/25%–33%; <60: 32%–49%/18%–25%). Proportional hazards models showed early improvement predicted later improvement across ages, though early improvements in PHQ and HDRS were more predictive of remission in those < 60 years (relative to those ≥ 60) and greater baseline IDS burden was more predictive of non-remission in those ≥ 60 years (relative to those < 60). These results indicate there is no significant effect of age on treatment outcomes in rTMS for TRD, though rating instruments may differ in assessment of symptom burden between younger and older adults during treatment.

The findings from the first, qualitative stage of a larger sequential mixed method study of bullying in the Australian nursing workplace are reported. Interviews with twenty-six nurses, recruited from two health care organizations, were analysed using the constant comparative method. Participants described informal organizational networks as the mechanism through which predatory, cooperative, and planned group bullying acts were promulgated. These predatory alliances enabled the co-option of legitimate organizational systems, the concealment of bullying, and the protection and promotion of perpetrators. By identifying the manner in which workplace bullying can be embedded within informal organizational networks, this research has important implications for further research in this field.

Universities enter into contracts with publishers or providers of aggregated resources on behalf of university libraries to provide staff and students with access to material in electronic format for educational and research purposes. Following a brief review of twelve database provider contracts, our research demonstrates that Australian academics are potentially breaching the contractual terms and conditions of electronic resources when accessing, downloading and printing articles and other materials. They are covered for research purposes, but not for educational purposes.

Adequate levels of vitamins and minerals are essential for optimal neural functioning. A high proportion of individuals, including children, suffer from deficiencies in one or more vitamins or minerals. This study investigated whether daily supplementation with vitamins/minerals could modulate cognitive performance and mood in healthy children. In this randomised, double-blind, placebo-controlled, parallel groups investigation, eighty-one healthy children aged from 8 to 14 years underwent laboratory assessments of their cognitive performance and mood pre-dose and at 1 and 3 h post-dose on the first and last days of 12 weeks' supplementation with a commercially available vitamins/mineral product (Pharmaton Kiddi™). Interim assessments were also completed at home after 4 and 8 weeks at 3 h post-dose. Each assessment comprised completion of a cognitive battery, delivered over the Internet, which included tasks assessing mood and the speed and accuracy of attention and aspects of memory (secondary, semantic and spatial working memory). The vitamin/mineral group performed more accurately on two attention tasks: ‘Arrows’ choice reaction time task at 4 and 8 weeks; ‘Arrow Flankers’ choice reaction time task at 4, 8 and 12 weeks. A single task outcome (Picture Recognition errors) evinced significant decrements at 12 weeks. Mood was not modulated in any interpretable manner. Whilst it is possible that the significant improvements following treatment were due to non-significant numerical differences in performance at baseline, these results would seem to suggest that vitamin/mineral supplementation has the potential to improve brain function in healthy children. This proposition requires further investigation.