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66 results

Page 1 of 4

  • The Northwest Participant and Clinical Interactions Network: Increasing opportunities for patients to participate in research across the Northwestern United States

  • Laura-Mae Baldwin, Laurie Hassell, Cindi Laukes, Michelle Doyle, Anne Reedy, Brenda Mollis, Sandra Albritton, Elizabeth Ciemins, Robert Coker, Jeannine Brant, Katherine R. Tuttle, Laura Baker, Bonnie Ramsey
  • Journal:
    Journal of Clinical and Translational Science / Volume 1 / Issue 2 / April 2017
    Published online by Cambridge University Press:
    19 April 2017, pp. 94-100
    • Article
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  • Introduction

    The Institute of Translational Health Sciences (ITHS) promotes and supports translational research collaboration between clinicians, communities, and investigators across the five-state Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region. The ITHS has developed a collaborative regional clinical research network, the Northwest Participant & Clinical Interactions Network (NW PCI), involving 12 diverse clinical health systems and academic institutions.

    Methods

    This descriptive article details NW PCI’s development, infrastructure and governance, tools, characteristics, and initial outcomes.

    Results

    Regional NW PCI sites are conducting largely industry-sponsored studies; they are interested in including more grant-funded research. Regional NW PCI sites had over 1,240 open studies involving over 6700 patients in 2016. NW PCI trials are largely industry-sponsored; NW PCI sites are interested in including more grant-funded research. In its first three years, the NW PCI Coordinating Center facilitated regional sites’ participation in 34 new grant and contract applications across diverse topics.

    Conclusion

    The NW PCI model supports the goals of the developing CTSA Trial Innovation Network by increasing access to cutting-edge research across the Northwestern U.S., by supporting investigators seeking diverse populations, including those with rare diseases, for their research studies, and by providing settings to test implementation and dissemination of effective interventions.

  • The separation of adult separation anxiety disorder

  • David S. Baldwin, Robert Gordon, Marianna Abelli, Stefano Pini
  • Journal:
    CNS Spectrums / Volume 21 / Issue 4 / August 2016
    Published online by Cambridge University Press:
    09 August 2016, pp. 289-294

  • The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorization of mental disorders places “separation anxiety disorder” within the broad group of anxiety disorders, and its diagnosis no longer rests on establishing an onset during childhood or adolescence. In previous editions of DSM, it was included within the disorders usually first diagnosed in infancy, childhood, or adolescence, with the requirement for an onset of symptoms before the age of 18 years: symptomatic adults could only receive a retrospective diagnosis, based on establishing this early onset. The new position of separation anxiety disorder is based upon the findings of epidemiological studies that revealed the unexpectedly high prevalence of the condition in adults, often in individuals with an onset of symptoms after the teenage years; its prominent place within the DSM-5 group of anxiety disorders should encourage further research into its epidemiology, etiology, and treatment. This review examines the clinical features and boundaries of the condition, and offers guidance on how it can be distinguished from other anxiety disorders and other mental disorders in which “separation anxiety” may be apparent.

  • Risk Regulation and Transnationality: Institutional Accountability as a Driver of Innovation

  • Robert Baldwin, Julia Black, Gerard O’Leary
  • Journal:
    Transnational Environmental Law / Volume 3 / Issue 2 / October 2014
    Published online by Cambridge University Press:
    26 June 2014, pp. 373-390

  • This article describes the processes that led the Irish Environmental Protection Agency (EPA) to develop a National Inspection Plan for domestic waste water treatment systems, following intervention from European Union institutions. The discussion focuses on two issues: the role of transnational institutional settings in galvanizing innovation and regulatory reform, and the practical challenges of dealing with lower risks. It is argued that multi-level transnational regimes have considerable potential to stimulate high-level reviews of regulatory strategy. As a result, lower risks present challenges that cannot be ignored in favour of policies that focus on the most severe risks. Traditional risk regulation theories, it is contended, do not provide much assistance in selecting intervention strategies in the face of such pressures, but the example of the Irish EPA shows how regulators can address these issues.

  • Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial

  • Renee Romeo, Martin Knapp, Jennifer Hellier, Michael Dewey, Clive Ballard, Robert Baldwin, Peter Bentham, Alistair Burns, Chris Fox, Clive Holmes, Cornelius Katona, Claire Lawton, James Lindesay, Gill Livingston, Niall McCrae, Esme Moniz-Cook, Joanna Murray, Shirley Nurock, John O'Brien, Michaela Poppe, Alan Thomas, Rebecca Walwyn, Kenneth Wilson, Sube Banerjee
  • Journal:
    The British Journal of Psychiatry / Volume 202 / Issue 2 / February 2013
    Published online by Cambridge University Press:
    02 January 2018, pp. 121-128
    Print publication:
    February 2013
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  • Background

    Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes.

    Aims

    To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia.

    Method

    A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0–13 weeks and 0–39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods.

    Results

    There were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively.

    Conclusions

    In terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers.

  • Stomach contents of small cetaceans stranded along the Sea of Oman and Arabian Sea coasts of the Sultanate of Oman

  • Louisa S. Ponnampalam, Tim J.Q. Collins, Gianna Minton, Isabelle Schulz, Howard Gray, Rupert F. G. Ormond, Robert M. Baldwin
  • Journal:
    Journal of the Marine Biological Association of the United Kingdom / Volume 92 / Issue 8 / December 2012
    Published online by Cambridge University Press:
    06 February 2012, pp. 1699-1710

  • This study examined the stomach contents of 11 bottlenose dolphins (Tursiops sp.), five Indo-Pacific humpback dolphins (Sousa chinensis) and two spinner dolphins (Stenella longirostris) that were found stranded along the Omani coastline. Across the three species examined, a total of 4796 fish otoliths and 214 cephalopod beaks were found, representing at least 33 species in 22 families. Prey item importance was calculated using the percentage by number and percentage by frequency of occurrence methods, and a modified index of relative importance. The fish families Apogonidae, Carangidae and Scombridae were the most numerically important prey of the bottlenose dolphins. Sciaenidae was the most numerically important fish family for the Indo-Pacific humpback dolphins. The myctophid Benthosema pterotum formed the majority of the prey items of spinner dolphins. Cephalopod remains found in the stomach samples were represented by the families Sepiidae, Loliginidae and Onychoteuthidae. The known depth distribution of prey items of bottlenose dolphins indicated that the animals fed in a wide variety of habitats. Indo-Pacific humpback dolphin prey items indicated feeding in shallow coastal areas. Spinner dolphins appear to have exploited the upper 200 m of the water column for food, where their vertically migrating mesopelagic prey are found at night. Most prey species found in the stomach contents do not appear to be of current commercial importance in Oman. However, the findings here indicated that all three species of dolphins were feeding in areas where artisanal and/or commercial fishing occurs and has conservation implications.

  • Preventing late-life depression: a clinical update

  • Robert C. Baldwin
  • Journal:
    International Psychogeriatrics / Volume 22 / Issue 8 / December 2010
    Published online by Cambridge University Press:
    01 July 2010, pp. 1216-1224

  • Background: Achieving remission in late-life depressive disorder is difficult; it is far better to prevent depression. In the last ten years there have been a number of clinical studies of the feasibility of prevention.

    Methods: A limited literature review was undertaken of studies from 2000 specifically concerning the primary prevention of late-life depressive disorder or where primary prevention is a relevant secondary outcome.

    Results: Selective primary prevention (targeting individuals at risk but not expressing depression) has been shown to be effective for stroke and macular degeneration but not hip fracture. It may also prove effective for the depression associated with caregiving in dementia. Emerging evidence finds effectiveness for indicated prevention (in those identified with subthreshold depression often with other risk factors such as functional limitation). Despite a number of promising risk factors (for example, diet, exercise, vascular risk factors, homocysteine and insomnia), universal prevention of late-life depression (acting to reduce the impact of risk factors at the population level) has no current evidence base, although a population approach might mitigate suicide.

    Conclusion: Interventions which work in preventing late-life depression include antidepressant medication in standard doses and Problem-Solving Treatment. When integrated into a care model, such as collaborative care, prevention is feasible but more economic studies are needed.

Integrated Management of Depression in the Elderly
  • Carolyn A. Chew-Graham, Robert Baldwin, Alistair Burns
  • Published online:
    18 December 2009
    Print publication:
    03 April 2008
  • Depression is one of the most common mental health problems facing older people, and it is often unrecognised and usually under-treated. Integrated Management of Depression in the Elderly provides an entirely new approach to understanding late-life depression, by using a series of case studies with commentaries from practitioners internationally. The book covers the epidemiology, presentation and diagnosis of depression in older people and outlines current evidence for effective management drawing on recently published work. The substantive part of the book presents ten case studies of increasing complexity, each case has a commentary from a primary care clinician and a health or social care professional, to outline how professionals should work together to manage the patient within their community. Contributions from world experts give the book an international appeal. It will appeal to a wide audience of health and social care professionals together with psychiatrists-in-training.

  • 12 - Mental health problems in older people

  • from Part II - Clinical issues
    • By Carolyn Chew-Graham, Professor of Primary Care in the School of Community Based Medicine, University of Manchester, Robert Baldwin, Consultant in Old Age Psychiatry at Manchester Royal Infirmary and Honorary Professor of Old Age Psychiatry at the University of Manchester
  • Edited by Linda Gask, Helen Lester, Tony Kendrick, Robert Peveler
  • Book:
    Primary Care Mental Health
    Published online:
    02 January 2018
    Print publication:
    01 October 2009, pp 174-197

  • Summary

    This chapter is divided into four main sections, presenting, in turn, the primary care management of the commonest mental health problems in older people: delirium, depression, dementia and delusions (the first three of these are compared in Table 12.1). The presentation and management of a typical case are illustrated for each. Although the discussion largely refers to the UK context and the general practitioner (GP), the majority of it will apply internationally and to primary care physicians (and indeed other professionals) more generally.

    Delirium

    Clinical presentation

    Delirium is a syndrome comprising disturbance of consciousness (often manifest as impaired attention or concentration), cognitive deficits (such as memory, orientation or language problems), disturbed sleep–wake cycle, associated features such as delusions or hallucinations (especially visual) and behavioural disturbances (such as agitation or apathy) and alterations in affect, notably fear (Table 12.1).

    The onset is often sudden (hours or days) and fluctuation is a hallmark. A useful mnemonic is the four ‘I's (Crausman, 2004):

  • intermittent impairment of cognition

  • inattention

  • incoherent thought

  • impaired consciousness.

    • Delirium is synonymous with ‘acute confusional state’ (see Chapter 16).

    Case 1. Delirium: Marjorie

    The GP is called to see an 83-year-old lady, Marjorie, who lives in a residential home and who has quickly become confused, withdrawn and irritable. She has wandered out of her room, awake, for the past three nights.

    She has a history of diabetes, ischaemic heart disease, peptic ulcer and recurrent urinary tract infections.

    Her medication comprises gliclazide, digoxin, aspirin, ramipril, atorvastatin, thyroxine, omeprazole and paracetamol.

    The nurse in charge has asked the GP to see her because Marjorie is being disruptive.

    What does the GP need to consider in relation to assessment, diagnosis and management?

    Two main presentations are recognised:

  • • hyperactive delirium (hallucinations, delusions, agitation and disorientation)

  • • hypoactive delirium (cognitive impairment with apathy or withdrawal, less often accompanied by hallucinations and delusions).

    • The latter form can easily be overlooked in older patients.

  • Comparison of older people with psychosis living in the community and in care homes

  • Emily Clancy, Robert C. Baldwin
  • Journal:
    Psychiatric Bulletin / Volume 32 / Issue 5 / May 2008
    Published online by Cambridge University Press:
    02 January 2018, pp. 177-179
    Print publication:
    May 2008
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  • Aims and Method

    To compare two groups of older people with chronic schizophrenia or delusional disorder living in the community and in care homes, along the domains of morbidity suggested by prior research. From the case-load of one old age psychiatrist, 22 individuals with chronic psychosis residing in care homes were compared to 23 living in their own homes. The measures used were: the Positive and Negative Symptom Score (PANSS; Kay et al, 1987); the Mini Mental State Examination (MMSE; Folstein et al, 1975); the Burvill Physical Illness Scale (Burvill et al, 1990); and an Activities of Daily Living Scale (IADL; Lawton et al, 1969).

    Results

    Those in care homes had significantly higher PANSS scores (38.9 v. 21.0, P<0.01), largely accounted for by significantly more deficit symptoms (14.2 v. 5.6, P<0.01). They also had poorer cognition and significantly greater impairment in daily-life activities but their medical condition was not significantly worse. Most were seen only by a psychiatrist.

    Clinical Implications

    The greater morbidity and disablement of older people with chronic schizophrenia or delusional disorder living in care homes is likely to be intrinsic to the disorder but does not appear to be taken into account in current service planning or delivery.

  • 2 - Management of late-life depression

  • Carolyn A. Chew-Graham, University of Manchester, Robert Baldwin, Alistair Burns, University of Manchester
  • Book:
    Integrated Management of Depression in the Elderly
    Published online:
    18 December 2009
    Print publication:
    03 April 2008, pp 17-32

  • Summary

    Introduction

    Most patients with depression are managed in primary care settings; however, a substantial number of patients are not recognized, and those who are diagnosed often do not receive effective treatment (Kessler et al. 1999). There is, however, a good evidence base for the management of depression in older people. Treatments that have been shown to work are the same as for younger adults: antidepressants, psychosocial and psychological interventions, or combinations of these and electroconvulsive treatment (ECT) for severe life-threatening or therapy-resistant cases. There is evidence to show that there are effective pharmacological (Wilson et al. 2001), psychological (Karel and Hinrichsen 2000) and psychosocial (Scogin and McElreath 1994) interventions for late-life depression, but these have yet to be adopted in primary care (Unützer 2002), in part because although cost-effective, they may involve added resource and investment to begin with. Only one in four depressed people receives effective pharmacological treatment and fewer than one in ten a talking therapy (Singleton et al. 2001). However, this is despite the fact that many people want and prefer ‘talking treatments’ (Rogers et al. 1993).

    General principles of treatment

    Goals of treatment

    Table 2.1 provides a framework and summary of the goals for depression management (Baldwin et al. 2002).

    Resolving all the symptoms of depression is the goal rather than getting the patient a bit better, as partial recovery is a predictor of future relapse.

  • 7 - Resources

  • Carolyn A. Chew-Graham, University of Manchester, Robert Baldwin, Alistair Burns, University of Manchester
  • Book:
    Integrated Management of Depression in the Elderly
    Published online:
    18 December 2009
    Print publication:
    03 April 2008, pp 114-139

  • Summary

    The aim of this chapter is bring together the variety of information found in the preceding chapters and commentaries into a practical resource for practitioners.

    Screening for depression in older people

    The usefulness of screening for depression depends on the baseline prevalence in the population screened; the higher the baseline prevalence the more likely is the screening to be cost-effective. Thus, targeted screening is more effective than screening an entire population. Examples include screening residents of a nursing home or the list of older patients on a general practice with physical conditions known to have strong links with depression, such as diabetes, chronic obstructive pulmonary disease or chronic heart disease (Krishnan et al. 2002). Iliffe and colleagues (page 95) add that screening should be linked to patients' perceptions of what is important and their SPICE acronym suggests five priority areas: senses, physical activity, incontinence, cognition and emotional distress.

    The Geriatric Depression Scale (GDS) has been advocated as a screening instrument. It comprises 30 questions and takes about 10 minutes to complete (Table 7.1). The GDS avoids questions which rely on physical symptoms, and uses a simple yes/no format. Although designed to be self-administered, rater-assistance is acceptable. There are shorter versions, including a four-item (questions 1, 3, 8 and 9) and a 15-item version (Table 7.1) which may be more appropriate for use in primary care.

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