Feasibility of training nurses in motivational interviewing to improve patient experience in mental health inpatient rehabilitation: a pilot study

WHAT IS KNOWN ON THE SUBJECT?: Recently, concerns have been raised about how well United Kingdom National Health Service nurses care for their patients and their level of compassion. Motivational interviewing (MI) is an established approach to helping people make positive behaviour changes, through directive, person-centred counselling within a collaborative relationship between clinician and recipient. Based on evidence that MI may influence nursing practice positively, an investigation into the feasibility of training nurses on mental health inpatient rehabilitation wards ('rehabilitation') in MI to improve patient experience was reported. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This pilot study demonstrates that training rehabilitation nurses in MI is feasible and provides preliminary evidence suggesting that a larger study to examine efficacy is warranted, including a calculation of sample size required to draw robust statistical conclusions. Nurses evaluated the training as highly relevant to their work. Patients responded well to interviews and focus groups with support from experts-by-experience; they were generally fairly satisfied with the rehabilitation ward and slight improvements in their experience were found following MI training for nurses but not at 6-month follow-up. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Rehabilitation nurses may face conflicting demands between ensuring patients with severe difficulties meet their basic needs and working with them to develop greater independence. Qualitative findings question whether nurse-patient interactions are fully valued as nursing interventions in inpatient rehabilitation. Learning MI might be a useful way of helping nurses think in detail about their interactions with patients and how to improve communications with their patients. The principles of MI should be incorporated into pre-registration training.

ABSTRACT

Introduction There is limited research addressing the experiences of patients in inpatient rehabilitation (rehabilitation), who often spend long periods in hospital, and the nursing approaches utilized. Aim Based on evidence that motivational interviewing (MI) may improve nursing practice, this was a pilot study evaluating the feasibility of training rehabilitation nurses in MI and measuring patient experience. Method Nurses underwent training and supervision focusing on MI spirit. Quantitative and qualitative measures were taken pretraining, 2 months post-training and 8 months post-training. Expert-by-experience research assistants facilitated patients' participation in the study. Results This study showed that training rehabilitation nurses in MI was feasible and relevant to their work. Patients participated in interviews and focus groups with support and potential improvements that require further empirical investigation in patient experience were found following the MI training. Discussion This pilot study establishes the feasibility of a larger study addressing efficacy. Tentative qualitative findings question whether interactions between nurses and patients are valued in rehabilitation and support MI as a promising skill set for rehabilitation nurses. Implications for practice Bringing MI into inpatient rehabilitation provoked reflection on nursing practice. Dilemmas for nurses about balancing safety with promoting autonomy and communicating constructively with patients emerged as important.

Abstract P5-08-31: Triple negative breast cancer and factors associated with its treatment in the US – A population study using central cancer registry data

This abstract was not presented at the symposium.

Human genome meeting 2016 : Houston, TX, USA. 28 February - 2 March 2016

O1 The metabolomics approach to autism: identification of biomarkers for early detection of autism spectrum disorder A. K. Srivastava, Y. Wang, R. Huang, C. Skinner, T. Thompson, L. Pollard, T. Wood, F. Luo, R. Stevenson O2 Phenome-wide association study for smoking- and drinking-associated genes in 26,394 American women with African, Asian, European, and Hispanic descents R. Polimanti, J. Gelernter O3 Effects of prenatal environment, genotype and DNA methylation on birth weight and subsequent postnatal outcomes: findings from GUSTO, an Asian birth cohort X. Lin, I. Y. Lim, Y. Wu, A. L. Teh, L. Chen, I. M. Aris, S. E. Soh, M. T. Tint, J. L. MacIsaac, F. Yap, K. Kwek, S. M. Saw, M. S. Kobor, M. J. Meaney, K. M. Godfrey, Y. S. Chong, J. D. Holbrook, Y. S. Lee, P. D. Gluckman, N. Karnani, GUSTO study group O4 High-throughput identification of specific qt interval modulating enhancers at the SCN5A locus A. Kapoor, D. Lee, A. Chakravarti O5 Identification of extracellular matrix components inducing cancer cell migration in the supernatant of cultivated mesenchymal stem cells C. Maercker, F. Graf, M. Boutros O6 Single cell allele specific expression (ASE) IN T21 and common trisomies: a novel approach to understand DOWN syndrome and other aneuploidies G. Stamoulis, F. Santoni, P. Makrythanasis, A. Letourneau, M. Guipponi, N. Panousis, M. Garieri, P. Ribaux, E. Falconnet, C. Borel, S. E. Antonarakis O7 Role of microRNA in LCL to IPSC reprogramming S. Kumar, J. Curran, J. Blangero O8 Multiple enhancer variants disrupt gene regulatory network in Hirschsprung disease S. Chatterjee, A. Kapoor, J. Akiyama, D. Auer, C. Berrios, L. Pennacchio, A. Chakravarti O9 Metabolomic profiling for the diagnosis of neurometabolic disorders T. R. Donti, G. Cappuccio, M. Miller, P. Atwal, A. Kennedy, A. Cardon, C. Bacino, L. Emrick, J. Hertecant, F. Baumer, B. Porter, M. Bainbridge, P. Bonnen, B. Graham, R. Sutton, Q. Sun, S. 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Optimizing real time fMRI neurofeedback for therapeutic discovery and development

While reducing the burden of brain disorders remains a top priority of organizations like the World Health Organization and National Institutes of Health, the development of novel, safe and effective treatments for brain disorders has been slow. In this paper, we describe the state of the science for an emerging technology, real time functional magnetic resonance imaging (rtfMRI) neurofeedback, in clinical neurotherapeutics. We review the scientific potential of rtfMRI and outline research strategies to optimize the development and application of rtfMRI neurofeedback as a next generation therapeutic tool. We propose that rtfMRI can be used to address a broad range of clinical problems by improving our understanding of brain–behavior relationships in order to develop more specific and effective interventions for individuals with brain disorders. We focus on the use of rtfMRI neurofeedback as a clinical neurotherapeutic tool to drive plasticity in brain function, cognition, and behavior. Our overall goal is for rtfMRI to advance personalized assessment and intervention approaches to enhance resilience and reduce morbidity by correcting maladaptive patterns of brain function in those with brain disorders.

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Guidelines are proposed for studies of rtfMRI neurofeedback for clinical therapeutics.

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Evidence-based guidelines are needed for clinical trials of rtfMRI neurofeedback.

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These guidelines will shape the design of future clinical trials.

Application of alpha/theta neurofeedback and heart rate variability training to young contemporary dancers: state anxiety and creativity

As one in a series on the impact of EEG-neurofeedback in the performing arts, we set out to replicate a previous dance study in which alpha/theta (A/T) neurofeedback and heart rate variability (HRV) biofeedback enhanced performance in competitive ballroom dancers compared with controls. First year contemporary dance conservatoire students were randomised to the same two psychophysiological interventions or a choreology instruction comparison group or a no-training control group. While there was demonstrable neurofeedback learning, there was no impact of the three interventions on dance performance as assessed by four experts. However, HRV training reduced anxiety and the reduction correlated with improved technique and artistry in performance; the anxiety scale items focussed on autonomic functions, especially cardiovascular activity. In line with the putative impact of hypnogogic training on creativity A/T training increased cognitive creativity with the test of unusual uses, but not insight problems. Methodological and theoretical implications are considered.

Sci-Fri AM: Imaging - 06: The role of body mass and gender in atlas construction for attenuation correction in PET/MRI

Attenuation correction (AC) in PET/MRI is difficult as there is no clear relationship between MR signal and 511 keV attenuation coefficients (μ) as there is with CT. One approach is to register a pre-defined atlas of μ to the PET/MRI for AC. However, the design of the atlas may strongly influence the quantitative accuracy of the AC. Here we compare 3 different atlas design approaches and evaluate their performance in an oncology patient population. The 3 strategies were: use of BMI-dependent atlases; use of gender-dependent atlases, and use of a gender- and sex-independent atlas. Seventeen patients were imaged with FDG PET/CT and subsequently scanned with 3T MRI. MR and PET/CT images were coregistered, CT scans converted to μ-maps, and the resulting MRI/μ-map paired data were used to construct 6 atlases: averaged male and female atlases, averaged BMI-specific atlases (obese >30, overweight 25-29.9, Normal 18.5-24.9), and a single atlas comprised of all patients averaged together. The atlases were then used for PET AC for patients not included in the construction of the atlas in a leave-one-out manner. Resulting PET images were compared to each other and to the gold-standard CT-based PET reconstructions across all voxels and tissue-specific regions (soft-tissue, bone, lung). Sex-specific atlases yielded best results (average relative percent error over the 3 VOIs = 0.4509) & BMI-based atlases yielded highest average relative percent error at 0.9340. In all cases, highest errors were in the VOIs located in the livers.

Prostate cancer screening and incidence among men younger than age 50

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Background: Prostate cancer has long been considered as a disease of older men. However, age at diagnosis with prostate cancer has continued to decline. Since the introduction of prostate-specific antigen (PSA) test in 1986, the prostate cancer incidence rate has steadily and dramatically increased in men under age 50. This study aims to better understand demographic variations in prostate cancer screening and incidence, and clinical characteristics of prostate cancers in men under age 50.

Methods: We examined prostate cancer testing data from the Behavioral Risk Factor Surveillance System (2002, 2004, 2006, and 2008) and prostate cancer incidence data from the CDC's National Program of Cancer Registries and the NCI's Surveillance, Epidemiology, and End Results programs (2001-2006). We estimated the weighted percentage of self-reported cancer testing using SUDAAN and age-adjusted cancer incidence rates and trends using SEER-STAT. Statistical significance for trends was determined by the annual percentage change (APC) differing form zero.

Results: A total of 29,176 prostate cancer cases were identified from 2001-2006 among men under age 50. Of these, 551 (1.9%) were among men under age 40. Incidence rates remained stable from 2001-2006; however the incidence of well-differentiated tumors decreased significantly (APC=−24.7) during this time period. About 44% of men aged 40-49 years old reported having a prostate cancer test in the past two years. Prostate cancer testing and incidence rates were highest among men who were black, non-Hispanic, or lived in the northeast. Black men had more than a 2-fold increase in cancer incidence than white men.

Conclusions: The magnitude of prostate cancer testing and incidence in men under age 50 reveals significant health/public health problems in this younger population. This study demonstrates substantial regional differences in prostate cancer testing and incidence in men under age 50. It also confirms that prostate cancer testing and incidence varies by race and ethnicity. We observed a large disparity in prostate cancer incidence between blacks and whites. The incidence rate remained stable over time; the dramatic decrease occurred in well-differentiated cancers.

No significant financial relationships to disclose.

Carotid endarterectomy: a Southern North Island regional consensus statement

AIMS

The aim of this project was to employ interdepartmental and cross district health board collaboration to reach a regional consensus on the management of patients who may benefit from carotid endarterectomy.

METHODS

All regional stroke physicians, neurologists, and vascular surgeons met to review relevant literature and local audits and to discuss best management strategies suited to the region.

RESULTS

A consensus statement was agreed upon and is presented here along with a summary of the supporting scientific evidence.

DISCUSSION

Regional interdisciplinary collaboration proved an effective way to reach a carotid endarterectomy management consensus across a wider geographical area that is served by a single vascular surgery department. This approach could serve as a model for other regional initiatives.

Conditional relations by monkeys: Reflexivity, symmetry, and transitivity

Two cynomolgous macaques categorized six colors into two groups of three after conditional discrimination training (zero-delay symbolic match-to-sample). The procedures resulted in the establishment of relations among the elements of each set-relations that were not specifically trained and that can be characterized by the properties of reflexivity, symmetry, and transitivity. Each set of colors was related to a characteristic pattern of responding: One response pattern involved temporal duration (press and hold the response keys); the second response pattern entailed repeated pressing and releasing of the response keys (fixed ratio 8). Six combinations of two colors were trained, three combinations from each set. After discriminative performance stabilized for each monkey, they were tested with 10 additional color combinations, all of which differed from the training combinations. The conditional relations established between test combinations can be characterized as stimulus equivalence. The training procedures were analogous to the procedure of using category names, and have implications for understanding the function of language in the formation of equivalence classes.