Sensory gating, neurocognition, social cognition and real-life functioning: a 2-year follow-up of early psychosis

BACKGROUND

Diminished sensory gating (SG) is a robust finding in psychotic disorders, but studies of early psychosis (EP) are rare. It is unknown whether SG deficit leads to poor neurocognitive, social, and/or real-world functioning. This study aimed to explore the longitudinal relationships between SG and these variables.

METHODS

Seventy-nine EP patients and 88 healthy controls (HCs) were recruited at baseline. Thirty-three and 20 EP patients completed 12-month and 24-month follow-up, respectively. SG was measured using the auditory dual-click (S1 & S2) paradigm and quantified as P50 ratio (S2/S1) and difference (S1-S2). Cognition, real-life functioning, and symptoms were assessed using the MATRICS Consensus Cognitive Battery, Global Functioning: Social (GFS) and Role (GFR), Multnomah Community Ability Scale (MCAS), Awareness of Social Inference Test (TASIT), and the Positive and Negative Syndrome Scale (PANSS). Analysis of variance (ANOVA), chi-square, mixed model, correlation and regression analyses were used for group comparisons and relationships among variables controlling for potential confounding variables.

RESULTS

In EP patients, P50 ratio (p < 0.05) and difference (p < 0.001) at 24-month showed significant differences compared with that at baseline. At baseline, P50 indices (ratio, S1-S2 difference, S1) were independently associated with GFR in HCs (all p < 0.05); in EP patients, S2 amplitude was independently associated with GFS (p = 0.037). At 12-month and 24-month, P50 indices (ratio, S1, S2) was independently associated with MCAS (all p < 0.05). S1-S2 difference was a trending predictor of future function (GFS or MCAS).

CONCLUSIONS

SG showed progressive reduction in EP patients. P50 indices were related to real-life functioning.

The Entrepreneurs: Dairy farmer perspectives on finding an industry solution for the surplus calf issue—A participatory case study

Current systems for managing surplus dairy calves are wrought with ethical and animal welfare concerns. Resolving complex problems in the dairy industry requires engagement from dairy farmers and other stakeholders. The main objective of this case study was to pilot a novel methodology to deepen our understanding of how dairy producers envision the future of surplus calves in Atlantic Canada, including identifying who they felt were important to speak to as they discussed this topic. A second objective was to understand the perspectives of a key group the producers requested to speak to, representing a variety of dairy industry partners, including veterinarians, genetics companies, and animal welfare scientists amongst others (referred to as the allied industry) on the future of surplus calves. To reach these objectives, we used an inclusive participatory approach that, to our knowledge, has not yet been applied to the surplus calf issue. This approach included a series of five participatory group discussions with volunteer dairy farmers from Atlantic Canada; the allied industry group was invited to two group discussions. Participants discussed the feasibility of creating a dairy beef system as a potential solution to the surplus dairy calf issue. During the discussions, participants were encouraged to make requests to speak to individuals that would help them design a dairy beef system. Audio-recorded transcripts were subjected to inductive qualitative content analysis where short descriptors were assigned to pieces of the discussion relevant to study objectives. Four key themes from the discussions included: (1) challenges with surplus calf production on the dairy farm, such as a lack of knowledge about what type of calf would be desired by the marketplace, (2) the role of leadership and partnership in the creation of a dairy beef system, including the need to overcome communication barriers between different stakeholders, (3) post-farm gate aspects of surplus calf production, including the desire to cater to a local market, and (4) ensuring that the proposed system is economically and socially viable. Knowledge gained from this type of participatory engagement can help stakeholders align their goals to resolve complex issues such as surplus calf management.

Dynamic and progressive changes in thalamic functional connectivity over the first five years of psychosis

The early stage of psychosis (ESP) is a critical period where effective intervention has the most favorable impact on outcomes. Thalamic connectivity abnormalities have been consistently found in psychosis, and are associated with clinical symptoms and cognitive deficits. However, most studies consider ESP patients as a homogeneous population and fail to take the duration of illness into account. In this study, we aimed to capture the progression of thalamic connectivity changes over the first five years of psychosis. Resting-state functional MRI scans were collected from 156 ESP patients (44 with longitudinal data) and 82 healthy controls (24 with longitudinal data). We first performed a case-control analysis comparing thalamic connectivity with 13 networks in the cortex and cerebellum. Next, we modelled the shape (flat, linear, curvilinear) of thalamic connectivity trajectories by comparing flexible non-linear versus linear models. We then tested the significance of the duration of illness and diagnosis in trajectories that changed over time. Connectivity changed over the ESP period between the thalamus and default mode network (DMN) and fronto-parietal network (FPN) nodes in both the cortex and cerebellum. Three models followed a curvilinear trajectory (early increase followed by a subsequent decrease), while thalamo-cerebellar FPN connectivity followed a linear trajectory of steady reductions over time, indicating different rates of change. Finally, diagnosis significantly predicted thalamic connectivity. Thalamo-cortical and thalamo-cerebellar connectivity change in a dynamic fashion during the ESP period. A better understanding of these changes may provide insights into the compensatory and progressive changes in functional connectivity in the early stages of illness.

Mortality and readmission in non-ischemic compared with ischemic cardiomyopathies after implantable cardioverter-defibrillator implantation

Background/Introduction

Uncertainty remains regarding the benefit of primary prevention ICDs overall in contemporary practice, and particularly in those with NICM compared with ICM.

Purpose

To evaluate the contemporary risk of death and readmission following following implantable cardioverter-defibrillator (ICD) implantation in patients with non-ischemic cardiomyopathies (NICM) compared with ischemic cardiomyopathies (ICM) in a large nationally representative cohort in the United States.

Methods

We used data from the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) ICD Registry linked with Medicare claims from April 1, 2010 to December 31, 2013 to establish a cohort of NICM and ICM patients with a left ventricular ejection fraction ≤35% who received a de novo, primary prevention ICD. We compared mortality, all-cause readmission, and heart failure readmission using Kaplan-Meier curves and Cox proportional hazard regressions models. We also evaluated temporal trends in mortality.

Results

Among 31,044 NICM and 68,458 ICM patients with a median follow up of 2.4 years, one-year mortality was significantly higher in ICM patients (12.3%) compared with NICM (7.9%, p&lt;0.001). The higher mortality in ICM patients remained significant after adjustment for covariates (hazard ratio (HR) 1.40; 95% confidence interval (CI) 1.36 to 1.45), and was consistent in subgroup analyses. These findings were consistent across the duration of the study. ICM patients were also significantly more likely to be readmitted for all causes (adjusted HR 1.15, CI 1.12 to 1.18) and for heart failure (adjusted HR 1.25, CI 1.21 to 1.31).

Conclusions

The risks of mortality and hospital readmission after primary prevention ICD implantation were significantly higher in patients with ICM compared with NICM, and these findings were consistent across all patient subgroups tested and over the duration of the study.

Funding Acknowledgement

Type of funding source: None

Heterogeneity of Outcomes and Network Connectivity in Early-Stage Psychosis: A Longitudinal Study

Imaging studies in psychotic disorders typically examine cross-sectional relationships between magnetic resonance imaging (MRI) signals and diagnosis or symptoms. We sought to examine changes in network connectivity identified using resting-state functional MRI (fMRI) corresponding to divergent functional recovery trajectories and relapse in early-stage psychosis (ESP). Prior studies have linked schizophrenia to hyperconnectivity in the default mode network (DMN). Given the correlations between the DMN and behavioral impairments in psychosis, we hypothesized that dynamic changes in DMN connectivity reflect the heterogeneity of outcomes in ESP. Longitudinal data were collected from 66 ESP patients and 20 healthy controls. Longitudinal cluster analysis identified subgroups of patients with similar trajectories in terms of symptom severity and functional outcomes. DMN connectivity was measured in a subset of patients (n = 36) longitudinally over 2 scans separated by a mean of 12 months. We then compared connectivity between patients and controls, and among the different outcome trajectory subgroups. Among ESP participants, 4 subgroups were empirically identified corresponding to: "Poor," "Middle," "Catch-up," and "Good" trajectory outcomes in the complete dataset (n = 36), and an independent replication (n = 30). DMN connectivity changes differed significantly between functional subgroups (F3,32 = 6.06, P-FDR corrected = .01); DMN connectivity increased over time in the "Poor" outcome cluster (β = +0.145) but decreased over time in the "Catch-up" cluster (β = -0.212). DMN connectivity is dynamic and correlates with a change in functional status over time in ESP. This approach identifies a brain-based marker that reflects important neurobiological processes required to sustain functional recovery.

An evaluation of the EOLAS psychoeducation programme for service users: An innovative approach to collaboration between clinicians and ‘experts by experience’

Introduction

Psychoeducation for service users has been shown in several recent meta-analyses to improve adherence with treatment, decrease rehospitalization rates and improve various measures of quality of life. The 8-week EOLAS Programme for service users with schizophrenia or bipolar disorder is unique in being designed, co-facilitated and evaluated collaboratively by both clinician and peer representatives. EOLAS forms part of the service plan of the national Health Service in Ireland.

Aims and objectives

To evaluate the impact of the EOLAS programme on participants’ perceived knowledge, confidence, advocacy, recovery attitudes and hope.

Methodology

Anonymised questionnaires were administered to participants before and after completion of the EOLAS Programme.

All survey participants were invited to attend for interview to examine qualitatively their experience of the programme. Interviews were recorded and subjected to thematic analysis.

Results

Forty-five subjects completed pre- and post-programme questionnaires (participation rate = 55%).

Significant improvements (P < 0.05) were identified across each of the 5 domains examined (i.e. perceived knowledge, confidence, advocacy, recovery attitudes, hope). Expressed satisfaction with the programme was high (95%).

At interview, participants (n = 12) particularly valued:

– the opportunity to ask questions of the psychiatrist e.g. about medication;

– improving self-care skills e.g. monitoring early warning signs of relapse;

– co-facilitation by a peer, which provided extra credibility and inspired hope;

– sharing experiences with peers.

Conclusions

The EOLAS programme succeeds in meeting the needs of the participants across the target domains. This success depends on the unique collaboration between clinicians and peer experts on which EOLAS is based.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A Three-Month Follow-Up Study Evaluating Changes in Clinical Profile and Attitudes Towards Involuntary Admission

Introduction

Involuntary admission and treatment is often a traumatic experience for patients and there is a wide variation in attitudes towards care even when patients are recovered.

Objectives/aims

The purpose of this large prospective study was to identify clinical predictors of attitudes towards care during involuntary admission.

Methods

Three hundred and ninety-one consecutively admitted involuntarily patients to three psychiatric inpatient units over a 30-month period were invited to participate in the study. Comprehensive assessments at admission and 3 months after discharge were attained including measures of symptoms, insight, functioning, attitudes towards involuntary admission and coercive experiences. Multiple linear regression modelling was used to determine the optimal explanatory variables for attitudes towards care.

Results

Two hundred and sixty-three individuals participated at baseline and 156 (59%) successfully completed follow-up assessments. Individuals improved significantly over time clinically and in their attitudes towards their care. At baseline greater insight (P < 0.001) and less symptoms (P = 0.02) were associated with more positive attitudes towards care as was older age (P = 0.001). At follow-up, greater insight (P < 0.001), less symptoms (P = 0.02) and being older (P = 0.04) were associated with more positive attitudes towards care. More positive attitudes towards care at follow-up were associated with greater improvements in insight over time (P < 0.001) and having a diagnosis of an affective psychosis (P = 0.0009).

Conclusions

The best predictors of positive attitudes towards care during and after involuntary admission are illness related factors, such as levels of insight and improvement in insight, rather than service or legislation related factors, such as the use of coercive measures, seclusion and restraint.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Identifying Clinically and Functionally Distinct Groups Among Healthy Controls and First Episode Psychosis Patients by Clustering on EEG Patterns

OBJECTIVE

The mismatch negativity (MMN) is considered as a promising biomarker that can inform future therapeutic studies. However, there is a large variability among patients with first episode psychosis (FEP). Also, most studies report a single electrode site and on comparing case-control group differences. Few have taken advantage of the full wealth of multi-channel EEG signals to examine observable patterns. None, to our knowledge, have used machine learning (ML) approaches to investigate neurophysiological derived subgroups with distinct cognitive and functional outcome characteristics. In this study, we applied ML to empirically stratify individuals into homogeneous subgroups based on multi-channel MMN data. We then characterized the functional, cognitive, and clinical profiles of these neurobiologically derived subgroups. We also explored the underlying low frequency range responses (delta, theta, alpha) during MMN.

METHODS

Clinical, neurocognitive, functioning data of 33 healthy controls and 20 FEP patients were collected. 90% of the patients had 6-month follow-up data. Neurocognition, social cognition, and functioning measures were assessed using the NCCB Cognitive Battery, the Awareness of Social Inference Test, UCSD Performance-Based Skills Assessment, and Multnomah Community Ability Scale. Symptom severity was collected using the PANSS. MMN amplitude and single-trial derived low frequency activity across 24 frontocentral channels were used as main variables in the ML k-means clustering analyses.

RESULTS

We found a consistent pattern of two distinctive subgroups. We labeled them as "better functioning" and "poorer functioning" clusters, respectively. Each subgroup can be mapped onto either better or poorer clinical, cognitive, and functioning profiles. Also, we identified two subgroups of patients: one showed improved MMN and one showed worsening of MMN over time. Patients with improved MMN had better follow-up clinical, cognitive, and functioning profile than those with worsening MMN. Among the low frequency bands, delta frequency appeared to be the most relevant to the observed MMN responses in all individuals. However, higher delta responses were not necessarily associated with a better functioning profile, suggesting that delta frequency alone may not be useful in clinical characterization.

CONCLUSIONS

The ML approach could be a robust tool to explore heterogeneity and facilitate the identification of neurobiological homogeneous subgroups in FEP.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Measures for screening for intimate partner violence: a systematic review

WHAT IS KNOWN ON THE SUBJECT?: Intimate partner violence (IPV) has a significant impact on the onset, duration and recurrence of mental health problems. Prevalence rates of IPV are significantly higher in mental health services, but the studies are limited. Accurate assessment of IPV is important for decision making in risk assessment and safety planning within mental health nursing. Psychometrically tested tools are the most accurate way to identifying all areas of IPV abuse: physical, sexual and psychological. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Ten IPV screening tools were identified in healthcare and three tools; Women Abuse Screen Tool (WAST), Abuse Assessment Screen (AAS) and Humiliation, Afraid, Rape and Kick (HARK) were identified as having strong psychometric values as they assessed all areas of IPV and were validated against an appropriate reference standard. None of the three IPV tools identified (WAST, AAS, HARK) were tested on men or in mental health settings impacting the gender sensitivities of the tools and the reliability of the prevalence rates of IPV in mental healthcare. Over seventy percent of the studies reviewed were conducted in America this impacts the cultural sensitivities of the IPV tools. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: IPV screening needs to be incorporated as a priority in mental health services in order to reduce the morbidity and mortality issues associated with this abuse. Psychometric tools to screen for IPV need to be incorporated to assist mental health professionals in decision making in risk assessment and safety planning. Further research is needed to improve the psychometric properties of IPV tools in mental health settings, to ensure they are culturally and gender sensitive.

ABSTRACT

Objective Intimate partner violence (IPV) is a public health priority due to the physical and mental impacts it has on health. No existing reviews have focused on the psychometric properties of IPV screening tools used to screen men and women within a mental health context. This review aimed to identify the best psychometrically tested screening tools available to assess all areas of IPV in men and women in mental health setting. Method Databases psycArticles, PsycINFO, Social Science, CINAHL, PubMed and Cochrane were searched from their starting date through to July 2015. Eligible studies were published in peer-reviewed publications in English. Results Thirty-six studies met the inclusion criteria. Ten IPV screening tools were identified. Three tools assessed all areas of IPV and were validated against an appropriate reference standard. One study tested IPV screening tool in a mental health setting. Conclusion Mental health nurses need to incorporate a psychometrically tested IPV tool as part of risk assessment and safety planning for clients. This review identified three tools that are suitable for identifying IPV in a mental health context. However, further research is necessary to validate IPV screening tools that are culturally sensitive and have been validated with men and women.

Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk

WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and safety planning are a core aspect of the role of the mental health nurse. Conflicting views exist on the value of risk assessment tools. Few studies have examined mental health nurses' attitudes towards risk, including use of tools and the role of positive risk in recovery. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Mental health nurses view risk assessment as a core dimension of their role and not merely an exercise to fulfil organizational clinical safety and governance obligations. The majority of nurses hold positive attitudes towards therapeutic or positive risk, and consider creative risk taking as vital to people's recovery. The majority of nurses believe that risk assessment tools facilitate professional decision making, however, some are concerned that tools may negatively impact upon therapeutic relationships. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Ongoing education on the use of risk assessment tools is required to minimize views that their use is incompatible with therapeutic engagement, and to enable nurses to develop confidence to engage with positive risk and to allow service users make decisions and take responsibility.

ABSTRACT

Introduction Risk assessment and safety planning are considered core components of the role of the mental health nurse; however, little is known about nurses' attitudes towards risk assessment, use of tools to assess risk or therapeutic risk taking. Aim This study aimed to explore mental health nurses' attitudes towards completing risk assessments, use of tools as an aid, and therapeutic or positive risk. Method An anonymous survey which included 13 attitudinal statements, rated on a five-point Likert scale, was completed by 381 mental health nurses working in adult services in Ireland. Findings Findings indicate strong support for the practice of risk assessment in mental health practice. The vast majority of nurses believe that risk assessment tools facilitate professional decision making; however, there is concern that the use of these tools may negatively impact upon therapeutic engagement with service users. The majority of participants have positive attitudes towards therapeutic risk, believing that service users have the right to take informed risks in the context of recovery-orientated care. Discussion The provision of education on the use of risk assessment tools within the context of engagement may help minimize views that the use of assessment tools are incompatible with therapeutic engagement.

Preserving Control: Understanding People's Experiences Before, During and After Detention Under the Irish Mental Health Act 2001

Introduction

The Mental Health Act 2001 provides a legal framework for the involuntary admission and treatment of individuals deemed to have a mental disorder to psychiatric units. The perspectives of people who have been detained are relatively poorly understood.

Objective

To develop a theoretical understanding of individual's experiences throughout the trajectory of their detention and to understand the psychological and social processes that individuals use to cope before, during and after detention.

Methods

Fifty individuals subject to detention across three psychiatric units consented to be interviewed three months after their detention. Using a semi-structured interview people recounted their experiences. Interviews were analysed using the principles underpinning Grounded Theory.

Results

The theory ‘Preserving Control’ encapsulates individuals’ experiences and consists of three related themes: ‘Losing Control’, ‘Regaining Control’ and ‘Maintaining Control’. ‘Losing Control’ describes individuals’ experiences of losing their autonomy and liberty thought the process of detention and hospitalisation. ‘Regaining Control describes, the strategies individuals used in an attempted to restore their loss of autonomy and control. ‘Maintaining Control’ describes how individuals lived with the consequences of detention and contended with impact on discharge.

Conclusions

Whilst a large variation existed in relation to the subjective experience of being detained, the characteristic process that individuals tend to experience related to identifiable phases of preserving control in the face of this loss of autonomy. Findings from this study highlight the importance of more sensitive interactions support and information during and after the detention process.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Managing preconceived expectations: mental health service users experiences of going home from hospital: a grounded theory study

ACCESSIBLE SUMMARY

What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge. Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service. What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital. While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision. What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices. The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms.

INTRODUCTION

Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the transition from hospital to community for service users.

AIM

The aim of this study was to develop a grounded theory that explored service users' experiences of going home from hospital.

METHOD

This qualitative study used grounded theory, and a total of 35 interviews were conducted with 31 service users.

RESULTS

The core category was 'Managing Preconceived Expectations', which had seven subcategories, describes how the participants were negatively perceived by themselves and others following their admission and discharge from hospital.

IMPLICATIONS FOR PRACTICE

This theory presents the strategies that the participants used to manage this new identity. This theory demonstrates that although there has been a move to adopt recovery-orientated services, key indicators of recovery were often absent for service users being admitted and subsequently discharged.

Localized microjetting in the collapse of surface macrocavities

This paper focuses on the multiscale mechanism of collapse of hemicylindrical annular surface macrocavities in steel caused by high-strain, high-strain rate plastic flow of copper. Experiments and simulations revealed that a two-stage process is responsible for the observed microjetting phenomena: the formation of lateral copper microjets from the localized shear flow in copper at the interface during the filling of the cavity, and their subsequent collision at the apex of the macrocavity generating two additional horizontal microjets. The lengths of these microjets were an order of magnitude smaller than the cavity size but linearly scaled with the cavity radius. This process of microjet development is sensitive to the cavity geometry and is unlike the previously observed jetting phenomena in cavitation, impact crater collapse, or shock-induced cavity collapse.

Does convenience matter in health care delivery? A systematic review of convenience-based aspects of process utility

OBJECTIVES

To systematically review the existing literature on the value associated with convenience in health care delivery, independent of health outcomes, and to try to estimate the likely magnitude of any value found.

METHODS

A systematic search was conducted for previously published studies that reported preferences for convenience-related aspects of health care delivery in a manner that was consistent with either cost-utility analysis or cost-benefit analysis. Data were analyzed in terms of the methodologies used, the aspects of convenience considered, and the values reported.

RESULTS

Literature searches generated 4715 records. Following a review of abstracts or full-text articles, 27 were selected for inclusion. Twenty-six studies reported some evidence of convenience-related process utility, in the form of either a positive utility or a positive willingness to pay. The aspects of convenience valued most often were mode of administration (n = 11) and location of treatment (n = 6). The most common valuation methodology was a discrete-choice experiment containing a cost component (n = 15).

CONCLUSIONS

A preference for convenience-related process utility exists, independent of health outcomes. Given the diverse methodologies used to calculate it, and the range of aspects being valued, however, it is difficult to assess how large such a preference might be, or how it may be effectively incorporated into an economic evaluation. Increased consistency in reporting these preferences is required to assess these issues more accurately.

'We have got the tools': Qualitative evaluation of a mental health Wellness Recovery Action Planning (WRAP) education programme in Ireland

In recent years, there has been a consistent drive to incorporate Recovery principles into the Irish mental health services. A group of Irish mental health service providers came together and delivered a 5-day Wellness Recovery Action Planning (WRAP) facilitator's programme. The programme was developed and delivered by key stakeholders including people with self-experience of mental health problem. This paper presents the qualitative findings from an evaluation of these facilitator's programmes. Three focus groups were held with 22 people, the majority of who described themselves as mental health professionals and/or people with self-experience of mental health problems. Data were analysed using a thematic approach and yielded four themes. Although the participants were positive about the programme and felt that their knowledge of Recovery and WRAP had improved, they felt that they still lacked confidence in terms of the presentation skills required for facilitating Recovery and WRAP programmes. The findings suggest that mental health service providers who wish to develop service users and clinicians as WRAP facilitators need to put more emphasis on the provision of facilitation and presentation skills in the programmes they develop.

Zoonotic helminths of urban brown rats (Rattus norvegicus) in the UK: neglected public health considerations?

Urban brown rats (Rattus norvegicus) carry microbial human pathogens but their role as reservoir hosts for helminths of public health importance is less well known. In this study, 42 brown rats trapped on Merseyside were subject to thorough combined helminthological and pathohistological post-mortem examination. Eggs of the rodent-borne zoonotic nematode Calodium hepaticum were initially detected in histological sections of the livers of 9.5% of rats, but overall diagnostic sensitivity increased to 16.6% when entire liver tissue was disrupted and the resulting filtrates were examined for released eggs. In their rat host, mainly trapped inside the dockland, infections with C. hepaticum were associated with a chronic multifocal pyogranulomatous hepatitis with intralesional eggs and peripheral fibrosis. Mean intensity of hepatic C. hepaticum egg infections was 1041 eggs. This is the first report of C. hepaticum in an urban brown rat population in the UK and provides original data for liver egg burdens in this abundant commensal rodent. The zoonotic cestode Rodentolepis nana had a prevalence of infection of 14.3%. Rodent-specific, non-zoonotic helminths found were the spiruroid Mastophorus muris (16.0%) in the stomach, the trichuroid Trichosomoides crassicauda in the urinary bladder (31.0%); the ascarid Heterakis spumosa was the commonest helminth of the large intestine (76.2%). Many millions of brown rats inhabit cities and rural areas of the UK, and the infective stages of the zoonotic worm species, particularly C. hepaticum, are likely to be widely distributed in the environment presenting a threat to public health.

Ecohydrological and socioeconomic integration for the operational management of environmental flows

Investment in and operation of flow control infrastructure such as dams, weirs, and regulators can help increase both the health of regulated river ecosystems and the social values derived from them. This requires high-quality and high-resolution spatiotemporal ecohydrological and socioeconomic information. We developed such an information base for integrated environmental flow management in the River Murray in South Australia (SA). A hydrological model was used to identify spatiotemporal inundation dynamics. River ecosystems were classified and mapped as ecohydrological units. Ecological response models were developed to link three aspects of environmental flows (flood duration, timing, and inter-flood period) to the health responses of 16 ecological components at various life stages. Potential infrastructure investments (flow control regulators and irrigation pump relocation) were located by interpreting LiDAR elevation data, digital orthophotography, and wetland mapping information; and infrastructure costs were quantified using engineering cost models. Social values were quantified at a coarse scale as total economic value based on a national survey of willingness-to-pay for four key ecological assets; and at a local scale using mapped ecosystem service values. This information was integrated using a constrained, nonlinear, mixed-integer, compromise programming optimization model and solved using a stochastic Tabu search algorithm. We tested the model uncertainty and sensitivity using 390 Monte Carlo model runs at varying weights of ecological health vs. social values. Integrating ecohydrological and socioeconomic information identified environmental flow management regimes that efficiently achieved both ecological and social objectives. Using an ecologically weighted efficient and socially weighted efficient scenario, we illustrated model outputs including a suite of cost-effective infrastructure investments and an operational plan for new and existing flow control structures including dam releases, weir height manipulation, and regulator operation on a monthly time step. Both the investments and management regimes differed substantially between the two scenarios, suggesting that the choice of weightings on ecological and social objectives is important. This demonstrates the benefit of integrating high-quality and high-resolution spatiotemporal ecohydrological and socioeconomic information for guiding the investment in and operational management of environmental flows.

Is that a rodent in your luggage? A mixed method approach to describe bushmeat importation into the United States

Bushmeat, defined as meat derived from wild animals, is a potential source of zoonotic pathogens. Bushmeat from restricted animals is illegal to import into the United States under US federal regulations. We reviewed US Centers for Disease Control and Prevention (CDC) port of entry surveillance records from September 2005 through December 2010 and conducted focus group studies to describe trends in and reasons for bushmeat importation into the United States. In total, 543 confiscated bushmeat items were recorded. Half of the confiscated bushmeat items identified were rodents. Africa was the most frequent continent of origin. Seasonality was evident, with bushmeat confiscations peaking in late spring to early summer. Four times more bushmeat was confiscated during an enhanced surveillance period in June 2010 compared with the same period in previous years, suggesting that routine surveillance underestimated the amount of bushmeat detected at US Ports of Entry. Focus groups held in three major US cities revealed that bushmeat importation is a multifaceted issue. Longstanding cultural practices of hunting and eating bushmeat make it difficult for consumers to acknowledge potential health and ecologic risks. Also, US merchants selling African goods, including bushmeat, in their stores have caused confusion among importers as to whether importation is truly illegal. Enhancing routine surveillance for bushmeat and consistent enforcement of penalties at all ports of entry, along with health education aimed at bushmeat importers, might be useful to deter illegal importation.

Supporting children whose parent has a mental health problem: an assessment of the education, knowledge, confidence and practices of registered psychiatric nurses in Ireland

Health professionals, including nurses, stand accused of ignorance or oversight of children whose parent experience a mental health problem. Psychiatric nurses are in an ideal position to respond to children's needs and support their parents in a proactive and sensitive manner. The aim of this study was to explore psychiatric nurses' education, knowledge, confidence and practice with regard to the support needs of children whose parent has a mental health problem. This study employed a self-completion anonymous survey design with a sample of registered psychiatric nurses from one integrated mental health service in Ireland. The sample reported relatively low levels of education, knowledge, confidence and supportive clinical practice when it came to children whose parent has a mental health problem. There is an urgent need for education on family-focused care, and the development of guidelines and child focused services if the needs of parents and children are to be met.

Improved hand hygiene technique and compliance in healthcare workers using gaming technology

BACKGROUND

In 2009, the World Health Organization recommended the use of a 'multi-faceted, multi-modal hand hygiene strategy' (Five Moments for Hand Hygiene) to improve hand hygiene compliance among healthcare workers. As part of this initiative, a training programme was implemented using an automated gaming technology training and audit tool to educate staff on hand hygiene technique in an acute healthcare setting.

AIM

To determine whether using this automated training programme and audit tool as part of a multi-modal strategy would improve hand hygiene compliance and technique in an acute healthcare setting.

METHODS

A time-series quasi-experimental design was chosen to measure compliance with the Five Moments for Hand Hygiene and handwashing technique. The study was performed from November 2009 to April 2012. An adenosine triphosphate monitoring system was used to measure handwashing technique, and SureWash (Glanta Ltd, Dublin, Ireland), an automated auditing and training unit, was used to provide assistance with staff training and education.

FINDINGS

Hand hygiene technique and compliance improved significantly over the study period (P < 0.0001).

CONCLUSION

Incorporation of new automated teaching technology into a hand hygiene programme can encourage staff participation in learning, and ultimately improve hand hygiene compliance and technique in the acute healthcare setting.

Service user involvement in mental health practitioner education in Ireland

In recent years, there is an ever increasing call to involve people who use mental health services in the development, delivery and evaluation of education programmes. Within Ireland, there is very little evidence of the degree of service user involvement in the educational preparation of mental health practitioners. This paper presents the findings on service user involvement in the education and training of professionals working in mental health services in Ireland. Findings from this study indicate that in the vast majority of courses curricula are planned and delivered without consultation or input from service users. Currently the scope of service user involvement is on teaching, with little involvement in curriculum development, student assessment and student selection. However, there is evidence that this is changing, with many respondents indicating an eagerness to move this agenda forward.

International albumin use: 1995 to 2006

Over the last ten years more reliable information regarding the risks and benefits of the use of albumin for fluid resuscitation has emerged. To determine what influence this has had on clinical practice, we sought to document albumin use (from mass of albumin supplied to hospitals) in 16 industrialised countries between 1995 and 2006. Data on national albumin and synthetic colloid use was sought from independent intensive care researchers and albumin issuers. The mass of albumin supplied per 10,000 persons on an annual basis by country and aggregated across the study countries was calculated. Volumes of synthetic colloid supplied per 10,000 persons were calculated. Data were obtained for 15 countries. Albumin use varied significantly between countries and throughout the observation period. Overall, aggregate albumin use decreased from a peak of 2.54 kg per 10,000 persons in 1995 to 1.40 kg per 10,000 persons in 1999; use has remained relatively constant since. Data on supply of synthetic colloids was available in only three countries and varied from 11.7 litres per 10,000 persons in Canada in 1995, to 231.8 litres per 10,000 persons in Denmark in 2004. Between 1995 and 1999 albumin use decreased and has been materially constant since; where data were available, use of synthetic colloids increased. Whether these practice changes have resulted in a net health gain or in harm requires further research.

Can 'search and destroy' reduce nosocomial methicillin-resistant Staphylococcus aureus in an Irish hospital?

In Ireland, the Department of Health and Children recommends admission screening of patients at increased risk of methicillin-resistant Staphylococcus aureus (MRSA), isolation of these patients until proven negative, and eradication of any MRSA identified. These actions form the basis of a programme called 'search and destroy' that has successfully reduced MRSA in Scandinavia. There is, however, very little information published on the use of search and destroy in Ireland. This study was carried out using a quantitative, quasi-experimental design in the form of an interventional cohort study. The effect of reducing the turnaround time for MRSA results (2007) and the introduction of pre-emptive isolation (2008) was examined in a hospital with an established admission screening programme for MRSA. Rates of MRSA infection and colonisation were monitored post-intervention and compared to baseline rates prior to the intervention (2005-2006). Rates of hospital-acquired (nosocomial) MRSA infections and colonisation fell in both 2007 and 2008. However, due to the quasi-experimental design of the study and the low endemic level of MRSA in the hospital, a causal link could not be established.

Touch in mental health nursing: an exploratory study of nurses' views and perceptions

The aim of this study was to explore psychiatric nurses' perceptions of physical touch with people who experience mental health problems. A descriptive exploratory qualitative research design was used. Semi-structured interviews were carried out with 10 registered psychiatric nurses who met the inclusion criteria and were randomly selected to participate in the study. Burnard's 14 stage-by-stage process of coding and categorization was used to analyse the data. Watson distinguished between two kinds of physical touch: instrumental and expressive. The findings indicated that physical touch was used in mental health nursing; however, it was only considered to be therapeutic to clients if used judiciously, with effective interpersonal skills. The participants in this study clearly identified the need to be sensitive to both the individual client needs, and honour their personal space and cultural background. A significant issue in this study was male participants concerns that touching female clients would be misinterpreted as a sexual advance. To protect themselves, male participants used touch in a cautious and minimal manner, and only in a public space, where others could view the interaction. In the absence of research on physical touch in mental health nursing there is a need for further research to explore in detail these findings.

Peer-reviewed publication output of psychiatric nurses in the Republic of Ireland

Pre-registration psychiatric nursing education, in the Republic of Ireland, has recently moved to a 4-year degree programme, with the first cohort of psychiatric nursing graduants graduating in 2006. In addition, a number of other policy initiatives have taken place that will have a significant impact on psychiatric nursing practice, education and research activity. To provide a baseline for future benchmarking and evaluation, the year 2005 seemed an appropriate time to reflect on and record publications by psychiatric nurses in the Republic of Ireland. This article reports the findings of a study undertaken to identify psychiatric nursing publications in peer-reviewed journals, with a view to establishing trends in publication, such as the type of publication, subject area and journal type. Emerging trends are identified and discussed in light of concurrent changes in psychiatric nursing and mental health care, and suggestions are made for future development of publication capacity.

Influence of NICE guidelines on removal of third molars in a region of the UK

We investigated compliance in the West Midlands, UK with the guidelines issued by the National Institute of Clinical Excellence (NICE) on the indications for the removal of third molars. We audited the practice at three departments of maxillofacial surgery that take referrals from three districts of the West Midlands. Of a total of 300 referral letters 217 (72%) specified a NICE-compliant diagnosis. A total of 267 patients (89%) were advised to have third molars removed and all three units achieved 100% compliance with NICE guidelines. There was a concordance of diagnosis of 69% between referring general dental practitioners and attending oral surgeons (concordance was 79% if only those referral letters that carried a specific indication were considered). Disease-free wisdom teeth made up a mean of only 6% of all referrals.