Protocol for a realist evaluation of Recovery College dementia courses: understanding coproduction through ethnography

INTRODUCTION

Support following a dementia diagnosis in the UK is variable. Attending a Recovery College course with and for people with dementia, their supporters and healthcare professionals (staff), may enable people to explore and enact ways to live well with dementia. Recovery Colleges are established within mental health services worldwide, offering peer-supported short courses coproduced in partnership between staff and people with lived experience of mental illness. The concept of recovery is challenging in dementia narratives, with little evidence of how the Recovery College model could work as a method of postdiagnostic dementia support.

METHODS AND ANALYSIS

Using a realist evaluation approach, this research will examine and define what works, for whom, in what circumstances and why, in Recovery College dementia courses. The ethnographic study will recruit five case studies from National Health Service Mental Health Trusts across England. Sampling will seek diversity in new or long-standing courses, delivery methods and demographics of population served. Participant observations will examine course coproduction. Interviews will be undertaken with people with dementia, family and friend supporters and staff involved in coproducing and commissioning the courses, as well as people attending. Documentary materials will be reviewed. Analysis will use a realist logic of analysis to develop a programme theory containing causal explanations for outcomes, in the form of context-mechanism-outcome-configurations, at play in each case.

ETHICS AND DISSEMINATION

The study received approval from Coventry & Warwickshire Research Ethics Committee (22/WM/0215). Ethical concerns include not privileging any voice, consent for embedded observational fieldwork with people who may experience fluctuating mental capacity and balancing researcher 'embedded participant' roles in publicly accessible learning events. Drawing on the realist programme theory, two stakeholder groups, one people living with dementia and one staff will work with researchers to coproduce resources to support coproducing Recovery College dementia courses aligned with postdiagnostic services.

Predictors of Post-Traumatic Growth in a Sample of United Kingdom Mental and Community Healthcare Workers during the COVID-19 Pandemic

Experiences of adversity can generate positive psychological effects alongside negative impacts. Little research to date has evaluated predictors of post-traumatic growth in mental or community healthcare workers during the COVID-19 pandemic. Following a survey of 854 community and mental healthcare staff in the United Kingdom in July to September 2020, multiple linear regression was used to determine the association between hypothesised risk and protective factors (personal, organisational and environmental variables) and total scores on the Post-traumatic Growth Inventory-Short Version. Positive self-reflection activities, black and minority ethnic status, developing new healthcare knowledge and skills, connecting with friends and family, feeling supported by senior management, feeling supported by the UK people, and anxiety about the personal and work-related consequences of COVID-19 each significantly independently predicted greater post-traumatic growth. Working in a clinical role and in mental healthcare or community physical healthcare predicted lower post-traumatic growth. Our research supports the value of taking an organisational growth-focused approach to occupational health during times of adversity, by supporting staff to embrace opportunities for personal growth. Valuing staff's cultural and religious identity and encouraging self-reflective activities, such as mindfulness and meditation, may help to promote post-traumatic growth.

The Prevalence of Burnout and Secondary Traumatic Stress in Professionals and Volunteers Working With Forcibly Displaced People: A Systematic Review and Two Meta-Analyses

Research suggests that professionals and volunteers who work with forcibly displaced people (FDP) experience burnout and secondary traumatic stress (STS) as a result of working with such a highly traumatized population. In the present systematic review and meta-analyses, we report the pooled prevalence rates of burnout and STS in individuals working both professionally and voluntarily with FDP. The CINAHL Complete, E-Journals, ERIC, MEDLINE Complete, OpenDissertations, PsycARTICLES, and PsycINFO databases were searched for articles published historically to September 2019. Studies (N = 15) were included and assessed for quality if (a) their sample comprised individuals working in a professional or voluntary capacity with refugees, asylum seekers, forced migrants, or displaced persons and (b) reported on an outcome of STS or burnout. Two meta-analyses were conducted using random-effects models to assess the prevalence of (a) burnout and (b) STS. The pooled prevalence of high-level burnout was 29.7%, 95% CI [13.8%, 45.6%], with considerable heterogeneity between studies, Q(5) = 112.42, p < .001, I² = 95.6%. The pooled prevalence of moderate, high, and severe STS was 45.7%, 95% CI [26.1%, 65.2%] with considerable heterogeneity between studies, Q(12) = 1,079.37, p < .001, I² = 98.9%. Significant differences were observed in reported prevalence depending on the measure administered. This review highlights the high prevalence of high-level burnout and moderate-to-severe STS reported by individuals working with FDP. The results have implications for future research, employment support for individuals working with FDP, and measure selection for assessing STS.

Practice-informed guidance for undertaking remotely delivered mental health research

BACKGROUND

The assessment and monitoring of health conditions using remote or online delivery is an emerging interest in healthcare systems globally but is not routinely used in mental health research. There is a growing need to offer remotely delivered appointments in mental health research. There is a lack of practical guidance about how nurse researchers can undertake remote research appointments ethically and safely, while maintaining the scientific integrity of the research.

AIM

To provide mental health nurse researchers with information about important issues to consider when assessing the appropriateness of remotely delivered research and methods to support the development of a supportive research relationship.

DISCUSSION

The practice guidance and checklist include issues a nurse researcher should consider when assessing suitability and eligibility for remotely delivered research visits, such as ethical considerations and arrangements, safety, communication, and identifying participants requiring further support. This article addresses processes to follow for assessing mental capacity, obtaining informed consent and collaboratively completing research measures.

CONCLUSION

Remotely delivered research appointments could be acceptable and efficient ways to obtain informed consent and collect data. Additional checks need to be in place to identify and escalate concerns about safeguarding or risks.

IMPLICATIONS FOR PRACTICE

Practical guidance for mental health nurse researchers when determining the appropriateness of remote research visits for participants, and an adaptable checklist for undertaking remote research appointments are outlined.

Interpersonal counselling for adolescent depression delivered by youth mental health workers without core professional training: a feasibility randomised controlled trial study protocol

BACKGROUND

Depression is a common health problem during adolescence and is associated with adverse academic, social and health outcomes. To meet the demand for treatment for adolescent depression, there is a need for evidence-based interventions suitable for delivery outside of specialist Child and Adolescent Mental Health Services (CAMHS). Interpersonal Counselling for Adolescents (IPC-A) is a brief manualised intervention for adolescent depression suitable for delivery by staff who are not qualified health professionals following participation in a brief training course. While initial piloting within Local Authority services has generated promising results, the effectiveness and cost-effectiveness of IPC-A has yet to be established. This study aims to assess the feasibility of a randomised controlled trial (RCT), evaluating the effectiveness and cost-effectiveness of IPC-A delivered by staff without core professional training in comparison to current provision.

METHOD

Feasibility RCT with process evaluation using ethnographic methodology. Eligible young people (n = 60) will be randomised in a 1:1 ratio to receive either IPC-A or treatment as usual (TAU). Participants will be assessed pre-randomisation (baseline) and followed up at 5, 10 and 23 weeks post-randomisation. A parallel process evaluation will generate understanding of intervention implementation across services and explore the acceptability of the intervention from the perspective of young people and other key stakeholders.

PARTICIPANTS

Young people aged 12-18 years presenting to non-specialist services with symptoms of depression. Youth workers, young people and stakeholders will participate in the process evaluation.

DISCUSSION

The need for effective and accessible interventions for young people with mild/sub-threshold depression who, in most cases, do not meet the threshold for mainstream mental health services is long overdue. The primary output of this feasibility trial will be the design of the subsequent full-scale trial. If the results of the current study indicate that this would be feasible, we intend to progress to a multi-site, assessor-blind, superiority RCT of the effectiveness and cost-effectiveness of IPC-A in comparison to TAU for adolescents presenting to non-specialist services with depressive symptoms. If satisfactory solutions to any problems encountered cannot be identified, alternative research designs will be considered. If proven effective, an IPC-A training programme could be implemented.

TRIAL REGISTRY

ISRCTN registry, ISRCTN82180413 , Registered 31 December 2019.

The men’s wellbeing project: promoting the well-being and mental health of men

Purpose

Comparatively, men have poorer physical and mental health outcomes than women, with a significantly higher suicide rate. Contributory factors are thought to be social and biological, leading to reduced access to health-care services. The study aims to develop and implement community-based support to increase awareness of and access to men’s mental health support networks and groups.

Design/methodology/approach

The project involved three key work-packages discussed in this paper: raising awareness of men’s mental health needs in health care, educational and community settings; collaboration between National Health Services (NHS) and non-NHS health-care support organisations to build multi-sector partnership working; and developing a supported sports-based community intervention aimed at men living with mental health conditions. The acceptability and feasibility of these work-packages were pragmatically evaluated through mixed-methods surveys and qualitative content analysis.

Findings

Overall, both community events and sports groups successfully engaged men living with mental health problems. Organisations interested in men’s mental health are continuing to engage in a partnership initiative. Community events were well-attended and received positive feedback, particularly regarding the educative and real-life experiences approach promoted in the events. The sports intervention is feasible and well-accepted by participants, who described feeling supported with their physical and mental health needs, with increased mental well-being reported.

Research limitations/implications

The main limitations of this project are that the authors only evaluated a football group rather than all work areas. The project collected outcomes relating to participants’ demographics and qualitative reflections of participating in the football group along with a retrospective survey of perceived benefits, but the project did not undertake a pre- and post-comparison of well-being outcomes owing to low completion of these measures. Future work could focus on collecting more pre- and post-measures related to well-being, recovery and inclusion and compare these with men not involved in the football groups or public events.

Practical implications

This paper discusses the development and feasibility of setting up community-based men’s mental health support networks, involving public events, partnership working and targeted-sports interventions. All initiatives were well-received and successfully attended by men living with mental health conditions. Evaluation of the programme revealed the value placed on education about mental health and the role that community sports interventions may play in men’s mental health care.

Social implications

This project has demonstrated three different ways of supporting men’s mental health needs in the community. Community public events were held to raise awareness of men’s mental health needs and issues were well-attended and highlighted the need for health promotion and education in this area across all the communities. The men’s football group demonstrated the feasibility of moving mental health support out into a non-clinical and more community arena in a way that men engaged effectively. Finally, the creation of MensNet has bought together disparate multi-sector organisations successfully to lead public health mechanisms to support men’s mental health needs.

Originality/value

This paper describes a new multi-disciplined approach to supporting health-seeking challenges among men, in particular, how partnership working across NHS and non-NHS sectors can successfully support an identified public health need pragmatically using existing services and organisations.

Mapping of modifiable barriers and facilitators of medication adherence in bipolar disorder to the Theoretical Domains Framework: a systematic review protocol

INTRODUCTION

People with bipolar disorder require long-term treatment but it is estimated that 40% of these people do not adhere to prescribed medication regimens. Non-adherence increases the risk of relapse, hospitalisation and suicide. Some evidence syntheses report barriers to mental health treatment adherence but rarely delineate between modifiable and non-modifiable barriers. They also fail to distinguish between the patients' perspective and that of other stakeholders such as clinicians despite of their different understanding and priorities about adherence. Facilitators of adherence, which are also important for informing adherence intervention design, are also lacking from syntheses and few syntheses focus on medications for bipolar disorder.This systematic review aims to identify modifiable barriers and facilitators (determinants) of medication adherence in bipolar disorder. We also plan to report determinants of medication adherence from perspectives of patients, carers, healthcare professionals and other third parties. A unique feature of this systematic review in the context of mental health is the use of the Theoretical Domains Framework (TDF) to organise the literature identified determinants of medication adherence.

METHODS AND ANALYSIS

The protocol adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and ENhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ) guidelines. This review will include both qualitative and quantitative primary studies exploring determinants of medication adherence in bipolar disorder. We will search the following databases using a preplanned strategy: CINAHL, Cochrane Library (CENTRAL), Embase, LiLACS, Medline, PsychINFO, PubMed without date restrictions. We will report the quality of included studies. We will use framework synthesis using the TDF as an a priori 'framework'. We will map the literature identified modifiable determinants to the domains of TDF.

ETHICS AND DISSEMINATION

Ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42018096306.

Low concentrations of sphingosylphosphorylcholine enhance pulmonary artery vasoreactivity: the role of protein kinase C delta and Ca2+ entry

Sphingosylphosphorylcholine (SPC) is a powerful vasoconstrictor, but in vitro its EC(50) is approximately 100-fold more than plasma concentrations. We examined whether subcontractile concentrations of SPC (100 nmol/L of SPC, and independent of the endothelium, 2-aminoethoxydiphenylborane-sensitive Ca(2+) entry, and Rho kinase. It was abolished by the phospholipase C inhibitor U73122, the broad spectrum protein kinase C (PKC) inhibitor Ro31-8220, and the PKC delta inhibitor rottlerin, but not by Gö6976, which is ineffective against PKC delta. The potentiation could be attributed to enhancement of Ca(2+) entry. SPC also potentiated the responses to prostaglandin F(2 alpha) and U436619, which activate a 2-aminoethoxydiphenylborane sensitive nonselective cation channel in intrapulmonary arteries. In this case, potentiation was partially inhibited by diltiazem but abolished by 2-aminoethoxydiphenylborane, Ro31-8220, and rottlerin. SPC (1 micromol/L) caused translocation of PKC delta to the perinuclear region and cytoskeleton of cultured intrapulmonary artery smooth muscle cells. We present the novel finding that low, subcontractile concentrations of SPC potentiate Ca(2+) entry in intrapulmonary arteries through both voltage-dependent and independent pathways via a receptor-dependent mechanism involving PKC delta. This has implications for the physiological role of SPC, especially in cardiovascular disease, where SPC is reported to be elevated.

The smooth muscle relaxant effect of hydrogen sulphide in vitro: evidence for a physiological role to control intestinal contractility

1. Sodium hydrogen sulphide (NaHS), a donor of hydrogen sulphide (H(2)S), produced dose-related relaxation of the rabbit isolated ileum (EC(50), 76.4+/-7.9 microM) and rat vas deferens (EC(50), 64.8+/-5.4 microM) and reduced ACh-mediated contraction of the guinea-pig isolated ileum. 2. NaHS also reduced the response of the guinea-pig (EC(50), 80.0+/-5.7 microM) and rat (EC(50), 108.2+/-11.2 microM) ileum preparations to electrical stimulation of the intramural nerves. In guinea-pig ileum this effect was spontaneously reversible and mimicked by sodium nitroprusside (SNP, EC(50), 2.1 microM). Combination of NaHS (20 microM) with SNP (0.5 microM) produced a greater than additive inhibition of the twitch response of the ileum to electrical stimulation. 3. The inhibitory effect of NaHS on the field-stimulated guinea-pig ileum was unaffected by pretreatment with L-NAME (100 microM), indomethacin (10 microM), naloxone (1 microM) or glibenclamide (100 microM). Furthermore, NaHS (200 microM) did not affect the contractile response of the ileum to KCl (10 to 60 mM). 4. Propargylglycine (PAG, 1 mM) and beta-cyanoalanine (BCA, 1 mM) (inhibitors of cystathionine-gamma-lyase) but not aminooxyacetic acid (AOAA, 1 mM) (inhibitor of cystathionine-beta-synthetase) caused a slowly developing increase in the contraction of the guinea-pig ileum to field stimulation. This effect was reversed by cysteine (1 mM). 5. These results show that NaHS relaxes gastrointestinal and urogenital smooth muscle and suggest that H(2)S is responsible for these effects. The possibility that endogenous H(2)S, formed as a consequence of activation of intramural nerves, plays a part in controlling the contractility of the guinea-pig ileum is discussed.

The smooth muscle relaxant effect of hydrogen sulphide in vitro: evidence for a physiological role to control intestinal contractility

1. Sodium hydrogen sulphide (NaHS), a donor of hydrogen sulphide (H(2)S), produced dose-related relaxation of the rabbit isolated ileum (EC(50), 76.4+/-7.9 microM) and rat vas deferens (EC(50), 64.8+/-5.4 microM) and reduced ACh-mediated contraction of the guinea-pig isolated ileum. 2. NaHS also reduced the response of the guinea-pig (EC(50), 80.0+/-5.7 microM) and rat (EC(50), 108.2+/-11.2 microM) ileum preparations to electrical stimulation of the intramural nerves. In guinea-pig ileum this effect was spontaneously reversible and mimicked by sodium nitroprusside (SNP, EC(50), 2.1 microM). Combination of NaHS (20 microM) with SNP (0.5 microM) produced a greater than additive inhibition of the twitch response of the ileum to electrical stimulation. 3. The inhibitory effect of NaHS on the field-stimulated guinea-pig ileum was unaffected by pretreatment with L-NAME (100 microM), indomethacin (10 microM), naloxone (1 microM) or glibenclamide (100 microM). Furthermore, NaHS (200 microM) did not affect the contractile response of the ileum to KCl (10 to 60 mM). 4. Propargylglycine (PAG, 1 mM) and beta-cyanoalanine (BCA, 1 mM) (inhibitors of cystathionine-gamma-lyase) but not aminooxyacetic acid (AOAA, 1 mM) (inhibitor of cystathionine-beta-synthetase) caused a slowly developing increase in the contraction of the guinea-pig ileum to field stimulation. This effect was reversed by cysteine (1 mM). 5. These results show that NaHS relaxes gastrointestinal and urogenital smooth muscle and suggest that H(2)S is responsible for these effects. The possibility that endogenous H(2)S, formed as a consequence of activation of intramural nerves, plays a part in controlling the contractility of the guinea-pig ileum is discussed.

Temporal patterns of circulating leptin levels in lean and obese adolescents: relationships to insulin, growth hormone, and free fatty acids rhythmicity

Alterations in nutritional status, such as obesity, markedly influence insulin, leptin, GH secretion, and free fatty acid (FFA) levels. We measured every hour for 24 h circulating leptin, insulin, GH, and FFA levels in lean and obese adolescents to determine: 1) the impact of adolescent obesity on the diurnal changes in leptin concentrations; and 2) the temporal relationships between the diurnal patterns of circulating leptin levels and insulin, GH, and FFA levels. During puberty, we found that the 24-h profile of circulating plasma leptin levels follows a bimodal pattern with minimal concentrations occurring early in the afternoon and a nocturnal elevation starting after midnight and culminating early morning. The time course of the diurnal variation in leptin levels in the obese adolescents was not different from that in lean controls. Of note, however, in obese girls leptin 24-h excursion and leptin night to day ratio were lower than those found in lean girls. In obese adolescents, mean GH levels varied significantly less during the day and night than lean controls. During the day, there were distinct preprandial increases and postprandial decreases in FFA levels, whereas after midnight FFA levels rose in both lean and obese adolescents. A significant positive correlation was found between mean plasma insulin levels between 0800 h and 2000 h and peak in leptin in lean and obese girls and boys (r = 0.63, P: < 0.001). Peak leptin was inversely correlated with the area under the nocturnal GH levels in all groups (r = -0.31, P: < 0.0003), whereas it was positively correlated with the nocturnal peak in FFA levels (r = 0.45, P: < 0.004). In summary, we report in obese adolescent girls a blunted relative diurnal excursion in leptin levels. This abnormal rhythmicity may, in part, explain their leptin resistance state. The nocturnal rise in leptin was paralleled by a nocturnal rise in GH and FFA levels. Additional studies are needed to test the potential link between the adipose-derived peptide and GH axis in humans.

An unusual cause for cardiac arrest

We report a case of organophosphate poisoning presenting as a cardiac arrest. The diagnosis was delayed due to the absence of a history of insecticide ingestion and the unusually acute presentation. Cardiac arrest with bradycardia poorly responsive to adrenaline and responsive to high dose atropine should alert the clinician to the possibility of an anticholinesterase poisoning. Early diagnosis is essential in order to manage these patients appropriately and increase the probability of survival.

Efficacy of balloon angioplasty of the superficial femoral artery and popliteal artery in the relief of leg ischemia

PURPOSE

To assess the efficacy of balloon angioplasty in the superficial femoral artery (SFA) and popliteal artery for relief of lower-limb claudication and critical ischemia.

METHODS

All patients who underwent SFA or popliteal balloon angioplasty at the Royal Adelaide Hospital between January 1989 and September 1994 were reviewed. Risk factors, indications, angiographic variables, and complications were assessed. Outcome was expressed in life-table form as patency, limb survival, and patient survival rates.

RESULTS

One hundred seventy-six patients (96 men, 80 women) who underwent 200 balloon angioplasty procedures were monitored for a mean of 25 months. Seventy-four percent of procedures were for claudication relief and 26% for critical ischemia. The cumulative patency rate at 24 months for all cases was 46%. The limb salvage rate was 95%, and the patient survival rate was 91% at 24 months.

CONCLUSION

Percutaneous transluminal angioplasty of the SFA and popliteal arteries is commonly used to treat claudication and critical ischemia but is associated with a high initial failure rate and poor patency at 24 months. Balloon angioplasty is not recommended to treat claudication.

An analysis of rotator cuff repair

Fifty-four patients who had surgery to repair a chronic rotator cuff tear (54 shoulders) were followed for an average of 25.9 months (range, 16 to 43). Forty-nine of 54 patients had at least 20 months of followup. The average age of the male patients (N = 37) was 52 (range, 24 to 80) and of the female patients (N = 17) was 56 (range, 38 to 72). All of these patients received a functional evaluation based on the Shoulder and Elbow Surgery Society classification system. Forty-eight patients had an individual examination and 33 patients had an isokinetic strength evaluation. There were 43 patients (80%) with a satisfactory functional result and 11 (20%) with an unsatisfactory result. Unsatisfactory results were associated with large and massive tears and decreased postoperative range of motion. Good functional results were obtained by open repair and subacromial decompression for rotator cuff tear. Arthroscopic evaluation and treatment did not affect the functional outcome, but it did increase costs by about $2000 per patient. Arthroscopy is useful to define tear size, which may affect the surgical approach, but the arthroscopic treatment of glenohumeral problems did not alter the functional result. The routine use of arthroscopy before rotator cuff repair is costly, not effective, and therefore not recommended.