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Mulligan LD, Bojanić L, Hunt IM, Baird A, Turnbull P, Kapur N, Appleby L, Shaw J. Substance use and self-poisoning in schizophrenia: 11-year findings from a national clinical survey of suicide in mental health patients in the UK. Schizophr Res 2024; 267:254-260. [PMID: 38581828 DOI: 10.1016/j.schres.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/03/2023] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
Suicide is the leading cause of unnatural death among people with schizophrenia. Substance use is a highly prevalent comorbid feature of schizophrenia and a modifiable risk factor for suicide. However, no studies have examined changes in the frequency of substance use or self-poisoning in those who died by suicide over time. Knowing this could support more tailored approaches to reducing specific risk factors and access to means in those with schizophrenia who are at risk of suicide. We conducted an 11-year observational study on a clinical survey of people with schizophrenia in the UK who died by suicide within 12 months of contact with mental health services between 2010 and 2020 (n = 2718). Overall, alcohol, cannabis and stimulants were the most frequently reported substances. The odds of lifetime use significantly increased over time for cannabis, stimulants, heroin, and benzodiazepines. There were differences in socio-demographic, behavioural and clinical factors between those with recent and historical alcohol and drug use before death. Deaths by hanging, jumping and self-poisoning were the most common suicide methods. Though deaths by hanging significantly increased over time, deaths by self-poisoning significantly decreased, especially by means of psychotropic medication and opioids. To improve risk management, clinical efforts should focus on identifying and treating people with schizophrenia using specific substances. Nationwide initiatives for improving safety in prescribing could be contributing to reduced risks of suicide via self-poisoning in this group.
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Affiliation(s)
- Lee D Mulligan
- Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, M13 9PL, UK.
| | - Lana Bojanić
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Isabelle M Hunt
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Alison Baird
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Pauline Turnbull
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Nav Kapur
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Louis Appleby
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Jenny Shaw
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
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2
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Bundy J, Shaw J, Hammel M, Nguyen J, Robbins C, Mercier I, Suryanarayanan A. Role of β3 subunit of the GABA type A receptor in triple negative breast cancer proliferation, migration, and cell cycle progression. Cell Cycle 2024:1-18. [PMID: 38623967 DOI: 10.1080/15384101.2024.2340912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/29/2024] [Indexed: 04/17/2024] Open
Abstract
Triple negative breast cancer (TNBC) is known for its heterogeneous nature and aggressive onset. The unresponsiveness to hormone therapies and immunotherapy and the toxicity of chemotherapeutics account for the limited treatment options for TNBC. Ion channels have emerged as possible therapeutic candidates for cancer therapy, but little is known about how ligand gated ion channels, specifically, GABA type A ligand-gated ion channel receptors (GABAAR), affect cancer pathogenesis. Our results show that the GABAA β3 subunit is expressed at higher levels in TNBC cell lines than non-tumorigenic cells, therefore contributing to the idea that limiting the GABAAR via knockdown of the GABAA β3 subunit is a potential strategy for decreasing the proliferation and migration of TNBC cells. We employed pharmacological and genetic approaches to investigate the role of the GABAA β3 subunit in TNBC proliferation, migration, and cell cycle progression. The results suggest that pharmacological antagonism or genetic knockdown of GABAA β3 subunit decreases TNBC proliferation and migration. In addition, GABAA β3 subunit knockdown causes cell cycle arrest in TNBC cell lines via decreased cyclin D1 and increased p21 expression. Our findings suggest that membrane bound GABAA receptors containing the β3 subunit can be further developed as a potential novel target for the treatment of TNBC.
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Affiliation(s)
- J Bundy
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, Saint Joseph's University, Pharmacology and Toxicology Center (PTC), Philadelphia, PA, USA
| | - J Shaw
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, Saint Joseph's University, Pharmacology and Toxicology Center (PTC), Philadelphia, PA, USA
| | - M Hammel
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, Saint Joseph's University, Pharmacology and Toxicology Center (PTC), Philadelphia, PA, USA
| | - J Nguyen
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, Saint Joseph's University, Pharmacology and Toxicology Center (PTC), Philadelphia, PA, USA
| | - C Robbins
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, Saint Joseph's University, Pharmacology and Toxicology Center (PTC), Philadelphia, PA, USA
| | | | - A Suryanarayanan
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, Saint Joseph's University, Pharmacology and Toxicology Center (PTC), Philadelphia, PA, USA
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O'Neill A, Shaw J, Plugge E, Brimblecombe N, Hargreaves C, Robinson C, Forsyth K. Social care in prisons: Urgent development required. Med Sci Law 2024:258024241233462. [PMID: 38403991 DOI: 10.1177/00258024241233462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Adam O'Neill
- Social Care and Society, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jenny Shaw
- Health and Justice Research Network, School of Health Sciences, University of Manchester, Manchester, UK
| | - Emma Plugge
- Population Health Sciences, University of Southampton, Southampton, UK
| | - Nicola Brimblecombe
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Claire Hargreaves
- Centre for Child and Family Justice Research, Lancaster University, Lancaster, UK
| | - Catherine Robinson
- Social Care and Society, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katrina Forsyth
- Social Care and Society, School of Health Sciences, University of Manchester, Manchester, UK
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Hunt IM, Baird A, Turnbull P, Ibrahim S, Shaw J, Appleby L, Kapur N. Psychiatric in-patient care in England: as safe as it can be? An examination of in-patient suicide between 2009 and 2020. Psychol Med 2024:1-7. [PMID: 38213183 DOI: 10.1017/s0033291723003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Psychiatric in-patients have a greatly elevated risk of suicide. We aimed to examine trends in in-patient suicide rates and determine if characteristics of in-patients who died by suicide have changed over time. METHODS We identified all in-patients in England who died by suicide between 2009 and 2020 from the National Confidential Inquiry into Suicide and Safety in Mental Health. Suicide rates were calculated using data from Hospital Episodes Statistics. RESULTS The rate of in-patient suicide per 100 000 bed days fell by 41.9% between 2009-2011 and 2018-2020. However, since 2016 the rate has remained static with no significant fall. Rates fell in men, those aged 30-59, and those with schizophrenia and other delusional disorders or personality disorder. Rates also fell for suicide by hanging (including hanging on the ward) and jumping. No falls were seen in suicide rates among women, younger and older age groups, and those with affective disorder. There was no indication of a transfer of risk to the post-discharge period or to home treatment/crisis care. More in-patients in the latter part of the study were aged under 25, were on authorised leave, and had psychiatric comorbidity. CONCLUSIONS In-patient suicide has significantly fallen since 2009, suggesting patient safety may have improved. The recent slowdown in the fall in rates, however, highlights that renewed preventative efforts are needed. These should include a greater focus on women, younger and older patients, and those with affective disorder. Careful reviews prior to granting leave are important to ensure a safe transition into the community.
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Affiliation(s)
- Isabelle M Hunt
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison Baird
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Saied Ibrahim
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jenny Shaw
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Louis Appleby
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester; and Mersey Care NHS Foundation Trust, Prescot, UK
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Lindenblatt N, Leuenberger NJ, Harder Y, Kappos EA, Pusic AL, Shaw J, Giovanoli P, Fontein DBY. Measuring quality of care in autologous breast reconstruction: a Delphi consensus. Eur J Surg Oncol 2024; 50:107254. [PMID: 38056020 DOI: 10.1016/j.ejso.2023.107254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 10/15/2023] [Accepted: 10/29/2023] [Indexed: 12/08/2023]
Abstract
Measuring and benchmarking quality of care in surgical oncology has been gaining popularity. In autologous breast reconstruction (ABR), a standardized set of indicators to assess quality of care is lacking. In this study, we defined a set of evidence-based quality indicators for autologous breast reconstruction. First, we performed a systematic review to identify factors related to quality of care in ABR. Variables were categorized depending on their function: indicators related to outcome, indicators related to process and case-mix variables. The review was followed by a 3-round Delphi Consensus to determine which indicators and case-mix-variables were considered relevant and feasible for inclusion in an ABR standard set of indicators. 932 unique articles were identified, of which 110 papers were included in the study. Indicators were categorized by function: outcome, process and case-mix variables. In total, 8 process indicators and 41 outcome indicators were extracted. 30 case-mix-variables were included. Following 3 rounds of questioning in the Delphi Consensus, all respondents agreed on type of ABR, oncological outcomes and patient satisfaction for the standard set. Indicators related to complications were consistently ranked highly. Most process indicators were not chosen after 3 rounds of questioning. 11 case-mix-variables were included in the final set. Following the Delphi Consensus, it was possible to identify 33 process and outcome indicators and 11 case-mix-variables for inclusion for a standard set of quality indicators. With the inclusion of both objective and patient-reported outcome measures, this set of indicators provides a multidimensional measurement tool for quality assessment for ABR.
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Affiliation(s)
- N Lindenblatt
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - N J Leuenberger
- Department of Hand and Plastic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Y Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - E A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - A L Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - J Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, University Hospital Basel, Basel, Switzerland
| | - P Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D B Y Fontein
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
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Bojanić L, Baird A, Ash K, Shaw J. Homicide as the first conviction: A retrospective cohort study. Aggress Behav 2023; 49:595-601. [PMID: 37390388 DOI: 10.1002/ab.22097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
The association between previous convictions and perpetrating homicide has been previously described but little is known about the characteristics of homicide offenders without previous convictions. By utilizing the unique database on homicide offenders held by the National Confidential Inquiry into Suicide and Safety in Mental Health, this study aimed to describe the sample of homicide perpetrators in England and Wales who have committed homicide as their first offense based on their sociodemographic and clinical characteristics. Compared with those with previous convictions, homicide offenders without previous convictions were more likely to be female and a member of an ethnic minority group. More of those without previous convictions belonged to the youngest (<25) and oldest (>55) age groups and were more likely to kill somebody family member or a spouse. Schizophrenia and other delusional disorders as well as affective disorders were more prevalent in those without previous convictions as were mental illness/insanity as a circumstance in homicide, but those without previous convictions were less likely to have been in previous contact with mental health services. There are clear sociodemographic and clinical differences between homicide perpetrators with and without previous convictions. Implications of these findings are discussed.
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Affiliation(s)
- Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), University of Manchester, Manchester, UK
| | - Alison Baird
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), University of Manchester, Manchester, UK
| | - Kosturika Ash
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), University of Manchester, Manchester, UK
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Forsyth K, Daker-White G, Archer-Power L, Senior J, Edge D, Webb R, Shaw J. Silos and rigid processes: Barriers to the successful implementation of the Older prisoner Health and Social Care Assessment and Plan. Med Sci Law 2023; 63:272-279. [PMID: 36448196 PMCID: PMC10498653 DOI: 10.1177/00258024221141641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Older adults are the fastest growing sub-group in prisons. They have complex health, social care and custodial needs and often the support they receive is sub-optimal. The Older prisoner Health and Social Care Assessment and Plan (OHSCAP) aimed to better meet these inter-related needs. As part of a wider study, a randomised controlled trial was conducted to evaluate the OHSCAPs effectiveness in meeting older prisoners' health, social care and custodial needs in comparison to treatment as usual. This article describes the nested qualitative study which aimed to explore the barriers and facilitators to the effective implementation of the OHSCAP. Semi-structured interviews were conducted with older adults (n = 14) and staff members t (n = 12). Data was analysed using the framework method. Three overarching key themes were identified. These were: (1) balancing care and custodial requirements; (2) prison, health and social care silos; and (3) rigid prison processes. Prison is an important opportunity to engage residents and improve public health. Cultural and strategic change is required for health, social care and custodial interventions, such as the OHSCAP, to be successfully implemented into prison settings.
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Affiliation(s)
- K. Forsyth
- Health and Justice Research Network, The University of Manchester, Manchester, UK
| | - G. Daker-White
- Population Health, The University of Manchester, Manchester, UK
| | | | - J. Senior
- Health and Justice Research Network, The University of Manchester, Manchester, UK
| | - D. Edge
- Equality, Diversity and Inclusion Research Unit, The University of Manchester, Manchester, UK
| | - R.T. Webb
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - J. Shaw
- Health and Justice Research Network, The University of Manchester, Manchester, UK
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Radin AK, Shaw J, Brown SP, Flint H, Fouts T, McCue E, Skeie A, Peña C, Youell J, Ratzliff A, Powers DM, Biss M, Lemon H, Sandoval D, Hartmann J, Hammar E, Doty-Jones A, Wilson J, Austin G, Chan KCG, Zheng Z, Fruhbauerova M, Ross M, Stright M, Pullen S, Edwards C, Walton M, Kerbrat A, Comtois KA. Comparative effectiveness of safety planning intervention with instrumental support calls (ISC) versus safety planning intervention with two-way text message caring contacts (CC) in adolescents and adults screening positive for suicide risk in emergency departments and primary care clinics: Protocol for a pragmatic randomized controlled trial. Contemp Clin Trials 2023; 131:107268. [PMID: 37321352 PMCID: PMC10530453 DOI: 10.1016/j.cct.2023.107268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/24/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Suicide is a leading cause of death in adolescents and adults in the US. Follow-up support delivered when patients return home after an emergency department (ED) or primary care encounter can significantly reduce suicidal ideation and attempts. Two follow-up models to augment usual care including the Safety Planning Intervention have high efficacy: Instrumental Support Calls (ISC) and Caring Contacts (CC) two-way text messages, but they have never been compared to assess which works best. This protocol for the Suicide Prevention Among Recipients of Care (SPARC) Trial aims to determine which model is most effective for adolescents and adults with suicide risk. METHODS The SPARC Trial is a pragmatic randomized controlled trial comparing the effectiveness of ISC versus CC. The sample includes 720 adolescents (12-17 years) and 790 adults (18+ years) who screen positive for suicide risk during an ED or primary care encounter. All participants receive usual care and are randomized 1:1 to ISC or CC. The state suicide hotline delivers both follow-up interventions. The trial is single-masked, with participants unaware of the alternative treatment, and is stratified by adolescents/adults. The primary outcome is suicidal ideation and behavior, measured using the Columbia Suicide Severity Rating Scale (C-SSRS) screener at 6 months. Secondary outcomes include C-SSRS at 12 months, and loneliness, return to crisis care for suicidality, and utilization of outpatient mental health services at 6 and 12 months. DISCUSSION Directly comparing ISC and CC will determine which follow-up intervention is most effective for suicide prevention in adolescents and adults.
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Affiliation(s)
- Anna K Radin
- St. Luke's Health System, Applied Research Division, Boise, ID, United States.
| | - Jenny Shaw
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Siobhan P Brown
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Hilary Flint
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Tara Fouts
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Elizabeth McCue
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Anton Skeie
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Cecelia Peña
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Jonathan Youell
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Anna Ratzliff
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
| | - Diane M Powers
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
| | - Matthew Biss
- Idaho Crisis and Suicide Hotline, Boise, ID, United States; SPARC Lived Experience Advisory Board, ID, United States
| | - Hannah Lemon
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | | | | | | | - Amelia Doty-Jones
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Jacob Wilson
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States; Cornerstone Whole Healthcare Organization, Inc., McCall, ID, United States
| | - George Austin
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - Kwun C G Chan
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Zihan Zheng
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Martina Fruhbauerova
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
| | - Michelle Ross
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Megan Stright
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Samuel Pullen
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States; Novant Health, Psychiatry and Mental Health Institute, Winston-Salem, NC, United States; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Christopher Edwards
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States; National Staffing Solutions (Contracted Provider for Optum Serve), Twin Falls, ID, United States
| | - Michael Walton
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Amanda Kerbrat
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
| | - Katherine Anne Comtois
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
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Butow P, Shaw J, Bartley N, Milch V, Sathiaraj R, Turnbull S, Der Vartanian C. Vaccine hesitancy in cancer patients: A rapid review. Patient Educ Couns 2023; 111:107680. [PMID: 36842287 PMCID: PMC9951090 DOI: 10.1016/j.pec.2023.107680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Vaccination is a key strategy to limit the impact of the COVID-19 pandemic, among vulnerable groups such as cancer patients. However, COVID-19 vaccine hesitancy is limiting vaccination uptake in this population as in others. This study aimed to synthesise the emerging literature on vaccine hesitancy in this population and in Oncology health professionals, reasons for and factors associated with hesitancy, and interventions that address hesitancy. METHODS A rapid review was undertaken PubMed, Ovid and Google across all years up to October 2021 for articles in English, from any country or region, addressing the above issues. Individual case studies, opinion pieces, commentary articles and conference abstracts were excluded. Article screening, data extraction and bias assessment were conducted by two authors. A narrative synthesis of the data was undertaken. RESULTS Eighteen eligible articles were identified. Reported COVID-19 vaccine hesitancy rates varied from 76.7 % to 3.9 %, with a mean of 38.4 %. A large international study (n > 20,000) reported a more conservative hesitancy rate of 19 %. Six broad, common reasons for hesitancy were identified. Oncologist advice was valued by patients. DISCUSSION Vaccine hesitancy remains a significant concern in the oncology context. Oncologists are key to addressing hesitancy and providing tailored advice to cancer patients. PRACTICE IMPLICATIONS Where possible, patients appreciate personalised, tailored information about vaccination which addresses its interaction with cancer and its treatment. Education programmes for oncologists to support effective communication in this context are needed. Webinars and peer-to-peer counselling may be useful but remain to be proven.
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Affiliation(s)
- P Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006, Australia.
| | - J Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006, Australia
| | - N Bartley
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006, Australia
| | - V Milch
- Cancer Australia, Level 14, 300 Elizabeth St, Surry Hills, NSW 2010, Australia
| | - R Sathiaraj
- Cancer Australia, Level 14, 300 Elizabeth St, Surry Hills, NSW 2010, Australia
| | - Scott Turnbull
- Cancer Australia, Level 14, 300 Elizabeth St, Surry Hills, NSW 2010, Australia
| | - C Der Vartanian
- Cancer Australia, Level 14, 300 Elizabeth St, Surry Hills, NSW 2010, Australia
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Bayefsky MJ, Shaw J, Hamer D, Martel R, Reich J, Blakemore JK. A balancing act: sex selection after pre-implantation genetic testing for aneuploidy for first versus second baby. Hum Reprod 2023:7174313. [PMID: 37208860 DOI: 10.1093/humrep/dead101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
STUDY QUESTION How often do patients undergoing frozen embryo transfer (FET) after preimplantation genetic testing for aneuploidy (PGT-A) choose to select for sex and do sex selection rates differ before and after successful delivery of a first baby? SUMMARY ANSWER When a choice was available between male and female embryos, patients selected the sex more frequently when trying to conceive the second child (62%) as compared to the first child (32.4%) and most commonly selected for the opposite sex of the first child. WHAT IS KNOWN ALREADY Sex selection is widely available in US fertility clinics. However, the rate of sex selection for patients undergoing FET after PGT-A is unknown. STUDY DESIGN, SIZE, DURATION This is a retrospective cohort study of 585 patients that took place between January 2013 and February 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS The study took place at a single, urban academic fertility center in the USA. Patients were included if they had a live birth after single euploid FET and returned for at least one subsequent euploid FET. The primary outcomes were the rates of sex selection for first versus second baby. Secondary outcomes were rate of selection for same versus opposite sex as first live birth and overall rate of selection for males versus females. MAIN RESULTS AND THE ROLE OF CHANCE Five hundred and eighty-five patients underwent a total of 1560 single euploid FETs resulting in either one or two live births. A choice between male and female euploid embryos was available for 919 FETs (first child: 67.5% (519/769) versus second child: 50.6% (400/791), P < 0.01). When a choice was available, patients selected the sex more frequently when trying to conceive the second child (first child: 32.4% (168/519) versus second child: 62.0% (248/400), P < 0.01). When sex was selected after first live birth, the opposite sex of the first child was selected 81.8% (203/248 FETs) of the time. Of transfers that involved sex selection, rates of male and female selection were similar for the first child, but selection for females was greater for the second child (first child: 51.2% (86/168) male versus 48.9% (82/168) female, second child: 41.1% (102/248) male versus 58.9% (146/248) female, P < 0.04). LIMITATIONS, REASONS FOR CAUTION The study was performed at one urban academic medical center in the Northeastern US, which may limit generalizability to other settings where PGT-A may be performed less frequently, or sex selection may be limited or not permitted. In addition, we could not reliably account for whether patients or their partners had prior children and if so, of what sex. WIDER IMPLICATIONS OF THE FINDINGS Patients undergoing PGT-A with both male and female euploid embryos were more likely to select for sex when attempting a second child and usually selected for the opposite sex of their first child. These findings highlight the potential for family balancing for patients who undergo PGT-A in settings where sex selection is permitted. STUDY FUNDING/COMPETING INTEREST(S) This study received no funding. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M J Bayefsky
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY, USA
| | - J Shaw
- Langone Fertility Center, New York University, New York, NY, USA
| | - D Hamer
- Grossman School of Medicine, New York University, New York, NY, USA
| | - R Martel
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - J Reich
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY, USA
| | - J K Blakemore
- Langone Fertility Center, New York University, New York, NY, USA
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11
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McFadzean IJ, Davies K, Purchase T, Edwards A, Hellard S, Ashcroft DM, Avery AJ, Flynn S, Hewson T, Jordan M, Keers R, Panagioti M, Wainwright V, Walter F, Shaw J, Carson-Stevens A. Patient safety in prisons: a multi-method analysis of reported incidents in England. J R Soc Med 2023:1410768231166138. [PMID: 37196674 PMCID: PMC10387805 DOI: 10.1177/01410768231166138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Prisoners use healthcare services three times more frequently than the general population with poorer health outcomes. Their distinct healthcare needs often pose challenges to safe healthcare provision. This study aimed to characterise patient safety incidents reported in prisons to guide practice improvement and identify health policy priorities.Design: We carried out an exploratory multi-method analysis of anonymised safety incidents from prisons. SETTING Safety incidents had been reported to the National Reporting and Learning System by prisons in England between April 2018 and March 2019. PARTICIPANTS Reports were reviewed to identify any unintended or unexpected incident(s) which could have, or did, lead to harm for prisoners receiving healthcare. MAIN OUTCOME MEASURES Free-text descriptions were examined to identify the type and nature of safety incidents, their outcomes and harm severity. Analysis was contextualised with subject experts through structured workshops to explain relationships between the most common incidents and contributory factors. RESULTS Of 4112 reports, the most frequently observed incidents were medication-related (n = 1167, 33%), specifically whilst administering medications (n = 626, 54%). Next, were access-related (n = 559,15%), inclusive of delays in patients accessing healthcare professionals (n = 236, 42%) and managing medical appointments (n = 171, 31%). The workshops contextualised incidents involving contributing factors (n = 1529, 28%) into three key themes, namely healthcare access, continuity of care and the balance between prison and healthcare priorities. CONCLUSIONS This study highlights the importance of improving medication safety and access to healthcare services for prisoners. We recommend staffing level reviews to ensure healthcare appointments are attended, and to review procedures for handling missed appointments, communication during patient transfers and medication prescribing.
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Affiliation(s)
- Isobel J McFadzean
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Kate Davies
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Thomas Purchase
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Stuart Hellard
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Sandra Flynn
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Tom Hewson
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Melanie Jordan
- School of Sociology & Social Policy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Richard Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, M25 3BL, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9NT, UK
| | - Verity Wainwright
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Florian Walter
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Jenny Shaw
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, M25 3BL, UK
- Independent Advisory Panel on Deaths in Custody, London, SW1H 9AJ, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
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12
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Shaw J, Devlin JF, Rudolph D, Schillig P. Extended pilot test of a cross-injection in situ denitrification system for pre-emptive treatment of municipal well water. J Contam Hydrol 2023; 256:104196. [PMID: 37182507 DOI: 10.1016/j.jconhyd.2023.104196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/16/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
Elevated groundwater nitrate concentrations have been linked to deleterious health and environmental effects. A significant source of the nitrate is nitrogen fertilizers applied to agricultural landscapes. Beneficial Management Practices (BMPs), including the optimization of fertilizer use and selective crop rotations, have proven to be effective in some cases. The city of Woodstock in southern Ontario relies on public wells for all of its municipal supply. Several of the wells have experienced chronic increases in nitrate concentrations exceeding the maximum allowable limit of 10 mg/L N-NO3-. While BMPs are established, an interim reduction plan based on enhanced in situ denitrification (Cross Injection System, CIS) in a 15 m thick zone of high nitrate mass flux within the aquifer zone was evaluated. Based in the results of preliminary acetate injection experiments, a C:N ratio of 2.35, (approximately 260 mg acetate/L), was selected to optimize the denitrification reaction. Injections were performed for six hours a day every day for a period of approximately two months. Dissolved oxygen (DO) and nitrate concentrations recorded over time indicated that reduction of both commenced within a few days of the beginning of the acetate injections and reduced levels were maintained for the remainder of the two-month injection period. Denitrification occurred throughout the profile although nitrate reduction was the highest in the lower groundwater velocity zones. An overall reduction of nitrate of 50% was achieved through the treated section of the aquifer. It is estimated that an upscaled treatment system utilizing a treatment width of only 70 m would be sufficient to reduce the nitrate concentrations to below the drinking water limit demonstrating the potential for the CIS method to functions as an interim groundwater nitrate reduction strategy.
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Affiliation(s)
- J Shaw
- Environmental Resources Management Ltd., Eaton House, North Hinksey Lane, Oxford OX20QS, UK
| | - J F Devlin
- Geology Department, University of Kansas, United States of America
| | - D Rudolph
- Department of Earth and Environmental Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - P Schillig
- RSI Entech, Oak Ridge, TN, United States of America
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13
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Radin AK, Shaw J, Brown SP, Torres J, Harper M, Flint H, Fouts T, McCue E, Skeie A, Peña C, Youell J, Doty-Jones A, Wilson J, Flinn L, Austin G, Chan KCG, Zheng Z, Fruhbauerova M, Walton M, Kerbrat A, Comtois KA. Comparative effectiveness of two versions of a caring contacts intervention in healthcare providers, staff, and patients for reducing loneliness and mental distress: A randomized controlled trial. J Affect Disord 2023; 331:442-451. [PMID: 36963515 DOI: 10.1016/j.jad.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Caring Contacts can effectively reduce suicide ideation, attempts, and death. In published clinical trials, Caring Contacts were sent by someone who knew the recipient. At scale, Caring Contacts programs rarely introduce the recipient and sender. It is not known whether receiving Caring Contacts from someone unknown is as effective as messages from someone the recipient has met. METHODS Pragmatic randomized controlled trial comparing Caring Contacts with (CC+) versus without an introductory phone call (CC). Recruitment occurred January-July 2021, with outcomes assessed at 6 months. Participants were primary care patients or healthcare providers/staff reporting adverse mental health outcomes on a qualifying survey. Participants were sent 11 standardized caring text messages over 6 months; when participants replied, they received personalized unscripted responses. CC+ calls were semi-structured. The primary outcome was loneliness (NIH Toolkit). RESULTS Participants included 331 patients (mean [SD] age: 45.5 [16.4], 78.9 % female) and 335 healthcare providers/staff (mean [SD] age: 40.9 [11.8], 86.6 % female). There were no significant differences in loneliness at 6 months by treatment arm in either stratum. In patients, mean (SD) loneliness was 61.9 (10.7) in CC, and 60.8 (10.3) in CC+, adjusted mean difference of -1.0 (95 % CI: -3.0, 1.0); p-value = 0.31. In providers/staff, mean (SD) loneliness was 61.2 (11) in CC, and 61.3 (11.1) in CC+, adjusted mean difference of 0.2 (95 % CI: -1.8, 2.2); p-value = 0.83. LIMITATIONS Study population was 93 % white which may limit generalizability. CONCLUSIONS Including an initial phone call added operational complexity without significantly improving the effectiveness of a Caring Contacts program.
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Affiliation(s)
- Anna K Radin
- St. Luke's Health System, Applied Research Division, Boise, ID, United States.
| | - Jenny Shaw
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Siobhan P Brown
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Jessica Torres
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - Maggie Harper
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - Hilary Flint
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Tara Fouts
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Elizabeth McCue
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Anton Skeie
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Cecelia Peña
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Jonathan Youell
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Amelia Doty-Jones
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Jacob Wilson
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Lee Flinn
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - George Austin
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - Kwun C G Chan
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Zihan Zheng
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Martina Fruhbauerova
- University of Washington, Department of Psychiatry and Behavioral Sciences, Center for Suicide Prevention & Recovery, Seattle, WA, United States
| | - Michael Walton
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Amanda Kerbrat
- University of Washington, Department of Psychiatry and Behavioral Sciences, Center for Suicide Prevention & Recovery, Seattle, WA, United States
| | - Katherine Anne Comtois
- University of Washington, Department of Psychiatry and Behavioral Sciences, Center for Suicide Prevention & Recovery, Seattle, WA, United States
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14
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Robinson L, Lawrie I, Hard J, Hewson T, Shaw D, Shaw W, Shaw J. Preparing for end-of-life: learning from Do Not Attempt Cardiopulmonary Resuscitation decision-making during COVID-19. Postgrad Med J 2023:7076127. [PMID: 36906840 DOI: 10.1093/postmj/qgad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/24/2023] [Accepted: 02/08/2023] [Indexed: 03/13/2023]
Abstract
During the COVID-19 pandemic, Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made differently. This included more prominent roles for specialties such as psychiatry and doctors in training. Concerns about inappropriate DNAR decisions led to anxiety for doctors, patients and the public. Positive outcomes may have included earlier and better-quality end-of life-discussions. However, COVID-19 exposed the need for support, training and guidance in this area for all doctors. It also highlighted the importance of effective public education about advanced care planning.
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Affiliation(s)
- Louise Robinson
- Secure Services, Lancashire and South Cumbria NHS Foundation Trust, Preston LSCFT PR3 2JH, United Kingdom.,Health and Justice Research Network, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Iain Lawrie
- Palliative Medicine, North Manchester General Hospital and Manchester University Hospitals NHS Foundation Trust, Manchester MUH trust M13 9WL, United Kingdom
| | - Jake Hard
- Secure Environments Group, Royal College of General Practitioners, London GPs MW1 2FB, United Kingdom
| | - Tom Hewson
- Health and Justice Research Network, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Daisy Shaw
- Royal Bolton NHS Foundation Trust, Bolton BL4 0JR, United Kingdom
| | - Will Shaw
- Stockport Medical Group, Stockport SK2 7NA, United Kingdom
| | - Jenny Shaw
- Health and Justice Research Network, University of Manchester, Manchester M13 9PL, United Kingdom.,Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, United Kingdom
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15
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Mok PLH, Walter F, Carr MJ, Antonsen S, Kapur N, Steeg S, Shaw J, Pedersen CB, Webb RT. Absolute risks of self-harm and interpersonal violence by diagnostic category following first discharge from inpatient psychiatric care. Eur Psychiatry 2023; 66:e13. [PMID: 36649931 PMCID: PMC9970150 DOI: 10.1192/j.eurpsy.2022.2352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Persons discharged from inpatient psychiatric services are at greatly elevated risk of harming themselves or inflicting violence on others, but no studies have reported gender-specific absolute risks for these two outcomes across the spectrum of psychiatric diagnoses. We aimed to estimate absolute risks for self-harm and interpersonal violence post-discharge according to gender and diagnostic category. METHODS Danish national registry data were utilized to investigate 62,922 discharged inpatients, born 1967-2000. An age and gender matched cohort study was conducted to examine risks for self-harm and interpersonal violence at 1 year and at 10 years post-discharge. Absolute risks were estimated as cumulative incidence percentage values. RESULTS Patients diagnosed with substance misuse disorders were at especially elevated risk, with the absolute risks for either self-harm or interpersonal violence being 15.6% (95% CI 14.9, 16.3%) of males and 16.8% (15.6, 18.1%) of females at 1 year post-discharge, rising to 45.7% (44.5, 46.8%) and 39.0% (37.1, 40.8%), respectively, within 10 years. Diagnoses of personality disorders and early onset behavioral and emotional disorders were also associated with particularly high absolute risks, whilst risks linked with schizophrenia and related disorders, mood disorders, and anxiety/somatoform disorders, were considerably lower. CONCLUSIONS Patients diagnosed with substance misuse disorders, personality disorders and early onset behavioral and emotional disorders are at especially high risk for internally and externally directed violence. It is crucial, however, that these already marginalized individuals are not further stigmatized. Enhanced care at discharge and during the challenging transition back to life in the community is needed.
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Affiliation(s)
- P L H Mok
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy & Optometry, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
| | - F Walter
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom.,Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom
| | - M J Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy & Optometry, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom.,National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom
| | - S Antonsen
- Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark.,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - N Kapur
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom.,National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom.,Centre for Mental Health and Safety, Division of Psychology & Mental Health, The University of Manchester, Manchester, United Kingdom
| | - S Steeg
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom.,Centre for Mental Health and Safety, Division of Psychology & Mental Health, The University of Manchester, Manchester, United Kingdom
| | - J Shaw
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom.,Centre for Mental Health and Safety, Division of Psychology & Mental Health, The University of Manchester, Manchester, United Kingdom
| | - C B Pedersen
- Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark.,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - R T Webb
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom.,National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom.,Centre for Mental Health and Safety, Division of Psychology & Mental Health, The University of Manchester, Manchester, United Kingdom
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16
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Byng R, Kirkpatrick T, Lennox C, Warren FC, Anderson R, Brand SL, Callaghan L, Carroll L, Durcan G, Gill L, Goodier S, Graham J, Greer R, Haddad M, Harris T, Henley W, Hunter R, Leonard S, Maguire M, Michie S, Owens C, Pearson M, Quinn C, Rybczynska-Bunt S, Stevenson C, Stewart A, Stirzaker A, Todd R, Walter F, Weston L, Wright N, Taylor RS, Shaw J. Evaluation of a complex intervention for prisoners with common mental health problems, near to and after release: the Engager randomised controlled trial. Br J Psychiatry 2023; 222:18-26. [PMID: 35978272 PMCID: PMC10895504 DOI: 10.1192/bjp.2022.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse. AIMS This study aims to evaluate whether the Engager intervention improves mental health outcomes following release. METHOD The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3-5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT). RESULTS In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI -1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact. CONCLUSIONS Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
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Affiliation(s)
- Richard Byng
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Tim Kirkpatrick
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Charlotte Lennox
- Division of Psychology and Mental Health, University of Manchester, UK
| | | | - Rob Anderson
- College of Medicine & Health, University of Exeter, UK
| | | | - Lynne Callaghan
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Lauren Carroll
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Graham Durcan
- Centre for Mental Health, South Bank Technopark, London, UK
| | - Laura Gill
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Sara Goodier
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Jonathan Graham
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Rebecca Greer
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | | | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, UK
| | - Sarah Leonard
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Mike Maguire
- Centre for Criminology, University of South Wales, UK
| | - Susan Michie
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, UK
| | | | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Faculty of Health Sciences, University of Hull, UK
| | - Cath Quinn
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | | | - Amy Stewart
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Alex Stirzaker
- South West Mental Health Clinical Network, NHS England, UK
| | - Roxanne Todd
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Florian Walter
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Lauren Weston
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, UK and Greater Manchester Manchester Health NHS Foundation Trust, UK
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17
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McDonnell S, Flynn S, Shaw J, Smith S, McGale B, Hunt I. Suicide bereavement in the UK: Descriptive findings from a national survey. Suicide Life Threat Behav 2022; 52:887-897. [PMID: 35611626 PMCID: PMC9790485 DOI: 10.1111/sltb.12874] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Those bereaved by suicide are a high-risk group of adverse health outcomes and suicidal behavior, yet little is known about the experiences and support needs of these individuals in the UK. METHODS We conducted a national cross-sectional study using an online survey and analyzed the experiences of 7158 participants who had been bereaved or affected by suicide. RESULTS Suicide had a major impact on 77% of participants, including those who had lost a friend and those exposed to suicide at a professional level. Mental and physical health problems linked to the suicide were reported in half. Adverse social outcomes and engaging in high-risk behaviors following the suicide were common. Over a third reported suicidal ideation and 8% had attempted suicide as a direct result of the suicide loss. Most had not accessed support services, with the majority viewing provision of local suicide bereavement support as inadequate. CONCLUSIONS Our results highlight the need for a multi-disciplinary approach in postvention and the provision of proactive outreach to support those bereaved by suicide. Postvention efforts need to acknowledge the death of a friend by suicide as a significant loss.
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Affiliation(s)
- Sharon McDonnell
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK,Suicide BereavementRamsbottomUK
| | - Sandra Flynn
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK
| | - Jenny Shaw
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchesterUK,Independent Advisory Panel on Deaths in CustodyLondonUK
| | - Shirley Smith
- If U Care Share FoundationChesterUK,Support After Suicide PartnershipLondonUK
| | - Barry McGale
- Suicide BereavementRamsbottomUK,Support After Suicide PartnershipLondonUK
| | - Isabelle M. Hunt
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK
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Favril L, Shaw J, Fazel S. Prevalence and risk factors for suicide attempts in prison. Clin Psychol Rev 2022; 97:102190. [PMID: 36029609 DOI: 10.1016/j.cpr.2022.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/28/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
Suicidal behaviour represents a substantial burden of morbidity and mortality in prisons worldwide. We aimed to synthesise the evidence on prevalence and risk factors for suicide attempts during incarceration. In this systematic review and meta-analysis, we searched four bibliographic databases for studies (published up to May 31, 2022) reporting on adults sampled from the general prison population who attempted suicide while incarcerated and an unselected comparison group. A total of 20 studies comprising 19,882 individuals (6.5% women) in 20 countries were eligible for inclusion. The pooled prevalence of suicide attempts during incarceration was 8.6% (95% CI 6.1-11.2) in men and 12.2% (95% CI 7.1-17.2) in women. Across all 36 risk factors studied, the strongest associations were found for suicidal ideation, previous self-harm, and markers of psychiatric morbidity. Prison-related risk factors included solitary confinement, victimisation, and poor social support while incarcerated. Sensitivity analyses indicate that risk factors for near-lethal suicide attempts are similar to those for suicide attempts more generally. In addition to providing a synthesis of previous work, our systematic review highlights several key limitations of the extant literature, which provide directions for future research.
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Affiliation(s)
- Louis Favril
- Faculty of Law and Criminology, Ghent University, Ghent, Belgium.
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Shepherd A, Shaw J. Personal recovery in forensic institutions as a political process: the significance of frameworks for clinical practice. BJPsych Open 2022; 8:e151. [PMID: 35924337 PMCID: PMC9380066 DOI: 10.1192/bjo.2022.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Support of personal recovery has been a stated goal for many mental health services since the early 2000s. Frameworks such as the CHIME-S described in this issue of BJPsych Open provide useful tools for the operationalisation of this in clinical practice. It is important, however, that through this act of normalisation we do not lose sight of the radical implications of personal recovery as a personal and political process taking place within a social world.
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Affiliation(s)
- Andrew Shepherd
- Greater Manchester Mental Health NHS Foundation Trust, Edenfield Unit, Prestwich Hospital, Prestwich, UK; and Centre for Mental Health and Safety, University of Manchester, UK
| | - Jenny Shaw
- Greater Manchester Mental Health NHS Foundation Trust, Edenfield Unit, Prestwich Hospital, Prestwich, UK; and Centre for Mental Health and Safety, University of Manchester, UK
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Counter C, Owen R, Sinha S, Muthusamy A, Drage M, Callaghan C, Elker D, Harper S, Sutherland A, Van Dellen D, Johnson P, Manas D, Shaw J, Forsythe J, Wilson C, Hughes S, Casey J, White S. O007 Pancreas and islet transplantation in the United Kingdom during the COVID-19 era. Br J Surg 2022; 109:znac242.007. [PMCID: PMC9384530 DOI: 10.1093/bjs/znac242.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Methods Results Conclusion Take-home message
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Affiliation(s)
| | - R Owen
- NHSBT Pancreas Advisory Group
| | - S Sinha
- NHSBT Pancreas Advisory Group
| | | | - M Drage
- NHSBT Pancreas Advisory Group
| | | | - D Elker
- NHSBT Pancreas Advisory Group
| | | | | | | | | | - D Manas
- NHSBT Pancreas Advisory Group
| | - J Shaw
- NHSBT Pancreas Advisory Group
| | | | | | | | - J Casey
- NHSBT Pancreas Advisory Group
| | - S White
- NHSBT Pancreas Advisory Group
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21
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Weston L, Rybczynska-Bunt S, Quinn C, Lennox C, Maguire M, Pearson M, Stirzaker A, Durcan G, Stevenson C, Graham J, Carroll L, Greer R, Haddad M, Hunter R, Anderson R, Todd R, Goodier S, Brand S, Michie S, Kirkpatrick T, Leonard S, Harris T, Henley W, Shaw J, Owens C, Byng R. Interrogating intervention delivery and participants' emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager. PLoS One 2022; 17:e0270691. [PMID: 35834470 PMCID: PMC9282559 DOI: 10.1371/journal.pone.0270691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background ‘Engager’ is an innovative ‘through-the-gate’ complex care intervention for male prison-leavers with common mental health problems. In parallel to the randomised-controlled trial of Engager (Trial registration number: ISRCTN11707331), a set of process evaluation analyses were undertaken. This paper reports on the depth multiple case study analysis part of the process evaluation, exploring how a sub-sample of prison-leavers engaged and responded to the intervention offer of one-to-one support during their re-integration into the community. Methods To understand intervention delivery and what response it elicited in individuals, we used a realist-informed qualitative multiple ‘case’ studies approach. We scrutinised how intervention component delivery lead to outcomes by examining underlying causal pathways or ‘mechanisms’ that promoted or hindered progress towards personal outcomes. ‘Cases’ (n = 24) were prison-leavers from the intervention arm of the trial. We collected practitioner activity logs and conducted semi-structured interviews with prison-leavers and Engager/other service practitioners. We mapped data for each case against the intervention logic model and then used Bhaskar’s (2016) ‘DREIC’ analytic process to categorise cases according to extent of intervention delivery, outcomes evidenced, and contributing factors behind engagement or disengagement and progress achieved. Results There were variations in the dose and session focus of the intervention delivery, and how different participants responded. Participants sustaining long-term engagement and sustained change reached a state of ‘crises but coping’. We found evidence that several components of the intervention were key to achieving this: trusting relationships, therapeutic work delivered well and over time; and an in-depth shared understanding of needs, concerns, and goals between the practitioner and participants. Those who disengaged were in one of the following states: ‘Crises and chaos’, ‘Resigned acceptance’, ‘Honeymoon’ or ‘Wilful withdrawal’. Conclusions We demonstrate that the ‘implementability’ of an intervention can be explained by examining the delivery of core intervention components in relation to the responses elicited in the participants. Core delivery mechanisms often had to be ‘triggered’ numerous times to produce sustained change. The improvements achieved, sustained, and valued by participants were not always reflected in the quantitative measures recorded in the RCT. The compatibility between the practitioner, participant and setting were continually at risk of being undermined by implementation failure as well as changing external circumstances and participants’ own weaknesses. Trial registration number ISRCTN11707331, Wales Research Ethics Committee, Registered 02-04-2016—Retrospectively registered https://doi.org/10.1186/ISRCTN11707331.
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Affiliation(s)
- Lauren Weston
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
- * E-mail:
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Cath Quinn
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Charlotte Lennox
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Mike Maguire
- Department of Criminology, University of South Wales, Cardiff, United Kingdom
| | - Mark Pearson
- Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Alex Stirzaker
- South West Mental Health Clinical Network, Taunton, United Kingdom
| | | | - Caroline Stevenson
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jonathan Graham
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lauren Carroll
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Rebecca Greer
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Mark Haddad
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Rachael Hunter
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Rob Anderson
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Roxanne Todd
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sara Goodier
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sarah Brand
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Susan Michie
- Division of Psychology and Language Sciences, Research Department of Clinical, Educational and Health Psychology, Kings College London, London, United Kingdom
| | - Tim Kirkpatrick
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Sarah Leonard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Tirril Harris
- Division of Psychology and Language Sciences, Research Department of Clinical, Educational and Health Psychology, Kings College London, London, United Kingdom
| | - William Henley
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Jenny Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christabel Owens
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Richard Byng
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
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Butow P, Havard PE, Butt Z, Juraskova, Sharpe L, Dhillon H, Beatty L, Beale P, Cigolini M, Kelly B, Chan RJ, Kirsten L, Best M, Shaw J. The impact of COVID-19 on cancer patients, their carers and oncology health professionals: A qualitative study. Patient Educ Couns 2022; 105:2397-2403. [PMID: 35120797 PMCID: PMC8801619 DOI: 10.1016/j.pec.2022.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Cancer patients, carers and oncology health professionals have been impacted by the COVID-19 pandemic in many ways, but their experiences and psychosocial responses to the pandemic are still being explored. This study aimed to document the experience of Australians living with cancer, family carers, and Oncology health professionals (HPs) when COVID-19 first emerged. METHODS In this qualitative study, participants (cancer patients currently receiving treatment, family carers and HPs) completed a semi-structured interview exploring their experiences of COVID-19 and the impact it had on cancer care. Participants also completed the Hospital Anxiety and Depression Scale (patients) and the Depression, Anxiety and Stress Scale (carers and HPs) to assess emotional morbidity. Thematic analysis was undertaken on qualitative data. RESULTS 32 patients, 16 carers and 29 HPs participated. Qualitative analysis yielded three shared themes: fear and death anxiety, isolation, and uncertainty. For HPs, uncertainty incorporated the potential for moral distress and work-stress. Patients and carers scoring high on anxiety/depression measures were more likely to have advanced disease, expressed greater death anxiety, talked about taking more extreme precautionary measures, and felt more impacted by isolation. CONCLUSION Cancer and COVID-19 can have compounding psychological impacts on all those receiving or giving care. PRACTICE IMPLICATIONS Screening for distress in patients, and burnout in HPs, is recommended. Increased compassionate access and provision of creative alternatives to face-to-face support are warrented.
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Affiliation(s)
- P Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006 Australia.
| | - P E Havard
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006 Australia
| | - Z Butt
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006 Australia
| | - Juraskova
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006 Australia
| | - L Sharpe
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006 Australia
| | - H Dhillon
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006 Australia
| | - L Beatty
- Flinders University, Órama Institute, College of Education, Psychology & Social Work, Adelaide, Australia
| | - P Beale
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, NSW 2006 Australia
| | - M Cigolini
- Department of Palliative Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
| | - B Kelly
- School of Medicine and Public Health, University of Newcastle, Callaghan NSW 2308, Australia
| | - R J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
| | - L Kirsten
- Nepean Cancer Care Centre, Penrith, NSW 2751, Australia
| | - M Best
- Institute for Ethics and Society, University of Notre Dame, Broadway, NSW 2007, Australia
| | - J Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, NSW 2006 Australia
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Mckinnon JE, Santiaguel J, Murta C, Yu D, Khursheed M, Moreau F, Klopp-Schulze L, Shaw J, Roy S, Kao A. POS1268 PHASE II TRIAL OF ENPATORAN IN PATIENTS HOSPITALIZED WITH COVID-19 PNEUMONIA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundEnpatoran is a selective and potent dual toll-like receptor (TLR) 7/8 inhibitor in development for the treatment of cutaneous and systemic lupus erythematosus (CLE/SLE). Enpatoran inhibits TLR7/8 activation in vitro and suppresses disease activity in lupus mouse models.1 Enpatoran was well tolerated and had linear pharmacokinetic (PK) parameters in healthy volunteers.2 As TLR7/8 mediate immune responses to single-stranded RNA viruses, including SARS-CoV-2, it was postulated that enpatoran may prevent hyperinflammation and cytokine storm in COVID-19.ObjectivesIn response to the COVID-19 pandemic, we conducted an exploratory Phase II trial to assess safety and determine whether enpatoran prevents clinical deterioration in patients (pts) hospitalized with COVID-19 pneumonia. PK and pharmacodynamics (PD) of enpatoran were also evaluated.MethodsANEMONE was a randomized, double-blind, placebo (PBO)-controlled study conducted in Brazil, the Philippines, and the USA (NCT04448756). Pts aged 18–75 years, hospitalized with COVID-19 pneumonia (WHO 9-point scale score =4) but not mechanically ventilated, with SpO2 <94% and PaO2/FiO2 ≥150 (FiO2 maximum 0.4) were eligible. Those with a history of uncontrolled illness, active/unstable cardiovascular disease and SARS-CoV-2 vaccination were excluded. Pts received PBO or enpatoran (50 or 100 mg twice daily [BID]) for 14 days, with monitoring to Day 28 and safety follow-up to Day 60. Primary outcomes were safety and time to recovery (WHO 9-point scale ≤3). Clinical deterioration (time to clinical status >4, WHO 9-point scale) was a secondary outcome. Exploratory endpoints were enpatoran and biomarker concentrations (cytokines, C-reactive protein [CRP], D-dimer and interferon gene signature [IFN-GS] scores) assessed over time.Results149 pts received either PBO (n=49), or enpatoran 50 mg (n=54) or 100 mg (n=46) BID; 88% completed treatment and 86% received concomitant steroids. Median age was 50 years (77% <60 years old), 66% were male, and 50% had ≥1 comorbidity (40% hypertension, 24% diabetes). Overall, 59% pts reported a treatment-emergent adverse event (TEAE) with three non-treatment-related deaths; 11% reported a treatment-related TEAE. The proportion of pts in the enpatoran group reporting serious TEAEs was low (50 mg BID 9%; 100 mg BID 2%) vs PBO (18%). Gastrointestinal disorders were most common (PBO 8%; 50 mg BID 28%; 100 mg BID 9%). The primary outcome of time to recovery with enpatoran vs PBO was not met; medians were 3.4–3.9 days. A positive signal in time to clinical deterioration from Day 1 through Day 28 was observed; hazard ratios [95% CI] for enpatoran vs PBO were 0.39 [0.13, 1.15] (50 mg BID) and 0.30 [0.08, 1.08] (100 mg BID). Mean enpatoran exposure was dose-proportional, and PK properties were within expectations. The median (quartile [Q]1– Q3) interleukin 6 (IL-6), CRP and D-dimer baseline concentration across the groups were 5.7 (4.0–13.5) pg/mL, 30.04 (11.40–98.02) and 0.62 (0.39–1.01) mg/L, respectively. Baseline IFN-GS scores were similar across groups.ConclusionThe ANEMONE trial was the first to evaluate the safety and efficacy of a TLR7/8 inhibitor in an infectious disease for preventing cytokine storm. Enpatoran up to 100 mg BID for 14 days was well tolerated by patients acutely ill with COVID-19 pneumonia. Time to recovery was not improved with enpatoran, perhaps due to the younger age of patients who had fewer comorbidities compared to those in similar COVID-19 trials. However, there was less likelihood for clinical deterioration with enpatoran than placebo. This trial provides important safety, tolerability, PK and PD data supporting continued development of enpatoran in SLE and CLE (NCT04647708, NCT05162586).References[1]Vlach, et al. J Pharmacol Exp Ther 2021;376:397–409;[2]Port, et al. Pharmacol Res Perspect 2021;9:e00842.AcknowledgementsWe would like to thank those who took part in the the ANEMONE trial. This study was sponsored by the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: 10.13039/100009945), who funded medical writing support by Bioscript Stirling Ltd.Disclosure of InterestsJohn E. McKinnon Consultant of: EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA, Joel Santiaguel Speakers bureau: Merck Healthcare KGaA, Claudia Murta Speakers bureau: Pfizer/Wyeth, Dongzi Yu Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Mukhy Khursheed Employee of: Merck Serono Ltd (an affiliate of Merck KGaA), Flavie Moreau Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Lena Klopp-Schulze Employee of: Merck Healthcare KGaA, Jamie Shaw Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Sanjeev Roy Employee of: Ares Trading SA (an affiliate of Merck KGaA), Amy Kao Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA)
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Shaw J. T113 Are repeat measurements required for critically high POCT glucose results? Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hunter RM, Anderson R, Kirkpatrick T, Lennox C, Warren F, Taylor RS, Shaw J, Haddad M, Stirzaker A, Maguire M, Byng R. Economic evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: a cost-utility and cost-consequences analysis. Eur J Health Econ 2022; 23:193-210. [PMID: 34351533 PMCID: PMC8882099 DOI: 10.1007/s10198-021-01360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND People in prison experience a range of physical and mental health problems. Evaluating the effectiveness and efficiency of prison-based interventions presents a number of methodological challenges. We present a case study of an economic evaluation of a prison-based intervention ("Engager") to address common mental health problems. METHODS Two hundred and eighty people were recruited from prisons in England and randomised to Engager plus usual care or usual care. Participants were followed up for 12 months following release from prison. The primary analysis is the cost per quality-adjusted life year (QALY) gained of Engager compared to usual care from a National Health Service (NHS) perspective with QALYs calculated using the CORE 6 Dimension. A cost-consequences analysis evaluated cross-sectoral costs and a range of outcomes. RESULTS From an NHS perspective, Engager cost an additional £2737 per participant (95% of iterations between £1029 and £4718) with a mean QALY difference of - 0.014 (95% of iterations between - 0.045 and 0.017). For the cost-consequences, there was evidence of improved access to substance misuse services 12 months post-release (odds ratio 2.244, 95% confidence Interval 1.304-3.861). CONCLUSION Engager provides a rare example of a cost-utility analysis conducted in prisons and the community using patient-completed measures. Although the results from this trial show no evidence that Engager is cost-effective, the results of the cost-consequences analysis suggest that follow-up beyond 12 months post-release using routine data may provide additional insights into the effectiveness of the intervention and the importance of including a wide range of costs and outcomes in prison-based economic evaluations. TRIAL REGISTRATION (ISRCTN11707331).
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Affiliation(s)
- Rachael Maree Hunter
- Research Department of Primary Care and Population Health, University College London (UCL), Rowland Hill Street, London, NW3 2PF, UK.
| | - Rob Anderson
- Primary Care Department, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tim Kirkpatrick
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Charlotte Lennox
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Fiona Warren
- Primary Care Department, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rod S Taylor
- Primary Care Department, College of Medicine and Health, University of Exeter, Exeter, UK
- University of Glasgow, Glasgow, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | | | - Alex Stirzaker
- NHS England, South West Mental Health Clinical Network, Taunton, UK
| | - Mike Maguire
- Centre for Criminology, University of South Wales, Pontypridd, UK
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
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Rendon D, Thomson R, Van Citters D, Shaw J. Optimization of suture attachment for fascia sacral colpopexy using an animal model. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shaw J, McGraw Z, Bruno O, Storelvmo T, Hofer S. Using Satellite Observations to Evaluate Model Microphysical Representation of Arctic Mixed-Phase Clouds. Geophys Res Lett 2022; 49:e2021GL096191. [PMID: 35845251 PMCID: PMC9285086 DOI: 10.1029/2021gl096191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/16/2021] [Accepted: 01/12/2022] [Indexed: 06/15/2023]
Abstract
Mixed-phase clouds play an important role in determining Arctic warming, but are parametrized in models and difficult to constrain with observations. We use two satellite-derived cloud phase metrics to investigate the vertical structure of Arctic clouds in two global climate models that use the Community Atmosphere Model version 6 (CAM6) atmospheric component. We report a model error limiting ice nucleation, produce a set of Arctic-constrained model runs by adjusting model microphysical variables to match the cloud phase metrics, and evaluate cloud feedbacks for all simulations. Models in this small ensemble uniformly overestimate total cloud fraction in the summer, but have variable representation of cloud fraction and phase in the winter and spring. By relating modeled cloud phase metrics and changes in low-level liquid cloud amount under warming to longwave cloud feedback, we show that mixed-phase processes mediate the Arctic climate by modifying how wintertime and springtime clouds respond to warming.
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Affiliation(s)
- J. Shaw
- Department of GeosciencesUniversity of OsloOsloNorway
- Now at Department of Atmospheric and Oceanic SciencesUniversity of Colorado at BoulderBoulderCOUSA
| | - Z. McGraw
- Department of GeosciencesUniversity of OsloOsloNorway
- Now at Department of Applied Physics and Applied MathematicsColumbia University and NASA Goddard Institute for Space StudiesNew YorkNYUSA
| | - O. Bruno
- Karlsruhe Institute of TechnologyInstitute of Meteorology and Climate ResearchKarlsruheGermany
| | - T. Storelvmo
- Department of GeosciencesUniversity of OsloOsloNorway
- School of BusinessNord UniversityBodøNorway
| | - S. Hofer
- Department of GeosciencesUniversity of OsloOsloNorway
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Sharpe L, Michalowski M, Richmond B, Menzies RE, Shaw J. Fear of Progression in chronic illnesses other than cancer: A systematic review and meta-analysis of a transdiagnostic construct. Health Psychol Rev 2022; 17:301-320. [PMID: 35132937 DOI: 10.1080/17437199.2022.2039744] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has been studied outside of the cancer context. This review aimed to: (1) meta-synthesize qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e. seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.
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Affiliation(s)
- Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - M Michalowski
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - B Richmond
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - R E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - J Shaw
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006.,Psycho-Oncology Co-operative Group (POCOG), The University of Sydney, NSW 2006
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Zheng W, Dinh D, Noaman S, Bloom J, Lefkovits J, Brennan A, Reid C, Al-Mukhtar O, Shaw J, Yang Y, Stub D, Kaye D, Cox N, Chan W. Effect of Concomitant Cardiac Arrest on Outcomes in Patients With Cardiogenic Shock Secondary to Acute Coronary Syndrome (ACS). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Lennox C, Leonard S, Senior J, Hendricks C, Rybczynska-Bunt S, Quinn C, Byng R, Shaw J. Conducting Randomized Controlled Trials of Complex Interventions in Prisons: A Sisyphean Task? Front Psychiatry 2022; 13:839958. [PMID: 35592376 PMCID: PMC9110768 DOI: 10.3389/fpsyt.2022.839958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
Randomized Controlled Trials (RCT) are the "gold standard" for measuring the effectiveness of an intervention. However, they have their limitations and are especially complex in prison settings. Several systematic reviews have highlighted some of the issues, including, institutional constraints e.g., "lock-downs," follow-ups, contamination of allocation conditions and a reliance on self-report measures. In this article, we reflect on our experiences and will describe two RCTs. People in prison are a significantly disadvantaged and vulnerable group, ensuring equitable and effective interventions is key to reducing inequality and promoting positive outcomes. We ask are RCTs of complex interventions in prisons a sisyphean task? We certainly don't think so, but we propose that current accepted practice and research designs may be limiting our understanding and ability to test complex interventions in the real-world context of prisons. RCTs will always have their place, but designs need to be flexible and adaptive, with the development of other rigorous methods for evaluating impact of interventions e.g., non-randomized studies, including pre-post implementation studies. With robust research we can deliver quality evidence-based healthcare in prisons - after all the degree of civilization in a society is revealed by entering its prisons.
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Affiliation(s)
- Charlotte Lennox
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah Leonard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Jane Senior
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Caroline Hendricks
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, University of Plymouth, Plymouth, United Kingdom
| | - Cath Quinn
- Community and Primary Care Research Group, University of Plymouth, Plymouth, United Kingdom
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Plymouth, United Kingdom
| | - Jenny Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Zheng W, Noaman S, Batchelor R, Bloom J, Hanson L, Stub D, Cox N, Walton A, Shaw J, French C, Yang Y, Chan W. Comparison of Resuscitation, Treatment and Outcomes following Out-of-Hospital Cardiac Arrest (OHCA) and Shockable Rhythm in Three Different Age Groups. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hunt IM, Richards N, Bhui K, Ibrahim S, Turnbull P, Halvorsrud K, Saini P, Kitson S, Shaw J, Appleby L, Kapur N. Suicide rates by ethnic group among patients in contact with mental health services: an observational cohort study in England and Wales. Lancet Psychiatry 2021; 8:1083-1093. [PMID: 34762843 DOI: 10.1016/s2215-0366(21)00354-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent evidence on suicide rates among psychiatric patients from minority ethnic backgrounds is scarce. We aimed to examine suicide rates among minority ethnic psychiatric patients and describe their social and clinical characteristics. METHODS We did a retrospective observational cohort study on a national case-series of patients in England and Wales who died by suicide within 12 months of contact with mental health services between 2007 and 2018. Data were collected as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. Suicide rates and standardised mortality ratios (SMRs) were estimated for South Asian (Indian, Pakistani, and Bangladeshi), Black African, Black Caribbean, Chinese, and White patients. FINDINGS A total of 698 patients in the four minority ethnic groups of South Asian, Black Caribbean, Black African, and Chinese were included (482 [69%] men; 216 [31%] women; mean age 41 years [SD 14·9, range 12-91] and compared with 13 567 White patients (9030 [66·6%] men; 4537 [33·4%] women; mean age 48 years [SD 15·8, range 10-100]). Rates and SMRs for suicide among minority ethnic patients were lower than for White patients (2·73 deaths, 95% CI 2·68-2·78) per 100 000 population. Differences were found between ethnic groups with higher suicide rates in Black Caribbean patients (1·89 deaths [95% CI 1·55-2·23] per 100 000 population) and lower rates in South Asian patients (1·49 deaths [1·33-1·64] per 100 000 population). There was an increase in rates among White patients in 2007-12 followed by a fall but no change among other ethnic groups. Schizophrenia was more common among Black African patients (54%) and Black Caribbean patients (44%), while affective disorder was more common among South Asian patients (41%). Minority ethnic patients overall showed markers of social adversity and received higher intensity care yet were viewed by clinicians as at lower risk than White patients. INTERPRETATION Effective approaches to prevention might differ between minority ethnic groups. Clinicians and the services in which they work should be aware of the common and distinct social and clinical needs of minority ethnic patients with mental illness. FUNDING The Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Isabelle M Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK.
| | - Nicola Richards
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Synergi Collaborative Centre, University of Oxford, Oxford, UK
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kristoffer Halvorsrud
- Department of Psychiatry, University of Oxford, Oxford, UK; NIHR ARC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Pooja Saini
- School of Psychology, Liverpool John Moore's University, Liverpool, UK
| | - Sadie Kitson
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Rivart P, Wainwright V, Flynn S, Hunt IM, Shaw J, Smith S, McGale B, McDonnell S. Ethnic Minority Groups' Experiences of Suicide Bereavement: A Qualitative Exploratory Study. Int J Environ Res Public Health 2021; 18:ijerph182211860. [PMID: 34831616 PMCID: PMC8621836 DOI: 10.3390/ijerph182211860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
It is estimated that between 36,000 and 360,000 people are affected by suicide every year in the UK, and a proportion may develop depression and post-traumatic stress disorder, or engage in high-risk behaviours. Recent systematic analyses have revealed a clear gap in research on suicide bereavement in minority ethnic groups. This study aimed to understand the experiences and support needs of individuals from ethnic minority backgrounds bereaved by suicide and was the first in the UK to investigate this matter. The study was a secondary analysis of data. Participants were 7158 people residing in the UK who completed an online survey about their experiences of suicide. Free-text qualitative responses of 227 participants who did not identify as White British were analysed using thematic analysis. Four themes were identified: maladaptive coping strategies, emotional processes following suicide, lack of support from agencies, and the importance of mental health awareness. Ethnic minority groups reported a lack of support despite attempts to engage with services, noted the prevalence of stigma within ethnic minority groups, and expressed a need to tackle this. These preliminary results suggest that ethnic minority individuals require visible and accessible services that can successfully engage with and support them.
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Affiliation(s)
- Pauline Rivart
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
- Correspondence:
| | - Verity Wainwright
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
| | - Sandra Flynn
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
| | - Isabelle M. Hunt
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
| | - Jenny Shaw
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
- Independent Advisory Panel on Deaths in Custody, London SW1H 9AJ, UK
| | - Shirley Smith
- If U Care Share Foundation, Chester-le-Street, Chester DH2 2EY, UK;
- Support After Suicide Partnership, London SE1 7NQ, UK;
| | - Barry McGale
- Support After Suicide Partnership, London SE1 7NQ, UK;
- Suicide Bereavement UK, Ramsbottom BL0 9EX, UK
| | - Sharon McDonnell
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
- Suicide Bereavement UK, Ramsbottom BL0 9EX, UK
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Forsyth K, Webb RT, Power LA, Emsley R, Senior J, Burns A, Challis D, Hayes A, Meacock R, Walsh E, Ware S, Shaw J. The older prisoner health and social care assessment and plan (OHSCAP) versus treatment as usual: a randomised controlled trial. BMC Public Health 2021; 21:2061. [PMID: 34758798 PMCID: PMC8579542 DOI: 10.1186/s12889-021-11965-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Older people are the fastest-growing demographic group among prisoners in England and Wales and they have complex health and social care needs. Their care is frequently ad hoc and uncoordinated. No previous research has explored how to identify and appropriately address the needs of older adults in prison. We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs 3 months after prison entry, compared to treatment as usual (TAU). Methods The study was a parallel randomised controlled trial (RCT) recruiting male prisoners aged 50 and over from 10 prisons in northern England. Participants received the OHSCAP or TAU. A clinical trials unit used minimisation with a random element as the allocation procedure. Data analysis was conducted blind to allocation status. The intervention group had their needs assessed using the OHSCAP tool and care plans were devised; processes that lasted approximately 30 min in total per prisoner. TAU included the standard prison health assessment and care. The intention to treat principle was followed. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30 November 2016. Results Data were collected between 28 January 2014 and 06 April 2016. Two hundred and forty nine older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. Two hundred and fifty three 3 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs – Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD = 2.07) and 2.06 (SD = 2.11) for the TAU group (mean difference = 0.088; 95% CI − 0.276 to 0.449, p = 0.621). No adverse events were reported. Conclusion The OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving the OHSCAP did not experience improved outcomes compared to those who received TAU. Trial registration Current Controlled Trials: ISRCTN11841493, 25/10/2012. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11965-5.
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Affiliation(s)
- Katrina Forsyth
- The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Roger T Webb
- The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | | | | | - Jane Senior
- The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Alistair Burns
- The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - David Challis
- Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Adrian Hayes
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath, BA1 3QE, UK
| | - Rachel Meacock
- The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Elizabeth Walsh
- Care UK, Hawker House, 5-6 Napier Court, Napier Road, Reading, Berkshire, RG1 8BW, UK
| | - Stuart Ware
- Restore Support Network, Exeter CVS, Wat Tyler House, King William Street, Exeter, EX4 6PD, UK
| | - Jenny Shaw
- The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Doyle M, Coid J, Ullrich S, Shaw J. Assessing protective factors to prevent post-discharge violent behaviour: Towards an assets-based approach for clinical risk management. J Psychiatr Res 2021; 143:416-421. [PMID: 34655951 DOI: 10.1016/j.jpsychires.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/27/2021] [Accepted: 10/10/2021] [Indexed: 02/05/2023]
Abstract
Medium secure forensic psychiatric units (MSUs) in the UK aim to be recovery-oriented to enable discharge to community-based services. Risk assessments are key to discharge planning, but clinical practice tends to focus on risk factors for violence rather than protective factors associated with a decrease in risk. The aims of this study were to investigate the reliability and validity of the Structured Assessment of Protective Factors (SAPROF) as a useful measure to support an assets-based approach when planning discharge from MSUs. A prospective cohort follow-up design was chosen for this study using a confidential inquiry design to ensure a total sample of all discharges. All forensic patients discharged from 32 NHS MSUs over a 12-month period were assessed at discharge and followed-up at six and 12 months post discharge. The occurrence and frequency of post-discharge violence were compared with discharge SAPROF scores. The inter-rater reliability between SAPROF raters was very high and the SAPROF significantly predicted community violence and scores were strongly correlated with violence frequency. The higher the SAPROF score the higher the protection against violence and the risk significantly diminished. Assessing protective factors is essential to identify assets and prevent violence with a focus on what makes somebody safe. This study supports the use of the SAPROF to inform discharge planning. Cultivating protective factors is likely to be motivating for patients and the SAPROF can provide an objective, reliable measure of internal, motivational and external assets that reduce risk and support defensible decision making at discharge.
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Affiliation(s)
- Michael Doyle
- University of Huddersfield, United Kingdom and Honorary Professor, Division of Psychology and Mental Health, University of Manchester, United Kingdom.
| | - Jeremy Coid
- West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Simone Ullrich
- Barts and the London School of Medicine and Dentistry; Wolfson Institute of Preventive Medicine, Centre for Psychiatry, Violence Prevention Research Unit, Queen Mary University of London, London, United Kingdom
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
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Cohen NS, Dinh D, Ajani A, Clark D, Brennan A, Nan Tie E, Dagan M, Hamilton G, Sebastian M, Shaw J, Oqueli E, Freeman M, Reid C, Stub D, Duffy SJ. Outcomes after percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (cabg). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with prior CABG requiring subsequent PCI there is uncertainty whether bypass grafts or native coronary arteries should be targeted.
Methods
We analysed data from 2,764 patients with prior CABG in the Melbourne Interventional Group registry (2005–2018), divided into two groups: those undergoing PCI to a native vessel (n=1,928) and those with PCI to a graft vessel (n=836).
Results
Patients with a graft vessel PCI were older, had more high-risk clinical characteristics (prior MI, heart failure, ejection fraction <50%, renal impairment, peripheral and cerebrovascular disease), and high-risk procedural features (ACC/AHA types B2/C lesions). However, patients in the native vessel group were more likely to have PCI to a chronic total occlusion. The majority of graft PCI were to saphenous vein grafts (84%), with 10% to radial and 6% to LIMA/RIMA grafts. Distal embolic protection devices were used in 30% of graft PCI. Patients with graft PCI had higher rates of no reflow (6.3% vs. 1.5%; p<0.001), coronary perforation (p=0.016) and inpatient stent thrombosis (p=0.028). However, 30-day mortality and major adverse cardiovascular and cerebrovascular events (MACCE) were similar. Unadjusted long-term mortality (median follow up 4.8 years) was higher in patients who had undergone a graft PCI (44% vs. 32%, p<0.001), but following Cox proportional hazards modelling, PCI vessel type was not a predictor of long-term mortality (HR 1.13; 95% CI 0.96–1.33, p=0.14).
Conclusions
Early clinical outcomes and risk-adjusted long-term mortality are similar for patients with prior CABG undergoing PCI to a native vessel or a bypass graft.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The Alfred Hospital
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Affiliation(s)
- N S Cohen
- The Alfred Hospital, Melbourne, Australia
| | - D Dinh
- Monash University, Melbourne, Australia
| | - A Ajani
- Royal Melbourne Hospital, Melbourne, Australia
| | - D Clark
- Austin Hospital, Melbourne, Australia
| | - A Brennan
- Monash University, Melbourne, Australia
| | - E Nan Tie
- The Alfred Hospital, Melbourne, Australia
| | - M Dagan
- The Alfred Hospital, Melbourne, Australia
| | | | | | - J Shaw
- The Alfred Hospital, Melbourne, Australia
| | - E Oqueli
- Ballarat Health Services, Ballarat, Australia
| | - M Freeman
- Eastern Health, Melbourne, Australia
| | - C Reid
- Monash University, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Melbourne, Australia
| | - S J Duffy
- The Alfred Hospital, Melbourne, Australia
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Nan Tie E, Fernando H, Nehme Z, Dinh D, Andrew E, Brennan A, Zaman S, Liew D, Stephenson M, Lefkovits J, Peter K, Duffy SJ, Shaw J, Smith K, Stub D. Sex differences in pre-hospital analgesia and outcomes in patients presenting with acute coronary syndromes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Opioid analgesia remains the mainstay of pain management in acute coronary syndromes (ACS). Significant sex differences persist in ACS presentation, management and outcomes, but the impact of sex-differences on pre-hospital pain management of ACS with opioids is unknown. There is increasing awareness of the importance of pre-hospital factors in ACS, as well as emerging concerns with opioid use impairing the gastrointestinal absorption of oral P2Y12 inhibitors.
Purpose
This study examined if sex-differences in pre-hospital pain scores, opioid administration and clinical outcomes exist in ACS patients.
Methods
Patients presenting with ACS via ambulance (2014–2018) that underwent percutaneous coronary intervention (PCI) were prospectively collected via the Victorian Cardiac Outcomes Registry (VCOR), the Melbourne Interventional Group (MIG), and linked to the Ambulance Victoria database. The primary outcome was 30-day major adverse cardiac events (MACE). Secondary outcomes were descriptive analyses of pre-hospital pain score, intravenous morphine equivalent analgesic dosing, plus predictors of MACE and Thrombolysis In Myocardial Infarction (TIMI) 0–1 flow pre-PCI using logistic regression.
Results
10,547 patients were included (female: 2,775 [26.3%]). Opioids were administered to 1,585 (57%) females and 5,068 (65%) males (p<0.001). Adjusted 30-day MACE was similar between opioid groups in both sexes (female: OR 1.21, CI 0.82–1.79, p=0.34; male: OR 0.89, 0.68–1.16, p=0.40). Median pain score at presentation was 6 (IQR 4,8) for both sexes. Median opioid dose was 2.5 mg (IQR 0,10) in females and 5 mg (IQR 0,10) in males (p<0.001), with similar pain relief achieved. Adjusted rates of TIMI 0–1 pre-PCI were higher in patients administered opioids (female: OR 2.83, CI 2.14–3.56, p<0.001; male: OR 2.95, CI 2.49–3.49, p<0.001).
Conclusions
Female patients undergoing PCI received less opioid analgesia, but no sex-differences in pre-hospital pain scores were seen. Opioid administration was associated with impaired antegrade flow in the culprit artery in both sexes, but not short-term MACE. Randomised trials evaluating the clinical implications of opioid administration in ACS with sex subgroup analyses are needed to guide clinical practice.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Melbourne Interventional GroupVictorian Cardiac Outcomes Registry
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Affiliation(s)
- E Nan Tie
- Monash University, Melbourne, Australia
| | - H Fernando
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - Z Nehme
- Monash University, Melbourne, Australia
| | - D Dinh
- Monash University, Melbourne, Australia
| | - E Andrew
- Monash University, Melbourne, Australia
| | - A Brennan
- Monash University, Melbourne, Australia
| | - S Zaman
- Westmead Hospital, Sydney, Australia
| | - D Liew
- Monash University, Melbourne, Australia
| | | | - J Lefkovits
- Royal Melbourne Hospital, Melbourne, Australia
| | - K Peter
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - S J Duffy
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - J Shaw
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - K Smith
- Monash University, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Cardiology, Melbourne, Australia
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38
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Nan Tie E, Dinh D, Clark D, Ajani AE, Brennan A, Cohen N, Dagan M, Shaw J, Sebastian M, Freeman M, Oqueli E, Reid C, Kaye D, Stub D, Duffy SJ. Trends in intra-aortic balloon pump use in cardiogenic shock in the post-SHOCK II trial era. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial infarction complicated by cardiogenic shock (MI-CS) has a poor prognosis, even with early revascularisation. Previously, intra-aortic balloon pump (IABP) use was thought to improve outcomes, but the SHOCK-II trial in 2012 found no survival benefit.
Purpose
This study aimed to determine the trends in IABP use in patients with MI-CS undergoing percutaneous intervention (PCI) over time and characteristics associated with use.
Methods
Between 2005–2018, patients presenting with MI-CS that underwent percutaneous coronary intervention (PCI) at a hospital participating in the Melbourne Interventional Group Registry were included. The primary outcome was the trend in IABP use over time. Secondary outcomes included mortality, 30-day MACCE (major adverse cardiovascular and cerebrovascular events) and predictors of outcome, determined via logistic regression.
Results
Of the 1,110 patients identified, IABP was used in 478 (43%). IABP was used more in patients with left main and left anterior descending culprit lesions (62% vs. 46%), lower ejection fraction (<35%; 18% vs. 11%), and pre-procedural inotrope use (81% vs. 73%), all p<0.05. IABP use was associated with higher inpatient bleeding (18% vs. 13%) and 30-day MACCE (58% vs. 51%), both p<0.05. The rate of MI-CS increased over time, but after 2012 there was a decline in IABP use (Figure 1). IABP use was a predictor of 30-day MACCE (OR 1.6, 95% CI 1.18–2.29, p=0.003). However, IABP was not associated with in-hospital, 30-day or long-term mortality (45% vs. 47%, p=0.44; 46% vs. 50%, p=0.25; 60% vs. 62%, p=0.39).
Conclusions
Consistent with the SHOCK II trial, IABP use is not associated with reduced short- or long-term mortality, but in this study was associated with increased short-term adverse events. IABP use is declining, but is still used in sicker patients with greater myocardium at risk, given limited alternatives.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Melbourne interventional group
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Affiliation(s)
- E Nan Tie
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - D Dinh
- Monash University, Melbourne, Australia
| | - D Clark
- Austin Hospital, Melbourne, Australia
| | - A E Ajani
- Royal Melbourne Hospital, Melbourne, Australia
| | - A Brennan
- Monash University, Melbourne, Australia
| | - N Cohen
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - M Dagan
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - J Shaw
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | | | - M Freeman
- Eastern Health, Melbourne, Australia
| | - E Oqueli
- Ballarat Health Services, Ballarat, Australia
| | - C Reid
- Monash University, Melbourne, Australia
| | - D Kaye
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - S J Duffy
- The Alfred Hospital, Cardiology, Melbourne, Australia
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Fernando H, Duong T, Huynh K, Noonan J, Shaw J, Duffy S, Nehme Z, Smith K, Myles P, Meikle P, Peter K, Stub D. Lignocaine versus opioids in coronary intervention: assessing antiplatelet activity and ticagrelor levels (LOCAL) study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Opioid analgesia impairs the bioavailability and antiplatelet effect of oral P2Y12 inhibitors prompting investigation of mitigation strategies including identifying alternative analgesic agents.
Purpose
To assess the impact of intravenous fentanyl and lignocaine on the bioavailability and antiplatelet effect of ticagrelor in patients with unstable angina and non-ST elevation myocardial infarction, as well as their procedural analgesic efficacy and safety.
Methods
The LOCAL trial was a prospective, single centre, double-blind, randomized, controlled trial where intravenous lignocaine was the experimental analgesic agent assessed in this trial compared to intravenous fentanyl as procedural analgesia during coronary angiography and percutaneous coronary intervention. Patients with an indication for dual antiplatelet therapy and no contraindication were given 180mg of ticagrelor orally as integral tablets with 250 mL of tap water at the end of the case. Blood was sampled at time 0, 0.5, 1, 2 and 4 hours post administration of ticagrelor for pharmacokinetic and comprehensive pharmacodynamic analysis.
Results
Seventy patients undergoing coronary angiography with an indication for ticagrelor loading were included in the pharmacokinetic and pharmacodynamic analysis. Plasma ticagrelor levels at 2 h post loading dose were significantly lower in the fentanyl compared to lignocaine treatment arm (476 vs. 792 ng/mL, p=0.02, see figure 1). The area under the plasma-time curves for ticagrelor (987 vs. 2189 ng.h/mL, p=0.001) and its active metabolite (173 vs. 394 ng.h/mL, p<0.001) were both significantly lower in the fentanyl arm. Platelet reactivity assessed by the VerifyNow assay was higher at all time points after baseline in the fentanyl compared to lignocaine arm. The VASP flow cytometry assay demonstrated higher platelet reactivity at 2 hours in the fentanyl group (40% vs. 22% platelet reactivity index, p=0.001). The Multiplate Analyzer demonstrated higher platelet reactivity in the fentanyl arm at 60 minutes (43 vs. 26 area under the curve units, p=0.001) as did expression of activated platelet GpIIb/IIIa receptor (2829 vs. 1426 geometric mean fluorescence intensity (GMFI), p=0.006) and P-selectin (439 vs. 211 GMFI, p=0.001). High on-treatment platelet reactivity (HPR) was significantly higher in the fentanyl arm at 60 min using the MPA (41% vs. 9%, p=0.002) and 120 min using the VFN (30% vs. 3%, p=0.003) and VASP (37% vs. 6%, p=0.002) assays (see figure 2). Both drugs were well tolerated with a high level of patient satisfaction (fentanyl 94% vs. lignocaine 97%, p=0.56).
Conclusion(s)
Unlike fentanyl, lignocaine does not impair the bioavailability or delay the antiplatelet effect of ticagrelor. Both drugs were well tolerated and effective with a high level of patient satisfaction for procedural analgesia. Systemic pain medication during PCI should be reconsidered and if performed, lignocaine is a beneficial alternative to fentanyl.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): TBA Figure 1. Ticagrelor and AM pharmacokineticsFigure 2. Ticagrelor pharmacodynamics
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Affiliation(s)
- H Fernando
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - T Duong
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - K Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J Noonan
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J Shaw
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - S Duffy
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - Z Nehme
- Monash University, Melbourne, Australia
| | - K Smith
- Monash University, Melbourne, Australia
| | - P Myles
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - P Meikle
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - K Peter
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Cardiology, Melbourne, Australia
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Morgan R, Clamp A, Ryder W, Wheeler C, Buckley E, Truelove J, Murphy A, Hasan J, Mitchell C, Burghel G, White D, Price M, Bhaskar S, Shaw J, Dive C, Wallace A, O'Connor J, Rothwell D, Edmondson R, Jayson G. 731P Multi-maintenance olaparib in relapsed, platinum-sensitive BRCA-mutant high-grade serous ovarian carcinoma (MOLTO): A phase II feasibility study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Murphy M, Newby J, Butow P, Joubert A, Kirsten L, Shaw J, Shepherd H, Andrews G. A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy ( iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety. Internet Interv 2021; 26:100449. [PMID: 34504779 PMCID: PMC8416957 DOI: 10.1016/j.invent.2021.100449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Evaluate the feasibility, acceptability and potential efficacy of a form of online therapy for clinical depression and/or anxiety in people living with advanced cancer. METHODS A single-arm open trial of a six-lesson clinician-supervised, internet-delivered cognitive behavioural therapy (iCBT) transdiagnostic intervention (iCanADAPT Advanced) was undertaken. Qualitative (semi-structured telephone interview conducted at 3-months) and quantitative data (questionnaires collected at pre-, post-, and 3-month follow-up) were analysed. RESULTS 27 participants partook (26 women, 56% breast cancer, mean age 56yo; average number of mental health diagnoses 1.8, with majority (81%) meeting criteria for generalised anxiety disorder). Feasibility - Unanticipated numbers (48%) of participants had physical health deterioration (cancer progression or death). iCBT had high adherence overall (completion rates: 37% did 6 lessons; 70% did 4 lessons) but adherence was higher for those whose cancer remained stable (completion rates: 43% did 6 lessons; 85% did 4 lessons). Acceptability - the intervention was acceptable to the majority of participants, with high treatment satisfaction. Advisory data was achieved regarding future versions. Potential efficacy - regardless of physical health status, participants who completed the iCBT showed a significant decrease over time in anxiety and depression symptoms. CONCLUSIONS Online therapies may be useful in assisting those living with advanced cancer dealing with clinical depression and anxiety disorders. The specific modality of clinician supervised iCBT has significant potential to be a suitable modality of online therapy.
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Affiliation(s)
- M.J. Murphy
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW, Sydney, NSW 2010, Australia
- Corresponding author.
| | - J.M. Newby
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW, Sydney, NSW 2010, Australia
- School of Psychology, UNSW, NSW 2052, Australia
| | - P. Butow
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
| | - A. Joubert
- School of Psychology, UNSW, NSW 2052, Australia
| | - L. Kirsten
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
- Nepean Cancer Care Centre, NSW 2747, Australia
| | - J. Shaw
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
| | - H.L. Shepherd
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
| | - G. Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW, Sydney, NSW 2010, Australia
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Shaw J, Scotchman E, Chandler N, Chitty LS. PREIMPLANTATION GENETIC TESTING: Non-invasive prenatal testing for aneuploidy, copy-number variants and single-gene disorders. Reproduction 2021; 160:A1-A11. [PMID: 32130205 DOI: 10.1530/rep-19-0591] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
The discovery of cell-free fetal DNA (cffDNA) in maternal plasma has enabled a paradigm shift in prenatal testing, allowing for safer, earlier detection of genetic conditions of the fetus. Non-invasive prenatal testing (NIPT) for fetal aneuploidies has provided an alternative, highly efficient approach to first-trimester aneuploidy screening, and since its inception has been rapidly adopted worldwide. Due to the genome-wide nature of some NIPT protocols, the commercial sector has widened the scope of cell-free DNA (cfDNA) screening to include sex chromosome aneuploidies, rare autosomal trisomies and sub-microscopic copy-number variants. These developments may be marketed as 'expanded NIPT' or 'NIPT Plus' and bring with them a plethora of ethical and practical considerations. Concurrently, cfDNA tests for single-gene disorders, termed non-invasive prenatal diagnosis (NIPD), have been developed for an increasing array of conditions but are less widely available. Despite the fact that all these tests utilise the same biomarker, cfDNA, there is considerable variation in key parameters such as sensitivity, specificity and positive predictive value depending on what the test is for. The distinction between diagnostics and screening has become blurred, and there is a clear need for the education of physicians and patients regarding the technical capabilities and limitations of these different forms of testing. Furthermore, there is a requirement for consistent guidelines that apply across health sectors, both public and commercial, to ensure that tests are validated and robust and that careful and appropriate pre-test and post-test counselling is provided by professionals who understand the tests offered.
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Affiliation(s)
- J Shaw
- London North Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
| | - E Scotchman
- London North Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
| | - N Chandler
- London North Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
| | - L S Chitty
- London North Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
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Dawson A, Wainwright V, Shaw J, Senior J, Fazel S, Perry A, Walker T, Pratt D. Processes and challenges associated with establishing a linked national suicide database across the criminal justice system. Int J Popul Data Sci 2021; 6:1376. [PMID: 34189275 PMCID: PMC8208520 DOI: 10.23889/ijpds.v6i1.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction There is a wealth of data contained within healthcare and criminal justice system (CJS) datasets that, if successfully linked, could provide more information about this population, particularly those offenders who die in non-custodial CJS settings where, comparatively, much less is known. Objectives This study aims to determine feasibility of conducting data linkage across key criminal justice datasets and outline the processes, methodological considerations and any other implications of setting up such a linkage. Method Five CJS datasets were identified for potential inclusion for linkage with Office for National Statistics (ONS) mortality data. Respective data teams were contacted, and scoping discussions were held via email, telephone contact and in person. Information was sought on available data, quality and completeness, unique identifiers, processes for record matching, cost implications, estimated timescales, required approvals, data security considerations and quality of data. Results All five datasets were deemed important to include and responses from data teams suggest that the proposed linkage is both feasible and valuable, within a reasonable timeframe and with minimal associated costs. The discovery of an additional ‘spine’ dataset provides a more effective method of record matching by linking police identifiers to unique prison and probation identifiers. Conclusions The proposed linkage could highlight key points across the criminal justice system at which to target suicide prevention strategies. A more comprehensive linkage, including healthcare services, would further extend the opportunity to target interventions.
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Affiliation(s)
- Alice Dawson
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Verity Wainwright
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jane Senior
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK
| | - Amanda Perry
- Department of Health Sciences, University of York, UK
| | - Tammi Walker
- School of Social Sciences, Humanities & Law, Teesside University, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Stenson C, Menne T, Osborne W, Publicover A, Kennedy H, Shaw J, Dewhurst F, Stocker R, Vidrine J. THE PATIENT AND CARER EXPERIENCE OF CHIMERIC ANTIGEN RECEPTOR T‐CELL THERAPY FOR RELAPSED/REFRACTORY B‐CELL LYMPHOMA AT A UK REGIONAL CENTRE. Hematol Oncol 2021. [DOI: 10.1002/hon.93_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- C. Stenson
- Freeman Hospital Clinical Haematology Newcastle upon Tyne UK
| | - T. Menne
- Freeman Hospital Clinical Haematology Newcastle upon Tyne UK
| | - W. Osborne
- Freeman Hospital Clinical Haematology Newcastle upon Tyne UK
| | - A. Publicover
- Freeman Hospital Clinical Haematology Newcastle upon Tyne UK
| | - H. Kennedy
- Freeman Hospital Clinical Haematology Newcastle upon Tyne UK
| | - J. Shaw
- Newcastle University Faculty of Medical Sciences Newcastle upon Tyne UK
| | - F. Dewhurst
- Newcastle University Faculty of Medical Sciences Newcastle upon Tyne UK
| | - R. Stocker
- Newcastle University Faculty of Medical Sciences Newcastle upon Tyne UK
| | - J. Vidrine
- Freeman Hospital Clinical Haematology Newcastle upon Tyne UK
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Flynn S, Ibrahim S, Kapur N, Appleby L, Shaw J. Mental disorder in people convicted of homicide: long-term national trends in rates and court outcome. Br J Psychiatry 2021; 218:210-216. [PMID: 32624025 DOI: 10.1192/bjp.2020.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Homicide rates have fallen markedly in the UK over the past decade. There has been little research on whether homicides by people with mental disorder have contributed to this downward trend. Furthermore, there is limited information on trends in court outcomes for people with mental disorder who commit homicide. AIMS To examine trends in general population homicide and homicide by people with mental disorder, and to explore court outcome. METHOD We conducted a national, consecutive case series of homicide in England and Wales (1997-2015). Data were received from the Home Office Statistics Unit of Home Office Science. Clinical information was obtained from psychiatric reports and mental health services. RESULTS There has been a fall in the homicide rate in England and Wales since 2008. Despite this, the relative contribution of mental disorder as a proportion of all homicide has increased. Our findings also showed the inappropriate management of people with serious mental illness convicted of homicide. Of those who committed homicide and were diagnosed with schizophrenia, a third were imprisoned, and there was a marked fall in hospital order referrals. We found this to be linked to substance misuse comorbidity. CONCLUSIONS The proportional increase in homicide by people with schizophrenia suggests more complex factors may be driving rates, such as substance misuse. Addressing substance misuse comorbidity and maintaining engagement with services may help prevent patient homicide. Despite their complex needs, people with serious mental illness continue to be imprisoned. Improvements in assessment and the timely transfer of prisoners to health services are required.
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Affiliation(s)
- Sandra Flynn
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Saied Ibrahim
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Louis Appleby
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
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Zhong S, Senior M, Yu R, Perry A, Hawton K, Shaw J, Fazel S. Risk factors for suicide in prisons: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e164-e174. [PMID: 33577780 PMCID: PMC7907684 DOI: 10.1016/s2468-2667(20)30233-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Rates of suicide among people in prison are elevated compared with people of similar age and sex who are living in the community. Improving assessments and interventions to reduce suicide risk requires updated evidence on risk factors. We aimed to examine risk factors associated with suicide in prisoners. METHODS We did an updated systematic review and meta-analysis of risk factors for suicide among people in prison. We searched five biblographic databases for articles published between Jan 1, 2006, and Aug 13, 2020, and one database for articles published between Jan 1, 1973, and Aug 13, 2020. Eligible studies reported risk factors in individuals who died by suicide while in prison and in controls from the general prison population. Two reviewers independently extracted data for each study using a standardised form. We calculated random-effects pooled odds ratios (ORs) for the association of suicide with demographical, clinical, criminological, and institutional risk factors, and investigated heterogeneity using subgroup and meta-regression analyses. This systematic review is registered with PROSPERO, CRD42020137979. FINDINGS We identified 8041 records through our searches, and used 77 eligible studies from 27 countries, including 35 351 suicides, in the main analysis. The strongest clinical factors associated with suicide were suicidal ideation during the current period in prison (OR 15·2, 95% CI 8·5-27·0), a history of attempted suicide (OR 8·2, 4·4-15·3), and current psychiatric diagnosis (OR 6·4, 3·6-11·1). Institutional factors associated with suicide included occupation of a single cell (OR 6·8, 2·3-19·8) and having no social visits (OR 1·9, 1·5-2·4). Criminological factors included remand status (OR 3·6, 3·1-4·1), serving a life sentence (OR 2·4, 1·3-4·6), and being convicted of a violent offence, in particular homicide (OR 3·1, 2·2-4·2). INTERPRETATION Several modifiable risk factors, such as psychiatric diagnosis, suicidal ideation during the current period in prison, and single-cell occupancy, are associated with suicide among people in prison. Preventive interventions should target these risk factors and include improved access to evidence-based mental health care. Understanding other factors associated with suicide might improve risk stratification and resource allocation in prison services. FUNDING Wellcome Trust, National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley.
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Affiliation(s)
- Shaoling Zhong
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | | | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amanda Perry
- Department of Health Sciences, University of York, York, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Jenny Shaw
- University of Manchester, Greater Manchester Mental Health Trust, Manchester, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
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Lennox C, Stevenson R, Owens C, Byng R, Brand SL, Maguire M, Durcan G, Stevenson C, Shaw J, Quinn C. Using multiple case studies of health and justice services to inform the development of a new complex intervention for prison-leavers with common mental health problems (Engager). Health Justice 2021; 9:6. [PMID: 33598771 PMCID: PMC7890896 DOI: 10.1186/s40352-021-00131-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND People in the criminal justice system have complex needs but often do not make use of services outside of prison, in many cases due to poorly joined up working between health and criminal justice services. The 'Engager' programme aimed to develop a complex collaborative care intervention for people leaving prison with common mental health problems that could support their transition into the community and facilitate joined up working between health, justice and social services. To augment our core intervention theory, we wanted to learn from innovative and forward-thinking services providing interagency support and/or treatment for people experiencing common mental health problems within the criminal justice system. We wanted to identify key elements of interagency practice to understand what was and was not effective in engaging people, maintaining their contact and improving mental health and other aspects of their lives. METHOD We used a multiple case study design with a focused ethnographic approach in four study sites. Data came from three sources (documents, field notes and semi-structured interviews) underwent a framework analysis. RESULTS We identified seven main themes, namely: collaboration, client engagement, client motivation, supervision, therapeutic approach, peers and preparations for ending. Engaging and motivating clients was dependent on the relationship built with the professional. This relationship was developed through building trust and rapport, which required time and respectful, open and honest communication. Professionals were often unable to build this relationship effectively if they did not work in effective interagency collaborations, particularly those which included shared practices and were supported by effective supervision. CONCLUSIONS The multiple case study design contributed insights as to how health and justice services work together. The main themes identified are well known factors in health and justice co-working. However, the novel insights were gleaned examining interdependence and interactions in complex, multifactorial phenomena and practice, in particular the importance of shared practice and supervision models. The approach of selecting a small number of cases representing identified knowledge gaps contributed a valuable addition to the program theory and delivery for an innovative complex intervention.
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Affiliation(s)
- Charlotte Lennox
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Rachel Stevenson
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Christabel Owens
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA UK
| | - Sarah L. Brand
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Mike Maguire
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL Wales
| | - Graham Durcan
- Centre for Mental Health, South Bank Technopark, 90 London Rd, London, SE1 6LD UK
| | - Caroline Stevenson
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Cath Quinn
- Community and Primary Care Research Group, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA UK
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Abstract
BACKGROUND Current UK evidence on the prevalence of personality disorder in homicide is lacking. The aims were to estimate the prevalence of personality disorder in homicide perpetrators from court reports and carry out a dimensional assessment in keeping with the new ICD-11 classification of the prevalence of severe personality disorder. Associations between severe personality disorder and sociodemographic, historical and offence-related characteristics were then explored. METHODS Six hundred court reports from a national case series of homicide perpetrators in England and Wales were analysed using a document-derived version of the Personality Assessment Schedule (PAS-DOC), providing categorical and dimensional personality assessments. The prevalence of personality disorder and severe personality disorder was estimated. Factors associated with the diagnosis of severe personality disorder were examined. RESULTS The prevalence of personality disorder using the PAS-DOC was 56.3% (95% confidence interval 52.3%, 60.3%), compared with 16% as diagnosed in reports. Severe personality disorder was present in 62% (n = 338) of all those with a personality disorder and was significantly associated with homicides of strangers and previous violence. CONCLUSIONS Severe personality disorder is highly prevalent among perpetrators of homicide, and the finding that it is more prevalent when strangers are the victims stresses both the need for early identification of those at risk of developing severe personality disorder and the development of appropriate early preventive interventions. There is also a need for the development of effective treatment and interventions for those with established severe personality disorder and better identification of this level of disorder by psychiatrists. The forthcoming ICD-11 classification should help in this endeavour. © 2021 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Nicola Swinson
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.,Hope House, Bellsdyke Hospital, NHS Forth Valley, UK
| | - Roger Webb
- Mental Health Epidemiology, University of Manchester, UK
| | - Jenny Shaw
- Forensic Psychiatry, University of Manchester, UK
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De Buitléir C, O' Connor E, Satti MM, Shaw J, Liew A. Efficacy and safety of a sodium-glucose co-transporter-2 inhibitor versus placebo as an add-on therapy for people with type 2 diabetes inadequately treated with metformin and a dipeptidyl peptidase-4 inhibitor: a systematic review and meta-analysis of randomised controlled trials. Diabet Med 2021; 38:e14409. [PMID: 32979231 DOI: 10.1111/dme.14409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022]
Abstract
AIMS To conduct a systematic review and meta-analysis to assess the efficacy, safety and tolerability of sodium-glucose co-transporter-2 inhibitors vs placebo as add-on therapy after metformin and dipeptidyl peptidase-4 inhibitor dual therapy in type 2 diabetes. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42018099398). A search was conducted via PubMed, www.clinicaltrials.gov and Cochrane Central Register of Controlled Trials of relevant randomised controlled trials up until 14 August 2020 that compared sodium-glucose co-transporter-2 inhibitors vs placebo as add-on therapy after metformin and dipeptidyl peptidase-4 inhibitor therapy. A random-effects model was used. RESULTS Six randomised controlled trials (1661 participants) met the inclusion criteria. Compared with placebo, sodium-glucose co-transporter-2 inhibitor treatment, as add-on to metformin and dipeptidyl peptidase-4 inhibitor therapy, was associated with a significant reduction in HbA1c level [mean difference -8 mmol/mol, 95% CI -10, -6 (-0.7%, 95% CI -0.9, -0.6); P < 0.00001], in fasting plasma glucose level [mean difference -1.70 mmol/l, 95% CI -1.91, -1.49; P < 0.00001], in weight (mean difference -1.76 kg, 95% CI -2.04, -1.48; P < 0.00001) and in blood pressure (systolic blood pressure: mean difference -3.6 mmHg, 95% CI -4.8, -2.4; P < 0.00001; diastolic blood pressure: mean difference -1.5 mmHg; 95% CI -2.4, -0.6; P = 0.002). Genital mycotic infections (odds ratio 7.37, 95% CI 3.06, 17.76; P < 0.00001) were more common with sodium-glucose co-transporter-2 inhibitors, but there was no significant statistical difference in urinary tract infections (odds ratio 1.16, 95% CI 0.63, 2.13; P = 0.64), in hypoglycaemia (odds ratio 1.36, 95% CI 0.61, 3.04; P = 0.45), or in discontinuation rates due to adverse events (odds ratio 1.52, 95% CI 0.78, 2.97; P = 0.22) between the two groups. CONCLUSIONS In comparison with placebo, add-on therapy with a sodium-glucose co-transporter-2 inhibitor is significantly more efficacious in lowering HbA1c , fasting plasma glucose and weight in people with type 2 diabetes following inadequate glycaemic control with metformin and a dipeptidyl peptidase-4 inhibitor. The rate of discontinuation due to adverse events was similar despite higher risk of genital mycotic infections.
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Affiliation(s)
- C De Buitléir
- Galway University Hospital, Galway, Ireland
- National University of Ireland, Galway, Ireland
| | - E O' Connor
- Portiuncula University Hospital, Ballinasloe, Ireland
| | - M M Satti
- National University of Ireland, Galway, Ireland
| | - J Shaw
- Newcastle University Translational and Clinical Research Institute, Newcastle-upon-Tyne, UK
| | - A Liew
- Galway University Hospital, Galway, Ireland
- National University of Ireland, Galway, Ireland
- Portiuncula University Hospital, Ballinasloe, Ireland
- Newcastle University Translational and Clinical Research Institute, Newcastle-upon-Tyne, UK
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McKenna B, Skipworth J, Forrester A, Shaw J. Prison mental health in-reach teams in Aotearoa New Zealand: A national survey. Psychiatr Psychol Law 2021; 28:774-784. [PMID: 35571595 PMCID: PMC9103505 DOI: 10.1080/13218719.2020.1855269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The STAIR in-reach model of care for prisoners with serious mental illness focuses on screening, triage, assessment, interventions and reintegration by using the principles of assertive community treatment. An evidence base exists for the efficacy for its use in Aotearoa New Zealand. However, little is known about its adoption throughout the country. This national survey of managers of in-reach teams to all prisons (N = 19) aimed to determine the pattern of in-reach service delivery. It compared STAIR in-reach teams with other teams regarding service structure, staffing, interventions, reintegration strategies and training needs. This study signals gains made by adopting the STAIR model (multi-disciplinary team service delivery, 'through the wire' support and use of technologies to assist discharge planning) and potential areas of improvement (further use of psychosocial interventions and training needs). To assist national adoption of STAIR, a review is required to consider the cultural responsivity, gender-responsivity and recovery-orientated characteristics of the model.
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Affiliation(s)
- Brian McKenna
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Jeremy Skipworth
- Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand
| | - Andrew Forrester
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Jenny Shaw
- Offender Health Research Network, University of Manchester, Manchester, UK
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