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Happell B, Gordon S, Hurley J, Foster K, Hazelton M, Lakeman R, Moxham L, Warner T. It takes it out of the textbook: Benefits of and barriers to expert by experience involvement in pre-registration mental health nursing education. J Psychiatr Ment Health Nurs 2024. [PMID: 38509738 DOI: 10.1111/jpm.13042] [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: 11/26/2023] [Revised: 12/22/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Service user involvement in mental health nursing education is beneficial in terms of attitudinal change to reduce stigma, clinical skill development and enhancing understandings of recovery-oriented practice. Service users as experts by experience have not been embedded within pre-registration nursing programs. Consequently, they remain limited in number, ad hoc and frequently tokenistic. Nurse academics responsible for the design and delivery of pre-registration mental health nursing curricula have a potentially important role in facilitating expert by experience involvement in mental health nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE Nurse academics teaching mental health nursing have generally favourable views about the importance of expert by experience involvement. Nurse academics experience significant barriers in supporting the implementation of academic positions for experts by experience, particularly in obtaining funding. The experts by experience could contribute to mental health nursing education does not appear to be clearly understood by nurse academics. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health services aspire to adopt a recovery-oriented approach to practice. Involving experts by experience in mental health nursing education can facilitate increased understanding and appreciation of recovery-oriented practice. Nurse academics could play an important role in supporting the implementation of experts by experience positions in nursing academia. To do so, they require an understanding of the benefits of EBE involvement in academia and the barriers that can be encountered when attempting to facilitate the implementation of such positions. Experts by experience contribute unique expertise, essential to the development of quality mental health services. Conveying this expertise through the educating the future nursing workforce in mental health is essential. ABSTRACT INTRODUCTION: Involving service users in mental health nursing education is ad hoc and minimal, despite growing evidence of its benefits. Insights and experiences of nurse academics teaching mental health to pre-registration students have been underrepresented in the research to date. AIM To seek insights and experiences of nurse academics involved in designing and delivering pre-registration mental health nursing education in Australian universities regarding involving service users in mental health nursing education. METHODS A descriptive qualitative study involving 19 nurse academics from 13 Australian universities, involved in pre-registration mental health nursing education. Data were analysed thematically. RESULTS Participants reported minimal service user involvement. Most sought an increase and identified barriers. Data analysis resulted in five identified themes: (1) value-rich, (2) resource-poor, (3) imperfect processes, (4) 'part, but not all' and (5) unrecognised worth. CONCLUSIONS Increasing meaningful involvement of service-users in mental health nursing education requires support and investment from multiple stakeholders. Nurse academics are crucial stakeholders in understanding the unique expertise service users bring. IMPLICATIONS FOR PRACTICE Service users being central to all aspects of mental health services requires their active participation in the education of health professionals. Nurse academics have an important role in realising this goal.
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Affiliation(s)
- Brenda Happell
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington South, Wellington, New Zealand
| | - John Hurley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Mike Hazelton
- School of Nursing and Midwifery, College of Medicine, Health and Well-being, University of Newcastle, Callaghan, New South Wales, Australia
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Richard Lakeman
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Lorna Moxham
- School of Nursing, Faculty of Science, Health and Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Terri Warner
- ANU Medical School, Australian National University, Acton, New South Wales, Australia
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Happell B, Gordon S, Sharrock J, O Donovan A, Warner T. 'We only come from one perspective': Exploring experiences of allies supporting expert by experience leadership in mental health education. J Psychiatr Ment Health Nurs 2024; 31:3-13. [PMID: 37462261 DOI: 10.1111/jpm.12955] [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: 02/08/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Academics from health professional backgrounds have a crucial role in supporting the implementation and sustainability of academic positions for experts by experience in mental health education. Perspectives and experiences of these academics have yet to be extensively explored. A deeper understanding will add to our understanding of this important role and provide guidance for academics with similar aspirations. AIM The aim of the study was to explore the experiences of supporting academic positions for experts by experience in mental health education. METHODS A qualitative exploratory design was utilised. In-depth interviews were conducted with academics who have actively supported academic positions for experts by experience. RESULTS Allyship was a key theme identified. Participants described allyship as complex, time-consuming and rewarding, through three sub-themes: the tension of allyship, the impact of being an ally and interpersonal and relational issues with health professional academics. CONCLUSIONS Allyship was influenced by the negative attitudes of many health professional academics, who do not appreciate the value of this work. IMPLICATIONS FOR PRACTICE Allyship has a crucial role in enhancing experts by experience leadership in the education of health professionals. Understanding the experience of allyship will assist in further understanding and developing these important roles.
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Affiliation(s)
- Brenda Happell
- Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Julie Sharrock
- Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia
| | - Aine O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Terri Warner
- ANU Medical School, Australian National University, Acton, Australian Capital Territory, Australia
- ACT Mental Health Consumer Network, Canberra, Australian Capital Territory, Australia
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Scholz B, Kirk L, Warner T, O'Brien L, Kecskes Z, Mitchell I. From a Single Voice to Diversity: Reframing 'Representation' in Patient Engagement. Qual Health Res 2024:10497323231221674. [PMID: 38229426 DOI: 10.1177/10497323231221674] [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] [Indexed: 01/18/2024]
Abstract
There has been a growing emphasis on consumer representation in the development of health policy, services, research, and education. Existing literature has critiqued how discourses of representativeness can disempower consumers working in health systems. The context of the current study is consumer engagement in the development of COVID-19 triage policy and practice in a local health service. Consumer engagement has often been an afterthought in the COVID response, with few examples of consumers in agenda-setting or decision-making roles. In the Australian Capital Territory, 26 consumer, carer, and community groups worked together with academics and clinicians to develop these principles. Interviews were conducted with stakeholders (including consumers, clinicians, and other health professionals) to evaluate the development of triage principles. A discursive psychological approach to analysis was used to explore participants' understandings about and constructions of consumers being representative (or not) and how this may reproduce power imbalances against consumers. The results explore two distinct ways in which participants talked about consumer representativeness: the first drawing on rhetoric about consumers as lay members of the public (as distinct from being professionally engaged in the health sector), and the second in terms of consumer representatives being diverse and having intersectional identities and experiences. Expectations about consumers to be representative of the general population may reproduce traditional power imbalances and silence lived experience expertise. These power imbalances may be challenged by a shift in the way representativeness is conceptualised to requiring health services to seek out diverse and intersectionally marginalised consumers.
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Affiliation(s)
- Brett Scholz
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
| | - Lucy Kirk
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
| | - Terri Warner
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
| | - Lauren O'Brien
- ACT Disability, Aged and Carer Advocacy Service, Canberra, ACT, Australia
| | - Zsuzsoka Kecskes
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Imogen Mitchell
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
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Happell B, Gordon S, Sharrock J, Warner T, Donovan AO. The Wisdom of Hindsight: Allies Reflections on Their Role in Supporting the Implementation of Expert by Experience Positions in Academia. Issues Ment Health Nurs 2024; 45:76-84. [PMID: 37616594 DOI: 10.1080/01612840.2023.2241075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 08/26/2023]
Abstract
Experts by experience involvement in mental health education has consistently demonstrated positive attitudinal outcomes including a greater appreciation for recovery-focused practice. Mental health academic allies have played a crucial role in supporting implementation of expert by experience academic positions. To date the inclusion of their views in research is limited. The aim of this study was to explore and present allies' reflections on their involvement in supporting expert by experience academic roles in relation to "hindsight" and "foresight." A qualitative descriptive design was used, involving in-depth semi-structured interviews with allies who had supported the implementation of academic roles for experts by experience. Participants described the wisdom of hindsight. Based on their own experiences they emphasised the importance of, laying the groundwork, facilitating a supportive environment, contributing to meaningful, credible, and sustainable roles, and vision for the future as key to successful implementation. They also described a vision for the expansion of expert by experience roles in mental health education in the future. Allies' reflections suggest the importance of preparation to facilitate a smooth as possible implementation process and enhance the likelihood of successful outcomes. The transition to recovery-focused mental health services requires the attitudes of health professionals to change. The potential of experts by experience to influence attitudinal change can be enhanced by understanding the experiences and reflections of academic allies.
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Affiliation(s)
- Brenda Happell
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
- Nursing Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia
| | - Sarah Gordon
- Department of Psychological Medicine School of Medicine, and Health Sciences, University of Otago, Wellington, Wellington South, New Zealand
| | - Julie Sharrock
- Nursing Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia
| | - Terri Warner
- ANU Medical School Florey Building, Australian National University, Acton, Australia
- ACT Mental Health Consumer Network, Canberra, Australia
| | - Aine O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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McPhee J, Warner T, Cruwys T, Happell B, Scholz B. 'They don't really know why they're here' mental health professionals' perspectives of consumer representatives. Int J Ment Health Nurs 2023; 32:819-828. [PMID: 36727283 DOI: 10.1111/inm.13124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/26/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
There are several barriers to meaningful, non-tokenistic consumer representation in mental health, including stigma and negative attitudes towards consumers. The aim of this study was to examine mental health professionals' perspectives about collaborating with consumer representatives. Semi-structured interviews were conducted with 11 mental health professionals across Australia. Informed by the social identity framework, the findings are discussed in relation to the themes of (1) the need for greater clarity about the roles of consumer representatives, (2) perceptions about whether consumer representatives are held to equal professional standards, (3) understandings of consumers' place in organizational hierarchies, (4) facilitating more meaningful collaboration between consumer representatives and non-consumer health professionals and (5) the blurring of these identities when mental health professionals have lived experience. Findings suggest that the social identities of mental health consumer representatives (along with their organizational roles) are often unclear and need development within healthcare organizations. Leaders can provide guidance on group boundaries to enable effective collaboration. The implications for healthcare organizations and policy include the provision of clear frameworks for collaborative mental healthcare and clear roles, terminology and responsibilities for mental health consumer representatives.
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Affiliation(s)
- Jody McPhee
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Terri Warner
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.,ACT Mental Health Consumer Network, Canberra, Australian Capital Territory, Australia
| | - Tegan Cruwys
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Brenda Happell
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
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Happell B, Gordon S, Sharrock J, Donovan AO, Kenny N, Warner T. There is something about oppression: Allies' perspectives on challenges in relationships with experts by experience. Int J Ment Health Nurs 2023; 32:744-754. [PMID: 36645058 DOI: 10.1111/inm.13117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Accepted: 12/28/2022] [Indexed: 01/17/2023]
Abstract
The genuine and meaningful involvement of Experts by Experience in the education of health professionals has consistently demonstrated positive attitudinal change in students. These changes are essential if policy goals for recovery-oriented services and service user participation in mental health services are to be realized. To date academic roles for Experts by Experience have often relied on the support of allies. Despite the important role allies play, research investigating their experiences is limited. The aim of this research was to explore allies' views on supporting implementation of the academic positions for Experts by Experience. A qualitative exploratory study was undertaken involving in-depth interviews with 16 allies. Data were analysed thematically. Challenges that can exist between allies and Experts by Experience was one theme identified from the data. Allies described occasional difficulties in their relationships with Experts by Experience where they felt they were perceived as representative of members of their broader profession with whom Experts by Experience had negative experiences. The perspectives of allies are presented in four subthemes: relationships imbedded in history; consequences of interpersonal stigma; supportive, protective or paternalistic?; and the passion remains, which describes allies' ongoing commitment to supporting Expert by Experience involvement. Understanding the challenges can assist allies to respond appropriately in a non-judgemental and supportive manner. Trauma informed practice may provide a useful framework to address conflicts and facilitate more positive relationships between allies and Experts by Experience. These positive relationships are essential to maximize the positive benefits of Experts by Experience on future clinicians.
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Affiliation(s)
- Brenda Happell
- Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia.,Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Julie Sharrock
- Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia
| | - Aine O' Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Nuala Kenny
- Health Service Executive Bantry, Cork, Ireland.,Expert by Experience, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Terri Warner
- ANU Medical School, Australian National University, Acton, Australian Capital Territory, Australia.,ACT Mental Health Consumer Network, Canberra, Australian Capital Territory, Australia
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Happell B, Gordon S, Sharrock J, Warner T, O'Donovan A. "Making It Happen": Supporting the Implementation of Positions for Experts by Experience in Mental Health Education. Issues Ment Health Nurs 2022; 43:1022-1029. [PMID: 35913791 DOI: 10.1080/01612840.2022.2095472] [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: 10/16/2022]
Abstract
Significant changes to mental health policy have positioned consumers of mental health services as active participants in all aspects of service design and delivery, leading to the development and expansion of consumer workforce roles (Experts by Experience [EBE]). Negative attitudes of health professions pose a major limitation to the success of these positions. EBE involvement in mental health education has shown favourable outcomes, particularly enhancing more positive attitudes. Unfortunately, these positions remain limited in number and scope and have largely been supported by individual clinical academic champions (allies). This article presents findings from a qualitative study, involving individual interviews that explored the experiences and perceptions of allies who supported the implementation of academic positions for EBE. Data were analysed thematically. "Making it happen" was the overarching theme identified. It comprised the sub-themes: strategic or opportunistic?; developing an argument; using evidence; showing what EBE bring; getting buy-in and utilising existing relationships. The articulation of these processes provides a useful guide to other allies interested in supporting the implementation of these positions. The implementation of further positions will ultimately improve the attitudes of other health professionals towards Expert by Experience roles.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Faculty of Health, Southern Cross University, East Lismore, Australia
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Julie Sharrock
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Happell B, Gordon S, Sharrock J, O'Donovan A, Warner T. 'What's she doing here?' Overcoming barriers to the implementation of Expert by Experience positions in academia. Aust Occup Ther J 2022; 69:689-702. [PMID: 35959799 PMCID: PMC10087197 DOI: 10.1111/1440-1630.12832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/10/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Experts by Experience involvement in the education of health professionals has gained momentum as an important strategy in ensuring quality, person-centred education. Despite being a requirement for occupational therapy programs in Australia and internationally, involvement is variable and limited. Barriers to the implementation of academic roles have been identified, including negative attitudes of colleagues, systemic barriers, and insufficient evidence of their value. Mental health academics who do not identify as having lived experience (referred to as allies) have provided crucial support for Experts by Experience. Understanding their perspectives on implementation barriers and how they can be addressed is crucial to facilitating a broader level of meaningful involvement. METHODS A qualitative exploratory research project was conducted, involving in-depth interviews with mental health academic allies (n = 16) from Australia, Ireland, and New Zealand. Participants were from the disciplines of nursing, occupational therapy, social work, and psychiatry. Data were analysed thematically. FINDINGS Two main themes were identified from the data analysis process: convincing colleagues and dealing with university barriers. Participants described varying attitudes from colleagues towards Experts by Experience, with many not understanding or appreciating their contribution to education and student outcomes. At the university level, reluctance to embrace innovation and funding and other resource shortages presented impediments to the implementation of Expert by Experience roles. Participants described using creative measures to overcome institutional barriers and encourage greater acceptance of such roles by colleagues. CONCLUSION This research describes how allies experienced and overcame barriers they faced when supporting the implementation of academic positions for Experts by Experience. Allies have an important role to play in overcoming systemic barriers, and the approaches they have taken to achieve this may be an important source of learning for others with similar aspirations.
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Affiliation(s)
- Brenda Happell
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia.,School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, Wellington, New Zealand
| | - Julie Sharrock
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,ACT Mental Health Consumer Network, Canberra, Australian Capital Territory, Australia
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Happell B, Donovan AO, Warner T, Sharrock J, Gordon S. Creating or taking opportunity: Strategies for implementing expert by experience positions in mental health academia. J Psychiatr Ment Health Nurs 2022; 29:592-602. [PMID: 35485983 PMCID: PMC9542198 DOI: 10.1111/jpm.12839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/19/2021] [Revised: 01/27/2022] [Accepted: 04/19/2022] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Experts by experience involvement in the education of health professionals demonstrate positive attitudinal change. Meaningful positions for Experts by Experience are limited and ad hoc, due to attitudinal and other barriers to innovation within the higher education sector. Experiences of allies who have supported the implementation of Expert by Experience positions have not been researched. This is important knowledge that could be utilized by potential allies. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Academic allies to experts by experience have a crucial role to play in identifying opportunities to establish, implement and sustain expert by experience positions. Allies who have successfully implemented positions for experts by experience have identified influential factors including: right person, right role, collaboration and coproduction, support, and career pathways. Understanding these factors can provide an important basis for other academics to support a widespread increase in academic roles for experts by experience in mental health education. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Establishing and maintaining genuine relationships with service users require significant attitudinal change on the part of mental health professionals. Involving experts by experience in mental health education provides an innovative approach to the challenging of attitudes and the enhancement of more collegial relationships with service users as colleagues in the workplace. This paper demonstrates the importance of allyship to the establishment, implementation and sustainability of expert by experience roles, and highlights critical factors allies have utilized in support of such roles. Nurses and other mental health professional academics have the potential to become allies and support change and innovation. ABSTRACT: Introduction Experts by experience in academia have demonstrated more positive student attitudes towards relationships with service users. Notwithstanding this supportive evidence, academic positions for EBE have not grown substantially. Enhanced understanding of positions that have been implemented is important knowledge for others with similar aspirations. Aim To enrich understanding of the role of allies in identifying and pursuing opportunities to support academic positions for experts by experience. Methods Qualitative exploratory approach, involving In-depth interviews with allies with expertise in supporting academic positions for experts by experience. Results Participants were enthusiastic about creating or taking opportunities to secure expert by experience involvement within their programs. Factors facilitating success included right person, right role, collaboration and coproduction, support and career pathways. Conclusions Significant barriers have prevented proliferation of academic roles for experts by experience. Despite barriers, allies have been successful in supporting the implementation and sustaining of positions, and gained considerable expertise, which may be invaluable to academics with similar aspirations. Implications for practice Realization of policy goals regarding service user involvement in mental health services requires health professionals with the will to embrace partnerships. By creating and taking opportunities, allies have developed expertise to facilitate implementation of positions more widely.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, Hunter Institute of Medical Research, Priority Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,University College Cork, Cork, Ireland
| | - Aine O Donovan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,ACT Mental Health Consumer Network, Canberra, ACT, Australia
| | - Julie Sharrock
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
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Happell B, Sharrock J, Warner T, O'Donovan A, Hurley E, Gordon S. Changing 'the world for the better': motivations of mental health academics for supporting expert by experience roles in mental health education. J Ment Health 2022:1-8. [PMID: 35766312 DOI: 10.1080/09638237.2022.2091759] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Despite demonstrating positive outcomes in education, academic positions for Experts by Experience in mental health have not been widely implemented. To date positions have been driven by individual champions (allies). Their motivation for this support has not yet been researched. AIMS To deepen understanding of motivations of mental health academics who have championed and supported implementation of EBE positions. METHODS A Qualitative exploratory, study was undertaken involving in-depth individual interviews with 16 academics with experience of actively supporting the implementation of Expert by Experience positions in academia. Data were analysed independently by two researchers using a structured thematic framework. RESULTS Motivations commonly arose from allies' own experiences of working with or exposure to Experts by Experience. Other motivating factors included: belief in the value of specific knowledge and expertise Experts by Experience contributed to mental health education; and, identifying the essential role Experts by Experience play in meeting policy expectations, and the broader philosophy of the university. CONCLUSIONS The motivations identified by allies in this study have implications for Expert by Experience roles. Deeper understanding of motivations to support these roles is essential to arguing for their value, and ultimately producing positive outcomes in the education of health professionals.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, and Hunter Institute of Medical Research, and Priority Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, Australia.,School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Julie Sharrock
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, Australia
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Emma Hurley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sarah Gordon
- Master of Culture, Health and Medicine (Advanced), Research Assistant, School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, Australia
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Gutmann C, Barwari T, Schulte C, Singh B, Theofilatos K, Joshi A, Zampetaki A, Chan M, Armstrong P, Kiechl S, Willeit J, Warner T, Mayr M. MicroRNA biomarkers of platelet function. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.168] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation (BHF), VASCage (Centre for Promoting Vascular Health in the Ageing Community) of the Austrian Research Promotion Agency FFG (COMET program - Competence Centers for Excellent Technologies)
Introduction
Antiplatelet therapy (APT) leads to reduced morbidity and mortality in patients with cardiovascular disease but some still have thrombotic events. Tailoring APT to platelet function is currently limited by a lack of suitable platelet function tests. It has been previously shown that different circulating microRNAs (miRNAs) are derived from platelets and their measurement could provide new markers of platelet reactivity.
Purpose
To compare the release of different platelet miRNAs in response to different platelet agonists.
Methods
Measurements of platelet function were performed by light transmission aggregometry (LTA) in participants of the 2015 follow-up of the Bruneck study (n=338), using the following agonists: arachidonic acid (1mM), adenosine diphosphate (5µM, 20µM), collagen (0.4 µg/ml, 4 µg/ml, 10µg/ml), TRAP-6 amide (25µM) and U46619 (10µM). LTA platelet releasates were then used for RT-qPCR measurements of five platelet-enriched miRNAs (miR-21, miR-126, miR-150, miR-197, miR-223). Platelet-poor plasma (PPP) served as negative control.
Results
Platelet activation led to aggregation and extracellular release of miRNAs, with aspirin users (n=155) showing significantly lower miRNA release than non-aspirin users (n=183). Agonist responsiveness differed among miRNAs, with miR-21 being hyperresponsive to arachidonic acid and miR-150 being hyperresponsive to adenosine diphosphate, whilst release of miR-126, miR-197 and miR-223 was strongest to collagen (10µg/ml). In non-aspirin users, inflammation markers such as granulocyte counts or C-reactive protein correlated positively with platelet-derived miRNAs measured in PPP, whilst they correlated negatively with platelet-derived miRNAs measured in releasates. These effects were absent in aspirin users.
Conclusions
MiRNAs released from activated platelets can be reliably detected in PPP and platelet releasates. Preferential release of miRNAs in response to specific agonists suggests a selective release mechanism. Elevated PPP levels and decreased releasate levels of platelet-derived miRNAs in inflammatory environments suggest platelet exhaustion ex vivo due to platelet pre-activation.
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Affiliation(s)
- C Gutmann
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - T Barwari
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - C Schulte
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - B Singh
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - K Theofilatos
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - A Joshi
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - A Zampetaki
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - M Chan
- Queen Mary University of London, The Blizard Institute, Barts and The London School of Medicine and Dentistry , London , United Kingdom of Great Britain & Northern Ireland
| | - P Armstrong
- Queen Mary University of London, The Blizard Institute, Barts and The London School of Medicine and Dentistry , London , United Kingdom of Great Britain & Northern Ireland
| | - S Kiechl
- Medical University of Innsbruck, Department of Neurology , Innsbruck , Austria
| | - J Willeit
- Medical University of Innsbruck, Department of Neurology , Innsbruck , Austria
| | - T Warner
- Queen Mary University of London, The Blizard Institute, Barts and The London School of Medicine and Dentistry , London , United Kingdom of Great Britain & Northern Ireland
| | - M Mayr
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
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Happell B, O'Donovan A, Sharrock J, Warner T, Gordon S. Understanding the impact of expert by experience roles in mental health education. Nurse Educ Today 2022; 111:105324. [PMID: 35278940 DOI: 10.1016/j.nedt.2022.105324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/30/2021] [Revised: 01/18/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND People with lived experience of mental distress and mental health service use (known as Experts by Experience) in mental health education have demonstrated positive outcomes and attitudinal change in students. Despite these findings, academic positions for Experts by Experience remain limited in number and scope, and the implementation of positions has primarily been driven by supportive mental health academics (known as allies). Less is known about the impact on Experts by Experience themselves, their colleagues and the broader organisation. OBJECTIVES The aim of this research is to better understand the impact of EBE on the universities they work in, from the perspectives of allies who have supported the implementation and sustainability of their positions. DESIGN Qualitative exploratory. SETTINGS Academic institutions providing education programs for health professionals, and had implemented academic positions for Experts by Experience, in Australia, Ireland and New Zealand. PARTICIPANTS Allies involved in supporting the implementation of Experts by Experience roles in mental health education (n = 16). METHODS Ethics approval was obtained prior to study commencement. Individual in-depth interviews were conducted with 16 participants, based on a broad interview guide. Data were analysed to identify main themes. Analysis was conducted independently by two researchers and reviewed by the team. RESULTS Participants described the impact of Experts by Experience in mental health education as positively influencing the participants themselves, the Experts by Experience, their colleagues, and the broader organisational culture. CONCLUSIONS Support for the implementation of Experts by Experience roles must move beyond the efforts of allies alone. Demonstrating the benefits beyond student outcomes is crucial to achieving this goal. The positive impact for a broader range of stakeholders provides further evidence of the value of Experts by Experience and supports the need to develop a more strategic approach to implementation of these roles.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Hunter Institute of Medical Research, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Priority Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia.
| | - Aine O'Donovan
- Office of Deputy President and Registrar, University College Cork, Cork, Ireland; School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland.
| | - Julie Sharrock
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Terri Warner
- Master of Culture, Health and Medicine (Advanced), School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; ACT Mental Health Consumer Network, Genge Street, Canberra 2600, Australia.
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, PO Box 7343, Wellington South, New Zealand.
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13
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Happell B, Warner T, Waks S, O'Donovan A, Manning F, Doody R, Greaney S, Goodwin J, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, van der Vaart KJ, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Something special, something unique: Perspectives of experts by experience in mental health nursing education on their contribution. J Psychiatr Ment Health Nurs 2022; 29:346-358. [PMID: 34032356 DOI: 10.1111/jpm.12773] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 09/27/2020] [Revised: 02/01/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal. ●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking. ●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues. ●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. ABSTRACT Introduction Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods Qualitative exploratory research methods were employed. In-depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, Hunter Institute of Medical Research, Priority Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,ACT Mental Health Consumer Network, Canberra, ACT, Australia
| | - Shifra Waks
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, ACT, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Annaliina Vatula
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | | | - Jerry Allon
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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White M, Wilsmore B, Shewa M, Warner T, Walker R, Williams T. Outcomes Following Atrial Fibrillation Hospitalisation in a Regional Australian Setting Between 2011 and 2019. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.431] [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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15
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Happell B, Warner T, Waks S, O'Donovan A, Manning F, Doody R, Greaney S, Goodwin J, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, der Vaart KJV, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Becoming an Expert by Experience: Benefits and Challenges of Educating Mental Health Nursing Students. Issues Ment Health Nurs 2021; 42:1095-1103. [PMID: 34156892 DOI: 10.1080/01612840.2021.1931583] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Expert by Experience involvement in mental health nursing education is increasing in popularity as a teaching technique. The emerging literature attests to its benefits in enriching the educational experience for students. Much less attention has been devoted to the experience from the perspective of the Experts themselves. To address this gap and ensure this important perspective is captured and considered, the aim of this paper is to present the perceptions and experiences of Experts by Experience in delivering an educational module to mental health nursing students. A qualitative exploratory approach was adopted, involving in-depth individual interviews with Experts by Experience who delivered a learning module to nursing students in Australia and Europe. Data were analysed thematically. Analysis produced two overarching themes: Empowerment, and Challenges. Challenges included six sub-themes: Being constructive, not just critical; Time to unpack and reflect; Need for co-production and support from nursing academics; Emotional and practical support; maintaining personal boundaries; and adapting to the audience. These findings make a significant contribution to a broader understanding of Expert by Experience involvement in mental health education. The use of standards to maintain integrity and avoid tokenism is recommended.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Terri Warner
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Shifra Waks
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Aine O'Donovan
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Fionnuala Manning
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Rory Doody
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Sonya Greaney
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - John Goodwin
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Chris Platania-Phung
- Department of Counselling, Australian College of Applied Psychology, Sydney, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Mari Lahti
- Faculty of Health and Social Sciences, Turku University of Applied Sciences, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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16
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Warner T, Ingram S. Improving access to MSK services in primary care: How applying quality improvement methodology can optimise the implementation of remote consultations. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.131] [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: 10/19/2022]
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Koohi N, Bancroft M, Patel J, Castro P, Akram H, Warner T, Kaski D. Saccadic bradykinesia in Parkinson's disease: Preliminary observations. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119532] [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: 10/20/2022]
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18
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Happell B, O'Donovan A, Sharrock J, Warner T, Gordon S. They are a different breed aren't they? Exploring how experts by experience influence students through mental health education. Int J Ment Health Nurs 2021; 30 Suppl 1:1354-1365. [PMID: 34021530 DOI: 10.1111/inm.12881] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/15/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/23/2022]
Abstract
Experts by Experience (EBE) in mental health are increasingly becoming involved in the education of health professionals. In response, research findings suggest positive attitudinal change towards people who experience mental distress and enhanced appreciation of recovery and person-centred approaches to practice. However, this growing body of evidence has not resulted in the broad adoption of these roles in academia. The perspectives of academics instrumental in implementing academic positions for EBE (referred to as allies) have not yet been articulated. Acknowledging this gap, the aim of this research was to explore experiences of allies involved in implementing EBE positions in academia regarding the impact of EBE led education on students. Qualitative exploratory methods were used involving in-depth interviews with allies. Data were analysed thematically. Participants observed significant positive impacts on students, as evidenced through four themes: contextualized learning, enhancing reflection, feedback from the clinical field, and students' own lived experience. The fifth sub-theme, Challenging experiences were observed to potentially detract from the student experience in some instances. Overall, participants were very supportive of EBE involvement and were confident this approach produced more person-centred and recovery-oriented clinicians, with the skills, knowledge and attitudes needed to work as practitioners. These findings support previous research and suggest positive implications for clinical practice and for students with their own mental health challenges.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, Hunter Institute of Medical Research, Priority Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Cluster for Resilience and Well-being, CQUniversity, Callaghan, New South Wales, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Julie Sharrock
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,ACT Mental Health Consumer Network, Canberra, Australian Capital Territory, Australia
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
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Scholz B, Happell B, Gordon S, Warner T, Roper C, Ellis P, Waks S, Platania-Phung C. 'People Just Need to Try It to Be Converted!': A Picture of Consumer Mental Health Research in Australia and New Zealand. Issues Ment Health Nurs 2021; 42:249-255. [PMID: 32790538 DOI: 10.1080/01612840.2020.1795763] [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: 10/23/2022]
Abstract
A range of barriers that impede collaborations between consumer researchers and other researchers have been identified, despite clear acknowledgement of the benefits of this approach in the literature. Recent research has questioned whether the costs of collaborative research outweigh the benefits. The overarching aim of the current study is to better understand non-consumer researchers' attitudes to, and issues concerning, engagement with consumer researchers. Non-consumer researchers from mental health disciplines were invited to participate in the cross-sectional Consumers as Researchers in Mental Health survey, and to respond to open-ended questions about their experiences of collaborative research with consumer researchers. The findings demonstrate a range of benefits associated with collaborations with consumer researchers - including increased relevance and credibility of research, and greater translation of research findings into changes in health policy, service, research and education. Collaborations were found to be varied and not limited by research design, decision-making styles, or research topic. Understanding these benefits within the context of identified barriers can make an important contribution to the proliferation of mental health consumer researcher roles.
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Affiliation(s)
- Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Brenda Happell
- School of Nursing and Midwifery, Faculty of Health and Medicine, Hunter Medical Research Institute, and Priority Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Terri Warner
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,ACT Mental Health Consumer Network, Canberra, Australia
| | - Cath Roper
- Centre for Psychiatric Nursing, Department of Nursing, Faculty of Health Sciences, The University of Melbourne, Victoria, Australia
| | - Pete Ellis
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand Wellington South
| | - Shifra Waks
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Chris Platania-Phung
- Australian College of Applied Psychology, Conjoint Lecturer, School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
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20
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Happell B, Gordon S, Roper C, Ellis P, Waks S, Warner T, Scholz B, Platania-Phung C. Establishing an expert mental health consumer research group: Perspectives of nonconsumer researchers. Perspect Psychiatr Care 2021; 57:33-42. [PMID: 32346891 DOI: 10.1111/ppc.12520] [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: 02/24/2020] [Revised: 03/29/2020] [Accepted: 04/12/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To explore the views and opinions of nonconsumer researchers to the concept of an Expert Consumer Researcher Group. DESIGN AND METHODS Qualitative exploratory involving individual interviews with nonconsumer mental health researchers experienced in working collaboratively with consumer researchers. Data were analyzed thematically. FINDINGS Participants viewed the concept positively, albeit with caution. Perceived advantages included: greater visibility and enhanced access; collegiality; sharing and creating expertise; broader acceptance; making it mandatory; and structure and location. Participants were concerned about potential tokenism and implementation barriers. PRACTICE IMPLICATIONS Consumer involvement enhances the quality and relevance of research, potentially impacting clinical practice.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, and Hunter Medical Research Institute, University of Newcastlee, Callaghan, New South Wales, Australia
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, Wellington South, New Zealand
| | - Cath Roper
- Centre for Psychiatric Nursing, Department of Nursing, Faculty of Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
| | - Pete Ellis
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, Wellington South, New Zealand
| | - Shifra Waks
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Terri Warner
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia.,ACT Mental Health Consumer Network, Canberra, Australian Capital Territory, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Chris Platania-Phung
- Australian College of Applied Psychology, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
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21
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Happell B, Gordon S, Roper C, Scholz B, Ellis P, Waks S, Warner T, Platania-Phung C. 'It is always worth the extra effort': Organizational structures and barriers to collaboration with consumers in mental health research: Perspectives of non-consumer researcher allies. Int J Ment Health Nurs 2020; 29:1168-1180. [PMID: 32596992 DOI: 10.1111/inm.12757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/23/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023]
Abstract
Consumer collaboration in mental health research has demonstrated significant benefits and reflects both contemporary research practice and policy goals for the expected genuine involvement of consumers in all aspects of mental health service delivery. Notable barriers have been identified as impeding consumer researcher positions that must be better understood and ultimately addressed. The aim of this research was to better understand these barriers from the perspectives of non-consumer researchers who have worked collegially with consumer researchers. We developed a self-report survey, Consumers as Researchers in Mental Health (CaRiMH) and administered it to non-consumer mental health researchers in Australia and New Zealand. Findings suggest a lack of organizational structures to support both consumer research and capacity building of consumer researchers. Most consumer researchers were employed casually with no set hours. Although consumer researchers were typically remunerated, inadequate funding and inflexibility of employment were highlighted as major barriers. There was variation in opinion about token involvement of consumer researchers and some uncertainty about whether these roles, where they existed, were actively resisted. Despite the acknowledged barriers, participants were positive about collaborations with consumer researchers. Overall, findings suggest consumer research is unlikely to proliferate without greater attention to organizational structures. A systematic and strategic approach to advancing mental health consumer research is required, including extra-organizational policy factors.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, and Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Cath Roper
- Centre for Psychiatric Nursing, Department of Nursing, Faculty of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Pete Ellis
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Shifra Waks
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Terri Warner
- Faculty of Health and Medicine, School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.,ACT Mental Health Consumer Network, Canberra, Australian Capital Territory, Australia
| | - Chris Platania-Phung
- Australian College of Applied Psychology, School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
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Affiliation(s)
- Cameron Moss
- University of Canberra, Centre for Applied Psychology, Canberra, Australia
| | - Terri Warner
- The Australian National University, ANU Medical School, Canberra, Australia
- ACT Mental Health Consumer Network, Canberra, Australia
| | - Brenda Happell
- University of Newcastle, School of Nursing and Midwifery, Newcastle, Australia
| | - Brett Scholz
- The Australian National University, ANU Medical School, Canberra, Australia
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Warner T, Williams T. 640 Patient Reported Characteristics of ACS Symptomology: a Tertiary Hospital Experience. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.647] [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: 10/23/2022]
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Jennings L, Lane S, Bogdon C, Warner T, Ward R, Brady K. 176 Emergency Department Utilization after Emergency Department-Initiated Buprenorphine. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.182] [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: 10/25/2022]
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Williams T, Condon J, Davies A, Brown J, Matheson L, Warner T, Savage L, Collins N, Boyle A, Inder K. A Nursing-Led Examination of Radial Artery Diameters, Occlusion Rates and Vascular Complications Utilising Ultrasound Measurements. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1013] [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: 10/28/2022]
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Preza E, Hardy J, Warner T, Wray S. Review: Induced pluripotent stem cell models of frontotemporal dementia. Neuropathol Appl Neurobiol 2017; 42:497-520. [PMID: 27291591 DOI: 10.1111/nan.12334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/15/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/11/2022]
Abstract
The increasing prevalence of dementia in the ageing population combined with the lack of treatments and the burden on national health care systems globally make dementia a public health priority. Despite the plethora of important research findings published over the past two decades, the mechanisms underlying dementia are still poorly understood and the progress in pharmacological interventions is limited. Recent advances in cellular reprogramming and genome engineering technologies offer an unprecedented new paradigm in disease modeling. Induced pluripotent stem cells (iPSCs) have enabled the study of patient-derived neurons in vitro, a significant progress in the field of dementia research. The first studies using iPSCs to model dementia have recently emerged, holding promise for elucidating disease pathogenic mechanisms and accelerating drug discovery. In this review, we summarize the major findings of iPSC-based studies in frontotemporal dementia (FTD) and FTD overlapping with amyotrophic lateral sclerosis (FTD/ALS). We also discuss some of the main challenges in the use of iPSCs to model complex, late-onset neurodegenerative diseases such as dementias.
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Affiliation(s)
- E Preza
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, WC1N 1PJ, UK.
| | - J Hardy
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, WC1N 1PJ, UK
| | - T Warner
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, WC1N 1PJ, UK
| | - S Wray
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, WC1N 1PJ, UK
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Heimburger D, Blevins M, Carothers CL, Warner T, Vermund S. Outcomes of the NIH fogarty international clinical research program:
Early alumni publications. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.583] [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: 10/23/2022] Open
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Blevins M, Smart A, Warner T, Carothers CL, Vermund S, Heimburger D. Outcomes and collaborations among alumni of the NIH Fogarty International
Clinical Research Program: Results from a 2013 impact evaluation. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.008] [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: 10/24/2022] Open
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McCourt A, Warner T, Bjorkqvist M. B28 Adipose Tissue Gene Expression Analyses In Huntington's Disease. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Silajd i E, Kalliolia E, Nambron R, Costelloe S, Martin N, Hill N, Frost C, Watt H, Hindmarsh P, Bjorkqvist M, Warner T. D04 A Study Of The Hypothalamo-pituitary Axes In Huntington's Disease. J Neurol Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.96] [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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Bjorkqvist M, McCourt A, Warner T. A20 Adipose Tissue Alterations In Huntington's Disease. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Peall K, Smith D, Kurian M, Wardle M, Waite A, Hedderly T, Lin J, Smith M, Whone A, Pall H, White C, Lux A, Jardine P, Bajaj N, Lynch B, Kirov G, O'Riordan S, Samuel M, Lynch T, King M, Chinnery P, Warner T, Blake D, Owen M, Morris H. ARE PSYCHIATRIC SYMPTOMS A CORE PHENOTYPE OF MYOCLONUS DYSTONIA SYNDROME CAUSED BY SGCE MUTATIONS? J Neurol Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306103.24] [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: 11/04/2022]
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Kalliolia E, Kalliolia R, Silajdzic E, Nambron R, Hill N, Hindmarsh P, Bjorkqvist M, Warner T. B27 Disruption of melatonin circadian rhythmicity in Huntington's disease (HD). J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sambu N, Dent H, Warner T, Englyst N, Leadbeater P, Hobson A, Calver A, Corbett S, Gray H, Simpson I, Curzen N. 20 What happens to platelet function and vascular inflammation when clopidogrel is withdrawn? Insights using short thrombelastography. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ahmed S, King C, Dorward N, Warner T. Cerebral abscess as a complication of a halo fixation device. Case Reports 2009; 2009:bcr06.2009.2024. [DOI: 10.1136/bcr.06.2009.2024] [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] Open
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Lubner SJ, Chen H, Holen K, LoConte N, Rikkers L, Weber S, Warner T, Eickhoff J, Fass T, Schelman W. A phase II clinical and biological study of lithium carbonate (Li) in patients with low-grade neuroendocrine tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15662 Background: Low-grade neuroendocrine tumors (NETs), such as carcinoid, islet cell tumors, and medullary thyroid carcinomas, respond poorly to chemotherapy, and effective, less toxic therapies are needed. Glycogen Synthase Kinase (GSK)-3β, a multifunctional protein kinase, has been shown to regulate growth and hormone production in NETs. Use of lithium carbonate (Li) in murine models suppressed carcinoid cell growth, reduced GSK-3β levels and reduced expression of chromogranin A. This study assessed the efficacy of Li in patients with NETs. Methods: Eligible pts had pathologically-proven, measurable low-grade NETs. Prior treatment was allowed if completed >4wks prior to registration. Standard eligibility criteria were used, and use of medications affecting Li metabolism or levels were prohibited. A single-arm, open-label, two-stage Phase II design was used. Li was dosed at 300mg orally TID with meals, titrated to a target serum level of 0.8–1.0mmol/L. The primary endpoint was objective tumor response by RECIST. Secondary endpoints included overall survival, progression-free survival, decrease of serum tumor markers, toxicity, and quality of life. Results: 15 pts were enrolled between 10/3/07and 7/17/08; 6 men, 9 women. The median age was 58 (range 47–74). Patients’ diagnoses were carcinoid tumor for 8 subjects, islet cell tumor for 5 subjects, and 2 unknown primary sites. ECOG PS was 0 (6 patients) or 1 (9 patients). Two pts came off study due to side effects (tremor, dizziness/abdominal pain). There were no radiographic responses. Due to an early stopping rule requiring at least 1 objective response in the first 13 evaluable pts, the study was closed to further accrual. 13 patients had pre- and post-therapy biopsies. Evaluation of quality of life and GSK-3β levels in tumor tissue is ongoing. Conclusions: Li was ineffective at obtaining a radiographic response in our 13 evaluable patients who were treated as part of this study. We will determine from tumor biopsies whether Li was effective at phosphorylating GSK-3β in order to make conclusions about GSK-3β as a therapeutic target for future NET treatment strategies. Funded through NIH grant R21CA117117- 01A2 and CTRC grant 1ULRR025011. No significant financial relationships to disclose.
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Affiliation(s)
- S. J. Lubner
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - H. Chen
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - K. Holen
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - N. LoConte
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - L. Rikkers
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - S. Weber
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - T. Warner
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - J. Eickhoff
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - T. Fass
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - W. Schelman
- University of Wisconsin Hospital and Clinics, Madison, WI
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Granata A, Warner T, Schiavo G. The dystonia-associated protein torsinA plays a role in the synaptic vesicle recycling. Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.171] [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: 10/23/2022]
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Gabbott PLA, Warner T, Busby SJ. Catecholaminergic neurons in medullary nuclei are among the post-synaptic targets of descending projections from infralimbic area 25 of the rat medial prefrontal cortex. Neuroscience 2007; 144:623-35. [PMID: 17101227 DOI: 10.1016/j.neuroscience.2006.09.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 09/15/2006] [Accepted: 09/17/2006] [Indexed: 10/23/2022]
Abstract
The infralimbic (IL) 'visceromotor' area of the rat medial prefrontal cortex projects to strategic subcortical nuclei involved in autonomic functions. Central among these targets are the nucleus tractus solitarius (NTS) and the rostral ventrolateral medulla (rVLM). By combining tract-tracing using the anterograde tracer biotinylated dextran amine (BDA) with immunolabeling for tyrosine hydroxylase (TH; an enzyme marker of catecholaminergic neurons), a limited proportion of BDA-labeled IL axonal boutons in the NTS and rVLM was found to be closely associated with TH immunopositive (+) target structures. Such structural appositions were mainly located proximally over the labeled dendritic arbors of identified TH+ neurons. Quantitative ultrastructural examination revealed that in NTS, TH+ dendritic shafts comprised 7.0% of the overall post-synaptic target population innervated by BDA-labeled IL boutons, whereas TH+ dendritic spines represented 1.25% of targets. In rVLM, TH+ shafts represented 9.0% and TH+ spines 2.5% of IL targets. Labeled IL boutons established exclusively asymmetric Gray Type 1 (presumed excitatory) synaptic junctions. The results indicate that subpopulations of catecholaminergic neurons in the NTS and rVLM are among the spectrum of post-synaptic neurons monosynaptically innervated by descending 'excitatory' input from IL cortex. Such connectivity, albeit restricted, identifies the potential direct influence of IL cortex on the processing and distribution of cardiovascular, respiratory and related autonomic information by catecholaminergic neurons in the NTS and VLM of the rat.
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Affiliation(s)
- P L A Gabbott
- Department of Biological Sciences, The Open University, Milton Keynes, UK.
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Cassaday R, Sondel P, King D, Warner T, Bridges A, Gan J, Schalch H, Hank J, Mahvi D, Albertini M. Clinical and immunological analysis of melanoma patients receiving immunization using particle-mediated gene transfer of genes for gp100 and GM-CSF into uninvolved skin. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13033] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13033 Background: To investigate a new method of activating melanoma-specific immune responses, we examined in vivo particle-mediated gene transfer (PMGT) of cDNAs for gp100 and GM-CSF into uninvolved skin of melanoma patients (pts). We now report the analysis of a completed Phase I clinical study. Methods: Two treatment groups of 6 pts each were evaluated. Group I received PMGT with cDNA for gp100 during each 3 week cycle; Group II received PMGT with cDNA for GM-CSF followed 3 days later by PMGT for gp100 at the same site. PMGT used 0.25 ug DNA and 250 ug gold/treatment. Endpoints included vaccine toxicity, transgene expression, immunological activation, and antitumor effects. Results: No systemic toxicity could be attributed to the vaccines, while local toxicity in both groups included mild erythema and induration which resolved within 2 weeks. Monitoring for autoimmunity showed no induction of pathologic autoantibodies. Biopsies of vaccine sites obtained 2 days after the gp100 PMGT showed 16% of gold beads to be in the dermis in Group I vs 3% in Group II, suggesting the prior GM-CSF PMGT inhibited bead penetration (p < 0.001 by chi-square; each bead penetration was analyzed as an independent event). Biopsies in Group I obtained 2 days after vaccination showed 16% of beads in the dermis vs 22% after 4 days (p < 0.001 by chi-square; each bead penetration was analyzed as an independent event). Transgene expression in vaccinated skin sites was detected by ELISA (GM-CSF) and IHC (gp100). One of 4 HLA-A2+ subjects showed a 5 × 5-mm DTH response to gp100 peptide 210M after Cycle 1. Preliminary in vitro studies suggest minimal immunological activation. Of 4 pts who enrolled with no evidence of disease, 2 remain disease-free after 61–73 months of follow-up. Conclusions: PMGT with cDNA for gp100 and GM-CSF yields transgene expression in normal human skin with minimal local or systemic toxicity. Pathologic autoimmunity was not demonstrated. Bead concentration in the dermis increases over time, suggesting persistence of beads in this skin level. Conclusions related to melanoma-specific immune induction await T-cell and antibody studies. Supported in part by the UW General Clinical Research Center (M01 RR03186). No significant financial relationships to disclose.
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Affiliation(s)
- R. Cassaday
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
| | - P. Sondel
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
| | - D. King
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
| | - T. Warner
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
| | - A. Bridges
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
| | - J. Gan
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
| | - H. Schalch
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
| | - J. Hank
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
| | - D. Mahvi
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
| | - M. Albertini
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Hubert H. Humphrey Cancer Center, Fridley, MN; University of Wisconsin, Madison, WI
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Helitzer D, Warner T, Pratt-Chavez H, Frias-Kletecka MC. 71 DEVELOPMENT AND VALIDATION OF THE COMPREHENSIVE RESILIENCY QUESTIONNAIRE AND THE ADVERSE CHILDHOOD EVENTS-SHORT FORM. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.70] [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: 11/18/2022]
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Burke SG, Wainwright CL, Vojnovic I, Warner T, Watson DG, Furman BL. The effect of NCX4016 [2-acetoxy-benzoate 2-(2-nitroxymethyl)-phenyl ester] on the consequences of ischemia and reperfusion in the streptozotocin diabetic rat. J Pharmacol Exp Ther 2005; 316:1107-14. [PMID: 16260580 DOI: 10.1124/jpet.105.096339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The aim of this study was to assess the effect of chronic administration of NCX4016 [2 acetoxy-benzoate 2-(2-nitroxymethyl)-phenyl ester], a nitric oxide-releasing aspirin derivative on the consequences of coronary artery occlusion in streptozotocin-diabetic rats. Rats were made diabetic by injection of streptozotocin (60 mg kg(-1)) and received insulin (2.5 U kg(-1) s.c.) daily for 4 weeks. Animals received vehicle (1 ml kg(-1) polyethylene glycol), aspirin (65.2 mg kg(-1)), NCX4016 (60 mg kg(-1)), or (iv) NCX4016 (120 mg kg(-1)) orally, once daily for the last 5 days before coronary artery occlusion (CAO). One hour after the last dose, pentobarbital-anesthetized rats were subjected to CAO for 30 min followed by 120-min reperfusion. Neither drug significantly modified initial hemodynamics or plasma glucose levels compared with vehicle treatment in either nondiabetic or diabetic rats. Neither drug modified the total ventricular premature beat (VPB) count in normal animals, although NCX4016, but not aspirin, reduced the total VPB count and the incidence of ventricular tachycardia in diabetic rats. In nondiabetic animals, both aspirin and NCX4016 reduced infarct size. However, in diabetic rats, infarct size was reduced only by the larger dose of NCX4016 (120 mg kg(-1)) but not by aspirin or the lower dose of NCX4016. These results demonstrate that the cardioprotective effects of NCX4016 are reduced in the presence of diabetes compared with the effects seen in nondiabetic animals. In summary, the present study confirms the protective effect of NCX4016 against ischemia-reperfusion injury in the normal rat heart and demonstrates for the first time its protective effect in the heart of streptozotocin-diabetic rats.
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Affiliation(s)
- S G Burke
- Department of Physiology and Pharmacology, Strathclyde Institute for Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
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Mahvi DM, Shi FS, Yang NS, Weber S, Hank J, Albertini M, Schiller J, Schalch H, Larson M, Pharo L, Gan J, Heisey D, Warner T, Sondel PM. Immunization by particle-mediated transfer of the granulocyte-macrophage colony-stimulating factor gene into autologous tumor cells in melanoma or sarcoma patients: report of a phase I/IB study. Hum Gene Ther 2002; 13:1711-21. [PMID: 12396624 DOI: 10.1089/104303402760293556] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The primary objective of this phase I study was to determine the safety of an autologous tumor vaccine given by intradermal injection of lethally irradiated granulocyte-macrophage colony-stimulating factor (GM-CSF) gene-transfected autologous melanoma and sarcoma cells. Secondary objectives included validation of the gene delivery technology (particle-mediated gene transfer), determining the host immune response to the tumor after vaccination, and monitoring patients for evidence of antitumor response. Sixteen patients were treated with either of two different doses of GM-CSF-treated tumor cells. One patient received treatment with both doses of tumor cells. No treatment-related local or systemic toxicity was noted in any patient. Patients administered 100% treated cells (i.e., with a preparation of tumor cells that had all been exposed to GM-CSF DNA transfection) had a more extensive lymphocytic infiltrate at the vaccine site than did patients given 10% treated cells (a preparation of tumor cells in which 10% had been exposed to GM-CSF transfection) or nontreated tumor. The generation of a systemic immune response to autologous tumor by a delayed-type hypersensitivity response to the intradermal placement of nontransfected tumor cells was noted in one patient. One patient had a transient partial response of metastatic tumor sites. The entire procedure, from tumor removal to vaccine placement, was accomplished in less than 6 hr in all patients. Four of 17 patient tumor preparations produced greater than 3.0 ng of GM-CSF per 10(6) cells per 24 hr in vitro. The one patient with greater than 30 ng of GM-CSF per 10(6) cells per 24 hr in vitro had positive DTH, a significant histologic inflammatory response, and clinically stable disease. This technique of gene transfer was safe and feasible, but resulted in clinically relevant levels of gene expression in only a minority of patients.
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Affiliation(s)
- D M Mahvi
- Department of Surgery, University of Wisconsin School of Medicine, Madison, WI 53792, USA.
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Castelon Konkiewitz E, Trender-Gerhard I, Kamm C, Warner T, Ben-Shlomo Y, Gasser T, Conrad B, Ceballos-Baumann AO. Service-based survey of dystonia in munich. Neuroepidemiology 2002; 21:202-6. [PMID: 12065883 DOI: 10.1159/000059525] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We performed a service-based epidemiological study of dystonia in Munich, Germany. Due to favourable referral and treatment patterns in the Munich area, we could provide confident data from dystonia patients seeking botulinum toxin treatment. A total of 230 patients were ascertained, of whom 188 had primary dystonia. Point prevalence ratios were estimated to be 10.1 (95% confidence interval 8.4-11.9) per 100,000 for focal and 0.3 (0.0-0.6) for generalised primary dystonia. The most common focal primary dystonias were cervical dystonia with 5.4 (4.2-6.7) and essential blepharospasm with 3.1 (2.1-4.1) per 100,000 followed by laryngeal dystonia (spasmodic dysphonia) with 1.0 (0.4-1.5) per 100,000.
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Affiliation(s)
- E Castelon Konkiewitz
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany
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Abstract
BACKGROUND Little is known about the quality of life in patients with cervical dystonia, although pain and depression are relatively common. OBJECTIVE To test the hypothesis that an individual's ability to cope with the disease will modify the association of intrinsic, extrinsic, and disease related factors with quality of life. METHODS Patients with cervical dystonia diagnosed by a movement disorder specialist were recruited from seven European countries. Data on quality of life (SF-36), measures of coping, and intrinsic, extrinsic, and disease related factors were collected by a self completed postal questionnaire. RESULTS 289 patients (101 men and 188 women), mean age 55 years, completed the questionnaire. Both physical and mental quality of life scores were predicted by self esteem and self deprecation, educational level, employment status, social support, response to botulinum toxin, disease severity, social participation, stigma, acceptance of illness, anxiety, and depression. In multivariable analyses, the strongest predictors were anxiety and depression. Severe depression was associated with a 19.1 point decrement in the physical summary score (95% confidence interval, -31.7 to -6.6; p = 0.003); however, disease duration and severity remained predictors. CONCLUSIONS Care for patients with cervical dystonia must not only focus on reducing the severity of the dystonia but also on the psychological wellbeing of the patient. Interventions aimed at treating depression or anxiety, especially of a cognitive nature, may have a large impact on improving quality of life.
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Affiliation(s)
- Y Ben-Shlomo
- Department of Social Medicine, MRC Health Services Collaboration, University of Bristol, Bristol, UK.
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Abstract
We report here the synthesis, purification, and characterization of several large polypeptides related to the human activin beta(A) subunit and their cyclic counterparts. In particular, we describe for the first time the total chemical synthesis of a 105-mer polypeptide, des[1-11] activin beta(A), and related large-loop polypeptide, by an optimized solid phase synthetic protocol based on 9-flouroenylmethyoxycarbonyl (Fmoc) chemistry. These studies show that automated chemical synthesis utilizing Fmoc-based solid phase synthetic strategies provides a practical alternative to recombinant DNA technology for the production of activin-related subunits, with the opportunity to rapidly provide different analogues and structural variants for subsequent structure-function and associated biophysical investigations.
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Affiliation(s)
- H H Keah
- Center for Bioprocess Technology, Department of Biochemistry & Molecular Biology, Monash University, Clayton 3800, Victoria, Australia
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Nalwa SS, Hartig GK, Warner T, Connor NP, Thielman MJ. Evaluation of poly-L-lactic acid and polyglycolic acid resorbable stents for repair of tracheomalacia in a porcine model. Ann Otol Rhinol Laryngol 2001; 110:993-9. [PMID: 11713925 DOI: 10.1177/000348940111001101] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poly-L-lactic acid and polyglycolic acid (PLPG) resorbable stents may offer a potential solution to the problem of tracheomalacia. Advantages of this material include its strength, its versatile shaping characteristics, and its resorbability, which would preclude surgical removal and allow for airway growth. The purpose of this pilot study was to examine the usefulness of PLPG stents for temporary external airway stenting of tracheomalacia in a porcine model. A severe tracheomalacia was created in 6 pigs by submucosal resection of segments of tracheal cartilage from 6 consecutive rings. The PLPG stent was then shaped to recreate the tracheal contour and sutured to the underlying airway. Endoscopic photodocumentation during spontaneous ventilation was obtained before and after reconstruction. After creation of the malacic tracheal segment, all animals developed stridor, retractions, and cyanosis during spontaneous ventilation. After repair, all animals were extubated without complication. All animals survived the follow-up period of 9 to 12 weeks without evidence of respiratory distress and with rapid weight gain. Repeat bronchoscopy showed no evidence of airway collapse during spontaneous ventilation. Tracheal measurements revealed growth of the stented segment with a mild narrowing within the repaired region. Histologic examination showed preservation of respiratory epithelium. These preliminary findings suggest that PLPG stents may serve a useful role in the surgical management of tracheomalacia.
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Affiliation(s)
- S S Nalwa
- Department of Surgery, University of Wisconsin Medical School, Madison, USA
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Patel H, Hart PE, Warner T, Allen I, Phillimore HE, Silver JR, Wood NW, Jeffery S, Patton MA, Crosby AH. Silver syndrome is not linked to any of the previously established autosomal dominant hereditary spastic paraplegia loci. Am J Med Genet 2001; 102:68-72. [PMID: 11471175 DOI: 10.1002/1096-8628(20010722)102:1<68::aid-ajmg1411>3.0.co;2-r] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The hereditary spastic paraplegias are a clinically variable and genetically heterogeneous group of disorders characterized by progressive and lower limb spasticity and weakness. Silver syndrome (SS) is a particularly disabling autosomal dominant form of the disease in which there is associated wasting of the hand muscles. In view of the fact that genes for hereditary spastic paraplegia can produce highly variable phenotypes, the eight known autosomal dominant loci were investigated for linkage to Silver syndrome. Genotyping of these loci in two large multigenerational families was incompatible with linkage to any of these regions, suggesting that an additional locus is responsible for this syndrome.
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Affiliation(s)
- H Patel
- Medical Genetics, St. George's Hospital Medical School, London, United Kingdom
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