Maturing out,natural recovery,and dual diagnosis: What are the implications for older adult mental health services?

In 1962, Charles Winick proposed that addiction was a self‐limiting process, whereby individuals stopped using substances once the stresses of life transitions ceased. The notion of maturing out, as labelled by Winick, often forms the basis of the natural recovery movement in alcohol and other drug (AOD) research, aiding the notion that older individuals either cease their substance use or fall victim to the higher mortality rates prevalent in substance‐using populations. As more consumers present to adult mental health treatment settings with co‐occurring substance use disorders, the idea that individuals will simply cease using AOD is outdated. Given the future challenges of an ageing population, it is prudent to explore those who fail to mature out of substance use, as well as challenge the notion that older adult mental health services rarely encounter substance‐using individuals. The present study explores Winick's research in the context of an ageing population and older adult mental health services. It also ponders the proposition put forth in subsequent research that older individuals with lifelong substance use switch to substances that are easier to obtain and better tolerated by their ageing bodies.     

A urologist’s perspective on prostate cancer imaging: past,present, and future

Prostate cancer is unique in that unlike other solid organ malignancies, only recently has imaging been employed to routinely detect and localize disease. The introduction of transrectal ultrasound was a significant development, transitioning digitally guided prostate biopsies to ultrasound guidance. The arrival of multiparametric MRI has become the next major step, transforming the way Urologist’s diagnose, stage, and treat prostate cancer. Recent recommendations against PSA screening have changed the landscape of urologic oncology with the changing needs being reflected in the initiation of additional robust imaging techniques at different time points in prostate cancer care. The current review aims to provide a clinical perspective in the history, current standard of care, and novel imaging modalities in the evaluation of prostate cancer.     

General practitioners’ views on leadership roles and challenges in primary health care: a qualitative study

Objective: To explore general practitioners’ (GPs) views on leadership roles and leadership challenges in general practice and primary health care.

Design: We conducted focus groups (FGs) with 17 GPs.

Setting: Norwegian primary health care.

Subjects: 17 GPs who attended a 5 d course on leadership in primary health care.

Results: Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical and leadership role. GPs recognized the need to take on leadership roles in primary care, but their lack of leadership training and credentials, and the way in which their practices were organized and financed were barriers towards their involvement.

Conclusions: GPs experience tensions between the clinical and leadership role and note a lack of leadership training and awareness. There is a need for a more structured educational and career path for GPs, in which doctors are offered training and preparation in advance.

• KEY POINTS

• Little is known about doctors’ experiences and views about leadership in general practice and primary health care. Our study suggests that:

• There is a lack of preparation and formal training for the leadership role.

• GPs experience tensions between the clinical and leadership role.

• GPs recognize leadership challenges at a system level and that doctors should take on leadership roles in primary health care.

     

Extended-spectrum β-lactamase-producing and AmpC-producing Escherichia coli from livestock and companion animals, and their putative impact on public health: a global perspective

The possible zoonotic spread of antimicrobial-resistant bacteria is controversial. This review discusses global molecular epidemiological data combining both analyses of the chromosomal background, using multilocus sequence typing (MLST), and analyses of plasmid (episomal) extended-spectrum β-lactamase (ESBL)/AmpC genes in Escherichia coli present in humans and animals. For consideration of major epidemiological differences, animals were separated into livestock and companion animals. MLST revealed the existence of ESBL-producing isolates thoughout the E. coli population, with no obvious association with any ancestral EcoR group. A similar distribution of major ESBL/AmpC types was apparent only in human isolates, regardless of their geographical origin from Europe, Asia, or the Americas, whereas in animals this varied extensively between animal groups and across different geographical areas. In contrast to the diversity of episomal ESBL/AmpC types, isolates from human and animals mainly shared identical sequence types (STs), suggesting transmission or parallel micro-evolution. In conclusion, the opinion that animal ESBL-producing E. coli is a major source of human infections is oversimplified, and neglects a highly complex scenario.     

Nursing students’ view on their future role and skills regarding euthanasia due to unbearable mental suffering: A mixed-method Study

AimTo explore final-year bachelor nursing students’ view on their future role and skills regarding euthanasia due to unbearable mental suffering (UMS-euthanasia) and to discover possible education needs.BackgroundSince UMS-euthanasia is legal in Belgium, nursing students will be confronted with this issue during their future internship, or professional career. Graduated nurses believe to have an important role in the process of euthanasia where good communication skills and sufficient legal knowledge are essential.DesignMixed-methods sequential explanatory design.MethodsFirst, a questionnaire was administered to all final-year bachelor nursing students at eight university colleges in Flanders (October 2020 and March 2021). Second, qualitative information was collected by organising focus groups with these students to gain more insights into the quantitative results (October 2021).ResultsThe final-year nursing students from the survey (n = 249) and from the three focus groups (n = 21) see a clear future role for themselves in the decision-making process, as well as in supporting the patient and family before, during and after UMS-euthanasia, but not in assisting in administering UMS-euthanasia. However, they also indicate they lack knowledge and skills in dealing adequately with UMS-euthanasia. Psychiatric internship alumni perceive a diminished role for themselves in the preparatory acts (p < 0.05). Ever involved in euthanasia shows a statistically significant difference in the demand for simulation.ConclusionsNursing students see an important role for nurses in UMS-euthanasia but feel inadequately prepared to take on this role. A combination of theoretical knowledge, clinical experience, open discussions, reflection and simulation is an opportunity to prepare nurses for their future role.     

Interventions to improve mental health nurses’ skills,attitudes, and knowledge related to people with a diagnosis of borderline personality disorder: Systematic review

ObjectivesThere is some evidence that mental health nurses have poor attitudes towards people with a diagnosis of borderline personality disorder and that this might impact negatively on the development of helpful therapeutic relationships. We aimed to collate the current evidence about interventions that have been devised to improve the responses of mental health nurses towards this group of people.DesignSystematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement.Data sourcesComprehensive terms were used to search CINAHL, PsycINFO, Medline, Biomedical Reference Collection: Comprehensive, Web of Science, ASSIA, Cochrane Library, EMBASE, ProQuest [including Dissertations/Theses], and Google Scholar for relevant studies.Review methodsIncluded studies were those that described an intervention whose aim was to improve attitudes towards, knowledge about or responses to people with a diagnosis of borderline personality disorder. The sample described had to include mental health nurses. Information about study characteristics, intervention content and mode of delivery was extracted. Study quality was assessed, and effect sizes of interventions and potential moderators of those interventions were extracted and converted to Cohen's d to aid comparison.ResultsThe search strategy yielded a total of eight studies, half of which were judged to be methodologically weak with the remaining four studies judged to be of moderate quality. Only one study employed a control group. The largest effect sizes were found for changes related to cognitive attitudes including knowledge; smaller effect sizes were found in relation to changes in affective outcomes. Self-reported behavioural change in the form of increased use of components of Dialectical Behaviour Therapy following training in this treatment was associated with moderate effect sizes. The largest effect sizes were found among those with poorer baseline attitudes and without previous training about borderline personality disorder.ConclusionsThere is a dearth of high quality evidence about the attitudes of mental health nurses towards people with a diagnosis of borderline personality disorder. This is an important gap since nurses hold the poorest attitudes of professional disciplines involved in the care of this group. Further work is needed to ascertain the most effective elements of training programmes; this should involve trials of interventions in samples that are compared against adequately matched control groups.     

Family members and health professionals’ perspectives on future life planning of ageing people with Down syndrome: a qualitative study

Abstract

Objectives: To address the way in which primary caregivers of people over 45 with Down syndrome describe daily life activities and context and foresee their future.

Methods: Thirteen family members and 15 health professionals participated to four focus groups. Meaningful concepts were identified and linked to the International Classification of Functioning, Disability and Health using established linking rules.

Results: A total of 258 relevant concepts were identified and linked to 75 categories of the classification: 38 were from activity and participation and 17 from environmental factors domains. The most commonly reported issues were mental functions (b117-intellectual functions and b152-emotional functions), community life activities (d910-community life and d920-recreation and leisure) and environmental factors (e310-support of immediate family, e355-support from health professionals and e555-associations and organizational services).

Conclusions: Information on the daily life and health of ageing people with Down syndrome is important to plan social and health care interventions tailored to deal with problems that they may encounter in older age. Considering the interaction between health and environment and maintaining a continuity of daily routines were reported as the most relevant topics for managing daily lives of persons with Down syndrome in older ages.

• Implications for rehabilitation

• Pay more attention to the interaction between environmental factors and health condition in ageing people with Down syndrome.

• Information about the life contest are important in order to plan present and future social–health care interventions.

• Future planning for people with Down syndrome is a great concern for family members.

     

The effects of exergaming and treadmill training on gait,balance, and cognition in a person with Parkinson’s disease: A case study

Background: Parkinson’s disease (PD) commonly impairs posture, gait, and cognition. Exercise in the form of aerobic activity as well as exergaming may improve motor ability and cognition in persons with PD. Exergaming and treadmill training can be a practical form of exercise within the home; however, there is minimal research on this combined multimodal intervention for persons with PD. Objective: We investigated the effects of this combined intervention on cognition, balance, and gait in a person with PD through supervised lab sessions augmented by home-based sessions. Methods: This case study utilized an ABA single subject experimental design with 4 weeks of pre-intervention, followed by 8 weeks of intervention, and 4 weeks of post-intervention. The intervention consisted of treadmill walking and Xbox Kinect exergaming, 30 minutes each, performed unsupervised at home and at supervised lab sessions. The two standard deviation band method was used to determine significance. Results: MiniBEST test, 2-minute walk distance, sway area, endurance test, and a few parameters of gait initiation and gait improved significantly throughout the intervention period. Only a few measures sustained the improvement 4 weeks after completion of intervention. Conclusion: Eight weeks of treadmill and exergaming intervention with a person with PD improved static and dynamic postural control measures, but not gait, cognition, endurance, and clinical measures of balance. Longer and more intense multimodal intervention may be warranted.     

Pervasive alienation: on seeing the invisible,meeting the inaccessible and engaging ‘lost to contact’ clients with major mental illness

Increasing integration of services for adults with severe mental health problems has highlighted the challenges to services posed by clients who are difficult to engage. There is a dearth of studies on direct work with individuals who are reclusive and difficult to contact, in contrast with the bulk of literature where the patient and network are present and available. This paper describes the work of a busy CMHT with such clients; barriers to collaborative work are explored and some of the team's strategies to overcome these barriers are delineated. Long, slow and persistent contact is observed to be a core feature of the work. The paper goes on to examine the fit between the realities of ongoing work with such clients and the available therapeutic and service discourses.     

‘I don't want to impose on anybody’: Older people and their families discuss their perceptions of risk,cause and care in the context of falls

Background

Falls in hospitalised patients remain an ongoing challenge for healthcare systems internationally. Limited research exists on the perspectives of older people on falls risk, cause and care.

Objectives

This study explored the experiences of patients and their families after a fall in a healthcare facility.

Methods

Semi-structured interviews were conducted with patients and families to explore the experience of having a fall. Data were analysed thematically.

Results

The themes that emerged from the 14 interviews included the following: explanations; physical environment; communication; experiences of care; perceptions of risk; ageism; feelings towards the fall; and independence and dignity.

Conclusions

This research emphasises the diversity in older people's experiences after experiencing a fall. Falls prevention should be incorporated as one part of healthy, dignified ageing.

Implications for practice

Falls prevention and management strategies should be multifactorial, including enhanced communication with the patient and their families. When engaging in education and awareness, falls prevention should be positioned as one component of independent and dignified healthy ageing.     

The effect of a training programme on school nurses’ knowledge,attitudes, and depression recognition skills: The QUEST cluster randomised controlled trial

BackgroundMental health problems in children and young people are a vital public health issue. Only 25% of British school children with diagnosed mental health problems have specialist mental health services contact; front-line staff such as school nurses play a vital role in identifying and managing these problems, and accessing additional services for children, but there appears limited specific training and support for this aspect of their role.ObjectivesTo evaluate the effectiveness of a bespoke short training programme, which incorporated interactive and didactic teaching with printed and electronic resources. Hypothesized outcomes were improvements in school nurses’ knowledge, attitudes, and recognition skills for depression.DesignA cluster-randomised controlled trial.Participants and setting146 school nurses from 13 Primary Care Trusts (PCTs) in London were randomly allocated to receive the training programme.MethodsSchool nurses from 7 PCTs (n = 81) were randomly allocated to receive the training intervention and from 6 PCTs (n = 65) for waiting list control. Depression detection was measured by response to vignettes, attitudes measured with the Depression Attitude Questionnaire, and knowledge by the QUEST knowledge measure. These outcomes were measured at baseline and (following training) 3 months and nine months later, after which nurses in the control group received the training programme.ResultsAt 3 months, 115 nurses completed outcome measures. Training was associated with significant improvements in the specificity of depression judgements (52.0% for the intervention group and 47.2% for the control group, P = 0.039), and there was a non-significant increase in sensitivity (64.5% compared to 61.5% P = 0.25). Nurses’ knowledge about depression improved (standardised mean difference = 0.97 [95% CI 0.58 to 1.35], P < 0.001); and confidence about their professional role in relation to depression increased. There was also a significant change in optimism about depression outcomes, but no change in tendency to defer depression management to specialists. At 9-month follow-up, improved specificity in depression identification and improved knowledge were maintained.ConclusionsThis school nurse development programme, designed to convey best practice for the identification and care of depression, delivered significant improvements in some aspects of depression recognition and understanding, and was associated with increased confidence in working with young people experiencing mental health problems.     

Influences on students’ assistive technology use at school: the views of classroom teachers,allied health professionals,students with cerebral palsy and their parents

Abstract

Purpose: This study explored how classroom teachers, allied health professionals, students with cerebral palsy, and their parents view high-tech assistive technology service delivery in the classroom.

Methods: Semi-structured interviews with six classroom teachers and six parents and their children were conducted. Additionally, two focus groups comprising 10 occupational therapists and six speech pathologists were carried out. Ethical and confidentiality considerations meant that the groups were not matched.

Results: Results revealed that it is often untrained staff member who determine students’ educational needs. The participants’ experiences suggested that, particularly in mainstream settings, there is a need for support and guidance from a professional with knowledge of assistive technology who can also take a lead and guide classroom teachers in how to meet students’ needs. Students’ motivation to use the technology was also found to be critical for its successful uptake.

Conclusions: The study points to the need for classroom teachers to be given sufficient time and skill development opportunities to enable them to work effectively with assistive technology in the classroom. The participants’ experiences suggest that such opportunities are not generally forthcoming. Only in this way can it be ensured that students with disabilities receive the education that is their right.

• Implications for Rehabilitation

• Classroom teachers, allied health professionals, students, parents need ongoing support and opportunities to practise operational, strategic and linguistic skills with the assistive technology equipment.

• System barriers to the uptake of assistive technology need to be addressed.

• To address the lack of time available for training, programing and other support activities around assistive technology, dedicated administrative support is crucial.

• Professional development around the use of the quality low cost ICF-CY checklist is recommended for both school and allied health staff.

     

Does a communication skills program enable symptom and distress screening?: The impact of training on radiation therapists’ confidence,knowledge, and use of distress screening

IntroductionDue to the prevalence of distress following a cancer diagnosis, routine symptom and distress screening is recommended as best practice. RTs perceive psychosocial support and screening to be part of their role, however feel they lack the education and skills to perform this confidently. The study aimed to evaluate the impact of providing communication skills training (RT Prepare CST) on the perceived barriers, knowledge, attitude, role, and confidence of radiation therapists (RTs) in using routine symptom and distress screening.MethodsA single-arm, pre-post intervention design was implemented. All RTs at one regional and one rural centre participated in RT Prepare CST. RTs completed a questionnaire: pre-intervention (T1); immediately post-intervention (T2); and, three months post-intervention (T3). Cochran's Q and McNemar's tests for non-parametric data were conducted to compare outcomes over time.ResultsOf 39 RTs approached, 37 (95%) consented to participate with 36 (92%) completing questionnaires at all three time points. Significant and sustained improvements post-intervention were noted from T1-T3 including: confidence in describing the PROMPT-Care tool to patients (p=0.002), discussing psychosocial issues (p=0.014); recognising signs of anxiety/depression (p<0.001); dealing with signs of anxiety (p=0.002), depression (p=0.015) and distress (p=0.008) as well as agreeing ‘the tool is useful in identifying psychosocial problems’ (p=0.029).ConclusionsRT Prepare CST was effective in increasing confidence, knowledge and attitudes of RTs in the psychosocial care of patients with a change in RT behaviour noted by a significant increase in the number of patients screened following the intervention. Providing routine CST and emotional cues training to RTs enhances their ability to care for patients holistically, equipping them with skills to be included within a psychosocial model of care. Engaged leadership and role models are essential to sustain the learnings from education programs and provide an environment to discuss and define roles within radiation therapy departments.     

Sudden Infant Death Syndrome (SIDS) on the ‘other side’: A personal account and a tribute to Dominic Lewis Stead, 21.11.95–22.02.96

My own experience of sudden death will remain with me lifelong. I hope that whenever I am able to face such a situation again I can give the same expert nursing care with such empathy, understanding and compassion that we were shown. Because it does matter how we care for the newly bereaved relative, and there is ample evidence that the quality of the initial care provided has a major impact on the relative's bereavement (RCN British Association for Accident and Emergency Medicine 1995).