Developing a social perspective in mental health services in primary care

The influence of Primary Care Trusts (PCTs) on the reorganisation of UK health and social care provision is already considerable. As well as challenging institutionalised processes of care, PCTs are encouraging innovation. This article reflects on a service pioneered by a small group of mental health social workers, which has been reconfigured within a new PCT, illuminated by examples of direct therapeutic work and service user feedback. In the new service, the practical application of a social perspective in mental health provision is demonstrated by eligibility criteria based on social context as well as psychological adversity. Possible developments arising from the prospective, multidisciplinary team membership and interface with secondary care are anticipated.     

Factors controlling the pharmacokinetics,biodistribution and intratumoral penetration of nanoparticles

Nanoparticle drug delivery to the tumor is impacted by multiple factors: nanoparticles must evade clearance by renal filtration and the reticuloendothelial system, extravasate through the enlarged endothelial gaps in tumors, penetrate through dense stroma in the tumor microenvironment to reach the tumor cells, remain in the tumor tissue for a prolonged period of time, and finally release the active agent to induce pharmacological effect. The physicochemical properties of nanoparticles such as size, shape, surface charge, surface chemistry (PEGylation, ligand conjugation) and composition affect the pharmacokinetics, biodistribution, intratumoral penetration and tumor bioavailability. On the other hand, tumor biology (blood flow, perfusion, permeability, interstitial fluid pressure and stroma content) and patient characteristics (age, gender, tumor type, tumor location, body composition and prior treatments) also have impact on drug delivery by nanoparticles. It is now believed that both nanoparticles and the tumor microenvironment have to be optimized or adjusted for optimal delivery. This review provides a comprehensive summary of how these nanoparticle and biological factors impact nanoparticle delivery to tumors, with discussion on how the tumor microenvironment can be adjusted and how patients can be stratified by imaging methods to receive the maximal benefit of nanomedicine. Perspectives and future directions are also provided.     

Mechanical behavior of fixation components for periprosthetic fracture surgery

BackgroundReliable periprosthetic fracture treatment needs detailed knowledge on the mechanical behavior of the fixation components used. The holding capacity of three conventional fixation components for periprosthetic fracture treatment was systematically investigated under different loading directions.MethodsLocking compression plates were fixed to a 7 cm long part of diaphyseal fresh frozen human femur with either a single 1.7 mm cerclage cable, a 5.0 mm monocortical or a bicortical locking screw (n = 5 per group). Constructs were loaded in lateral, torsional and axial direction with respect to the bone axis in a load-to-failure test. Corresponding stress distribution around the screw holes was analyzed by finite element modeling.FindingsBoth screw fixations revealed significantly higher stiffness and ultimate strength in axial compression and torsion compared to the cerclage (all P < 0.01). Ultimate strength in lateral loading and torsion was significantly higher for bicortical screws (mean 3968 N SD 657; mean 28.8 Nm SD 5.9) compared to monocortical screws (mean 2748 N SD 585; mean 14.4 Nm SD 5.7 Nm) and cerclages (mean 3001 N SD 252; mean 3.2 Nm SD 2.0) (P ≤ 0.04). Stress distribution around the screw hole varied according to the screw type and load direction.InterpretationFixation components may be combined according to their individual advantages to achieve an optimal periprosthetic fracture fixation.     

Youth Risk Assessment in Complex Agency Practice

Advancements in the delivery of community-based services and tight utilization management of high-cost treatment options result in youths with serious behavior problems receiving intervention in lower levels of care than was true ten or fifteen years ago. This shift in where services tend to be delivered necessitates enhancement of risk assessment technology. Systems, structures, tools, and practice guidelines/protocols are available to support contemporary service provision. A model of clinical risk assessment and management is elaborated that integrates multiple sources of data and interdisciplinary teamwork to prevent adverse case outcomes and to maximize potential for community safety.     

Smoking cessation and serious mental illness: a service evaluation of a drop‐in stop smoking clinic on an acute in‐patient unit

Aims and objectives. To evaluate the effect of a stop smoking clinic on the quit rates of patients admitted to an acute in‐patient unit. Background. The relationship between poor physical health and severe mental illness is well established. High rates of smoking appear to play an important causal role in the excess morbidity and mortality in this population. Stop smoking interventions for the general population are clinically effective and cost‐effective. There is a small but promising evidence base for effective interventions to help people with a mental illness who wish to stop smoking but these have mostly been tested with community patients rather than acute in‐patients. Methods. A service evaluation of a drop‐in stop smoking clinic on an acute mental health in‐patient unit was conducted. Patients’ smoking status was measured at baseline and four weeks after their quit date using patient self‐report and an expired breath carbon monoxide reading. Results. Over a six‐month evaluation period, 46 patients set a quit date and 13 (28·3%) were abstinent at the four‐week follow‐up stage, verified by a carbon monoxide reading (χ² = 33, df = 1, sig p < 0·0001). Conclusions. This small‐scale evaluation has shown a drop‐in stop smoking intervention to be feasible, acceptable and associated with positive outcomes; further research with larger, more representative samples is required. Relevance to clinical practice. Enforcing smoke‐free legislation is a contentious issue on mental health in‐patient units, and there is a paucity of research to guide nursing practice in this area. An admission period in a smoke‐free environment provides a crucial opportunity to offer smoking cessation treatment. With appropriate resources, expertise and support, it appears possible to apply smoking cessation interventions that are successful within the general population to mental health patients during an acute admission.