Falls Prevention – A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls

Posted on January 31, 2011 by lancashirecarelibraryblog

A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls, Age & Ageing,  2010 Nov;39(6):704-10

Conroy S et al.

United Kingdom

 

Abstract:

OBJECTIVE: to determine the clinical effectiveness of a day hospital-delivered multifactorial falls prevention programme, for community-dwelling older people at high risk of future falls identified through a screening process.

DESIGN: multicentre randomised controlled trial.

SETTING: eight general practices and three day hospitals based in the East Midlands, UK. Participants: three hundred and sixty-four participants, mean age 79 years, with a median of three falls risk factors per person at baseline. Interventions: a day hospital-delivered multifactorial falls prevention programme, consisting of strength and balance training, a medical review and a home hazards assessment. Main outcome measure: rate of falls over 12 months of follow-up, recorded using self-completed monthly diaries.

RESULTS: one hundred and seventy-two participants in each arm contributed to the primary outcome analysis. The overall falls rate during follow-up was 1.7 falls per person-year in the intervention arm compared with 2.0 falls per person-year in the control arm. The stratum-adjusted incidence rate ratio was 0.86 (95% CI 0.73-1.01), P = 0.08, and 0.73 (95% CI 0.51-1.03), P = 0.07 when adjusted for baseline characteristics. There were no significant differences between the intervention and control arms in any secondary outcomes.

CONCLUSION: this trial did not conclusively demonstrate the benefit of a day hospital-delivered multifactorial falls prevention programme, in a population of older people identified as being at high risk of a future fall.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Falls Elderly | Tagged: , , | Comments Off

OT – Visual art in physical rehabilitation: experiences of people with neurological conditions

Posted on January 31, 2011 by lancashirecarelibraryblog

Visual art in physical rehabilitation: experiences of people with neurological conditions, The British Journal of Occupational Therapy, Volume 74, Number 1, January 2011 , pp. 44-52

Symons, Jane; Clark, Hannah; Williams, Kerry; Hansen, Emily; Orpin, Peter

Abstract:

Aims: The aims of this study were to understand the experience of participation in visual art from the perspective of adults undergoing outpatient physical rehabilitation and to determine whether art has a place in this context.

Method: This qualitative study involved interviewing adults who attended a weekly art class run by a qualified art teacher and occupational therapists in an outpatient physical rehabilitation setting. Nine participants with neurological conditions discussed their experience of the programme and the goals they were working towards or had achieved through painting.

Findings: The themes that emerged from the study show that art contributed to the participants meeting their individual rehabilitation goals. It also assisted the participants in using time, increasing enjoyment, regaining confidence and planning for engagement in future activities. All these achievements were seen by the participants to contribute to their rehabilitation or recovery. The identified themes align with the aims of rehabilitation and are similar to findings from many other studies investigating the use of art by people affected by illness or disability.

Conclusion: The findings of this study inform clinical practice in the use of visual art with clients in rehabilitation and validate its place in a physical rehabilitation programme.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: ABI Acquired Brain Injury, arts, OT - Evidence Based OT, OT - Occupational Therapy | Tagged: , , , , | Comments Off

RCT of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change

Posted on January 30, 2011 by lancashirecarelibraryblog

Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change, Behaviour Research & Therapy,  2010 Dec;48(12):1170-9

Abstract:

Parent-centred interventions for childhood obesity aim to improve parents’ skills and confidence in managing children’s dietary and activity patterns, and in promoting a healthy lifestyle in their family. However, few studies assess changes in parenting over the course of treatment. This study describes the evaluation of a lifestyle-specific parenting program (Group Lifestyle Triple P) on multiple child and parent outcomes. One-hundred-and-one families with overweight and obese 4- to 11-year-old children participated in an intervention or waitlist control condition. The 12-week intervention was associated with significant reductions in child BMI z score and weight-related problem behaviour. At the end of the intervention, parents reported increased confidence in managing children’s weight-related behaviour, and less frequent use of inconsistent or coercive parenting practices. All short-term intervention effects were maintained at one-year follow-up assessment, with additional improvements in child body size. The results support the efficacy of Group Lifestyle Triple P and suggest that parenting influences treatment outcomes. Further research is needed to evaluate the long-term effectiveness of the intervention and to elucidate the mechanisms of change.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: CAMHS, obesity | Tagged: | Comments Off

Suicide schemas in non-affective psychosis: An empirical investigation

Posted on January 29, 2011 by lancashirecarelibraryblog

Suicide schemas in non-affective psychosis: An empirical investigation, Behaviour Research & Therapy. 2010 Dec;48(12):1211-20

Pratt D, Gooding P, Johnson J, Taylor P, Tarrier N

School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK

Abstract:

Suicide is the leading cause of premature death among individuals experiencing psychosis. The risk of suicide is proposed to increase with a greater potential for activation of suicide related schemas. Empirical representations of suicide schemas were compared between individuals experiencing non-affective psychosis, with and without a history of suicidal behaviour. Employing a cross-sectional between-groups comparison design, 84 participants, previously diagnosed with a non-affective psychotic disorder, were recruited from community mental health services. Participants completed a demographic questionnaire and clinical measures of psychopathology. To assess participants’ suicide schemas, a series of direct and indirect cognitive tasks were designed and administered. Pathfinder analysis enabled the construction of empirically derived representations of the groups’ suicide schemas based on responses to the cognitive tasks. The suicide group achieved significantly greater scores on measures of anxiety, depression, hopelessness and suicidality than the non-suicide group, but not on measures indicative of the severity of psychosis. The suicide schema for the suicide group was more elaborate and extensive than for the non-suicide group, even when clinical measures were taken into account. Clinical and theoretical implications are discussed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: suicide | Tagged: | Comments Off

Guided self-help for disordered eating: A randomised control trial

Posted on January 28, 2011 by lancashirecarelibraryblog

Guided self-help for disordered eating: A randomised control trial. Behaviour Research and Therapy, Volume 49, Issue 1, January 2011, Pages 25-31

Traviss GD, Heywood-Everett S, Hill AJ

Leeds Institute of Health Sciences, Academic Unit of Psychiatry & Behavioural Sciences, Charles Thackrah Building, Clarendon Road, University of Leeds, Leeds LS2 9LJ, UK.

Abstract:

Treatment guidelines recommend evidence-based guided self-help (GSH) as the first stage of treatment for bulimia nervosa and binge eating disorder. The current randomised control trial evaluated a cognitive behavioural therapy-based GSH pack, ‘Working to Overcome Eating Difficulties,’ delivered by trained mental health professionals in 6 sessions over 3 months. It was congruent with the transdiagnostic approach and so was intended as suitable for all disordered eating, except severe anorexia nervosa. Eighty one clients were randomly allocated to either a GSH or waiting list condition. Eating disorder psychopathology (EDE-Q), key behavioural features and global distress (CORE) were measured at pre- and post-intervention, and 3- and 6-month follow-up. Results showed significant improvements in eating disorder psychopathology, laxative abuse, exercise behaviours, and global distress, with the GSH condition being superior to the waiting list on all outcomes. Treatment gains were maintained at 3 and 6 months. This study adds to the evidence supporting GSH for disordered eating, including EDNOS. However, further work is needed to establish the factors that contribute to observed therapeutic improvements and determine for whom GSH is most suitable.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Bibliotherapy, Eating Disorders | Tagged: , | Comments Off

Three-year course of clinical symptomatology in young people at ultra high risk for transition to psychosis

Posted on January 27, 2011 by lancashirecarelibraryblog

Three-year course of clinical symptomatology in young people at ultra high risk for transition to psychosis, Acta Psychiatrica Scandinavica, 2011 Jan;123(1):36-42

E Velthorst, DH Nieman, RM Klaassen et al

Abstract:

OBJECTIVE: The investigation into the course of ultra high risk (UHR) symptomatology of those patients who eventually do not meet the psychosis-threshold criteria within the 3-year timeframe of the study.

METHOD: The course of UHR symptoms, GAF score and employment status was investigated in 57 patients who did not make a transition to psychosis and who were examined within the Dutch Prediction of Psychosis Study in Amsterdam, the Netherlands.

RESULTS: At the 3-year follow-up, 75% of the patients who did not make a transition to psychosis had remitted from UHR status. With a Generalized Estimation Equation Model it was shown that this group recovered from positive (F = 52.7, P < 0.0001), negative (F = 24.3, P < 0.0001), disorganization (F = 14.4, P < 0.0001) and general symptoms (F = 25.0, P < 0.0001) within the timeframe of the study. In addition, the level of global functioning and likelihood of having a job and/or education significantly improved. The largest improvements occurred within the first year. UHR symptoms did not re-occur after improvement.

CONCLUSION: With the current UHR criteria, a large percentage of the included subjects appear to have transitory complaints and dysfunctioning. A refinement of the UHR criteria may diminish the chance of including ‘false positives’ in future UHR studies.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Psychosis, recovery, risk assessment | Tagged: , , | Comments Off

Systematic review of practice-based research on psychological therapies in routine clinic settings

Posted on January 26, 2011 by lancashirecarelibraryblog

Systematic review of practice-based research on psychological therapies in routine clinic settings, British Journal of Clinical Psychology, Volume 49, Number 4, November 2010 , pp. 421-453

Cahill, Jane; Barkham, Michael; Stiles, William B.

Abstract:

PURPOSE: To review the published material on practice-based research and to compare results with benchmarks derived from efficacy studies.

METHODS: Electronic and manual searches were carried out up to and including 2008. Studies were screened for content relevance and selected according to specified inclusion criteria. Data were extracted from all studies that met criteria and were quality assessed using an adapted version of a checklist designed for the appraisal of both randomized and non-randomized studies of health care interventions. Studies were synthesized according to (1) the type of problem being treated and (2) study design using descriptive and meta-analytic methods where appropriate.

RESULTS: Psychological treatment conducted in routine clinic settings is effective for a range of client problems, particularly common mental health problems (uncontrolled effect size = 1.29; 95% CI = 1.26-1.33, N = 10,842). When benchmarked against data from efficacy studies, practice-based studies yielded effect sizes that fell short of the selected benchmark. In contrast, the practice-based studies achieved the benchmark for percentage of clients meeting a stringent criterion for recovery.

CONCLUSIONS: Clients receiving treatment as normally delivered within routine practice report significant relief of symptoms. However, the result of comparisons with efficacy benchmarks is dependent on the outcome index used. Notwithstanding this, substantive factors are also likely to contribute. Therefore, in addition to attending to methodological issues, further work is required to understand the relative contribution of these factors.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: psychological | Tagged: , , , , | Comments Off

Lancashire Care Staff – Managing aggression and violence in mental health services

Posted on January 25, 2011 by lancashirecarelibraryblog

Managing aggression and violence in mental health services, Mental Health Practice, 2010 Oct; 14 (2): 38-2

Butterworth Roy, & Harbison Ian

Practice development nurse, Secure services, Lancashire Care NHS Foundation Trust

Abstract:

Client safety in mental health services is a consistently topical issue, particularly when it concerns the management of aggression and violence. Following the merger of several mental health services in Lancashire, nursing staff recognised the need to establish a single set of standards for safe and effective practice. In a medium secure unit in the trust, staff have developed expertise in managing challenging behaviour, and the practice development nurse and personal safety coordinator have been able to call on this expertise when standardising staff education and training programmes. A staff-driven change process has led to the development of a university postgraduate teaching programme, a network of effective aggression-management trainers, a framework for standardised skill application, and a forum for service and practice development. Links are being sought with other mental health services to share experiences and promote discussion about the standardisation of practice regionally and nationally.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: aggression, Forensic Mental Healthcare, Violence and Staff | Tagged: , , | Comments Off

Restraint in inpatient areas: the experiences of service users

Posted on January 25, 2011 by lancashirecarelibraryblog

Restraint in inpatient areas: the experiences of service users, Mental Health Practice, 2010 Nov; 14(3): 22-6

Sturrock, Ian

Senior staff nurse, Moorlands View low secure unit, Lynfield Mount Hospital, Bradford

Abstract:

Violent and aggressive behaviour by patients is more common in mental health trusts than in other settings. Research has focused on training staff to deal with this behaviour, but there has been little research into how those being restrained feel. A literature review of research that has been undertaken with mental health inpatients identifies that alternative forms of management and better training are needed to help staff avoid the practice. Above all, better communication between staff members and between staff and service users is vital to reduce the number of incidents in which restraint is used.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: aggression, Forensic Mental Healthcare, Restraint, Service users, Violence and Staff | Tagged: , , , , | Comments Off

Talking Mats & Dementia – ‘She can see how much I actually do!’ Talking Mats®: helping people with dementia and family carers to discuss managing daily living

Posted on January 24, 2011 by lancashirecarelibraryblog

‘She can see how much I actually do!’ Talking Mats®: helping people with dementia and family carers t  discuss managing daily living, Housing, Care & Support, 2010 Oct; 13(3): 27-35

Oliver TM; Murphy J; Cox S

Talking Mats Research and Development Centre, University of Stirling, UK
 

 

Abstract:

People with dementia who feel included in decisions about their care show higher well-being and positive adjustment to accepting care than those who feel their family make decisions for them (Bourgeois, 1991). Most carers want to involve the person with dementia in decision-making and care arrangements, but many struggle because of the communication and cognitive problems associated with the condition. Research examined whether the Talking Mats framework could help people with dementia and their family carers feel more involved in decisions about managing their daily living. Eighteen couples (person with dementia and family carer) were asked to discuss how the person with dementia was managing their daily living activities using the Talking Mats framework (Condition A), and when having a typical conversation (Condition B). Each couple then completed a brief questionnaire separately to measure how involved they felt in both types of discussion. Both the person with dementia and their family carer felt more involved in discussions about managing daily living when using the Talking Mats framework than when having a typical conversation. Qualitative analysis of all discussions also offered insight into what people with dementia who are still living at home are managing in relation to their daily living. The study will contribute in a practical way to the current debate on how to involve people with dementia meaningfully in service planning. This will have implications for the organisation, delivery, and improvement of services to people with dementia.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: dementia, Talking Mats | Tagged: , , , , | Comments Off

Psychosocial assessment tool within acute care

Posted on January 23, 2011 by lancashirecarelibraryblog
Psychosocial assessment tool within acute care  Mental Health News, January 2011

Click on the title above to access this resource

Abstract:

We previously reported in Mental Health News that Cheshire and Wirral Partnership Trust (CWPT), had implemented an ‘Acute Care Approach’ (see diagram below) to its mental health inpatient wards. The approach involves a dedicated acute care consultant working with a nominated ward which provides increased medical input to the wards. The released time that this model creates provides the patients with an increase in therapeutic time. An evaluation of this model demonstrated an increase in service user satisfaction as well as staff satisfaction. This model has led to a reduction in bed use by 50%, ensuring appropriate use of acute inpatient beds and a purposeful admission.

Since the approach has been implemented, an assessment tool has also been piloted in one area of the trust. A 2-day training package has been delivered in East Cheshire which has taught the inpatient and CRHT nursing staff how to use the KGV (Krawiecka, Goldberg & Vaughan) Psychiatric Assessment Scale. This comprehensive assessment tool measures the intensity, frequency, conviction, control and duration of symptoms. It assesses anxiety, depression, hallucinations, delusions, elevated mood, suicidal thoughts and behaviours as well as observing flattened affect, incongruous affect, over activity, psychomotor retardation, abnormal speech, poverty of speech and abnormal movements.

Lancashire Care staff can click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Filed under: psychosocial | Tagged: , , , , , | Comments Off

2011 A special briefing produced by the well-being and public mental health programme on the Public Health White Paper Healthy Lives, Healthy People

Posted on January 22, 2011 by lancashirecarelibraryblog

A special briefing produced by the well-being and public mental health programme on the Public Health White Paper Healthy Lives, Healthy People , 2011, NMHDU

Click on the title to download the special briefing

Abstract:

A special briefing produced by the well-being and public mental health programme on the Public Health White Paper Healthy Lives, Healthy People.

The White Paper presents many opportunities to build on the considerable volume of research and practice evidence for the integration of mental health within an overall public health approach. Furthermore the proposed new public health system at both national and local levels also provides considerable opportunities and scope for mental health to be both complementary and central to future local strategies and improved health and wellbeing outcomes for local communities.

The opportunities lie both in ensuring mental health is complementary and integral to overall approaches to improving public health and well-being and also in ensuring that the promotion of the public’s mental health and wellbeing is an action and commitment in its own right.

Lancashire Care staff can either click on the link, or email: susan.jennings@lancashirecare.nhs.uk

Filed under: health promotion, Healthy Eating, obesity, Physical Health, Public Health, well-being | Tagged: , , , , , , | Comments Off

Changes in quality of life in forensic psychiatric outpatients after 6 months of community-based treatment

Posted on January 21, 2011 by lancashirecarelibraryblog

Changes in quality of life in forensic psychiatric outpatients after 6 months of community-based treatment , Personality and Mental Health, 2010, Vol 4 (4) pgs. 257-70

Yvonne H. A. Bouman et al.

Abstract:

Over the last few decades, quality of life (QoL) has become an important outcome measure for treatment success in general psychiatry. So far, this is not the case in forensic psychiatry, although several (treatment) models include factors related to QoL, such as the good lives model. In this study, we investigated change in QoL over a 6-month treatment period in 102 forensic outpatients with personality disorders (PDs) or traits of PDs. To this end, the extended Dutch version of the Lancashire Quality of Life Profile was used.

Objective indicators of QoL did not change during these 6 months, with one exception: Significantly more patients reported to have a helping friend at the second time point. Eight of 10 subjective indicators of QoL changed differentially for patients with different baseline levels of QoL. Those with low scores showed significant improvement on nine indicators, whereas those with high scores reported a lower QoL after 6 months on five indicators. Treatment intensity, mood and severity of PD did not mediate these changes. Subjective QoL deserves consideration as an important theoretical construct in forensic treatment and the Lancashire QoL Profile is sensitive to change during such treatment.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Personality Disorders, Quality of Life | Tagged: , , , , , , | Comments Off

Time to Read – Thinking of starting up a reading group?

Posted on January 20, 2011 by lancashirecarelibraryblog

Time to Read , 2010, Dignity in Care Network

Click on the title above to download the Facilitator’s resource pack

“Time to Read” was one of the Bright Ideas Grant winning projects.

Since May this year, the project has been working with groups in different care settings testing out different approaches to setting up and running successful reading groups in social care settings.

As part of the project they have produced a facilitators support pack to help staff and volunteers set up and run their own reading groups.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Filed under: dignity in care, Reading, recovery | Tagged: , , , , , , , , , | Comments Off

Service User Experience – ‘I can try and do my little bit’ – training staff about self-injury

Posted on January 19, 2011 by lancashirecarelibraryblog

‘I can try and do my little bit’ – training staff about self-injury, Journal of Learning Disabilities and Offending Behaviour, 2011, Vol. 2 (1) pgs 4-7

Paul Moores
Service user

with Rebecca Fish and Helen Duperouzel
Calderstones Partnership NHS Foundation Trust, UK

Abstract:

This article details the experiences of a service user who has been employed as a trainer since 2007 in the secure learning disability service where he lives. This service has traditionally not used service user experience to inform training, and Paul was one of the first people to be involved in training staff. The training is part of a one-day introduction session about self-injury. Paul introduces himself and does a short talk about his experiences and then staff delegates are invited to ask him questions for a one-hour question and answer session. Some of the staff take the course as part of induction, while others may have been employed at the service for many years.

This article is written from the point of view of a service user who is involved in training staff about working with people who self-injure in the secure learning disability service where he lives.
• I am a service user living in a secure unit who talks to staff in training about self-injury.
• I do an hour each month answering questions and I get paid for it.
• I enjoy training the staff and it has made me more confident.
• I get some good feedback about my work from the staff.
• I wanted to tell other people about this experience.
• This report is made of parts of a recorded interview that I did with a member of staff and
meetings with her to write this into an article.

This article is written by Paul Moores, Service user, with Rebecca Fish and Helen Duperouzel, Calderstones Partnership NHS Foundation Trust, UK.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Learning Disabilities, Self Harm, Self Harm Men, Service users | Tagged: | Comments Off

Therapeutic effects of music and singing for older people

Posted on January 19, 2011 by lancashirecarelibraryblog

Therapeutic effects of music and singing for older people, Nursing Standard, 2010 Jan 13-19; 24 (19): 35-41

Skingley A; Vella-Burrows T

Abstract:

Aim To identify how music and singing may be used therapeutically by nurses in caring for older people. 

Method

A multimethod approach was taken, comprising a search of the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Medline databases, and the extraction of relevant articles from three existing reviews.
Findings Two reviews and 16 research reports were identified, the majority of which were intervention studies. All the studies reported benefits from music or singing for older pepople. Positive findings related to dementia, specific disorders (osteoarthritis pain, post-operative delirium, sleep difficulties, chronic obstructive pulmonary disease), and older people living at home. Recommendations for nursing were made, although there is a need for clarification on how nursing interventions should be implemented.

Conclusion

The evidence base to support the benefits of music and singing is increasing, and it is suggested that nurses may contribute to appropriate interventions and referrals. There is a need for further research, both to support these findings and to explore the nursing role in relation to providing music and singing therapies.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: dementia, Music thereapy, Therapeutic Interventions, Therapy | Tagged: , , , , , , | Comments Off

Reaching Out, Reaching In – Promoting mental health and emotional wellbeing in secure settings

Posted on January 18, 2011 by lancashirecarelibraryblog

Reaching Out, Reaching In , September 2010, Centre for Mental Health

Click on the title to access the full-text of this report

Abstract:

This study was commissioned by the Department of Health to review current levels and standards of mental health provision in the young people’s secure estate in England.

This paper suggests that there is an urgent need for all secure units to develop an integrated, whole system and comprehensive approach to supporting the mental health and wellbeing of the young people in their care and, no less important, to ensure that any improvements made while in custody are supported and maintained following release.

 

Lancashire care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Filed under: CAMHS, prisons, well-being | Tagged: , , , , | Comments Off

The Lonely Society – Isolation & Modern Society

Posted on January 18, 2011 by lancashirecarelibraryblog

The Lonely Society , 2010, Mental Health Foundation

click on the title above to access the full-text of this report

Abstract:

Lancashire Care staff can either click on the title above or email: susan.jennings@lancashirecare.nhs.uk

Filed under: depression, Loneliness, mental health foundation | Tagged: , , , , , | Comments Off

Good Practice & Dementia – Living well with dementia: a National Dementia Strategy

Posted on January 17, 2011 by lancashirecarelibraryblog

Living well with dementia: a National Dementia Strategy, Department of Health, 2011

Click on the title above to acccess the full-text of this report

Abstract:

This good practice compendium has been brought together from across the regions to support local delivery of the national dementia strategy and improve outcomes for people with dementia and their carers. It is an enabler for local change, as described in the Department of Health’s revised outcomes focused implementation plan.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Filed under: dementia, Department of Health 2011 | Tagged: , , , , , | Comments Off

East Midlands Innovation Report

Posted on January 16, 2011 by lancashirecarelibraryblog

East Midlands Innovation Report - 2010

Abstract:

NHS East Midlands has published its first annual Innovation Report, celebrating the range and impact of the activities that have taken place in the East Midlands to promote innovation. The report explains how many patients and staff have been engaged in transforming the region’s health services together with partners from universities, social care and the voluntary sector.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Filed under: Innovation | Tagged: , , , , , | Comments Off

Falls Prevention – About 250 patients a month used to have falls at York Teaching Hospital NHS Foundation Trust. But when, in August, nurse managers introduced a new system to assess, monitor and check patients at risk of falling, the figure almost halved, to 140

Posted on January 15, 2011 by lancashirecarelibraryblog

Simple practice changes lead to better patient experiences, Nursing Management, Oct 2010. Vol. 17, Iss. 6; p. 6 (2 pages)

Abstract:

About 250 patients a month used to have falls at York Teaching Hospital NHS Foundation Trust. But when, in August, nurse managers introduced a new system to assess, monitor and check patients at risk of falling, the figure almost halved, to 140.

The changes that were put in place appear simple, but they relate to good-practice techniques that staff can sometimes forget to consider, or simply have too little time to do.

‘Every two hours, we go to patients at risk of falling and give them a drink to keep them hydrated,’ says Jennie Booth, a senior nurse in the trust’s quality and safety team. ‘We check to see if they need the toilet and can reach everything, including their call bell. We check their footwear to make sure it fits properly and is not slipping off, and we make sure the areas round them are not cluttered. We record that we have done everything by ticking charts and signing them.’

York Teaching Hospital NHS Foundation Trust has been taking part in a project to test the introduction of the eight ‘high impact actions’ for nursing and midwifery that were published by the NHS Institute for Innovation and Improvement last November.

Many of the suggestions for how practice should change to achieve the actions have come from nurses themselves. More than 600 presented the Department of Health (DH) with ideas from their workplaces that they think other care providers can use to improve services. The best have been collated and published in a reference book called the Essential Collection.

Meanwhile, chief nursing officer for England Dame Chris Beasley has singled out York Teaching Hospital NHS Foundation Trust and Southampton University Hospitals NHS Trust to test a system of rapid changes to practice. The system is known as ’30 wards in 30 days’ and aims to cut the number of patients who experience falls or pressure ulcers.

‘We want to find out whether it is sustainable to introduce such changes this way rather than one ward at a time, so they can be spread rapidly across organisations,’ says Professor Beasley.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Falls Elderly, Innovation, TQM | Tagged: , , , , , , , , | Comments Off

Carers – Triangle of Care – THE TRIANGLE OF CARE – Carers Included: A Best Practice Guide in Acute Mental Health Care

Posted on January 14, 2011 by lancashirecarelibraryblog

Triangle of Care , 2011, The National Mental Health Development Unit (NMHDU)

Click on the title above to access the full-text of this report

Abstract:

The Princess Royal Trust for Carers and Cheshire and Wirral Partnership NHS Foundation Trust (CWP) are hosting the launch of The Triangle of Care in the North West. The launch day is an event aimed at providers of acute mental health services; crisis resolution home treatment (CRHT) and acute inpatient, including ward and CRHT managers and clinicians, modern matrons and service managers as well as carers, carer leads and carer and service user representatives.

The Triangle of Care best practice guidance was published by the National Mental Health Development Unit (NMHDU) and The Princess Royal Trust for Carers, and encourages partnership working with carers at all levels including service planning. It is concerned in the care planning and treatment of people with mental health issues in acute inpatient and home treatment services.

The launch event is being held on Tuesday 1st February 2011 at Sycamore House, Cheshire Oaks. Speakers on the day include Paul Rooney, the National Acute Care Programme Lead, and Alan Worthington, the Carer Advisor to the National Acute Care Programme, along with other local speakers. Attendees will have access to the self assessment tool to benchmark their own services and space to plan ahead.

In order to reserve your place at this event contact Rachel Cross, Event and Communications Co-ordinator, North West Joint Improvement Partnership on rachel.cross@northwestjip.nhs.uk indicating your name, job title, organisation, e-mail address and any special requirements or telephone Rachel on  0161 242 1322.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Filed under: Care Plans, carers, Service users | Tagged: , , , , , , , , , , | Comments Off

Information Literacy – Finding, using and managing information: nursing, midwifery health and social care information literacy competences

Posted on January 14, 2011 by lancashirecarelibraryblog

Finding, using and managing information: nursing, midwifery health and social care information literacy competences, RCN, 2011

Click on the title above to access the full-text of this report

Abstract:

The Royal College of Nursing recognised the need for information literacy competences to complement its clinical competence framework, helping nurses, midwives, health care assistants and nursing students develop their skills in using information and knowledge and apply this to their practice. These competences are intended to support the individual and the nursing team’s thinking about the information required to inform activities of varying complexity and are intended for use by staff in NHS career bands 1-9.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Filed under: evidence-based practice, information literacy, nursing | Tagged: , , , , , , , | Comments Off

High impact actions: preventing falls and encouraging exercise

Posted on January 14, 2011 by lancashirecarelibraryblog

High impact actions: preventing falls and encouraging exercise, Nursing Management,  Jul 2010. Vol. 17, Iss. 4; p. 22 (4 pages)

Karen Lowton, Anne Laybourne, David Whiting, Finbarr Martin, Dawn Skelton

UK

Abstract:

This article, the second in a series on the NHS Institute for Innovation and Improvement’s eight high impact actions, reviews the roles played by nurses and local organisations in preventing falls among older people through early intervention and the promotion of active lifestyles.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Exercise and Health, Falls Elderly, Innovation, TQM | Tagged: , , , , , , , | Comments Off

Where to Position Clozapine: Re-examining the Evidence

Posted on January 13, 2011 by lancashirecarelibraryblog

Where to Position Clozapine: Re-examining the Evidence, Canadian Journal of Psychiatry. Oct 2010. Vol. 55, Iss. 10; p. 677 –

Ofer Agid, George Foussias, Shayna Singh, Gary Remington.

Abstract:

To review clozapine’s position in treatment algorithms for schizophrenia. Clozapine’s status is reviewed in the context of its initial discovery and unique clinical and (or) pharmacological profile, withdrawal and link with hematologic concerns, reintroduction with monitoring guidelines, prototype for atypicality, positioning in treatment algorithms, and current evidence regarding efficacy, effectiveness, and side effects. The hematologic monitoring implemented with clozapine’s reintroduction here in North America has proven successful in preventing clozapine-related deaths secondary to agranulocytosis. While its other side effects are not without concern, present evidence does not link clozapine to increased mortality rates; indeed, it appears better than other antipsychotics in this regard. Moreover, its clinical superiority compared with all other antipsychotics has been confirmed both in efficacy and in effectiveness trials. Schizophrenia continues to represent a treatment challenge, with many people demonstrating suboptimal response and poor functional outcome. Clozapine is routinely positioned as a third-line treatment in schizophrenia, but in light of existing evidence this warrants re-examination.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Pharmacy, Schizophrenia | Tagged: , , , , , | Comments Off

The Patient Health Questionnaire 2-item is a rapid, sensitive and specific screening tool for identifying adolescents with major depression

Posted on January 12, 2011 by lancashirecarelibraryblog

The Patient Health Questionnaire 2-item is a rapid, sensitive and specific screening tool for identifying adolescents with major depression, Evidence Based Mental Health 2010;13:104

Tiffin

abstracted from: Richardson LP, Rockhill C, Russo JE, et al. Evaluation of the PHQ-2 as a brief screen for
detecting major depression among adolescents. Pediatrics 2010;125:e1097–103.

Abstract:

Question

Is the Patient Health Questionnaire 2-item depression screen (PHQ-2) effective as a brief screening tool for depression among adolescents?

Patients

3775 adolescents (13–17 years old) who attended a group health facility in the previous 12 months. The adolescents were randomly selected and sent a brief 10-item questionnaire, including the PHQ-2. Of those selected, 2291 (61%) completed the PHQ-2, and 281 (12%) screened positive for possible depression using the optimal PHQ-2 cut-off for major depression in adults (score ≥3). Based on the results of this screen, 499 adolescents were selected for telephone interview: 271 with PHQ-2 scores ≥3 and 228, age- and gender-matched adolescents, with PHQ-2 scores ≤2.

Setting

US primary care setting; enrolment September 2007 to June 2008.

Test

The PHQ-2 administered over the telephone. The PHQ-2 questions assess how frequently the individual had (1) a depressed mood and/or (2) lack of pleasure in usual activities in the last 2 weeks. Frequency is rated on a …

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

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Interpersonal psychotherapy for depression

Posted on January 11, 2011 by lancashirecarelibraryblog

Interpersonal psychotherapy for depression, Advances in Psychiatric Treatment (2011) 17: 23-31

Roslyn Law is Chair of the UK Interpersonal Psychotherapy (IPTUK) network and Assistant Director for Psychology and Psychotherapies in South West London and St George’s Mental Health NHS Trust.

Abstract:

Interpersonal psychotherapy is an evidence-based therapy, originally developed to treat major depression. It is cited in numerous good practice guidelines. The biopsychosocial signs of depression are understood in the context of current social and interpersonal stressors, defined in terms of role transitions, disputes, bereavements and sensitivities. In therapy, the patient learns to understand the interactions between symptoms and interpersonal difficulties and the ways in which they are mutually reinforcing. Patients are helped to break this pattern and achieve a reduction in depressive symptoms and improvement in interpersonal functioning through improved communication, expression of affect and proactive engagement with the current interpersonal network. The therapeutic relationship is used as a tool for exploring and modelling external relationships. This article outlines the background to interpersonal psychotherapy, the process of therapy and the expansion of the evidence base.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Uncategorized | Tagged: , , , | Comments Off

Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis

Posted on January 10, 2011 by lancashirecarelibraryblog

Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis, The British Journal of Psychiatry (2011) 198: 11-16

Barbui C, Cipriani A,  Patel V, Ayuso-Mateos JL, van Ommeren M

Abstract:

BACKGROUND: Depression is a common condition that has been frequently treated with psychotropics.

AIMS: To review systematically the evidence of efficacy and acceptability of antidepressant and benzodiazepine treatments for patients with minor depression.

METHOD: A systematic review and meta-analysis of double-blind randomised controlled trials comparing antidepressants or benzodiazepines v. placebo in adults with minor depression. Data were obtained from MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Controlled Trials Register and pharmaceutical company websites. Risk of bias was assessed for the generation of the allocation sequence, allocation concealment, masking, incomplete outcome data, and sponsorship bias.

RESULTS: Six studies met inclusion criteria. Three studies compared paroxetine with placebo; fluoxetine, amitriptyline and isocarboxazid were studied in one study each. No studies compared benzodiazepines with placebo. In terms of failures to respond to treatment (6 studies, 234 patients treated with antidepressants and 234 with placebo) no significant difference between antidepressants and placebo was found (relative risk (RR) 0.94, 95% CI 0.81-1.08). In terms of acceptability, data extracted from two studies (93 patients treated with antidepressants and 93 with placebo) showed no statistically significant difference between antidepressants and placebo (RR = 1.06, 95% CI 0.65-1.73). There was no statistically significant between-study heterogeneity for any of the reported analyses.

CONCLUSIONS: There is evidence showing there is unlikely to be a clinically important advantage for antidepressants over placebo in individuals with minor depression. For benzodiazepines, no evidence is available, and thus it is not possible to determine their potential therapeutic role in this condition.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

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NICE Guidance – Personality Disorder

Posted on January 10, 2011 by lancashirecarelibraryblog

Christopher Garrett, Tennyson Lee, Samantha Blackburn, Leanne Priestly, and Kamaldeep Bhui

Abstract:

Aims and method Using the National Institute for Health and Clinical Excellence (NICE) guidelines on borderline personality disorder as a framework, we describe the profile of the first 100 individuals referred to a personality disorder service in London, captured through the use of record review and case study.

Results The referral population ethnic profile does not match the wider population of the borough; a third of the borough is Bangladeshi, but only 9% of those referred to the service are. Of those diagnosed with borderline personality disorder and on psychotropic medications, only one person had a clear current indication based on NICE guidelines. Of the 100 individuals who were referred to the service, a quarter were accepted to the programme; a third either did not want to proceed with the assessment or were unprepared for an intensive programme.

Clinical implications The under-representation of Black and minority ethnic individuals in referrals in the peresonality disorder service needs to be actively addressed. Interventions are required to support psychiatrists in reviewing their prescribing practice regarding individuals with borderline personality disorder. Access to the service needs to be improved.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: ethnic minorities, NICE Guidelines, Personality Disorders | Tagged: , , , , , | Comments Off

Behavioural activation delivered by the non-specialist: phase II randomised controlled trial

Posted on January 9, 2011 by lancashirecarelibraryblog

Behavioural activation delivered by the non-specialist: phase II randomised controlled trial, British Journal of Psychiatry,  2011 Jan;198:66-72

Ekers D, Richards D, McMillan D, Bland JM, Gilbody S

Mental Health Research Centre, Durham University, Health Centre, Chester Le Street, Co Durham, DH3 3UR, UK

Abstract:

Background: Behavioural activation appears as effective as cognitive-behaviour therapy (CBT) in the treatment of depression. If equally effective, then behavioural activation may be the preferred treatment option because it may be suitable for delivery by therapists with less training. This is the first randomised controlled trial to look at this possibility.

AIMS: To examine whether generic mental health workers can deliver effective behavioural activation as a step-three high-intensity intervention.

METHOD: A randomised controlled trial (ISRCTN27045243) comparing behavioural activation (n = 24) with treatment as usual (n = 23) in primary care.

RESULTS: Intention-to-treat analyses indicated a difference in favour of behavioural activation of -15.79 (95% CI -24.55 to -7.02) on the Beck Depression Inventory-II and Work and Social Adjustment Scale (mean difference -11.12, 95% CI -17.53 to -4.70).

CONCLUSIONS: Effective behavioural activation appears suitable for delivery by generic mental health professionals without previous experience as therapists. Large-scale trial comparisons with an active comparator (CBT) are needed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Filed under: Behavioural Activation, depression | Tagged: , , , , | Comments Off

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