Physical leisure activities and their role in preventing dementia: a systematic review

Physical leisure activities and their role in preventing dementia: a systematic review, International Journal of Evidence-Based Healthcare , 2009; 7(4): 270-82

Stern, C

Abstract:

Aim To synthesise the best available evidence concerning the role of physical leisure activities in preventing dementia among older adults.

Methods Studies containing adults aged 60 years and older with or without a clinical diagnosis of dementia who did or did not participate in physical leisure activities were considered. Activities were those that required active movement of the body such as gardening or playing sports, which were not for occupation-related purposes nor activities of daily living. Experimental and observational studies in the English language were targeted; there was no date restriction.

Results A total of 17 epidemiological studies were included in the review. The evidence was equivocal regarding the relationship between participation in physical activities during midlife and later life and the prevention of dementia.

Conclusion Participating in physical activities during middle and later adult life can be neither refuted nor recommended to prevent the onset of dementia. Engaging in some physical activities (i.e. gardening, walking) appears to be more beneficial than engaging in other activities.

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

Risks and benefits of antipsychotic drugs in elderly patients with dementia

Risks and benefits of antipsychotic drugs in elderly patients with dementia, Journal of Psychosocial Nursing & Mental Health Services,  2008 Nov; 46(11): 19-23

Howland, R H

Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania

Abstract:

Memory impairment and other cognitive disturbances characterize dementia, but other noncognitive behavioral and psychiatric symptoms are very common. The most important behavioral and psychiatric symptoms associated with dementia (BPSAD) are agitation, aggression, and psychosis, and they have serious consequences for patients and caregivers. No medication has been approved for the treatment of BPSAD, but antipsychotic drugs are the best studied and most commonly used. However, in addition to these drugs’ expected side effects, cerebrovascular adverse events and death are two serious adverse effects associated with their use in dementia patients. This article highlights the studies examining the risks and benefits of antipsychotic drugs for BPSAD. Weighing small but significant risks compared with possible benefits is a complex treatment decision.

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

Cochrane – Exercise to improve self-esteem in children and young people

Exercise to improve self-esteem in children and young people  , Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003683. DOI: 10.1002/14651858.CD003683.pub2.

 Eilin Ekeland¹, Frode Heian², Kåre Birger Hagen³, Jo M Abbott⁴, Lena Nordheim⁵

¹Norwegian Physiotherapist Association/ Norsk Fysioterapeutforbund, Oslo, Norway. ²Child and Adolescence Psychiatric Dept, Molde Hospital, NO-6407 Molde, Norway. ³National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway. ⁴Clinical School of Midwifery and Neonatal Nursing Studies, La Trobe University, Carlton, Australia. ⁵Centre for Evidence Based Practice, Bergen University College, Bergen, Norway

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Abstract:

Background

Psychological and behavioural problems in children and adolescents are common, and improving self-esteem may help to prevent the development of such problems. There is strong evidence for the positive physical health outcomes of exercise, but the evidence of exercise on mental health is scarce.

Objectives

To determine if exercise alone or exercise as part of a comprehensive intervention can improve self-esteem among children and young people.

Search strategy

Computerised searches in MEDLINE, EMBASE, The Cochrane Controlled Trials Register (CENTRAL), CINAHL, PsycINFO and ERIC were undertaken and reference lists from relevant articles were scanned. Relevant studies were also traced by contacting authors. Dates of most recent searches: May 2003 in (CENTRAL), all others: January 2002.

Selection criteria

Randomised controlled trials where the study population consisted of children and young people aged from 3 to 20 years, in which one intervention arm was gross motor activity for more than four weeks and the outcome measure was self-esteem.

Data collection and analysis

Two reviewers independently selected trials for inclusion, assessed the validity of included trials and extracted data. Investigators were contacted to collect missing data or for clarification when necessary.

Main results

Twenty-three trials with a total of 1821 children and young people were included. Generally, the trials were small, and only one was assessed to have a low risk of bias. Thirteen trials compared exercise alone with no intervention. Eight were included in the meta-analysis, and overall the results were heteregeneous. One study with a low risk of bias showed a standardised mean difference (SMD) of 1.33 (95% CI 0.43 to 2.23), while the SMD’s for the three studies with a moderate risk of bias and the four studies with a high risk of bias was 0.21 (95% CI -0.17 to 0.59) and 0.57 (95% CI 0.11 to 1.04), respectively. Twelve trials compared exercise as part of a comprehensive programme with no intervention. Only four provided data sufficient to calculate overall effects, and the results indicate a moderate short-term difference in self-esteem in favour of the intervention [SMD 0.51 (95% CI 0.15 to 0.88)].

Authors’ conclusions

The results indicate that exercise has positive short-term effects on self-esteem in children and young people. Since there are no known negative effects of exercise and many positive effects on physical health, exercise may be an important measure in improving children’s self-esteem.
These conclusions are based on several small low-quality trials.

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

Cochrane – Interventions for promoting physical activity

Interventions for promoting physical activity  Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD003180. DOI: 10.1002/14651858.CD003180.pub2.

Charles Foster¹, Melvyn Hillsdon², Margaret Thorogood³

¹BHF Health Promotion Reserach Group, University of Oxford, Headington, Oxford, UK. ²Department of Excercise and Health Sciences, University of Bristol , Bristol , UK. ³Public Health and Epidemiology, University of Warwick, Coventry, UK

Abstract:

Background

Little is known about the effectiveness of strategies to enable people to achieve and maintain recommended levels of physical activity.

Objectives

To assess the effectiveness of interventions designed to promote physical activity in adults aged 16 years and older, not living in an institution.

Search strategy

We searched The Cochrane Library (issue 1 2005), MEDLINE, EMBASE, CINAHL, PsycLIT, BIDS ISI, SPORTDISCUS, SIGLE, SCISEARCH (from earliest dates available to December 2004). Reference lists of relevant articles were checked. No language restrictions were applied.

Selection criteria

Randomised controlled trials that compared different interventions to encourage sedentary adults not living in an institution to become physically active. Studies required a minimum of six months follow up from the start of the intervention to the collection of final data and either used an intention-to-treat analysis or, failing that, had no more than 20% loss to follow up.

Data collection and analysis

At least two reviewers independently assessed each study quality and extracted data. Study authors were contacted for additional information where necessary. Standardised mean differences and 95% confidence intervals were calculated for continuous measures of self-reported physical activity and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% confidence intervals were calculated.

Main results

The effect of interventions on self-reported physical activity (19 studies; 7598 participants) was positive and moderate (pooled SMD random effects model 0.28 95% CI 0.15 to 0.41) as was the effect of interventions (11 studies; 2195 participants) on cardio-respiratory fitness (pooled SMD random effects model 0.52 95% CI 0.14 to 0.90). There was significant heterogeneity in the reported effects as well as heterogeneity in characteristics of the interventions. The heterogeneity in reported effects was reduced in higher quality studies, when physical activity was self-directed with some professional guidance and when there was on-going professional support.

Authors’ conclusions

Our review suggests that physical activity interventions have a moderate effect on self-reported physical activity, on achieving a predetermined level of physical activity and cardio-respiratory fitness. Due to the clinical and statistical heterogeneity of the studies, only limited conclusions can be drawn about the effectiveness of individual components of the interventions. Future studies should provide greater detail of the components of interventions.

 

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

Major trauma care in England – NAO

Major trauma care in England   February 2o10, National Audit Office

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Abstract:

“Current services for people who suffer major trauma are not good enough. There is unacceptable variation, which means that if you are unlucky enough to have an accident at night or at the weekend, in many areas you are likely to receive worse quality of care and are more likely to die. The Department of Health and the NHS must get a grip on coordinating services through trauma networks, on costs and on information on major trauma care, if they are to prevent unnecessary deaths.” 　

 

                              Amyas Morse, head of the National Audit Office, 5 February 2010

 

There is unacceptable variation in major trauma care in England depending upon where and when people are treated, according to a National Audit Office report published today. Care for patients who have suffered major trauma, for example following a road accident or a fall, has not significantly improved in the last 20 years despite numerous reports identifying poor practice, and services are not being delivered efficiently or effectively.

 

Survival rates vary significantly from hospital to hospital, with a range from five unexpected survivors to eight unexpected deaths per 100 trauma patients, reflecting the variable quality of care. The NAO estimates that 450 to 600 lives could be saved each year in England if major trauma care was managed more effectively.

 

For best outcomes care should be led by consultants experienced in major trauma; but major trauma is most likely to occur at night and at weekends, when consultants are not normally in the emergency department. Only one hospital has 24-hour consultant care, seven days a week.　　

 

Major trauma care is not coordinated and there are no formal arrangements for taking patients directly for specialist treatment or transferring them between hospitals. CT scanning is very important for major trauma patients; however, a significant number of patients that need a scan do not receive one. Not enough patients who need a critical care bed are given one.

 

Access to rehabilitation services, which can improve patients’ recovery, quality of life and reduce the length of hospital stay, varies across the country and patients are not always receiving the care that they need. The costs of major trauma care are not well understood. The estimated annual lost economic output from deaths and serious injuries from major trauma is between £3.3 billion and £3.7 billion.

 

Collecting information on care is essential for monitoring and improving services, but only 60 per cent of hospitals delivering major trauma care contribute to the Trauma Audit and Research Network (TARN). The performance of the 40 per cent of hospitals that do not submit data to TARN cannot be measured.

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

The Evidence – Self care reduces costs and improves health: the evidence

Self care reduces costs and improves health: the evidence    January 2010, Expert Patient Programme

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Abstract:

This report reviews existing literature on self-management of care, as well as using research through questionnaires, focus groups and interviews, to provide examples of how economically beneficial it could be for the NHS.

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

Developing Skills: Talking about end of life care – Twelve pilot schemes in England

Developing Skills: Talking about end of life care – Twelve pilot schemes in England  January 2010

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Abstract:

Effective and sensitive communication between staff and patients, their relatives and carers is fundamental to high quality end of life care.  This project will see 12 pilot sites across England explore and help develop a more skilled and confident workforce.

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

National End of Life Care Programme Fact Sheets – Palliative Care

National End of Life Care Programme Fact Sheets    National End of Life Care Programme

Click on the title above to download the factsheets

Fact Sheets

• Fact Sheet 9: Independent Mental Capacity Advocates
• Fact Sheet 8: End of Life Care in Sheltered and Extra care housing
• Fact Sheet 7: Models of Delivery
• Fact Sheet 6: Support for Carers
• Fact Sheet 5: Preferred Priorities for Care an Advance Care Plan
• Fact Sheet 4: End of Life Care Commissioning
• Fact Sheet 3: Advance Decisions to Refuse Treatment
• Fact Sheet 2: Advance Care Planning
• Fact Sheet 1: End of Life Care Strategy

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

Religion, spirituality and mental health

Religion, spirituality and mental health, The Psychiatrist (2010) 34: 63-64

Simon Dein, Christopher C. H. Cook, Andrew Powell, and Sarah Eagger

Honorary Consultant Psychiatrist in Rehabilitation and Liaison Psychiatry at Princess Alexandra Hospital, and Senior Lecturer in Psychiatry at University College London

Abstract:

Research demonstrates important associations between religiosity and well-being; spirituality and religious faith are important coping mechanisms for managing stressful life events. Despite this, there is a religiosity gap between mental health clinicians and their patients. The former are less likely to be religious, and recent correspondence in the Psychiatric Bulletin suggests that some at least do not consider it appropriate to encourage discussion of any spiritual or religious concerns with patients. However, it is difficult to see how failure to discuss such matters can be consistent with the objective of gaining a full understanding of the patient’s condition and their self-understanding, or attracting their full and active engagement with services.

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

An evaluation of nurse prescribing. Part 2: a literature review

An evaluation of nurse prescribing. Part 2: a literature review, British Journal of Nursing (BJN), 2009 Dec 10; 18 (22): 1398-1402

O’Connell E; Creedon R; McCarthy G; Lehane B

School of Nursing and Midwifery, University College Cork, Ireland

Abstract:

Aim: This is the second of a 2-part literature review, which aims to provide a summary of the research conducted into nurse prescribing and patients’ perspectives, the prescribing practice and benefits of prescribing. Background: Prescriptive authority for nurses was first introduced by America in 1969, followed later by the UK, Canada, New Zealand, Australia and Sweden. A review of research conducted internationally was performed to inform the development of prescribing policies and practice and to guide future research. Method: A number of electronic databases were searched in March 2009 and 155 results were retrieved. Forty-four studies satisfied the criteria for inclusion. Twenty-two of those studies are included in this part of the review. Findings: Sixteen studies reviewed were UK based, four from the USA and just two from Australia. Twenty-one of the studies focused solely on primary/secondary care, with just one on the hospital setting alone. Twelve studies incorporated nurse prescribers’ views, while nine elicited patients’ views and one explored the views of the general public and nurse prescribing. Findings of studies relating to patients’ perspectives on prescribing were generally positive but methodologies in these studies were very diverse. Varied and context-specific evidence of the practices of nurse prescribers was presented in studies investigating this aspect of nurse prescribing. Conclusion: This review has demonstrated the diversity of research conducted in the area of patients’ perspectives on nurse prescribing, prescribing practices and benefits of nurse prescribing. It has identified areas that require further investigation which, in turn, will inform the future development of nurse and midwife prescribing.

 

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

New guidelines on assisted suicide: will nurses be prosecuted?

New guidelines on assisted suicide: will nurses be prosecuted? British Journal of Nursing 2009 Dec 10; 1, 8(22): 1396-7

Smith,  S W , Lecturer in Law at Birmingham Law School

Abstract:

In the recent decision by the House of Lords, in R (on the application of Purdy) vs Director of Public Prosecutions, the Director of Public Prosecutions was directed to publish a prosecutorial policy on when to seek charges under Section 2(1) of the Suicide Act in cases relating to assistance with dying. Consistent with that decision, the Director of Public Prosecutions published an interim policy in September. This article describes the purpose and scope of that policy. It further provides an analysis of the factors relating to prosecution, which are included in the DPP’s guidance. Finally, the effect that the guidance may have on healthcare workers is considered.

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

Latest Report – Dementia 2010 – A major new report from the Alzheimer’s Research Trust commissioned by the University of Oxford

    Dementia 2010   January 2o10, Alzheimer’s Reseach Trust

Executive Summary

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Abstract:

The cost of dementia

The Alzheimer’s Research Trust has commissioned the Health Economics Research Centre at the University of Oxford to produce a report on the economic cost of dementia to the UK, and the country’s investment in research to find new treatments, preventions and cures.

The Oxford team’s findings are astonishing. They show dementia to be the greatest medical challenge of our time.

• Over 820,000 people in the UK live with Alzheimer’s and other dementias.
• Dementia costs the UK economy £23 billion per year: more than cancer and heart disease combined.
• Dementia research is severely underfunded, receiving 12 times less support than cancer research.

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

Does lithium protect against dementia?

Does lithium protect against dementia? Bipolar Disorders, 2010, Volume 12 Issue 1, Pages 87 - 94

Lars Vedel Kessing, Julie Lyng Forman, Per Kragh Andersen

Department of Psychiatry, University Hospital of Copenhagen ,   ^b Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark

Abstract:

Objective: To investigate whether treatment with lithium in patients with mania or bipolar disorder is associated with a decreased rate of subsequent dementia.

Methods: Linkage of register data on prescribed lithium in all patients discharged from psychiatric health care service with a diagnosis of mania or bipolar disorder and subsequent diagnoses of dementia in Denmark during a period from 1995 to 2005.

Results: A total of 4,856 patients with a diagnosis of a manic or mixed episode or bipolar disorder at their first psychiatric contact were included in the study. Among these patients, 2,449 were exposed to lithium (50.4%), 1,781 to anticonvulsants (36.7%), 4,280 to antidepressants (88.1%), and 3,901 to antipsychotics (80.3%) during the study period. A total of 216 patients received a diagnosis of dementia during follow-up (103.6/10,000 person-years). During the period following the second prescription of lithium, the rate of dementia was decreased compared to the period following the first prescription. In contrast, the rates of dementia during multiple prescription periods with anticonvulsants, antidepressants, or antipsychotics, respectively, were not significantly decreased compared to the rate of dementia during the period with one prescription of these drugs.

Conclusions: Continued treatment with lithium was associated with a reduced rate of dementia in patients with bipolar disorder in contrast to continued treatment with anticonvulsants, antidepressants, or antipsychotics. Methodological reasons for these findings cannot be excluded due to the nonrandomized nature of the data.

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

Multisystemic Therapy (MST) for Youth Offending, Psychiatric Disorder and Substance Abuse: Case Examples from a UK MST Team

Multisystemic Therapy (MST) for Youth Offending, Psychiatric Disorder and Substance Abuse: Case Examples from a UK MST Team , Child and Adolescent Mental Health, 2010

Charles Wells, Jai Adhyaru, Jacqueline Cannon, Moira Lamond, Geoffrey Baruch

Brandon Centre for Counselling and Psychotherapy for Young People, 26 Prince of Wales Road, London, NW5 3LG, UK

Abstract:

Background: The paper illustrates the MST treatment model with three types of presenting problem in young people aged 14–15.

Method: The MST model is described and then illustrated with detailed case material from a violent young person convicted of robbery, a young person with a history of serious self-harming behaviour and hospitalisation, and a young person persistently smoking cannabis.

Results: All three cases improved after the MST intervention despite disparate presenting problems that included re-offending, the elimination of self-harming behaviour and a significant reduction in the use of cannabis. The three young people were re-integrated into the education system.

Conclusion: This case series illustrates the potential uses of the MST model in CAMHS although RCT data are needed to replicate the effectiveness of MST in the British context.

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

Youth Therapist Strategies to Enhance Client Homework Completion

Youth Therapist Strategies to Enhance Client Homework Completion, Child and Adolescent Mental Health, 2010

Carolyn Houlding, Fred Schmidt, Diane Walker

Lakehead University, 955 Oliver St, Thunder Bay, ON P7B 5E1, Canada

Abstract:

Background: This study examined strategies youth therapists use to attempt to enhance their clients’ therapeutic homework completion.

Method: Thirty-two youth mental health therapists participated. All participants completed a ‘Follow-Through Strategy’ survey and 13 also participated in a semi-structured interview. Interviews were recorded, transcribed and analysed.

Results: On the survey, therapists reported using a broad range of strategies to attempt to enhance therapeutic homework completion. Interview results indicated participants emphasized strategies related to therapeutic engagement to attempt to enhance homework completion.

Conclusions: Future studies should employ prospective design and examine the differential and collective impact of strategies therapists described using.

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

Collecting Routine Outcome Data in a Psychotherapy Community Clinic for Young People: Findings from an Ongoing Study

Collecting Routine Outcome Data in a Psychotherapy Community Clinic for Young People: Findings from an Ongoing Study, Child and Adolescent Mental Health, 2010, Volume 15 Issue 1, Pages 30 - 36

Geoffrey Baruch & Ioanna Vrouva

Brandon Centre for Counselling and Psychotherapy for Young People, 26 Prince of Wales Road, London NW5 3LG, UK

Research Department of Clinical, Educational and Health Psychology, University College London, UK

Abstract:

Background: The paper reports on the collection of routine outcome data from an ongoing audit at a voluntary sector psychotherapy service for young people aged 12 to 21 years in London offering once-weekly psychotherapy.

Method: The study uses intake and follow-up data from an ongoing audit of the psychotherapy service that started in 1993; 1608 young people were included in the study. Measures and areas of interest include the Youth Self Report Form, a significant other (SO) version of the Teacher’s Report Form, the Young Adult Self Report Form, and the Young Adult Behaviour Check List.

Results: Percentage returns at intake were 94% (self), 66% (SO) and 80% (therapist), but became 35%, 21% and 38% at 3-month follow-up, and decreased further at 6- and 12-month follow-up. At all time points, significant other report rates were lower than self or therapist report rates. Young people who did not provide data at intake were more likely to have dropped out of treatment. Over the 15-year period of the audit, intake self-report data rates remained stable (about 94%) whereas SO and especially therapist report rates increased. However, there was a reduction in self, significant other and therapist report rates at 3- and 6-month follow-up.

Conclusions: Collecting routine outcome data was compromised by a variety of factors, and systematic efforts, including introducing initiatives for participation are needed to increase follow-up data rates and improve their quality.

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

Developing the Primary Mental Health Worker Role in England

Developing the Primary Mental Health Worker Role in England ,  Child and Adolescent Mental Health, 2010, Volume 15 Issue 1, Pages 23 - 29

Nicole Hickey, Tami Kramer & Elena Garralda

Academic Unit of Child and Adolescent Psychiatry, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG, UK

 

 Abstract:

Background: The Primary Mental Health Worker (PMHW) interface role was introduced in England 13 years ago. This study evaluated the development of the role.

Method: 415 English PMHWs (64% of workforce) completed a survey about the services they provide, management organisation, training and development, and job satisfaction.

Results: PMHWs perceive their role to involve successful collaboration with primary care staff, offering improved access to mental health services, and being supported by a generally good infrastructure; although training opportunities remain an area of need.

Conclusions: The workforce development policy appears, from the PMHWs’ perspective, to be successful although training opportunities need consideration.

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

To find inner peace: soft massage as an established and integrated part of palliative care

To find inner peace: soft massage as an established and integrated part of palliative care, International Journal of Palliative Nursing, 2009 Nov; 15 (11): 541-5

Beck I; Runeson I; Blomqvist K

Abstract:

The aim of this study was to demonstrate how people with incurable cancer experienced soft massage in a palliative care setting in which massage was used as an established and integrated part of the nursing care. To reach a deep understanding of the experiences of receiving soft massage a qualitative method with a phenomenological approach was chosen. The study was based on interviews with eight patients in an advanced home care setting who had all received soft massage as part of their daily care. Soft massage was experienced by the informants as a way to fi nd inner peace. During the massage the patients felt dignifi ed, while memories from past massage sessions were about becoming free. These experiences of dignity and freedom brought hopes for the future. The conclusion is that soft massage ought to be offered in the ordinary palliative care. More research is needed to understand what is needed to integrate and establish methods such as soft massage in the palliative care.

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

Treatment need and provision in medium secure care

Treatment need and provision in medium secure care, British Journal of Forensic Practice, Jul; 11(2): 24-31

Davies J; Oldfield K

Abertawe Bro Morgannwg University NHS Trust, Swansea University, Chiral

Abstract:

Individuals being treated in medium secure hospitals have typically engaged in some form of offending in other service settings or while in the community. Although psychological treatment for addressing such behaviour in medium secure hospitals is beginning to be developed, at present there is a lack of evidence of ‘what works’. This paper reports a review of the type and level of offending behaviour engaged in by those in a single medium secure service, including the conviction histories for such behaviours and the psychological approaches to risk reduction and offending behaviour taken in medium secure hospitals in England and Wales. The need to develop an evidence base for psychological treatment in medium secure services including at the individual level is clearly indicated.

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

Living and dying with dignity: a qualitative study of the views of older people in nursing homes

Living and dying with dignity: a qualitative study of the views of older people in nursing homes, Age & Ageing, 2009 Jul; 38 (4): 411-6

Hall S; Longhurst S; Higginson I

King’s College London, Department of Palliative Care, Policy and Rehabilitation, London, UK

Abstract:

BACKGROUND: most older people living in nursing homes die there. An empirically based model of dignity has been developed, which forms the basis of a brief psychotherapy to help promote dignity and reduce distress at the end of life. OBJECTIVE: to explore the generalisability of the dignity model to older people in nursing homes. METHODS: qualitative interviews were used to explore views on maintaining dignity of 18 residents of nursing homes. A qualitative descriptive approach was used. The analysis was both deductive (arising from the dignity model) and inductive (arising from participants’ views). RESULTS: the main categories of the dignity model were broadly supported: illness-related concerns, social aspects of the illness experience and dignity conserving repertoire. However, subthemes relating to death were not supported and two new themes emerged. Some residents saw their symptoms and loss of function as due to old age rather than illness. Although residents did not appear to experience distress due to thoughts of impending death, they were distressed by the multiple losses they had experienced. CONCLUSIONS: these findings add to our understanding of the concerns of older people in care homes on maintaining dignity and suggest that dignity therapy may bolster their sense of dignity.

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

Palliative dementia care: a blended model

Palliative dementia care: a blended model, Canadian Nursing Home, 2009 Mar; 20 (1): 21-4

Abstract:

Dementia, one of the ten leading causes of death in seniors, is rarely recognized as an illness that people actually die from. It follows that quality dementia care should require the inclusion of a palliative approach as well. Drawing upon the norms of practice (dimensions) expounded by The Canadian Hospice Palliative Care Association, the authors discuss a blended model that integrates dementia care concepts (including person-centred care) with palliative care philosophy.

 

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

Diagnosing borderline personality disorder: Examination of how clinical indicators are used by professionals in the health setting

Diagnosing borderline personality disorder: Examination of how clinical indicators are used by professionals in the health setting , Clinical Psychologist, Volume 13, Issue 1 March 2009 , pages 21 – 27

Amanda Jane Commons Treloar; Andrew J. Lewis

Abstract:

This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline personality disorder. The current study examines how clinical indicators used to screen for this complex disorder differ across service settings, professions, specialised training and years of clinical experience. A purpose-designed survey was administered to 108 mental and emergency medicine health practitioners across an Australian health service and a New Zealand health service to record the level of significance placed on different clinical indicators in the application of the diagnosis of borderline personality disorder. A heavy reliance was placed on observable behavioural symptoms, such as self-mutilation and impulsive behaviours that are self-damaging, in the screening of borderline personality disorder as a psychiatric diagnosis. Statistically significant differences were found between emergency medical staff and mental health clinicians in their use of diagnostic indicators of borderline personality disorder, χ²(4) = 17.248, p = .002. Implications of these findings for the screening, assessment and diagnosis of patients with borderline personality disorder are discussed.

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

The standard NHS contracts for acute hospital, mental health, community and ambulance services and supporting guidance

The standard NHS contracts for acute hospital, mental health, community and ambulance services and supporting guidance  January 2010, Department of Health

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Abstract:

The NHS standard contracts for Mental Health and Learning Disability, Ambulance Services,  Acute Hospital and Community Services were published on 18 January 2010. 

The contracts support the  NHS Operating Framework for 20010-2011 and should be read in conjunction with the  Principles and Rules for Co-operation and Competition and the PCT Procurement Guide.

The NHS standard contracts cover agreements between PCTs and all types of provider delivering  NHS funded services.  The contract will apply to agreements from April 2010 for:

• NHS Trusts
• NHS Foundation Trusts
• New agreements between PCTs and independent sector providers
• New agreements between PCTs and third sector providers

Guidance on each of the contracts is  published to support the implementation and interpretation of the contracts

A model consortium agreement and associated guidance have been updated and are published alongside the contracts

A standard format national variation will be issued for use by PCTs and providers on existing contracts. The standard variation will reflect the policy priorities outlined in the 2010/2011 Operating Framework.

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

Non-pharmaceutical management of depression

Non-pharmaceutical management of depression , 29th January 2010, Scottish Intercollegiate Guidelines Network (SIGN)

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Abstract:

BACKGROUND

Depression is a significant health problem which affects men and women of all ages and social backgrounds.The personal, social and economic consequences are substantial.

Depression is associated with sickness absence and prevents many people seeking, maintaining or returning to employment. Prescribed antidepressant medication is the most common treatment.

WHY WE NEED A GUIDELINE

Depression Alliance Scotland proposed the development of this guideline based on feedback from service users who were seeking information about interventions other than prescribed antidepressants which could be helpful in managing their depression.

The Scottish Integrated Care Pathway (ICP) for depression sets standards for appropriate care and treatment of people with depression. It states that for those who choose a non-pharmacological approach, or for whom medication is not effective, there should be the offer of a brief depressionfocused psychological intervention.

There is a need for accessible and robust evidence based information about the alternatives to prescribed antidepressants to be available to both GPs and service users.

REMIT

This guideline provides an assessment of, and presents the evidence base for, the efficacy of non-pharmaceutical therapies, encompassing psychological therapies, structured exercise and lifestyle interventions, and a range of alternative and complementary treatments, many of which are not routinely available within the NHS.

TARGET USERS OF THE GUIDELINE

This guideline will be of particular interest to those developing mental health services, health care professionals in primary and secondary care (eg GPs, community psychiatric nurses, clinical psychologists and psychiatrists) and patients with depression and their carers.

It may also be helpful to voluntary organisations and exercise professionals working in exercise referral schemes, public or private fitness centres, and physical activity promotion.

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

cognitive therapy for social anxiety in a 45-year-old man with a 27-year history of paranoid schizophrenia – Case Report

Schizophrenia, obsessive covert mental rituals and social anxiety: Case report , Clinical Psychologist, Volume 13, Issue 2 July 2009 , pages 75 – 77

Phillip J. Tully; Christopher J. Edwards

Abstract:

This case study reports the outcomes of cognitive therapy for social anxiety in a 45-year-old man with a 27-year history of paranoid schizophrenia. The intervention targeted the overlapping and interrelated symptoms of social anxiety and delusional beliefs. After 11 sessions of treatment, the patient showed no improvement in social anxiety, avoidance or self-consciousness. Failure to make significant progress was potentially due to treatment of social anxiety rather than the obsessional delusional thoughts. Clinicians should be cautious to distinguish between anxiety associated with obsessional delusions, non-obsessional delusions and non-delusional thoughts when treating social anxiety in schizophrenia.

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

Gardens: inclusive designs for care homes

Gardens: inclusive designs for care homes, Nursing & Residential Care, 2009 Dec; 11 (12): 624-7

Julia Swann

Abstract:

Residents and visitors can enjoy outdoor living spaces whether they are in the gardens or inside a care home. This article explores garden features and describes how to design well planned inclusive gardens.

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

Inflammation in Alzheimer’s disease: relevance to pathogenesis and therapy

Inflammation in Alzheimer’s disease: relevance to pathogenesis and therapy, Alzheimers Research Therapy,  2010, 2:1 pages 1-9

Elina Zotova¹ , James AR Nicoll^1,2 , Raj Kalaria³ , Clive Holmes^1,4  and Delphine Boche¹

¹  Division of Clinical Neurosciences, School of Medicine, University of Southampton, Mailpoint 806, Level D, South Pathology Block, Southampton General Hospital, Southampton, SO16 6YD, UK

²  Neuropathology, Department of Cellular Pathology, Southampton University Hospitals NHS Trust, Southampton, SO16 6YD, UK

³  Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK

⁴  Memory Assessment Centre, Moorgreen Hospital, Hampshire Partnership Trust, Southampton, SO30 3JB, UK

Abstract:

Evidence for the involvement of inflammatory processes in the pathogenesis of Alzheimer’s disease (AD) has been documented for a long time. However, the inflammation hypothesis in relation to AD pathology has emerged relatively recently. Even in this hypothesis, the inflammatory reaction is still considered to be a downstream effect of the accumulated proteins (amyloid beta (Aβ) and tau). This review aims to highlight the importance of the immune processes involved in AD pathogenesis based on the outcomes of the two major inflammation-relevant treatment strategies against AD developed and tested to date in animal studies and human clinical trials – the use of anti-inflammatory drugs and immunisation against Aβ.

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

Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?

Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms? Addiction, 2010

John F. Kelly et al..

Abstract:

Rationale  Indices of negative affect, such as depression, have been implicated in stress-induced pathways to alcohol relapse. Empirically supported continuing care resources, such as Alcoholics Anonymous (AA), emphasize reducing negative affect to reduce relapse risk, but little research has been conducted to examine putative affective mechanisms of AA’s effects.

Methods  Using lagged, controlled, hierarchical linear modeling and mediational analyses this study investigated whether AA participation mobilized changes in depression symptoms and whether such changes explained subsequent reductions in alcohol use. Alcohol-dependent adults (n = 1706), receiving treatment as part of a clinical trial, were assessed at intake, 3, 6, 9, 12 and 15 months.

Results  Findings revealed elevated levels of depression compared to the general population, which decreased during treatment and then remained stable over follow-up. Greater AA attendance was associated with better subsequent alcohol use outcomes and decreased depression. Greater depression was associated with heavier and more frequent drinking. Lagged mediation analyses revealed that the effects of AA on alcohol use was mediated partially by reductions in depression symptoms. However, this salutary effect on depression itself appeared to be explained by AA’s proximal effect on reducing concurrent drinking.

Conclusions  AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.

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

Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis

Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis , Cognitive Behaviour Therapy, Volume 38, Issue 4 December 2009 , pages 196 – 205

Gerhard Andersson; Pim Cuijpers

Abstract:

Computerized and, more recently, Internet-based treatments for depression have been developed and tested in controlled trials. The aim of this meta-analysis was to summarize the effects of these treatments and investigate characteristics of studies that may be related to the effects. In particular, the authors were interested in the role of personal support when completing a computerized treatment. Following a literature search and coding, the authors included 12 studies, with a total of 2446 participants. Ten of the 12 studies were delivered via the Internet. The mean effect size of the 15 comparisons between Internet-based and other computerized psychological treatments vs. control groups at posttest was d = 0.41 (95% confidence interval [CI]: 0.29-0.54). However, this estimate was moderated by a significant difference between supported (d = 0.61; 95% CI: 0.45-0.77) and unsupported (d = 0.25; 95% CI: 0.14-0.35) treatments. The authors conclude that although more studies are needed, Internet and other computerized treatments hold promise as potentially evidence-based treatments of depression.

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

Schizophrenia & Secure Settings – Associations between the Illness Perception Questionnaire

Associations between the Illness Perception Questionnaire for Schizophrenia and engagement in treatment in a secure setting, Clinical Psychologist, Volume 13, Issue 2 July 2009 , pages 69 – 74

Prveen Shah;  Tim Hull; Gerard Anthony Riley

Department of Psychology, University of Birmingham, Birmingham

South Staffordshire Healthcare NHS Foundation Trust, Hatherton Centre, Stafford, UK

Abstract:

The purpose of the present study was to investigate whether individuals’ beliefs about their psychosis are associated with engagement in treatment in a forensic setting. The study was cross-sectional correlational in design, and used self- and other-report measures. Thirty residents on two secure units completed the Illness Perception Questionnaire for Schizophrenia (IPQS) and the University of Rhode Island Change Assessment (URICA) (as a measure of their engagement). Compliance with treatment was also rated by staff, using the Service Engagement Measure (SEM). The Timeline (beliefs in a chronic and relapsing course) and Treatment Control (beliefs in the treatability of the condition) subscales of the IPQS were associated with higher self-reported engagement on the URICA, accounting for 46% of the variance in URICA scores. None of the IPQS subscales, however, was significantly correlated with the SEM. Illness beliefs merit further investigation as a potential influence on treatment engagement in a forensic setting, but the IPQS may need further refinement, and better measures of engagement are needed.

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