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BMJ Open May 2024Although adolescents make treatment gains in psychiatric residential treatment (RT), they experience significant difficulty adapting to the community and often do not...
Families in transition (FIT) study protocol: feasibility, acceptability and preliminary effects of a group-based parent training in parents of youth in psychiatric residential treatment.
INTRODUCTION
Although adolescents make treatment gains in psychiatric residential treatment (RT), they experience significant difficulty adapting to the community and often do not sustain treatment gains long term. Their parents are often not provided with the necessary support or behaviour management skillset to bridge the gap between RT and home. Parent training, a gold standard behaviour management strategy, may be beneficial for parents of these youth and web-based parent training programmes may engage this difficult-to-reach population. This study focuses on a hybrid parent training programme that combines Parenting Wisely (PW), a web-based parent training with facilitated discussion groups (Parenting Wisely for Residential Treatment (PW)). This study aims to: (1) establish the feasibility and acceptability of PW, (2) evaluate whether PW engages target mechanisms (parental self-efficacy, parenting behaviours, social support, family function) and (3) determine the effects of PW on adolescent outcomes (internalising and externalising behaviours, placement restrictiveness).
METHODS AND ANALYSIS
In this randomised control trial, parents (n=60) will be randomly assigned to PW or treatment as usual. Each week for 6 weeks, parents in the PW condition will complete two PW modules (20 min each) and attend one discussion group via Zoom (90 min). Adolescents (n=60) will not receive intervention; however, we will evaluate the feasibility of adolescent data collection for future studies. Data from parents and adolescents will be collected at baseline, post intervention (6 weeks post baseline) and 6 months post baseline to allow for a robust understanding of the longer-term effects of PW on treatment gain maintenance.
ETHICS AND DISSEMINATION
The study has been approved by The Ohio State University Institutional Review Board (protocol number 2022B0315). The outcomes of the study will be shared through presentations at both local and national conferences, publications in peer-reviewed journals and disseminated to the families and organisations that helped to facilitate the project.
TRIAL REGISTRATION NUMBER
NCT05764369 (V.1, December 2022).
Topics: Humans; Adolescent; Parents; Feasibility Studies; Residential Treatment; Parenting; Female; Male; Mental Disorders; Randomized Controlled Trials as Topic; Social Support
PubMed: 38816058
DOI: 10.1136/bmjopen-2023-080603 -
BMJ Open May 2024Compulsory admissions are associated with feelings of fear, humiliation and powerlessness. The number of compulsory admissions in Germany and other high-income countries... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness of a peer-supported crisis intervention to reduce the proportion of compulsory admissions in acute psychiatric crisis interventions in an outreach and outpatient setting: study protocol for an exploratory cluster randomised trial combined with qualitative methods.
INTRODUCTION
Compulsory admissions are associated with feelings of fear, humiliation and powerlessness. The number of compulsory admissions in Germany and other high-income countries has increased in recent years. Peer support has been shown to increase the self-efficacy of individuals with mental health conditions in acute crises and to reduce the use of coercive measures in clinical settings. The objective of this study is to reduce the number of compulsory admissions by involving peer support workers (PSWs) in acute mental health crises in outreach and outpatient settings.
METHODS AND ANALYSIS
This one-year intervention is an exploratory, cluster randomised study. Trained PSWs will join the public crisis intervention services (CIS) in two of five regions (the intervention regions) in the city of Bremen (Germany). PSWs will participate in crisis interventions and aspects of the mental health services. They will be involved in developing and conducting an antistigma training for police officers. The remaining three regions will serve as control regions. All individuals aged 18 and older who experience an acute mental health crisis during the operating hours of the regional CIS in the city of Bremen (around 2000 in previous years) will be included in the study. Semistructured interviews will be conducted with PSWs, 30 patients from control and intervention regions, as well as two focus group discussions with CIS staff. A descriptive comparison between all participants in the intervention and control regions will assess the proportion of compulsory admissions in crisis interventions during the baseline and intervention years, including an analysis of temporal changes.
ETHICS AND DISSEMINATION
This study was approved by the Ethics Committee of the University of Bremen (file 2022-09) on 20 June 2022. The results will be presented via scientific conferences, scientific journals and communicated to policy-makers and practitioners.
TRIAL REGISTRATION NUMBER
DRKS00029377.
Topics: Humans; Crisis Intervention; Peer Group; Germany; Qualitative Research; Mental Disorders; Randomized Controlled Trials as Topic; Commitment of Mentally Ill; Male; Adult; Female; Mental Health Services
PubMed: 38816053
DOI: 10.1136/bmjopen-2023-083385 -
BMC Health Services Research May 2024Body worn cameras (BWC) are mobile audio and video capture devices that can be secured to clothing allowing the wearer to record some of what they see and hear. This...
BACKGROUND
Body worn cameras (BWC) are mobile audio and video capture devices that can be secured to clothing allowing the wearer to record some of what they see and hear. This technology is being introduced in a range of healthcare settings as part of larger violence reduction strategies aimed at reducing incidents of aggression and violence on inpatient wards, however limited evidence exists to understand if this technology achieves such goals.
AIM
This study aimed to evaluate the implementation of BWCs on two inpatient mental health wards, including the impact on incidents, the acceptability to staff and patients, the sustainability of the resource use and ability to manage the use of BWCs on these wards.
METHODS
The study used a mixed-methods design comparing quantitative measures including ward activity and routinely collected incident data at three time-points before during and after the pilot implementation of BWCs on one acute ward and one psychiatric intensive care unit, alongside pre and post pilot qualitative interviews with patients and staff, analysed using a framework based on the Consolidated Framework for Implementation Research.
RESULTS
Results showed no clear relationship between the use of BWCs and rates or severity of incidents on either ward, with limited impact of using BWCs on levels of incidents. Qualitative findings noted mixed perceptions about the use of BWCs and highlighted the complexity of implementing such technology as a violence reduction method within a busy healthcare setting Furthermore, the qualitative data collected during this pilot period highlighted the potential systemic and contextual factors such as low staffing that may impact on the incident data presented.
CONCLUSION
This study sheds light on the complexities of using such BWCs as a tool for 'maximising safety' on mental health settings. The findings suggest that BWCs have a limited impact on levels of incidents on wards, something that is likely to be largely influenced by the process of implementation as well as a range of contextual factors. As a result, it is likely that while BWCs may see successes in one hospital site this is not guaranteed for another site as such factors will have a considerable impact on efficacy, acceptability, and feasibility.
Topics: Humans; Pilot Projects; Male; Female; Adult; Psychiatric Department, Hospital; Violence; Video Recording; Middle Aged; Qualitative Research; Wearable Electronic Devices
PubMed: 38812029
DOI: 10.1186/s12913-024-11085-x -
BMC Nursing May 2024Palliative care schemes, which include pain management, symptom control, psychosocial support and rehabilitation, aim to boost patients' quality of life, ease the burden...
Impact of a comprehensive rehabilitation palliative care program on the quality of life of patients with terminal cancer and their informal caregivers: a quasi-experimental study.
BACKGROUND
Palliative care schemes, which include pain management, symptom control, psychosocial support and rehabilitation, aim to boost patients' quality of life, ease the burden and anxiety of informal caregivers, and ultimately provide a comprehensive approach to enhance well-being during this challenging and sensitive period. This study aims to evaluate the impact of a comprehensive rehabilitation palliative care program on the quality of life of patients with terminal cancer and their informal caregivers.
METHODS
This quasi-experimental study, conducted from August 2023 to January 2024 at outpatient clinics affiliated with the Oncology Center at Mansoura University, Egypt, focused on cancer patients and their caregivers in the palliative care department. Employing pre- and post-test phases, data were gathered using a questionnaire, EORTC QLQ C30, Hospital Anxiety and Depression Scale, Short Form Health Survey, Caregiver Burden Inventory, and Beck Anxiety Inventory. The investigation evaluated a 16-week rehabilitation program comprising exercise, psychoeducation, individual counselling, and spiritual support. Exercises, led by a physiotherapist, targeted fatigue and stress through tailored aerobic and resistance training. Psychoeducation sessions aimed to bolster coping abilities, covering fatigue management and nutrition. Trained counsellors addressed spiritual and existential concerns. Personal advisory sessions were available for individual support. Caregivers received education on rehabilitation and palliative care protocols, ensuring comprehensive patient care.
RESULTS
The mean age for cancer patients was 65.79 ± 13.85. In contrast, the mean age for primary carers was 42.05 ± 11.15. The QOL for cancer patients during the pre-test phase was 77.8 ± 7.16 and rose to 87.34 ± 14.56 during the post-test phase. Additionally, the total anxiety level of patients before the rehabilitation palliative care program was conducted was 15.45 ± 3.05 compared to 6.12 ± 3.21 after the post test phase. Furthermore, the total depression levels of the patients during the pre-test phase were 20.89 ± 9.21. However, after implementing the rehabilitation palliative care program, it decreased to 15.5 ± 6.86. In regards to the total quality of life of informal caregivers, it was measured at 67.28 ± 32.09 before conducting the program. Nevertheless, it increased to 25.95 ± 40.29 after conducting it. Additionally, the total Caregiver Burden Inventory before implementing the program was 37.45 ± 25.7, and it decreased to 29.36 ± 16.4 after conducting it. Additionally, the total score on the Beck Anxiety Inventory decreased from 45.7 ± 4.3 during the initial testing phase to 17.35 ± 23.67.
CONCLUSION
The program for rehabilitation palliative care successfully achieved its goals by enhancing the overall quality of life for cancer patients and their caregivers. Additionally, it reduced the anxiety and depression levels among the patients, as well as the anxiety and caregiver burden among the caregivers. Continue research into the effectiveness of rehabilitation palliative care programs to identify best practices, improve existing programs, and expand access to these services.
PubMed: 38812027
DOI: 10.1186/s12912-024-02028-2 -
Psychiatry Investigation May 2024This study explores whether cancer patients' dysfunctional self-focus is a significant contributor to their fear of progression. In addition, we investigated whether...
OBJECTIVE
This study explores whether cancer patients' dysfunctional self-focus is a significant contributor to their fear of progression. In addition, we investigated whether their psychiatric symptoms such as depression, anxiety, and dysfunctional beliefs about sleep may mediate the relationship between these factors.
METHODS
We conducted a retrospective medical records review of 196 cancer patients who visited the Stress Management Clinic for the first time from March to September 2022. Their demographic information and responses to rating scales such as the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Dysfunctional Self-focus Attribution Scale (DSAS), Patient Health Questionnaire-9 Items (PHQ-9), State subcategory of the State and Trait of Anxiety Inventory (STAI-S), Insomnia Severity Index (ISI), Cancer-related Dysfunctional Beliefs about Sleep scale (C-DBS), and numeric rating scales of pain and fatigue were collected.
RESULTS
A high FoP-Q-SF score was significantly correlated with high PHQ-9 (r=0.60), STAI-S (r=0.38), ISI (r=0.34), C-DBS (r=0.47), pain (r=0.24), fatigue (r=0.37), and DSAS (r=0.58, all p<0.001). A linear regression analysis showed that the FoP-Q-SF score was significantly predicted by younger age (β=-0.13, p=0.011), PHQ-9 (β=0.36, p<0.001), STAI-S (β=0.18, p=0.001), C-DBS (β=0.22, p<0.001), and DSAS (β=0.25, p<0.001). A mediation analysis showed that dysfunctional self-focus directly influenced patients' fear of progression. In addition, cancer patients' depression, anxiety, and cancer-related dysfunctional beliefs about sleep mediated this relationship.
CONCLUSION
We observed that dysfunctional self-focus may influence cancer patients' fear of progression, mediated by depression, anxiety, and cancer-related dysfunctional beliefs about sleep.
PubMed: 38810999
DOI: 10.30773/pi.2023.0354 -
Journal of Taibah University Medical... Jun 2024In the field of health services, telenursing is a contemporary information and communication technology system that enables the provision of nursing care and services to... (Review)
Review
INTRODUCTION
In the field of health services, telenursing is a contemporary information and communication technology system that enables the provision of nursing care and services to remote areas. Telenursing can increase psychological general well-being in patients with chronic conditions. Nevertheless, the effects of telenursing on patients with heart failure have not been examined.
OBJECTIVE
This study was aimed at ascertaining how telenursing treatments affect quality of life in patients with heart failure.
METHOD
The inclusion criteria were articles from 2015 to 2023 in English, reporting quality of life outcomes for participants with heart failure in randomized controlled trials of telenursing interventions. The exclusion criteria were studies of psychiatric disorders, literature reviews, systematic reviews, and umbrella reviews. The systematic review was registered with PROSPERO registration number CRD42023484361. The review was conducted with five databases: PubMed, Scopus, Willey, Proquest, and Emerald Insight. Critical appraisal was conducted with the Joanna Briggs Institute's Critical Appraisal Checklist. The data were synthesized with Review Manager version 5.4.
RESULTS
Eleven randomized controlled trials (2032 patients) met the inclusion criteria. A significant effect on quality of life was observed after telenursing intervention. The heterogeneity was high, at 98% (SMD = 1.05; 95% CI [0.12, 1.98]; ρ = 0.03).
CONCLUSION
Telenursing interventions can improve quality of life among patients with heart failure and therefore may be applied in hospitals providing nursing care, to remotely provide education and monitor the quality of life of patients with heart failure.
PubMed: 38807966
DOI: 10.1016/j.jtumed.2024.04.009 -
Frontiers in Health Services 2024During the COVID-19 pandemic individuals with mental illnesses faced challenges accessing psychiatric care. Our study aimed to describe patient characteristics and...
INTRODUCTION
During the COVID-19 pandemic individuals with mental illnesses faced challenges accessing psychiatric care. Our study aimed to describe patient characteristics and compare admissions and length of stay (LOS) for psychiatric-related hospitalizations before and during the COVID-19 pandemic.
METHODS
We conducted a retrospective analysis using health administrative data comparing individuals with an acute psychiatric admission between two time periods: 1st March 2019 to 31st December 2019 (pre-COVID) and 1st March 2020 to 31st December 2020 (during-COVID). Multivariable negative binomial regression was used to model the association between most responsible diagnosis type and the two-time periods to hospital LOS, reporting the Rate Ratio (RR) as the measure of effect.
RESULTS
The cohort comprised 939 individuals who were predominately male (60.3%) with a severe mental illness (schizophrenia or mood-affective disorder) (72.7%) and a median age of 38 (IQR: 28.0, 52.0) years. In the multivariable analysis, anxiety disorders (RR: 0.63, CI: 0.4, 0.99) and personality disorders (RR: 0.52, CI: 0.32, 0.85) were significantly associated with a shorter LOS when compared to individuals without those disorders. Additionally, when compared to hospital admissions for non-substance related disorders the LOS for patients with substance-related disorders were significantly shorter during the COVID period (RR: 0.45, CI: 0.30, 0.67) and pre-COVID period (RR: 0.31, CI: 0.21, 0.46).
CONCLUSIONS
We observed a significant difference in the type and length of admissions for various psychiatric disorders during the COVID-19 period. These findings can support systems of care in adapting to utilization changes during pandemics or other global health events.
PubMed: 38807747
DOI: 10.3389/frhs.2024.1365785 -
Frontiers in Psychiatry 2024Mental health services have transitioned from treating symptoms to emphasizing personal recovery. Despite its importance, integrating personal recovery into clinical...
INTRODUCTION
Mental health services have transitioned from treating symptoms to emphasizing personal recovery. Despite its importance, integrating personal recovery into clinical practice remains work in progress. This study evaluates the psychometric qualities of the Brief INSPIRE-O, a five-item patient-reported outcome measure assessing personal recovery.
METHOD
The study collected data from 2018 to 2020 at the Mental Health Services, Capital Region of Denmark, using an internet-based system examining 8,192 non-psychotic patients - receiving outpatient treatment.
MATERIALS
This study evaluated the Brief INSPIRE-O and used measures of symptomatology (SCL-10), well-being (WHO-5), and social functioning (modified SDS).
RESULTS
The study population comprised 76.8% females with a mean age of 32.9 years, and diagnoses included anxiety (28%), depression (34%), and personality disorder (19%). The mean Brief INSPIRE-O score (39.9) was lower than the general population norm (71.1). The Brief INSPIRE-O showed acceptable test-retest reliability (0.75), scalability (0.39), and internal consistency (0.73). Correlations with other mental health criteria were in the expected direction for symptomatology (-0.46), well-being (0.60), and social functioning (-0.43) and remained consistent across diagnoses.
DISCUSSION
The Brief INSPIRE-O demonstrated strong psychometric qualities and could be recommended as a measure of personal recovery for use in both research and clinical practice. Its strong theoretical basis and short completion time make it suitable for use for research. Incorporating Brief INSPIRE-O into clinical assessment will further support the process of mental health systems re-orientating towards personal recovery.
PubMed: 38807686
DOI: 10.3389/fpsyt.2024.1327020 -
Journal of Occupational Health May 2024Participatory organizational interventions to improve psychosocial working conditions are important for a safe and healthy work environment. However, there are few...
INTRODUCTION
Participatory organizational interventions to improve psychosocial working conditions are important for a safe and healthy work environment. However, there are few systematic reviews or meta-analyses investigating the effects of these interventions on workers' mental health and work-related outcomes. We apply the protocol for systematic review and meta-analysis to examine the effect of participatory organizational intervention on mental health and work performance.
METHODS AND ANALYSIS
The participants, interventions, comparisons, and outcomes (PICO) of the studies in this systematic review and meta-analysis were defined as follows: (P) inclusion of all workers, (I) participatory organizational intervention, (C) treatment as usual or no intervention (including waitlist control), and (O) mental health and work performance. Published studies will be searched using the following electronic databases: PubMed, EMBASE, PsycINFO, PsycARTICLES, and Japan Medical Abstracts Society. Studies that (1) included participatory organizational intervention, (2) included participants who were working as of the baseline survey period, (3) assessed mental health or work performance outcomes, (4) used a cluster randomized controlled trials design, (5) were published in English or Japanese, and (6) were published in peer-reviewed journals (including advanced online publication) will be included. Study selection and the risk of bias assessment will be performed independently by two reviewers. A meta-analysis will be performed to statistically synthesize the included studies. Publication bias will be assessed for meta-bias using Egger's test as well as visually on a funnel plot. We will assess the heterogeneity by using the Q statistic.
PubMed: 38805736
DOI: 10.1093/joccuh/uiae028 -
PloS One 2024The Seamless Care Optimizing the Patient Experience (SCOPE)-Mental Health program is a comprehensive case management and psychiatric care initiative that supports...
Implementation and adaptation of a hub-based psychiatric and primary care program: A qualitative descriptive analysis of The Seamless Care Optimizing the Patient Experience (SCOPE) Mental Health program.
BACKGROUND
The Seamless Care Optimizing the Patient Experience (SCOPE)-Mental Health program is a comprehensive case management and psychiatric care initiative that supports primary care physicians in independent medical practices. This program offers a range of services that aims to enhance primary care capacity for mental health and provide accessible clinical care for patients. With its flexible hub-based approach, this program allows participating sites to tailor their implementation based on their available resources and specific needs within their community.
OBJECTIVES
The aim of this quality improvement initiative was to investigate the evolution of this collaborative mental health model, focusing on specific site adaptations, local implementation challenges, and opportunities for ongoing development and sustainability across SCOPE sites in the Greater Toronto Area.
METHOD
This evaluation employed a qualitative descriptive design where semi-structured interviews, guided by the Reach Effectiveness Adoption, Implementation, and Maintenance framework were conducted with staff from all 8 SCOPE-Mental Health sites. Site representatives were interviewed virtually between March and July 2023 and data were analyzed using qualitative content analysis.
FINDINGS
The SCOPE-Mental Health model permits flexibility through specific local adaptations led by community need that leverage existing assets either at the site or within the individual community. Adoption by primary care physicians was crucial to program success and facilitated efficiency and interprofessional collaboration. Maintenance efforts included pathway refinement, and marketing and funding considerations. Challenges to program development included continuity of staff, physician compensation issues, and electronic health record interoperability. The SCOPE-Mental Health program fosters linkages among unaffiliated primary care offices, hospitals, and community-based resources to improve mental health care. Key recommendations include advocating for sustainable funding and facilitated mechanisms for psychiatric consultations.
CONCLUSIONS
This initiative offers valuable insights for healthcare organizations seeking to develop similar programs, emphasizing the need for tailored approaches and ongoing evaluation to ensure a lasting impact in underserved communities.
Topics: Humans; Primary Health Care; Mental Health Services; Mental Health; Qualitative Research; Quality Improvement; Mental Disorders; Program Evaluation; Ontario
PubMed: 38805497
DOI: 10.1371/journal.pone.0303750