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This presentation will describe a prospective study, due to commence in March 2010, to evaluate the use of Protected Engagement Time in adult acute inpatient wards in three mental health trusts in England.
Patients on acute psychiatric wards in the UK have recurrently reported that they are unhappy with the ward environment, that they are bored and have little to do, that wards are intimidating, and above all, that contact between staff and patients is often identified as too limited in both quantity and quality, and as lacking therapeutic content.
Protected Engagement Time (PET) has emerged as a promising initiative for improving quantity and usefulness of staff-patient contact. During fixed periods of the day, staff are asked to focus solely on patient contact, and are relieved of their administrative duties. However, we do not have any evidence about whether it works or how it should be implemented to achieve the best results.
This study aims to address this lack of evidence and will have three components:
a) A national survey investigating how widespread PET now is in England
b) Evaluation of the effects of PET on patients and staff by comparing 12 wards with PET and 12 wards without, by investigating staff-patient interactions, patient satisfaction, staff burnout and perceptions of the ward environment.
c) In-depth qualitative case studies on three wards with PET.
The objectives for each component and the measures used will be described in detail in the presentation, in addition to an update of study progress.
Improving the quality of care on psychiatric inpatient wards has been a major focus in recent mental health policy, a recurrent criticism being that contact between staff and patients is limited in time and therapeutic value. Change is unlikely to be achieved without recruitment and retention of a high quality and well-motivated work force.
The NHS commissioned national inpatient mental health staff morale study is intended to inform service planning and policy by delivering evidence on the morale of the inpatient mental health workforce and the clinical, organisational, architectural and human resources factors that influence it.
100 wards in 17 area ‘Trusts’ are participating in the study, in addition to 40 community teams. The study will take place over two years, and has 6 modules:
1. A quantitative questionnaire for all staff in participating wards and
2. A comparison group in 20 community mental health teams and 20 crisis teams.
3. Case studies of 10 wards scoring in the top and bottom quartile for indicators of morale.
4. Repeated questionnaires for 20 wards in the second year to investigate how morale changes over time.
5. Staff who leave the wards in the course of the first year will be asked their reasons for leaving.
6. Links between rates of staff sickness and morale will be investigated.
Questionnaires have been distributed to 3,500 staff with a response rate of 65%, results from which will be presented in 2009.
Trust law has grown and developed over recent years through the continued ingenuity of practitioners and the provision of innovative new trust laws by offshore jurisdictions. The wealth managed through the medium of trust law has also changed in recent years, as increasingly it has come from the newly rich of Asia. This brings distinctive issues to the fore: the role of settlors, family members and trusted advisors in trust administration; the position of trustees in relation to instructions coming from such persons; and an increased desire for confidentiality in trust administration and the settlement of trust disputes. This collection focuses on trusts which are deliberately created to manage wealth and the concomitant issues such trusts raise in other areas of law. Essays from leading members of the judiciary, practitioners and academics explore these developments and their implications for the users of trust law and for society in general.
To determine the functional integrity of the neural systems involved in emotional responding/regulation and response control/inhibition in youth (age 10–18 years) with disruptive behavioral disorders (DBDs: conduct disorder and/or oppositional defiant disorder) as a function of callous-unemotional (CU) traits.
Twenty-eight healthy youths and 35 youths with DBD [high CU (HCU), n = 18; low CU (LCU), n = 17] performed the fMRI Affective Stroop task. Participants viewed positive, neutral, and negative images under varying levels of cognitive load. A 3-way ANOVA (group×emotion by task) was conducted on the BOLD response data.
Youth with DBD-HCU showed significantly less activation of ventromedial prefrontal cortex (vmPFC) and amygdala in response to negative stimuli, compared to healthy youth and youth with DBD-LCU. vmPFC responsiveness was inversely related to CU symptoms in DBD. Youth with DBD-LCU showed decreased functional connectivity between amygdala and regions including inferior frontal gyrus in response to emotional stimuli. Youth with DBD (LCU and HCU) additionally showed decreased insula responsiveness to high load (incongruent trials) compared to healthy youth. Insula responsiveness was inversely related to ADHD symptoms in DBD.
These data reveal two forms of pathophysiology in DBD. One associated with reduced amygdala and vmPFC responses to negative stimuli and related to increased CU traits. Another associated with reduced insula responses during high load task trials and related to ADHD symptoms. Appropriate treatment will need to be individualized according to the patient's specific pathophysiology.
Background: Suicide rates are higher in the over 65s than in younger adults and there is a strong link between deliberate self harm (DSH) and suicide in older people. The association between personality disorder (PD) and DSH in older adults remains uncertain. Our objective was to describe this association.
Methods: A case control study was conducted in which participants were: (i) those who had undertaken an act of DSH and (ii) a hospital-based control group drawn from a geographical contiguous population. PD was assessed using the Standardised Assessment of Personality (SAP)
Results: Seventy-seven cases of DSH were identified; 61 (79.2%) of these participants were interviewed. There were 171 potential controls identified of whom 140 (81.9%) were included. An SAP was completed in 45/61 (73.8%) of cases and 100/140 (71.4%) of controls. The mean age was 79.8 years (SD = 9, range 65–103). The crude odds ratio for the association between PD and DSH was 5.91 [(95% CI 2.3, 14.9) p<0.0001]. There was a strong interaction with age stratified at 80 years. There was no association between PD and DSH after age 80. The adjusted odds ratio for PD in the group <80 years was 20.5 [(95% CI 3, 141) p = 0.002]. Borderline and impulsive PD traits tended to be associated with an episode of DSH more than other personality types.
Conclusions: PD appears to be a strong and independent risk for an act of DSH in people aged between 65 and 80 years and should be looked for as part of any risk assessment in this population. Access to specialist services may be required to optimally manage this problem and reduce the subsequent risk of suicide.
We have combined 22 deep Chandra ACIS-I pointings to map over one square degree of the Carina complex. Our x-ray survey detects 69 of 70 known O-type stars and 61 of 130 known early B stars. The majority of single O stars display soft X-ray spectra and have a mean log LX/Lbol ≈ −7.5 suggesting shocks embedded in the O-star winds. Over OB stars show unusually high X-ray luminosities, high shock temperatures or time variability, not predicted for embedded wind shocks.
Only 5 Of?p stars have been identified in the Galaxy. Of these, 3 have been studied in detail, and within the past 5 years magnetic fields have been detected in each of them. The observed magnetic and spectral characteristics are indicative of organised magnetic fields, likely of fossil origin, confining their supersonic stellar winds into dense, structured magnetospheres. The systematic detection of magnetic fields in these stars strongly suggests that the Of?p stars represent a general class of magnetic O-type stars.
The Tarantula Survey is an ESO Large Programme which has obtained multi-epoch spectroscopy of over 1,000 massive stars in the 30 Doradus region of the Large Magellanic Cloud. The assembled consortium will exploit these data to address a range of fundamental questions in both stellar and cluster evolution.
Sharp reductions in the wild rabbit (Oryctolagus cuniculus (L.)) population in the Mallee are associated with annual myxomatosis epizootics. The extent to which the population reductionsare the direct result of the epizootics varies with time of epizootic occurrence. All grazing animals in the Mallee are under nutritional stress each summer and autumn. When the epizootic occurs during the early summer heavy losses occur in a previously healthy population. Similar losses which occur in the late summer and autumn are the result of a nutritional stress – epizootic complex. The end result in each case is a population reduction of about 80%.
This reduction occurs in a population which is the most resistant to myxomatosis known in Victoria and in association with epizooties caused by field strains of myxoma virus of moderate virulence only.
The earlier summer epizootics are of considerable economic importance because they sharply reduce the pressure on the limited food available for other grazing animals.
The occurrence of antibody to myxoma virus in wild rabbits following epizootics is highest in the semi-arid north-west of Victoria and lowest in temperate southern Victoria. Occurrence ranges up to about 90% in the north-west and to about 70% in the south except on the Western Plains where epizootics are rare and antibody occurrence seldom exceeds 30%.
The establishment of the European rabbit flea may be changing the pattern of occurrence of antibody in the north-west by causing spring outbreaks of myxomatosis. It is suggested that the effects of the replacement of a simple recurring system of epizootic and breeding season several months apart by the occurrence of myxomatosis twice in the same year, once coincident with the breeding season, will be complex. The occurrence of detectable antibody may be less dependent on the infection rate and may be dependent to some extent on the relative timing of spring myxomatosis and the breeding season.
Myxomatosis on the Western Plains is an enzootic disease in contrast with the epizootic pattern which is general in eastern Australia. The most unusual aspects are the presence of significant numbers of diseased rabbits throughout the winter and the continuously low percentage of rabbits with antibodies to myxoma virus.
Climatic and topographic conditions are unsuited to the production of the high densities of mosquitoes necessary for widespread epizootics. Under these conditions the effects of less efficient methods of myxomatosis transmission are apparent. The unusual epidemiology of myxomatosis has resulted in selection for virulence of the virus similar to that which has occurred under summer epizootic conditions. All field strains are now in the mid range of virulence.