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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.
Adequate fruit and vegetable intake is important in the prevention of chronic disease. Health literacy is associated with health outcomes but its role in dietary behaviour has received little attention. The present study investigated the association between a multidimensional measure of health literacy, sociodemographic characteristics, and fruit and vegetable intake in rural Australia.
A cross-sectional survey on intake of fruits and vegetables (servings/d), demographic characteristics and health literacy profile using a nine-scale Health Literacy Questionnaire (HLQ). Associations between health literacy and fruit and vegetable intake were assessed using logistic regression.
A large rural area of Victoria.
Adults residing in the Grampians region (n 1154; 61 % female, mean age 52 (sd 17) years).
The HLQ scale ‘Actively managing my health’ predicted (OR; 95 % CI) fruit (2·31; 1·87, 2·84) and vegetable (1·81; 1·45, 2·26) intake. The scales ‘Appraisal of health information’ (fruits: 1·73; 1·41, 2·13; vegetables: 1·49; 1·20, 1·86), ‘Social support for health’ (fruits: 1·31; 1·06, 1·63; vegetables: 1·40; 1·10, 1·76) and ‘Ability to find good health information’ (fruits: 1·25; 1·05, 1·48; vegetables: 1·36; CI 1·13, 1·63) also predicted fruit and vegetable intake. These associations remained significant after adjusting for age, gender, educational attainment and having private health insurance.
Health literacy, particularly being proactive, appraising information and having social support for health, is associated with greater fruit and vegetable intake. Future interventions should consider the health literacy needs of the community to improve fruit and vegetable intake.
In traditional transit timing variations (TTVs) analysis of multi-planetary systems, the individual TTVs are first derived from transit fitting and later modelled using n-body dynamic simulations to constrain planetary masses. We show that fitting simultaneously the transit light curves with the system dynamics (photo-dynamical model) increases the precision of the TTV measurements and helps constrain the system architecture. We exemplify the advantages of applying this photo-dynamical model to a multi-planetary system found in K2 data very close to 3:2 mean motion resonance, K2-19. In this case the period of the larger TTV variations (libration period) is much longer (>1.5 years) than the duration of the K2 observations (80 days). However, our method allows to detect the short period TTVs produced by the orbital conjunctions between the planets that in turn permits to uniquely characterise the system. Therefore, our method can be used to constrain the masses of near-resonant systems even when the full libration curve is not observed.
Little is known about the relative extent of crime against people with
severe mental illness (SMI).
To assess the prevalence and impact of crime among people with SMI
compared with the general population.
A total of 361 psychiatric patients were interviewed using the national
crime survey questionnaire, and findings compared with those from 3138
general population controls participating in the contemporaneous national
Past-year crime was experienced by 40% of patients v.
14% of controls (adjusted odds ratio (OR) = 2.8, 95% CI 2.0–3.8); and
violent assaults by 19% of patients v. 3% of controls
(adjusted OR = 5.3, 95% CI 3.1–8.8). Women with SMI had four-, ten- and
four-fold increases in the odds of experiencing domestic, community and
sexual violence, respectively. Victims with SMI were more likely to
report psychosocial morbidity following violence than victims from the
People with SMI are at greatly increased risk of crime and associated
morbidity. Violence prevention policies should be particularly focused on
people with SMI.
Domestic and sexual violence are significant public health problems but little is known about the extent to which men and women with severe mental illness (SMI) are at risk compared with the general population. We aimed to compare the prevalence and impact of violence against SMI patients and the general population.
Three hundred and three randomly recruited psychiatric patients, in contact with community services for ⩾1 year, were interviewed using the British Crime Survey domestic/sexual violence questionnaire. Prevalence and correlates of violence in this sample were compared with those from 22 606 general population controls participating in the contemporaneous 2011/12 national crime survey.
Past-year domestic violence was reported by 27% v. 9% of SMI and control women, respectively [odds ratio (OR) adjusted for socio-demographics, aOR 2.7, 95% confidence interval (CI) 1.7–4.0], and by 13% v. 5% of SMI and control men, respectively (aOR 1.6, 95% CI 1.0–2.8). Past-year sexual violence was reported by 10% v. 2.0% of SMI and control women respectively (aOR 2.9, 95% CI 1.4–5.8). Family (non-partner) violence comprised a greater proportion of overall domestic violence among SMI than control victims (63% v. 35%, p < 0.01). Adulthood serious sexual assault led to attempted suicide more often among SMI than control female victims (53% v. 3.4%, p < 0.001).
Compared to the general population, patients with SMI are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimization. Psychiatric services, and public health and criminal justice policies, need to address domestic and sexual violence in this at-risk group.
Stars are tidally disrupted and accreted when they approach massive black holes (MBHs) closely, producing a flare of electromagnetic radiation. The majority of the (approximately two dozen) tidal disruption events (TDEs) identified so far have been discovered by their luminous, transient X-ray emission. Once TDEs are detected in much larger numbers, in future dedicated transient surveys, a wealth of new applications will become possible. Here, we present the proposed Einstein Probe mission, which is a dedicated time-domain soft X-ray all-sky monitor aiming at detecting X-ray transients including TDEs in large numbers. The mission consists of a wide-field micro-pore Lobster-eye imager (60° × 60°), and is designed to carry out an all-sky transient survey at energies of 0.5-4 keV. It will also carry a more sensitive telescope for X-ray follow-ups, and will be capable of issuing public transient alerts rapidly. Einstein Probe is expected to revolutionise the field of TDE research by detecting several tens to hundreds of events per year from the early phase of flares, many with long-term, well sampled lightcurves.
We prove an upper bound on sums of squares of minors of
-matrices. The bound is sharp for Hadamard matrices, a result due to de Launey and Levin [‘
-matrices with near-extremal properties’, SIAM J. Discrete Math.23(2009), 1422–1440], but our proof is simpler. We give several corollaries relevant to minors of Hadamard matrices.
The term myeloproliferative disorders (MPDs) describes a group of conditions in which an intrinsic stem cell defect is present in the bone marrow. This leads to hypercellularity in one or more of the myeloid cell lines (red blood cells, platelets, granulocytes and their precursors), or increased bone marrow fibrosis. MPDs are rare; combined annual incidence is 6 per 100,000.
MPDs may present in asymptomatic patients as an incidental finding, or may be associated with constitutional features such as weight loss, sweats or lethargy. Splenomegaly is common but lymphadenopathy is not a feature. The most significant complications are: arterial thrombosis, venous thrombosis, secondary marrow fibrosis and transformation to acute myeloblastic leukaemia (AML). Treatment aims to reduce the risk of such complications.
Recent advances in the understanding of the pathogenesis of these disorders have radically changed the approach to the diagnosis of MPD and are the focus of new treatment developments.
Standard acute psychiatric care in the UK is costly but problematic. Alternatives to standard in-patient wards exist, but little is known about their effectiveness, implementation and sustainability. This paper explores successful features and limitations of five residential alternative services in England and factors that facilitate or impede their initial and sustained implementation and success.
Semi-structured interviews about the functioning of six alternative services were conducted with 36 mental health professionals with good working knowledge of, and various connections with these services. A group interview with study researchers was also conducted. Data were analysed using thematic analysis.
One service did not show evidence of operating as an alternative and was excluded from further analysis. The remaining five alternatives are valued for providing a more holistic style of care than standard services that confers many perceived benefits. However, they are seen as less appropriate for compulsorily detained or highly disturbed patients, and as providing less comprehensive treatment packages than hospital settings. Factors identified as important to successful implementation and sustainability are: responding to known shortcomings in local acute care systems; balancing role clarity and adaptability; integration with other services; and awareness of the alternative among relevant local health-care providers.
Residential alternatives can play an important role in managing mental health crises. Their successful implementation and endurance depend on establishing and maintaining a valued position within local service systems. Findings contribute to bridging the gap between research evidence on the problems of standard acute care and delivering improved crisis management services.
Cochlear implantation has been used to rehabilitate profoundly deafened adults for more than 25 years. However, surgical labyrinthectomy is often considered a contraindication to cochlear implantation, especially if there is a significant delay between the two procedures. As the role of cochlear implantation continues to expand, this idea requires reconsideration.
A 59-year-old woman presented to our clinic after undergoing bilateral surgical labyrinthectomies for intractable Ménière's disease 21 years prior. Despite the significant time delay, she underwent cochlear implantation with a good audiological outcome and improved quality of life.
Changes to the cochlea and vestibule following surgical labyrinthectomy include cochlear ossification and obliteration of the vestibule. These issues have been thought to limit the potential for cochlear implantation, especially when there is a significant delay between the two procedures. However, delayed cochlear implantation, even decades after labyrinthectomy, remains a viable treatment option which can benefit selected patients.
To present a case of extraskeletal Ewing's sarcoma originating in the masseter muscle, and to review the diagnosis and management of these rare tumours.
Case report and literature review.
We report a patient with Ewing's sarcoma of the masseter muscle with mandibular invasion. She was treated with induction chemotherapy, salvage surgery and free flap reconstruction.
This case highlights the management of these rare tumours. Aggressive multi-modal treatment, including multi-agent chemotherapy, surgical resection and irradiation, appears to offer the best prognosis. Contemporary reconstructive techniques can restore function and form in cases with challenging defects.
The incidence of most haematological malignancies increases with age. Given that those aged >65 years represent the fastest growing segment of Western populations, these cancers may commonly present to medical teams with an interest in older patients. Over the last 20 years there have been dramatic improvements in the outlook for patients diagnosed with haematological cancers, but there is evidence that many of these improvements have been restricted to younger patients. It is therefore important that older patients with haematological malignancies are rapidly diagnosed and promptly treated with the best available therapies. Clinical trials that specifically encompass older patients are clearly important. In this review, the presentation and management of common haematological malignancies will be discussed, including myelodysplasia, acute leukaemia, lymphoproliferative disorders and myeloma.
Key questions regarding residential alternatives to standard acute psychiatric care, such as crisis houses and short-stay in-patient units, concern the role that they fulfil within local acute care systems, and whether they manage people with needs and illnesses of comparable severity to those admitted to standard acute wards.
To study the extent to which people admitted to residential alternatives and to standard acute services are similar, and the role within local acute care systems of admission to an alternative service.
Our approach combined quantitative and qualitative methods. Consecutive cohorts of patients in six residential alternatives across England and six standard acute wards in the same areas were identified, and clinical and demographic characteristics, severity of symptoms, impairments and risks compared. Semi-structured interviews with key stakeholders in each local service system were used to explore the role and functioning of each alternative.
Being already known to services (OR = 2.6, 95% CI 1.3–5.2), posing a lower risk to others (OR = 0.49, 95% CI 0.31–0.78) and having initiated help-seeking in the current crisis (OR = 2.2, 95% CI 1.2–4.3) were associated with being admitted to an alternative rather than a standard service. Stakeholder interviews suggested that alternatives have a role that is similar but not identical to standard hospital services. They can divert some, but not all, patients from acute admission.
Residential alternatives are integrated into catchment area mental health systems. They serve similar, but not identical, clinical populations to standard acute wards and provide some, but not all, of the functions of these wards.
Outcomes following admission to residential alternatives to standard in-patient mental health services are underresearched.
To explore short-term outcomes and costs of admission to alternative and standard services.
Health of the Nation Outcome Scales (HoNOS), Threshold Assessment Grid (TAG), Global Assessment of Functioning (GAF) and admission cost data were collected for six alternative services and six standard services.
All outcomes improved during admission for both types of service (n = 433). Adjusted improvement was greater for standard services in scores on HoNOS (difference 1.99, 95% CI 1.12–2.86), TAG (difference 1.40, 95% CI 0.39–2.51) and GAF functioning (difference 4.15, 95% CI 1.08–7.22) but not GAF symptoms. Admissions to alternatives were 20.6 days shorter, and hence cheaper (UK£3832 v. £9850). Standard services cost an additional £2939 per unit HoNOS improvement.
The absence of clear-cut advantage for either type of service highlights the importance of the subjective experience and longer-term costs.