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318 results

Page 1 of 16

  • Mental Health in Medicine: A novel stepped care model in medical psychiatry and the implementation of measurement-based care

  • D. Wiercigroch, S. Wright, N. Bangloy, S. Bush, A. Wai, D. Koshy, L. Thomson, N. Abdel Gawad, S. Abbey, M. Kaye, M. Kelsey, A. Tan, J. Delwo, K. Sheehan
  • Journal:
    European Psychiatry / Volume 67 / Issue S1 / April 2024
    Published online by Cambridge University Press:
    27 August 2024, p. S157
    • Article
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  • Introduction

    Individuals with co-occurring mental and physical health issues have worse health outcomes in both domains. Integration improves outcomes and aligns with patient preference, but health services tend to be siloed. The Mental Health in Medicine Clinic (MHiM) supports patients receiving inpatient or outpatient medical or surgical care at a tertiary academic hospital in Toronto, Canada. The predominantly virtual clinic has an interdisciplinary team offering services via stepped care, matching patient need with service intensity. Measurement-based care (MBC), the systematic evaluation of patient reported outcomes, was not initially used routinely in the clinic, but its implementation may improve treatment decision-making and may be useful in allocating patients within a stepped care model.

    Objectives

    1) To describe the stepped care model, referral patterns, diagnoses, and level of care provided since implementation of stepped care. 2) To conduct a quality improvement initiative to implement MBC in the clinic, with a goal of 50% of patients completing at the time of first assessment and prior to discharge from the clinic.

    Methods

    We reviewed the electronic medical record for referral source, diagnoses, and level of stepped care within the clinic. We conducted semi-structured interviews with stakeholders (clinicians, administrative staff, patients) to explore barriers to implementation of MBC. Interviews were analyzed for themes around barriers and facilitators to MBC. Plan, Do, Study, Act cycles were carried out around change concepts informed by stakeholder interviews and relevant literature.

    Results

    The MHiM clinic began operations in August 2020. The clinic operated on a physician-only model until March 2022 and then shifted to a stepped care model with an interdisciplinary team. The most frequent referral sources were internal medicine, COVID19 clinics, consultation-liaison psychiatry, red blood cell disorders clinic and cardiology. Since the implementation of stepped care, 250 referrals were assessed. 58% of new referrals were assessed by the psychiatrist, 42% were managed by the NP, and 25% consulted with the social worker. Referrals consisted of trauma and stress-related disorders (32%), depression (21%) or anxiety disorders (20%). Personality, substance use, and psychotic disorders accounted for less than 10% of referrals combined. Some patients did not have any diagnosis (6%). Results from the quality improvement initiative to implement MBC will also be presented.

    Conclusions

    The MHiM clinic provides an integrated care pathway addressing comorbid mental and physical health conditions. We describe a novel stepped care model and the implementation of MBC. Future directions include ongoing quality improvement of MBC and its integration within the clinic to assess and re-assess service intensity.

    Disclosure of Interest

    None Declared

  • Training on Addressing Patients’ Values (including Spirituality and Worldview) in Decision Making

  • A. L. H. Peh, D. C. L. Teo, E. K. Ong, M. S. Q. Tan
  • Journal:
    European Psychiatry / Volume 67 / Issue S1 / April 2024
    Published online by Cambridge University Press:
    27 August 2024, p. S794
    • Article
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  • Introduction

    Patients’ values are relevant in patient-centred care (PCC) as awareness and recognition of these can lead to better decision making and improved outcomes. Training in decision making is sorely lacking, especially in the area of spirituality and worldview.

    Objectives

    Our poster describes a training workshop to provide such medical education to healthcare professionals. The half-day training covers: importance of addressing patients’ values in decision making; using decisional aids; role of spirituality and worldview of the patient.

    Methods

    Clinicians of the hospital, including doctors, nurses and allied healthcare professionals were invited to attend the training. The evaluations by the participants for the workshops conducted in 2021-2023 were collated and presented.

    Results

    Four workshops in 2021 to 2023 were conducted, with a total of 43 participants. We achieved overall ratings of above average and excellent in more than 80% of responses; content relevance and usefulness to work, presentation and facilitation were similarly rated. Most participants would recommend it to colleagues.

    Conclusions

    The “Addressing Patients’ Values in Decision Making” workshop for clinicians will allow the hospital to promulgate a culture of quality care through patient engagement.

    Disclosure of Interest

    None Declared

  • Prioritizing Equity in Antimicrobial Stewardship Efforts (EASE): a framework for infectious diseases clinicians

  • Jacinda C. Abdul-Mutakabbir, Karen K. Tan, Candace L. Johnson, Caitlin L. McGrath, Danielle M. Zerr, Jasmine R. Marcelin
  • Journal:
    Antimicrobial Stewardship & Healthcare Epidemiology / Volume 4 / Issue 1 / 2024
    Published online by Cambridge University Press:
    03 May 2024, e74
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  • Health equity gaps persist across minoritized groups due to systems of oppression affecting health-related social needs such as access to transportation, education and literacy, or food and housing security. Consequently, disparities in the prevalence of multidrug-resistant infections, infectious disease outcomes, and inappropriate antimicrobial use have been reported across minoritized populations. The Joint Commission and Centers for Medicare and Medicaid Services (CMS) have formally acknowledged the importance of integrating health equity-focused initiatives into existing hospital quality improvement (QI) programs. Here, we review documented disparities in antimicrobial stewardship and offer a framework, derived from components of existing health equity and QI tools, to guide clinicians in prioritizing equity in antimicrobial stewardship efforts (EASE).

  • The developmental origins of health and disease and intergenerational inheritance: a scoping review of multigenerational cohort studies

  • Jie Tan, Zifang Zhang, Lijing L. Yan, Xiaolin Xu
  • Journal:
    Journal of Developmental Origins of Health and Disease / Volume 15 / 2024
    Published online by Cambridge University Press:
    07 March 2024, e1

  • Epidemiologic research has increasingly acknowledged the importance of developmental origins of health and disease (DOHaD) and suggests that prior exposures can be transferred across generations. Multigenerational cohorts are crucial to verify the intergenerational inheritance among human subjects. We carried out this scoping review aims to summarize multigenerational cohort studies’ characteristics, issues, and implications and hence provide evidence to the DOHaD and intergenerational inheritance. We adopted a comprehensive search strategy to identify multigenerational cohorts, searching PubMed, EMBASE, and Web of Science databases from the inception of each dataset to June 20th, 2022, to retrieve relevant articles. After screening, 28 unique multigenerational cohort studies were identified. We classified all studies into four types: population-based cohort extended three-generation cohort, birth cohort extended three-generation cohort, three-generation cohort, and integrated birth and three-generation cohort. Most cohorts (n = 15, 53%) were categorized as birth cohort extended three-generation studies. The sample size of included cohorts varied from 41 to 167,729. The study duration ranged from two years to 31 years. Most cohorts had common exposures, including socioeconomic factors, lifestyle, and grandparents’ and parents’ health and risk behaviors over the life course. These studies usually investigated intergenerational inheritance of diseases as the outcomes, most frequently, obesity, child health, and cardiovascular diseases. We also found that most multigenerational studies aim to disentangle genetic, lifestyle, and environmental contributions to the DOHaD across generations. We call for more research on large multigenerational well-characterized cohorts, up to four or even more generations, and more studies from low- and middle-income countries.

Putting Women Up
  • Gender Equality and Politics in Myanmar
  • Edited by Netina Tan, Meredith L. Weiss
  • Published by:
    ISEAS–Yusof Ishak Institute
    Published online:
    18 April 2024
    Print publication:
    06 February 2024
  • For the duration of Myanmar's experiment with electoral democracy, why did some women run for political office, and not others? What role did gatekeepers such as party leaders play in those decisions, and using what criteria in selecting candidates? How did experience of domestic violence or harassment affect women's likelihood to participate in politics, especially beyond the local level? And what implications might these earlier patterns have for a post-coup Myanmar, should meaningful elections be restored?

    The contributors to Putting Women Up: Gender Equality and Politics in Myanmar answer these questions by examining the internal politics of nine political parties in Myanmar and both men's and women's attitudes towards and experiences of political leadership. Drawing on extensive interview, survey, and focus-group discussion data collected from across Myanmar in 2017 and 2020, this book offers a mixed-methods approach to explain how factors from party rules to formative personal trauma to patriarchal biases to ethno-religious context shape women's and men's likelihood to join local and national politics. The findings expand on culturalist insights on gender inequality to provide context-sensitive, evidence-backed policy recommendations to promote women's political leadership, despite militarization and violence in post-coup Myanmar.

  • Appendix Two - Survey Questions

  • Edited by Netina Tan, McMaster University, Ontario, Meredith L. Weiss, University at Albany, State University of New York
  • Book:
    Putting Women Up
    Published by:
    ISEAS–Yusof Ishak Institute
    Published online:
    18 April 2024
    Print publication:
    06 February 2024, pp 173-184

  • Summary

    Section (3) Political and Social Attitudes

    1. Please tell me how you feel about the following statements. Would you say you (1) strongly agree, (2) somewhat agree, (3) somewhat disagree, or (4) strongly disagree? (7) *Do not understand the question, (8) *Can't choose, (9) *Decline to answer

    1) In a group, we should sacrifice our individual interest for the sake of the group's collective interest.

    2) I think I have the ability to participate in politics.

    3) When a mother-in-law and daughter-in-law come into conflict, even if the mother-in-law is in the wrong, the husband should still persuade his wife to obey his mother.

    4) If one could have only one child, it is more preferable to have a boy than a girl.

    5) In politics, women should not be involved as much as men.

    6) If a woman earns more money than her husband, it's almost certain to cause problems.

    7) I would support my daughter to join parties and participate in politics if she so wished.

    8) When jobs are scarce, men should have more right to a job than women.

    2. I prefer to have neighbours who are of the same religion than to have neighbours who are from a different religion.

    1) Strongly agree

    2) Agree

    3) Neither agree nor disagree

    4) Disagree

    5) Strongly disagree

    6) Refuse to answer

    Section (4) Political Knowledge and Attitudes

    1. I am going to name a number of institutions. For each one, please tell me how much trust do you have in them? Is it (1) a great deal of trust, (2) quite a lot of trust, (3) not very much trust, (4) none at all? [For the enumerator: Mark 97 as “No answer/Don't know” and 98 as “Refuse to answer”]

    1) The president

    2) State/Region government

    3) Political parties (not any specific party)

    4) National Parliament

    5) Civil service

    6) The military

    7) The police

    8) Ward/Village/Tract Administrator

    9) Health care administration

    10) Education professionals (teachers, etc.)

    2. Could you tell me for each whether you trust people from this group (1) completely, (2) somewhat, (3) not very much, (4) not at all? [For the enumerator: Mark 97 as “No answer/Don't know” and 98 as “Refuse to answer”]

    1) Your neighborhood

    2) People of another religion

    3) People of another nationality

  • Appendix Five - Samples of Elite Interview Questions

  • Edited by Netina Tan, McMaster University, Ontario, Meredith L. Weiss, University at Albany, State University of New York
  • Book:
    Putting Women Up
    Published by:
    ISEAS–Yusof Ishak Institute
    Published online:
    18 April 2024
    Print publication:
    06 February 2024, pp 192-197

  • Summary

    Party Recruitment, Candidate Selection and Attitudes Towards Political Leadership (Gatekeepers)

    Personal Political Experiences

    1. Please describe your occupational/educational background (Icebreaking question).

    2. Did you have any experience participating in politics or public life before joining party?

    3. What were your main motivations for becoming involved in politics/ party?

    4. Has anyone else in your family been involved in politics? If so, please give details.

    5. How many years have you been an active member of ______________ party? (ask only if you cannot get the information publicly)

    6. Has your participation in politics resulted in any difficulties or improvements in your home life?

    7. Did you face any harassment or intimidation being a party gatekeeper? (Note to interviewer: this can be in the form of online, social media, verbal harassment, physical threats, attacks or exclusion from places to campaign)

    Intra Party Rules and Candidate Selection Procedures

    8. Please tell me how people in your party get chosen to be members of central committee (CC) or central executive committee (CEC)?

    9. Different levels of candidate selection:

    a. Did your Central Committee play an important role in selecting candidates?

    b. Did your Township Chairman play an important role in selecting candidates?

    c. Were there other individuals who played a key role in the candidate selection process? (please identify gender)

    10. Experience in Party Positions:

    a. Have you held any position within your party? (e.g. Central committee, township committee, Youth wing, Women's wing)

    b. If so, how did you get chosen for that position?

    11. How do people in your party get chosen to become members of the party's township committee? (prompt to interviewer: please record separately the process for: i) chairperson, ii) secretary, and iii) other positions)

    12. Can you explain more of your party's rules, criteria and procedures in selecting candidates for the last general election? (Please check if there is an internal election process, check if ordinary party members have a chance to be nominated as candidates). Can you describe the process in more detail?

    13. Can the ordinary party members decide who the party nominates as a candidate for a general election?

    14. If you could change the rules and procedures used by your party for candidate selection, what would you change?

  • Appendix One - Background of Selected Political Parties and Vote Shares

  • Edited by Netina Tan, McMaster University, Ontario, Meredith L. Weiss, University at Albany, State University of New York
  • Book:
    Putting Women Up
    Published by:
    ISEAS–Yusof Ishak Institute
    Published online:
    18 April 2024
    Print publication:
    06 February 2024, pp 167-172

  • Summary

    The Arakan National Party (ANP) was the product of a merger between the Rakhine National Development Party (RNDP) and the Arakan League for Democracy (ALD) and was registered with the Union Election Commission (UEC) on 6 March 2014. At the time of their founding, ANP's goals were “federalism”, “democratisation”, and “development”, but in practice the party has had a strong focus on Rakhine nationalism. Previously, the RNDP, led by Dr Aye Maung, was registered on 6 May 2010 and won a total of 32 seats in the 2010 elections. The ALD was founded in 1989 and ran in the 1990 election, winning 11 seats. The ALD re-registered with the UEC in 2012, before combining with the RNDP to form the ANP in 2014. The party claimed to have township executive committees (TECs) in 17 townships and more than 20,000 members in 2020.

    Dr Manam Tu Ja, former vice president of the Kachin Independence Organization (KIO), attempted to register the Kachin State Progressive Party with the UEC for the 2010 elections. He was controversially prevented from doing so, like the other ethnic Kachin parties. He then founded the Kachin State Democracy Party (KSDP) in 2013, and, at the second attempt, on 13 January 2014. The KSDP claimed to have around 13,000 members in 2015. The KSDP was merged with three other ethnic Kachin parties to form the Kachin State People's Party.

    The LNDP was registered with the UEC on 17 December 2013, with the aim of representing the Lisu people in Myanmar and promoting the development of that ethnicity. The LNDP has a close cooperative relationship with the USDP. The party claimed to have TECs in 18 townships and around 11,000 members in 2020.

    The Mon Democratic Front was established in 1988 and ran in the 1990 elections, winning 5 seats. The party re-registered with the UEC after the 2010 elections, using the name the Mon Democratic Party. In 2014, the party joined with a few MPs from the All Mon Region Democracy Party and changed its name to the Mon National Party. In 2018 (overlapping the start of our field research) the MNP merged with other ethnic Mon parties to form the Mon Party.

  • Delivery of a telehealth supported home exercise program with dietary advice to increase plant-based protein intake in people with non-alcoholic fatty liver disease: a 12-week randomised controlled feasibility trial

  • Christine L. Freer, Elena S. George, Sze-Yen Tan, Gavin Abbott, Robin M. Daly
  • Journal:
    British Journal of Nutrition / Volume 131 / Issue 10 / 28 May 2024
    Published online by Cambridge University Press:
    25 January 2024, pp. 1709-1719
    Print publication:
    28 May 2024
    • Article
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  • This study evaluated the feasibility and safety of a telehealth delivered exercise plus plant-based protein diet in adults with non-alcoholic fatty liver disease (NAFLD). This was a 12-week, randomised controlled feasibility trial including twenty-eight adults aged > 45 years with NAFLD randomised to a home muscle strengthening program (3 d/week) with increased protein intake (target ∼1·2–1·5 g/kg/d) from predominately plant-based sources and behavioural change support (3–4 text messages/week) (Pro-Ex n 14) or usual care (UC, n 14). Feasibility was assessed via retention (≤ 10 % attrition), adherence (exercise ≥ 66 %; recommended daily protein serves ≥ 80 %) and safety (adverse events). Secondary outcomes included macronutrient intake (3 × 24-h records), weight, moderate-to-vigorous physical activity (MVPA) and 30 s sit-to-stand (STS) performance. Study retention was 89 %. Mean exercise adherence (Pro-Ex) was 52 % with one adverse event from 241 sessions. In Pro-Ex, mean daily plant protein serves increased (0·9 to 1·4/d) and animal protein decreased (1·5 to 1·2/d) after 12-weeks, but overall adherence (serves/day) was 32[RD1] % (plant) and 42 % (animal). Relative to UC, Pro-Ex experienced a mean 2·7 (95 % CI: 0·9, 4·4) increase in 30 s STS number, 46-minute (95 % CI: −153, 245) increase in MVPA, 1·7 kg (95 % CI: −3·5, 0·2) decrease in weight, 35·2 g (95 % CI: 11·0, 59·3) increase in protein. In adults with NAFLD a telehealth home exercise and dietary intervention was safe and improved habitual plant and animal protein intake, but overall adherence was modest suggesting more intensive healthcare support may be required.

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