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‘Group consultations/visits’ are described as providing shared medical appointments delivering a range of care options and education by clinicians while providing elements of patient choice, empowerment and peer support.
This innovative and cost effective model of care delivery was first conceived in the US and has been gaining a strong foothold in the UK since 2016, mainly limited to GP settings.
The project goal was to attempt to transfer the model into a mental health setting by developing and delivering a novel intervention, to improve health and wellbeing options in a CMHT population.
A four session course was developed focussing on stress, sleep and nutrition. These chosen topics covered common significant challenges to patient health in psychiatry. Sessions were delivered to proactively address these important health related issues in a group visit setting.
Baseline and post intervention feedback including telephone interviews were conducted to evaluate the effectiveness of the intervention.
The qualitative data and the positive feedback obtained from participants indicate the intervention was highly valued and deemed effective in promoting positive health and lifestyle changes. Participants valued the educational and co-production aspects as well as the social and peer support elements of the groups. They appreciated the level of access they had with the clinicians involved, to explore their health and wellbeing in more detail without being limited by the usual 30 minute clinic follow-up sessions.
The clinicians involved found the sessions rewarding and more engaging than most of routine 1:1 clinic sessions as they were able to spend quality time exploring important issues and not just educate the patients but also be educated by their questions and feedback about their lived experiences.
The project aim was met and we believe this intervention can be successfully incorporated into the identified service provision gap within the CMH T model. There is potential to build on and embed this innovation with roll-out to a wide range of service users in different settings.
In line with existing literature from GP settings, the consensus was that the amalgamated group visits/consultations model could be successfully modified to meet the needs of patients in the Mental Health arena who have a range of physical health and lifestyle concerns.
We planned to obtain more information about improvement in patient self-management but this was affected by the pandemic. However, we believe it is a cost effective and helpful innovation which warrants further promotion and evaluation.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
Zero-sum thinking and aversion to trade pervade our society, yet fly in the face of everyday experience and the consensus of economists. Boyer & Petersen's (B&P's) evolutionary model invokes coalitional psychology to explain these puzzling intuitions. I raise several empirical challenges to this explanation, proposing two alternative mechanisms – intuitive mercantilism (assigning value to money rather than goods) and errors in perspective-taking.
Professional money management appears to require little skill, yet its practitioners command astronomical salaries. Singh's theory of shamanism provides one possible explanation: Financial professionals are the shamans of the global economy. They cultivate the perception of superhuman traits, maintain grueling initiation rituals, and rely on esoteric divination rituals. An anthropological view of markets can usefully supplement economic and psychological approaches.
In the United Kingdom (UK), 23,000 people annually are diagnosed with facial palsy (acute onset facial paralysis). For nearly one third this will result in a permanent disability, including in some the inability to smile. In addition to initial pharmacological therapy, guidelines recommend tailored facial exercise (TFE) therapy repeated every day. However, not all patients are currently able to access such specialist physical therapy. ‘Smart specs’ (using miniaturized sensors in the frames to measure facial movement) are currently being developed. Linked to a smartphone, these could allow people to practice TFEs discreetly, provide immediate feedback, and supply data on outcomes to the patient and their clinician.
Modelling of introduction of Facial Remote Activity Monitoring Eyewear (FRAME) into treatment pathways for patients with facial palsy. This included: (i) review on effectiveness of TFE therapy; (ii) national surveys (medical staff, facial therapy specialists and patients) to gather data on access to TFE therapy; (iii) Delphi Exercise to identify consensus on key outcome measures; and, (iv) economic modelling to estimate cost-effectiveness and determine a range of acceptable costs for the technology. In parallel, research to examine target markets to inform product development, and production of integral commercialization plan.
Searches short-listed ten studies to add to the three included in the 2011 Cochrane review. Surveys indicate approximately thirteen percent of eligible UK patients access personalized TFE therapy. Estimated annual expenditure on hospital treatments for facial palsy patients is currently >GBP 80 million (>USD 106 million) compared with <GBP 0.5 million (<USD 0.66 million) on TFE therapy. Patients with permanent defects can suffer a loss of up to two quality-adjusted life years (QALYs).
Findings from this study, particularly in relation to costs and benefits, will inform the design of a subsequent randomized controlled trial. A novel wearable technology could make a major difference to people's lives, as well as generating potential efficiencies for healthcare.
Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families.
Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services.
Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE–2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire.
Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81).
Significance of Results:
While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the identification and evaluation of both patients' and caregivers' experiences, satisfaction, distress, and unmet needs.
To identify predictors of treatment for urinary tract infections (UTI) among patients undergoing total hip (THA) or knee (TKA) arthroplasties and to assess an intervention based on these predictors.
We conducted a retrospective cohort study of 200 consecutive patients undergoing THA/TKA between February 21, 2011, and June 30, 2011, to identify predictors of treatment for UTI and a prospective cohort study of 50 patients undergoing these procedures between May 21, 2012, and July 17, 2012, to assess the association of signs or symptoms and UTI treatment. We then conducted a before-and-after study to assess whether implementing an intervention affected the frequency of treatment for UTI before or after THA/TKA.
The orthopedics department of a university health center.
Patients undergoing THA or TKA.
Surgeons revised their UTI screening and treatment practices.
Positive leukocyte esterase (P<.0001; P<.0001) and urine white blood cell count>5 (P=.01; P=.01) were associated with preoperative or postoperative UTI treatment. In the prospective study, 12 patients (24%) had signs and symptoms consistent with UTI. The number of patients treated for presumed UTI decreased 80.2% after the surgeons changed their practices, and surgical site infection (SSI) rates, including prosthetic joint infections (PJIs), did not increase.
Urine leukocyte esterase and white blood cell count were the strongest predictors of treatment for UTI before or after THA/TKA. The intervention was associated with a significant decrease in treatment for UTI, and SSI/PJI rates did not increase.
Driven by the unprecedented wealth of high quality data that is accumulating for the Frontier Fields, they are becoming some of the best-studied strong lensing clusters to date, and probably the next few years. As will be discussed intensively in this focus meeting, the FF prove transformative for many fields: from studies of the high redshift Universe, to the assembly and structure of the clusters themselves. The FF data and the extensive collaborative effort around this program will also allow us to examine and improve upon current lens modeling techniques. Strong lensing is a powerful tool for mass reconstruction of the cores of galaxy clusters of all scales, providing an estimate of the total (dark and seen) projected mass density distribution out to 0.5 Mpc. Though SL mass may be biased by contribution from structures along the line of sight, its strength is that it is relatively insensitive to assumptions on cluster baryon astrophysics and dynamical state. Like the Frontier Fields clusters, the most “famous” strong lensing clusters are at the high mass end; they lens dozens of background sources into multiple images, providing ample lensing constraints. In this talk, I will focus on how we can leverage what we learn from modeling the FF clusters in strong lensing studies of the hundreds of clusters that will be discovered in upcoming surveys. In typical clusters, unlike the Frontier Fields, the Bullet Cluster and A1689, we observe only one to a handful of background sources, and have limited lensing constraints. I will describe the limitations that such a configuration imposes on strong lens modeling, highlight measurements that are robust to the richness of lensing evidence, and address the sources of uncertainty and what sort of information can help reduce those uncertainties. This category of lensing clusters is most relevant to the wide cluster surveys of the future.
A new thermal imaging technique is characterized that uses an optically trapped erbium oxide nanoparticle cluster of approximately 150 nm. This technique can measure absolute temperature and has an imaging spatial resolution of the trapped particle. Scanning optical probe thermometry has been used to thermally image a cluster of gold nanowires that were excited with the trapping laser. Following a deconvolution of the measured thermal profile, a point spread function of the imaging technique has been determined to be a Gaussian with a FWHM of 165 nm. This width is a function of the clustering of Er2O3 nanoparticles used to image the nanowire. Optical probe thermometry has further been used to measure the temperature of nucleation events where a dichotomy of temperature for nucleated water occurs from degassed water and native water. Degassed water has been measured to nucleate at 555K confirming water adjacent to the gold nanoparticle superheats to the spinodal decomposition temperature before nucleating into a water vapor bubble. Following this event, the temperature inside the vapor bubble rises to the melting point of the gold nanoparticle, 1300 K which is followed by temperature stabilization. The rapid and significant temperature increase is attributed to the loss of a thermal dissipation pathway, to the surrounding water, previously available to the gold nanoparticle due to the insulator nature of the growing vapor envelope around the gold nanoparticle.
The government's cocoa spraying gangs in Ghana treat about two million hectares of the crop against black pod disease and mirids, the key insect pests of cocoa in West Africa, each August through to December, based on recommendations issued in the 1950s. A few cocoa farmers use additional pesticides. We studied the temporal distribution of two important mirid species, Distantiella theobroma (Dist.) and Sahlbergella singularis Hagl., in 1991, 1999, 2003 and 2012 to determine the appropriate timing for the application of control measures in current farming systems. There was a significant correlation between mirid abundance and pod availability on trees, as well as the number of basal shoots and the cocoa variety grown. Mirid populations peaked between January and April and from September to October. Surveys (interviews and focus group discussions involving over 300 farmers in 33 cocoa-growing districts) on pesticide use, sources of recommendations, and perceived successes and failures of current cocoa pest treatments suggested that the 1950 recommendations on the timing of insecticide application need revising.