2,046 research outputs found
Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome: a systematic review
Background. Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments has been advocated as part of clinical care to aid the recognition of psychosocial problems, to inform clinical decision making, to monitor therapeutic response and to facilitate patient-doctor communication. However, their adoption is not without cost and the benefit of their use is unclear. Method. A systematic review was conducted. We sought experimental studies that examined the addition of routinely administered measures of HRQoL to care in both psychiatric and non-psychiatric settings. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycLIT and Cochrane Controlled Trials Register (to 2000). Data were extracted independently and a narrative synthesis of results was presented. Results. Nine randomized and quasi-randomized studies conducted in non-psychiatric settings were found. All the instruments used included an assessment of mental well-being, with specific questions relating to depression and anxiety. The routine feedback of these instruments had little impact on the recognition of mental disorders or on longer term psychosocial functioning. While clinicians welcomed the information these instruments imparted, their results were rarely incorporated into routine clinical decision making. No studies were found that examined the value of routine assessment and feedback of HRQoL or patient needs in specialist psychiatric care settings. Conclusions. Routine HRQoL measurement is a costly exercise and there is no robust evidence to suggest that it is of benefit in improving psychosocial outcomes of patients managed in non-psychiatric settings. Major policy initiatives to increase the routine collection and use of outcome measures in psychiatric settings are unevaluated
Routinely administered questionnaires for depression and anxiety : systematic review
Objectives To examine the effect of routinely administered psychiatric questionnaires on the recognition, management, and outcome of psychiatric disorders in non-psychiatric settings. Data sources Embase, Medline, PsycLIT, Cinahl, Cochrane Controlled Trials Register,and hand searches of key journals. Methods A systematic review of randomised controlled trials of the administration and routine feedback of psychiatric screening and outcome questionnaires to clinicians in non-psychiatric settings. narrative overview of key design features and end points, together with a random effects quantitative synthesis of comparable studies. Main outcome measures Recognition of psychiatric disorders after feedback of questionnaire results; interventions for psychiatric disorders and outcome of psychiatric disorders. Results Nine randomised studies were identified that examined the use of common psychiatric instruments in primary care and general hospital settings. Studies compared the effect of the administration of these instruments followed by the feedback of the results to clinicians, with administration with no feedback. Meta-analytic pooling was possible for four of these studies (2457 participants), which measured the effect of feedback on the recognition of depressive disorders. Routine administration and feedback of scores for all patients (irrespective of score) did not increase the overall rate of recognition of mental disorders such as anxiety and depression (relative risk of detection of depression by clinician after feedback 0.95, 95% confidence interval 0.83 to 1.09). Two studies showed that routine administration followed by selective feedback for only high scores increased the rate of recognition of depression (relative risk of detection of depression after feedback 2.64, 1.62 to 4.31). This increased recognition, however, did not translate into an increased rate of intervention. Overall, studies of routine administration of psychiatric measures did not show an effect on patient outcome. Conclusions The routine measurement of outcome is a costly exercise. Little evidence shows that it is of benefit in improving psychosocial outcomes of those with psychiatric disorder managed in non-psychiatric settings
A meta-analysis of randomized trials of behavioural treatment of depression
Reproduced with permission of the publisher. Copyright © 2008 Cambridge University Press.Background. Depression is a common, disabling condition for which psychological treatments, in particular cognitive
behavioural therapies are recommended. Promising results in recent randomized trials have renewed interest in
behavioural therapy. This systematic review sought to identify all randomized trials of behavioural therapy for
depression, determine the effect of such interventions and examine any moderators of such effect.
Method. Randomized trials of behavioural treatments of depression versus controls or other psychotherapies were
identified using electronic database searches, previous reviews and reference lists. Data on symptom-level, recovery/
dropout rate and study-level moderators (study quality, number of sessions, severity and level of training) were
extracted and analysed using meta-analysis and meta-regression respectively.
Results. Seventeen randomized controlled trials including 1109 subjects were included in this meta-analysis. A
random-effects meta-analysis of symptom-level post-treatment showed behavioural therapies were superior to controls
[standardized mean difference (SMD)-0.70, 95% CI -1.00 to -0.39, k=12, n=459], brief psychotherapy (SMD -0.56,
95% CI -1.0 to -0.12, k=3, n=166), supportive therapy (SMD -0.75, 95% CI -1.37 to -0.14, k=2, n=45) and equal
to cognitive behavioural therapy (SMD 0.08, 95% CI -0.14 to 0.30, k=12, n=476).
Conclusions. The results in this study indicate behavioural therapy is an effective treatment for depression with
outcomes equal to that of the current recommended psychological intervention. Future research needs to address issues
of parsimony of such interventions
Techniques in splintage and support during reconstruction of the tibia
The aim of this article is to help clinicians and
allied professionals understand problems that may arise
with use of external fixators in limb reconstruction and
trauma, and in particular describe how preventative strategies
can be implemented. The indications for splinting and
orthotic use with external fixators can be broadly subdivided
into those that facilitate functional loading and
those that maintain joint integrity and function. Specific
techniques to accompany use of external fixators in fracture
management and limb reconstruction are described.
In particular, problems concerning knee, ankle and foot
support together with leg length issues are covered and
proposals for dealing with joint subluxation, forefoot
deformity and toe clawing, regenerate deformity after fixator
removal and oedema control are discussed. The solutions
described and illustrated are intended to assist those
who use external fixators but do not have regular therapist
input for support in the after-care of their patients
Cognitive, behavioural or cognitive-behavioural self-help interventions for subclinical depression in older adults: A systematic review and meta-analysis
Background Subclinical depression is a risk factor for the development of major depression in older adults. We aimed to determine the effectiveness of pure self-help or self-help with minimal support to reduce depressive symptoms and to prevent the onset of major depression in this population.Methods This was a systematic review and meta-analysis of trials that used self-administrated cognitive, behavioural or cognitive-behavioural interventions for older adults with subclinical depression compared to control groups. Medline, Embase, PsycInfo and Cochrane databases were searched for relevant studies.Results We analysed eight trials involving 1449 participants. A small but significant effect favouring the intervention was found at short-term [d = 0.33; 95% CI (Confidence Interval): 0.20â0.47] and at long-term (d = 0.22; 95% CI: 0.04â0.40) for depressive symptoms. None of the studies looked at the preventive effect of self-help interventions in reducing the probability of a subsequent diagnosis of major depression.Limitations The low number of studies meant that it was not possible to test for publication bias. The absence of pre-published protocols for many of the studies meant that there is a possibility of selective reporting bias for some of the primary studies.Conclusions There is some evidence that cognitive-behavioural self-help interventions may reduce depressive symptoms in older adults with subclinical depression. However, no study examined whether the intervention had a preventative effect in reducing the likelihood of a subsequent diagnosis of major depression
Can we better understand severe mental illness through the lens of Syndemics?
Current health care systems do not sufficiently address contributors, also known as modifiable behavior factors, to severe mental illnesses (SMI). Instead treatment is focused on decreasing symptom-experience rather than reducing the detrimental effect of biological predisposition and behavioral influences on illness. Health care services and patients alike call for a more comprehensive, individual approach to mental health care, especially for people with SMI. A Syndemics framework has been previously used to identify ecological and social contributors to an HIV epidemic in the 1990s, and the same framework is transferable to mental health research to identify the relationship between contributing factors and the outcomes of SMI. Using this approach, a holistic insight into mental illness experience could inform more effective health care strategies that lessen the burden of disease on people with SMI. In this review, the components of a Syndemic framework, the scientific contributions to the topic so far, and the possible future of mental health research under the implementation of a Syndemic framework approach are examined
Loneliness, social isolation and social relationships: what are we measuring? A novel framework for classifying and comparing tools
OBJECTIVES: We present a novel way of classifying and comparing measures of social relationships to help readers interpret the growing literature on loneliness and social isolation and to provide researchers with a starting point to guide their choice of measuring tool. METHODS: Measures of social relationships used in epidemiological studies were identified from two systematic reviewsâone review on the association between social relationships and health and social care service use, and a second review on the association between social relationships and health. Questions from each measure were retrieved and tabulated to derive a classification of social relationship measures. RESULTS: We present a classification of measures according to two dimensions: (1) whether instruments cover structural or functional aspects of social relationships and (2) the degree of subjectivity asked of respondents. We explain how this classification can be used to clarify the remit of the many questionnaires used in the literature and to compare them. CONCLUSIONS: Different dimensions of social relationships are likely to have different implications for health. Our classification of social relationship measures transcends disciplinary and conceptual boundaries, allowing researchers to compare tools that developed from different theoretical perspectives. Careful choice of measures is essential to further our understanding of the links between social relationships and health, to identify people in need of help and to design appropriate prevention and intervention strategies
Use of standardised outcome measures in adult mental health services - Randomised controlled trial
This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at http://bjp.rcpsych.or
Varenicline for smoking cessation and reduction in people with severe mental illnesses : systematic review and meta-analysis
AIMS: To determine the effectiveness and safety of varenicline in treating tobacco dependence in patients with severe mental illness. DESIGN: A systematic review and meta-analysis of randomised controlled trials that compared varenicline with a placebo or an alternative intervention for smoking cessation or reduction. SETTING: Both in-patient and out-patient settings in any country. PARTICIPANTS: Adult patients aged 18 and over with any type of severe mental illness. The systematic review included eight studies comprising 398 participants. MEASURES: Primary outcome measures were (1) smoking cessation (2) smoking reduction measured by changes in the number of cigarettes smoked per day and (3) number of psychiatric adverse events, which were collected at the end of treatment. FINDINGS: The random-effect pooled estimates from the five studies that reported smoking related outcomes found that varenicline is statistically superior to placebo in smoking cessation (risk ratios 4.33; 95% CI: 1.96-9.56), and smoking reduction was higher in varenicline groups (mean reduced daily cigarettes was 6.39; 95% CI: 2.22-10.56). There is no significant difference regarding neuropsychiatric and other adverse events. CONCLUSIONS: Varenicline appears to be significantly more effective than placebo in assisting with smoking cessation and reduction in people with severe mental illness. There appears to be no clear evidence that varenicline was associated with an increased risk of neuropsychiatric or other adverse events compared with placebo. This article is protected by copyright. All rights reserved
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