How to assess and manage hypertension during and after pregnancy.

Hypertensive disorders of pregnancy are increasingly important complications of which clinicians should have an up-to-date knowledge to facilitate prompt recognition, diagnosis and management. These disorders affect a growing number of pregnancies worldwide, with incidence rates likely to increase in the future commensurate with increasing maternal age and maternal comorbidities independent of age, with consequent effects on maternal and fetal/neonatal morbidity and mortality rates. This article mainly focuses on management within the UK of these disorders, examining their current working definitions, detection methods and recent developments in screening tool development. The current NICE-recommended strategies for treating these disorders and minimizing their occurrence in pregnancy are also explored. In addition, the association between adverse pregnancy outcome and increased risk of future maternal and offspring cardiovascular disease is described, with comments on future strategies to help minimize these potential risks

Golden goose or white elephant? Exploring lifelong learning through the professional group of operating department practitioners

General findings indicated practitioners were engaging in a variety of learning as advocated by their regulatory body, and thus meeting their professional and organisational responsibilities. Further investigation presents a tale of contrasts:from the positive experiences of learning which are driven by a commitment to delivering high standards of patient care, to the negative experiences with regards to participation and provision. Participation was hampered by a range of structural and organisational barriers, some of which were identified as being unique to this group.Providing a 'snap-shot' of learning within the NHS at a time of challenge and financial constraints the research questions the underpinning philosophy of lifelong learning policy in promoting inclusivity and prosperity and exposes deficiencies within organisational policy

How do we evaluate the cost of nosocomial infection? The ECONI protocol: an incidence study with nested case-control evaluating cost and quality of life

Introduction Healthcare-associated or nosocomial infection (HAI) is distressing to patients and costly for the National Health Service (NHS). With increasing pressure to demonstrate cost-effectiveness of interventions to control HAI and notwithstanding the risk from antimicrobial-resistant infections, there is a need to understand the incidence rates of HAI and costs incurred by the health system and for patients themselves. Methods and analysis The Evaluation of Cost of Nosocomial Infection study (ECONI) is an observational incidence survey with record linkage and a nested case-control study that will include postdischarge longitudinal follow-up and qualitative interviews. ECONI will be conducted in one large teaching hospital and one district general hospital in NHS Scotland. The case mix of these hospitals reflects the majority of overnight admissions within Scotland. An incidence survey will record all HAI cases using standard case definitions. Subsequent linkage to routine data sets will provide information on an admission cohort which will be grouped into HAI and non-HAI cases. The case-control study will recruit eligible patients who develop HAI and twice that number without HAI as controls. Patients will be asked to complete five questionnaires: the first during their stay, and four others during the year following discharge from their recruitment admission (1, 3, 6 and 12 months). Multiple data collection methods will include clinical case note review; patient-reported outcome; linkage to electronic health records and qualitative interviews. Outcomes collected encompass infection types; morbidity and mortality; length of stay; quality of life; healthcare utilisation; repeat admissions and postdischarge prescribing. Ethics and dissemination The study has received a favourable ethical opinion from the Scotland A Research Ethics Committee (reference 16/SS/0199). All publications arising from this study will be published in open-access peer-reviewed journal. Lay-person summaries will be published on the ECONI website. Trial registration number NCT03253640; Pre-results

Difficulties in Emotion Regulation and Psychopathic Traits in Violent Offenders

Purpose: The present study aimed to advance our understanding of the relevance of emotion dysregulation (ED) for psychopathy. Methods: Latent Profile Analysis (LPA) and Structural Equation Modeling (SEM) were employed to examine person- and variable-centered associations between ED domains and psychopathic traits in a moderately-large (N=268) sample of violent male offenders. Results: LPA results indicated a 3-class solution with offenders most accurately classified based on ED levels (low, medium, high) across domains. The three ED subgroups revealed linear positive associations with psychopathy total, affective, and lifestyle facet scores, such that elevated levels of these traits were found in subgroups with greater ED. A similar linear trend emerged for the antisocial \u2013 but not interpersonal \u2013 facet, in-line with recent studies showing positive associations between executive functioning and interpersonal features of psychopathy. In SEM analyses, a latent ED factor positively predicted a super-ordinate psychopathy factor, controlling for psychopathological distress. Conclusions: Taken together, current findings support the notion that ED involves broad difficulties across emotion regulation domains, which vary by degree rather than in kind, and that these difficulties have linear positive relations with psychopathic traits among violent offenders

Kaupapa Māori practitioner's whakaaro (thoughts) of traditional practices (rongoā, rāranga, mirimiri and pūrākau) assisting rangatahi Māori (Māori youth) with suicidal behaviours : a thesis presented in partial fulfillment of the requirements for the degree of Master's of Science in Psychology at Massey University, Wellington, New Zealand

Worldwide, a person dies by suicide every 40 seconds (World Health Organization, 2018). An estimated 793,000 people take their lives by suicide every year, and for every one suicide, 20 more people attempt suicide (World Health Organization, 2018). Internationally, for the younger generation aged 15–29 years, suicide is the second most prominent cause of death (World Health Organization, 2018). In Aotearoa (New Zealand), the Māori (Indigenous people) population has an approximate average age of 22 (Statistics New Zealand, 2017) and we are losing rangatahi Māori (Māori youth) to suicide at almost double the rate than their non-Indigenous counterparts (aged 15–24) (Ministry of Health, 2015; World Health Organization, 2018). Western attempts at suicide prevention lack cultural specificity, while Indigenous suicide prevention methods focus on reconnection back to culture, cultural living and traditional practices. Māori practitioners whakaaro (thoughts) show traditional Māori practices of rāranga, pūrākau, mirimiri and rongoā have beneficial properties that alleviate suicidal behaviours. This project incorporates an overarching Kaupapa Māori methodology while integrating qualitative research and semistructured interviews offers flexibility, subjectivity and to extract rich whakaaro for an experiential thematic analysis approach. Seven wāhine (female) Māori practitioners were interviewed. Findings show three critical whakaaro that can assist rangatahi Māori wellbeing: i) Healing as a Whole, ii) Protecting with Wairua and iii) Self-Healing. This study offers mental health professional’s valuable insight into utilizing Māori practitioners as a viable culturally appropriate method for positively promoting Māori wellbeing and protective factors that may prevent suicide. Future research could explore traditional practices as alternative treatment for whānau (family) who have experienced or supported tāngata (people) with suicidal behaviours

Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

<p>Abstract</p> <p>Background</p> <p>Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments might be too brief for the hospital to initiate these programmes. Therefore, it was relevant to evaluate a new clinical practice which combined the general practitioner's (GP) referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway.</p> <p>Methods</p> <p>The design was an exploratory prospective trial. The outcome measured was the number of patients referred to a preoperative smoking and alcohol cessation programme at the same time as being referred for elective surgery by their GP. The participants consisted of 72 high-risk patients who were referred for elective surgery by 47 local participating GPs.</p> <p>The GPs, nurses, and specialists in internal medicine, prehabilitation and surgery developed new clinical practice guidelines based on the literature and interviews with 11 local GPs about the specific barriers for implementing a smoking and alcohol cessation programme. The role of the GP was to be the gatekeeper: identifying daily smokers and hazardous drinkers when referring them to surgery; handing out information on risk reduction; and referring those patients identified to a preoperative smoking and alcohol cessation programme. The role of the hospital was to contact these patients to initiate smoking and alcohol cessation at the hospital out-patient clinic for life-style intervention.</p> <p>Results</p> <p>The GPs increased their referral to the smoking and alcohol cessation programme from 0% to 10% (7/72 patients) in the study period.</p> <p>Conclusion</p> <p>The effect of the study was limited in integrating the efforts of primary care providers and hospital surgical departments in increasing the up-take of preoperative smoking and alcohol cessation programmes aimed at smokers and harmful drinkers referred for surgery. New strategies for cooperation between GPs and surgical departments are urgently needed.</p> <p>Trial registration</p> <p>J.nr. 2005-54-1781 in Danish Data Protection Agency.</p> <p>J.nr. 07 268136 in Scientific Ethical Committee for Copenhagen and Frederiksberg Municipalities.</p