Facilitating professional liaison in collaborative care for depression in UK primary care; a qualitative study utilising normalisation process theory

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Background: Collaborative care (CC) is an organisational framework which facilitates the delivery of a mental health intervention to patients by case managers in collaboration with more senior health professionals (supervisors and GPs), and is effective for the management of depression in primary care. However, there remains limited evidence on how to successfully implement this collaborative approach in UK primary care. This study aimed to explore to what extent CC impacts on professional working relationships, and if CC for depression could be implemented as routine in the primary care setting. Methods: This qualitative study explored perspectives of the 6 case managers (CMs), 5 supervisors (trial research team members) and 15 general practitioners (GPs) from practices participating in a randomised controlled trial of CC for depression. Interviews were transcribed verbatim and data was analysed using a two-step approach using an initial thematic analysis, and a secondary analysis using the Normalisation Process Theory concepts of coherence, cognitive participation, collective action and reflexive monitoring with respect to the implementation of CC in primary care. Results: Supervisors and CMs demonstrated coherence in their understanding of CC, and consequently reported good levels of cognitive participation and collective action regarding delivering and supervising the intervention. GPs interviewed showed limited understanding of the CC framework, and reported limited collaboration with CMs: barriers to collaboration were identified. All participants identified the potential or experienced benefits of a collaborative approach to depression management and were able to discuss ways in which collaboration can be facilitated. Conclusion: Primary care professionals in this study valued the potential for collaboration, but GPs’ understanding of CC and organisational barriers hindered opportunities for communication. Further work is needed to address these organisational barriers in order to facilitate collaboration around individual patients with depression, including shared IT systems, facilitating opportunities for informal discussion and building in formal collaboration into the CC framework. Trial registration: ISRCTN32829227 30/9/2008.UK Medical Research CouncilNIHR Collaboration for Leadership in Applied Health ResearchCare South West Peninsul

Phytochemical And Anti-Sickling Properties Of Hymenocardia acidia (Tul)

The plant Hymenocardia acidia is a member of the family Euphorciaceae. The various morphological parts are used in Nigeria for the treatment of eye infections, diarrhoea, dysentery, rheumatic pains and most importantly sickle cell anaemia. The present study aims at unveiling the reality or otherwise of its anti-sickling claim. To this end, the plant was processed accordingly and assayed for anti-sickling activity using a standard method. The stem-bark and leaves reversed sickling red blood cells in a dose dependent manner. Moreover, this study also revealed the presence of tannins, flavonoids, saponins, alkaloids, resins, steroids, terpenes, etc. Thus the use of the plant in traditional medicine practice in the treatment of sickle cell disorder might be justified. Key words: Hymenocardia acidia, traditional medicine practice, anti-sickling activity, red blood cells. Nigerian Journal of Physiological Sciences Vol.18(1-2) 2003: 82-8

Chemistry and bacteriostatic activity of the essential oil and major isolates from the fruit rind of Citrus paradisi Macfad

The volatile principles from the fruit rind of Citrus paradisi Macfad were extracted produced using two models: Clevenger and Soxhlet, to yield 2.6 and 9.3 % v/w respectively. The essential oil produced via Clevenger equipment was chemically characterized with GC-MS and it revealed the presence of twenty four (24) isolates among which the monocyclic monoterpene (-)-Limonene (91.1 %) was found to be the chief element in the oil. The activities of the oils extracted through the two models and their major constituents against a wide species of clinical bacteria isolates were studied. Gram positive bacteria were found to be more sensitive than the gram negative species used. The oil produced from Clevenger (OPC) and (-)-Limonene were the most active with MIC of 62 μg/mL against Bacillus subtilis. However, the oil produced from Soxhlet (OPS) had an MIC of 1000 μg/mL against the same species. The oils were not active against Micrococcus luteus and P. aeruginosa. The results obtained in this study have justified the uses of Citrus paradisi Macfad in traditional medicinal practices for the treatment of skin related ailments as well as gastrointestinal disorders. Key words: Citrus paradisi, bacteriostatic activity, isolates, essential oil, fruit rind. Journal of Pharmaceutical and Allied Sciences Vol.2(2) 2005: 219-22

The behavioural dimension of SME’s owner on affecting the financial decisions

This research seeks the effect of behavioural and non-behavioural factors of SME’s owners and their business characteristic on the financing decisions. Moreover, this research categorized SMEs owners based on their behavioural aspects on establishing a behavioural mapping in SMEs industry. The sample of this research is the informal SMEs owners in Surakarta, Central Java, Indonesia. In investigating the relationship of the independent variable on financial decision making, this research employed the hierarchical linear multiple regression model (HLMR) and multiple logistic regression (LR). Furthermore, this research employed cluster analysis for building a behavioural mapping in SMEs industry. This study discovered a significant effect of behavioural aspects of SME’s owners on the financing decisions, which is, instead of having significant enforcement on the financing decisions, the non-behavioural aspects were more likely impacted on the SMEs owners’ investment decisions. The finding shows that there are three significant groups of SMEs owners in the Surakarta region. The result of this research gives key insights, mainly to the involved stakeholder to keep the sustainability of the SMEs industry

What works to promote walking at the population level? A systematic review.

OBJECTIVE: Interventions to promote walking have focused on individual or group-based approaches, often via the randomised controlled trial design. Walking can also be promoted using population health approaches. We systematically reviewed the effectiveness of population approaches to promote walking among individuals and populations. DESIGN: A systematic review. DATA SOURCES: 10 electronic databases searched from January 1990 to March 2017. ELIGIBILITY CRITERIA: Eligibility criteria include pre-experimental and postexperimental studies of the effects of population interventions to change walking, and the effects must have been compared with a 'no intervention', or comparison group/area/population, or variation in exposure; duration of ≥12 months of follow up; participants in free-living populations; and English-language articles. RESULTS: 12 studies were identified from mostly urban high-income countries (one focusing on using tax, incentivising the loss of parking spaces; and one using policy only, permitting off-leash dogs in city parks). Five studies used mass media with either environment (n=2) or community (n=3) approaches. Four studies used environmental changes that were combined with policies. One study had scaled up school-based approaches to promote safe routes to schools. We found mass media, community initiatives and environmental change approaches increased walking (range from 9 to 75 min/week)

Clinical characteristics and comorbidities in psoriatic arthritis: Experience from a single rheumatology centre in Malaysia

Aim of the work: To evaluate the clinical features and associated comorbidities of psoriatic arthritis (PsA) patients from a single rheumatology centre in Malaysia. Patients and methods: 247 PsA patients in rheumatology clinic, Raja Permaisuri Bainun Hospital were included. Clinical and laboratory data were retrieved from the medical record. Results: The mean age was 56 ± 13.5 years, 56.1% were female, and 38.9% were Indians. The onset of psoriasis and PsA was significantly earlier among Malays (P  0.05). Conclusion: PsA was more prevalent in Indians. Malays have younger disease onset. Pustular psoriasis and onycholysis were common in males, while scalp psoriasis in females. Asymmetrical oligoarthritis and plaque psoriasis were the commonest pattern and psoriasis subtype respectively. Comorbidities were not associated with the pattern of arthritis in PsA patients