Facilitating access to voluntary and community services for patients with psychosocial problems: a before-after evaluation

<p>Abstract</p> <p>Background</p> <p>Patients with psychosocial problems may benefit from a variety of community, educational, recreational and voluntary sector resources, but GPs often under-refer to these through lack of knowledge and time. This study evaluated the acceptability and effectiveness of graduate primary care mental health workers (GPCMHWs) facilitating access to voluntary and community sector services for patients with psychosocial problems.</p> <p>Methods</p> <p>Patients with psychosocial problems from 13 general practices in London were referred to a GPCMHW Community Link scheme providing information and support to access voluntary and community resources. Patient satisfaction, mental health and social outcomes, and use of primary care resources, were evaluated.</p> <p>Results</p> <p>108 patients consented to take part in the study. At three-month follow-up, 63 (58%) had made contact with a community service identified as suitable for their needs. Most were satisfied with the help provided by the GPCMHW in identifying and supporting access to a suitable service. There was a reduction in the number of patients with a probable mental health problem on the GHQ-12 from 83% to 52% (difference 31% (95% CI, 17% – 44%). Social adjustment improved and frequencies of primary care consultations and of prescription of psychotropic medications were reduced.</p> <p>Conclusion</p> <p>Graduates with limited training in mental health and no prior knowledge of local community resources can help patients with psychosocial problems access voluntary and community services, and patients value such a scheme. There was some evidence of effectiveness in reducing psychosocial and mental health problems.</p

Meteorological measurements at Auchencorth Moss from 1995 to 2016

The Auchencorth Moss atmospheric observatory has being measuring meteorological parameters since 1995. The site was originally set‐up to measure the deposition of sulphur dioxide at a site that represented the vegetation and climate typical of NW Europe, in relatively clean background air. It is one of the longest running flux monitoring sites in the region, over semi‐natural vegetation, providing infrastructure and support for many measurement campaigns and continuous monitoring of air pollutants and greenhouse gases. The meteorological sensors that are used, data processing and quality reviewing procedures are described for a set of core measurements up to 2016. These core measurements are essential for the interpretation of the other atmospheric variables

Delivering stepped care: an analysis of implementation in routine practice

addresses: Mood Disorders Centre, University of Exeter, Exeter, EX4 4QG, UK. [email protected]: PMCID: PMC3283464types: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't© 2012 Richards et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.In the United Kingdom, clinical guidelines recommend that services for depression and anxiety should be structured around a stepped care model, where patients receive treatment at different 'steps,' with the intensity of treatment (i.e., the amount and type) increasing at each step if they fail to benefit at previous steps. There are very limited data available on the implementation of this model, particularly on the intensity of psychological treatment at each step. Our objective was to describe patient pathways through stepped care services and the impact of this on patient flow and management

Preparation of Active Proteins, Vaccines and Pharmaceuticals as Fine Powders using Supercritical or Near-Critical Fluids

Supercritical or near-critical fluid processes for generating microparticles have enjoyed considerable attention in the past decade or so, with good success for substances soluble in supercritical fluids or organic solvents. In this review, we survey their application to the production of protein particles. A recently developed process known as CO2-assisted nebulization with a Bubble Dryer® (CAN-BD) has been demonstrated to have broad applicability to small-molecule as well as macromolecule substances (including therapeutic proteins). The principles of CAN-BD are discussed as well as the stabilization, micronization and drying of a wide variety of materials. More detailed case studies are presented for three proteins, two of which are of therapeutic interest: anti-CD4 antibody (rheumatoid arthritis), α1-antitrypsin (cystic fibrosis and emphysema), and trypsinogen (a model enzyme). Dry powders were formed in which stability and activity are maintained and which are fine enough to be inhaled and reach the deep lung. Enhancement of apparent activity after CAN-BD processing was also observed in some formulation and processing conditions

Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression

Psychological therapies provided in primary care are usually briefer than in secondary care. There has been no recent comprehensive review comparing their effectiveness for common mental health problems. We aimed to compare the effectiveness of different types of brief psychological therapy administered within primary care across and between anxiety, depressive and mixed disorders

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Free radical addition to olefins. Part 14. - Addition to trifluoromethyl radicals to fluoroethylenes

A competitive method has been used to determine the relative Arrhenius parameters for the addition of trifluoromethyl radicals to specific sites in fluoroethylenes taking the addition to one end of ethylene as standard. olefin (site→) † k2/k2 ethylene (E2-E 2 ethylene)/kcal mol-1 † A2/A 2 ethylene →CH2=CHF 0.48 0.49±0.13 0.85±0.07 →CH2=CF2 0.15 1.20±0.34 0.60±0.06 →CHF=CH2 0.056 1.92±0.46 0.51±0.10 →CHF=CF2 0.031 1.91±0.05 0.28±0.06 →CF2=CH2 0.0055 3.24±0.96 0.23±0.08 →CF2=CHF 0.016 2.65±0.72 0.35±0.07 →CF2=CF2 0.12 1.74±0.22 0.87±0.09 † expressed per active site. The relative activation energies correlate well with those for the addition of other halogenoalkyl radicals to the same olefins. The A-factors have been calculated from absolute rate theory using two models of the transition state, one resembling the products and the other resembling the reactants. Comparison of the calculated and experimental A-factors suggests that formation of the bond between the trifluoro-methyl radical and the alkene has proceeded sufficiently far, in the transition state, to cause significant breaking of the alkene double bond.</p