Atlantic Provinces Transportation Forum 2015: Final Report

In Atlantic Canada, people spend an increasing amount of time, energy and money in getting from one place to another: Because of urban sprawl and traffic congestion, commuters living in and around cities spend more time going to and from work. Because of the centralization of public services in urban areas, rural residents are travelling further for jobs, health care, post-secondary education, shopping, recreation or other activities. Because of long-distance labour mobility and globalization, people are now commuting greater distances to go to work, often hopping across continents or oceans. And tourists are coming from ever more distant lands to visit Atlantic Canada, moving between urban and rural areas

Development and evaluation of an Individualised Outcome Measure (IOM) for randomised controlled trials in mental health

Predefined, researcher-selected outcomes are routinely used as the clinical end-point in randomised controlled trials (RCTs); however, individualised approaches may be an effective way to assess outcome in mental health research. The present study describes the development and evaluation of the Individualised Outcome Measure (IOM), which is a patient-specific outcome measure to be used for RCTs of complex interventions. IOM was developed using a narrative review, expert consultation and piloting with mental health service users (n=20). The final version of IOM comprises two components: Goal Attainment (GA) and Personalised Primary Outcome (PPO). For GA, patients identify one relevant goal at baseline and rate its attainment at follow-up. For PPO, patients choose an outcome domain related to their goal from a predefined list at baseline, and complete a standardised questionnaire assessing the chosen outcome domain at baseline and follow-up. A feasibility study indicated that IOM had adequate completion (89%) and acceptability (96%) rates in a clinical sample (n=84). IOM was then evaluated in an RCT (ISRCTN02507940). GA and PPO components were associated with each other and with the trial primary outcome. The use of the PPO component of IOM as the primary outcome could be considered in future RCTs

Evaluating the feasibility of complex interventions in mental health services: standardised measure and reporting guidelines

Aims: To develop a) an empirically-based standardised measure of the feasibility of complex interventions for use within mental health services and b) reporting guidelines to facilitate feasibility assessment. Method: A focussed narrative review of studies assessing implementation blocks and enablers was conducted with thematic analysis and vote counting used to determine candidate items for the measure. Twenty purposively sampled studies (15 trial reports, 5 protocols) were included in the psychometric evaluation, spanning different interventions types. Cohen’s Kappa was calculated for inter-rater reliability and test-retest reliability. Results: 95 influences on implementation were identified from 299 reviewed references. The final measure - Structured Assessment of Feasibility (SAFE) - comprises 16 items rated on a Likert scale. SAFE demonstrated excellent inter-rater (kappa 0.84, 95% CI 0.79 - 0.89) and test re-test reliability (kappa 0.89, 95% CI 0.85 - 0.93). Cost information and training time were the two influences least likely to be reported in intervention papers. SAFE Reporting Guidelines include 16 items organised into 3 categories (Intervention, Resource consequences, Evaluation). Conclusion: SAFE is a novel approach to evaluating interventions, and supplements efficacy and health economic evidence. SAFE Reporting Guidelines will allow feasibility of an intervention to be systematically assessed

Psychometric evaluation of the Questionnaire about the Process of Recovery (QPR)

Background: Supporting recovery is the aim of national mental health policy in many countries, including England. There is a need for standardised measures of recovery, to assess policy implementation and inform clinical practice. Only one measure of recovery has been developed in England: the Questionnaire about the Process of Recovery (QPR) which measures recovery from the perspective of adult mental health service users with a psychosis diagnosis. Aims: To independently evaluate the psychometric properties of the 15-item and 22-item versions of QPR. Method: Two samples were used: Dataset 1 (n=88) involved assessment of QPR at baseline, two weeks and three months. Dataset 2 (n=399; ISRCTN02507940) involved assessment of QPR at baseline and one year. Results: For the 15-item version, internal consistency was 0.89, convergent validity was 0.73, test-retest reliability was 0.74 and sensitivity to change was 0.40. Confirmatory factor analysis showed the 15-item version offered a good fit. For the 22 item version comprising two sub-scales, the Interpersonal sub-scale was found to under-perform and the Intrapersonal sub-scale overlaps substantially with the 15 item version. Conclusions: Both the 15-item and the Intrapersonal sub-scale of the 22-item versions of the QPR demonstrated satisfactory psychometric properties. The 15-item version is slightly more robust and also less burdensome, so it can be recommended for use in research and clinical practice. Declaration of interest: None

A national survey of recovery practice in community mental health teams

Background There is a policy and professional consensus about the importance of ‘recovery’ in mental health services, but the link between recovery-orientation of mental health teams and personal recovery of service users has been under-researched. Aims To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England. Objectives: (1) To compare variations between NHS Trust, team type and participant ratings of recovery-orientation of mental health teams; (2) To explore the relationship between service user ratings of recovery orientation and personal recovery; (3) To test the hypothesis that clinician-rated recovery orientation differs between clinicians with and without personal experience of mental illness or supporting a family member or friend with mental illness. Method In six English Mental Health NHS Trusts (purposively sampled to maximise geographic and demographic spread), randomly-chosen community adult mental health teams were surveyed. A random sample of ten service users, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using Questionnaire about Processes of Recovery (QPR). Results Team leaders (n=22) rated recovery orientation higher than clinicians (n=109) or service users (n=120) (Wald(7)=7.0, p=0.03), and both NHS Trust and team type influenced RSA ratings. Service user-rated recovery orientation was a predictor of personal recovery (b=0.52, p <.001; 95%CI: .31 to .74). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians. Conclusions Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery

Interprofessional simulation as an enhancement of psychological fidelity : a focus group study of medical and nursing students

Background and Aims. Interprofessional simulation has the potential to enhance the perceived realism of clinical simulation in the education of different healthcare professionals. This study considers how the inclusion of more than one profession in clinical simulation contributes to this psychological fidelity, defined as the subjective perception of the realism of a simulation, and the cues identified by medical and nursing students. Methods. Eight focus groups were carried out with 27 medical and 18 nursing students in Newcastle and Oxford, UK. These were carried out immediately after students' participation in simulation sessions consisting of three acute scenarios. Focus group discussions encompassed perceptions of the realism of the simulation and of participants' own and other professional groups. Thematic analysis was carried out on transcripts. Results. The analysis identified features of psychological fidelity that were influenced by the interprofessional element of the simulation. These included overall impressions of realism, and the perceived roles and expectations of doctors and nurses within the simulation. In particular, the presence of the other professional group afforded a more authentic response. Other features varied with the viewpoint of the student groups, in particular the realism of the patient manikin, which held lower psychological fidelity for the nursing students, because it did not allow them to fulfill their perceived role of delivering holistic, relational care. Conclusion. Recognizing “psychological fidelity” as a subjective response to simulation allows greater consideration of the limitations of fidelity as a designed or engineered property of a simulation. While interprofessional involvement directly enhances psychological fidelity in some ways, potential differences in the views of students from different professional groups should be considered when implementing interprofessional simulation

Evidence of Resistance to Cry34/35Ab1 Corn by Western Corn Rootworm (Coleoptera: Chrysomelidae): Root Injury in the Field and Larval Survival in Plant-Based Bioassays

Western corn rootworm, Diabrotica virgifera virgifera LeConte (Coleoptera: Chrysomelidae), is a serious pest of corn in the United States, and recent management of western corn rootworm has included planting of Bt corn. Beginning in 2009, western corn rootworm populations with resistance to Cry3Bb1 corn and mCry3A corn were found in Iowa and elsewhere. To date, western corn rootworm populations have remained susceptible to corn producing Bt toxin Cry34/35Ab1. In this study, we used single-plant bioassays to test field populations of western corn rootworm for resistance to Cry34/35Ab1 corn, Cry3Bb1 corn, and mCry3A corn. Bioassays included nine rootworm populations collected from fields where severe injury to Bt corn had been observed and six control populations that had never been exposed to Bt corn. We found incomplete resistance to Cry34/35Ab1 corn among field populations collected from fields where severe injury to corn producing Cry34/35Ab1, either singly or as a pyramid, had been observed. Additionally, resistance to Cry3Bb1 corn and mCry3A corn was found among the majority of populations tested. These first cases of resistance to Cry34/35Ab1 corn, and the presence of resistance to multiple Bt toxins by western corn rootworm, highlight the potential vulnerability of Bt corn to the evolution of resistance by western corn rootworm. The use of more diversified management practices, in addition to insect resistance management, likely will be essential to sustain the viability of Bt corn for management of western corn rootworm