Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study

Background: Teams working in the community to manage crisis in dementia are available, but with widely varying models of practice it is difficult to determine the effectiveness of such teams. The aim of this study is to develop a model of best practice for dementia services managing crisis, as well as a set of resources to help teams implement this model: these will be (respectively) the Best Practice Tool and Toolkit, to improve the effectiveness of crisis teams working with older people with dementia and their carers. Objective: To detail a protocol describing the development a ‘Best Practice Model,’ to include a Best Practice Tool and Toolkit intended to measure and improve practice delivery. Methods: This paper describes the protocol for a prospective study which will use qualitative methods to establish an understanding of current practice to develop a ‘Best Practice Model,’ to include a Best Practice Tool and Toolkit intended to measure and improve practice delivery. Participants (people with dementia, carers, staff members and stakeholders) from a variety of geographical areas, with a broad experience of crisis and non-crisis working, will be purposively selected to participate in qualitative methodology including interviews, focus groups, a consensus workshop, and development and field testing of both the Best Practice Tool and Toolkit. Results: Not applicable as protocol is describing a prospective study for development of a 'Best Practice Model' for Teams Managing Crisis in Dementia. Conclusions: This is the first study to systematically explore the requirements needed to fulfil effective and appropriate home management for people with dementia and their carers at a time of mental health crisis, as delivered by Teams Managing Crisis in Dementia (TMCDs). This systematic approach to development will support greater acceptability and validity of the Best Practice Tool and Toolkit and lay the foundation for a large scale trial with TMCDs across England to investigate effects on practice and impact on service provision, and associated experiences of people with dementia and their carers. Clinical Trial: Not applicable

Protocol for the development of an evidence-based ‘Best Practice Model’ for Teams Managing Crisis in Dementia

Background: Teams working in the community to manage crisis in dementia are available, but with widely varying models of practice it is difficult to determine the effectiveness of such teams. The aim of this study is to develop a model of best practice for dementia services managing crisis, as well as a set of resources to help teams implement this model: these will be (respectively) the Best Practice Tool and Toolkit, to improve the effectiveness of crisis teams working with older people with dementia and their carers. Objective: To detail a protocol describing the development a ‘Best Practice Model,’ to include a Best Practice Tool and Toolkit intended to measure and improve practice delivery. Methods: This paper describes the protocol for a prospective study which will use qualitative methods to establish an understanding of current practice to develop a ‘Best Practice Model,’ to include a Best Practice Tool and Toolkit intended to measure and improve practice delivery. Participants (people with dementia, carers, staff members and stakeholders) from a variety of geographical areas, with a broad experience of crisis and non-crisis working, will be purposively selected to participate in qualitative methodology including interviews, focus groups, a consensus workshop, and development and field testing of both the Best Practice Tool and Toolkit. Results: Not applicable as protocol is describing a prospective study for development of a 'Best Practice Model' for Teams Managing Crisis in Dementia. Conclusions: This is the first study to systematically explore the requirements needed to fulfil effective and appropriate home management for people with dementia and their carers at a time of mental health crisis, as delivered by Teams Managing Crisis in Dementia (TMCDs). This systematic approach to development will support greater acceptability and validity of the Best Practice Tool and Toolkit and lay the foundation for a large scale trial with TMCDs across England to investigate effects on practice and impact on service provision, and associated experiences of people with dementia and their carers. Clinical Trial: Not applicabl

Developing a model of best practice for teams managing crisis in people with dementia: a consensus approach

BACKGROUND: Teams delivering crisis resolution services for people with dementia and their carers provide short-term interventions to prevent admission to acute care settings. There is great variation in these services across the UK. This article reports on a consensus process undertaken to devise a Best Practice Model and evaluation Tool for use with teams managing crisis in dementia. METHODS: The Best Practice Model and Tool were developed over a three stage process: (i) Evidence gathering and generation of candidate standards (systematic review and scoping survey, interviews and focus groups); (ii) Prioritisation and selection of standards (consultation groups, a consensus conference and modified Delphi process); (iii) Refining and operationalising standards (consultation group and field-testing). RESULTS: One hundred sixty-five candidate standards arose from the evidence gathering stage; were refined and reduced to 90 through a consultation group exercise; and then reduced to 50 during the consensus conference and weighted using a modified Delphi process. Standards were then operationalised through a clinical consultation group and field-tested with 11 crisis teams and 5 non-crisis teams. Scores ranged from 48 to 92/100. The median score for the crisis teams was 74.5 (range 67-92), and the median score for non-crisis teams was 60 (range 48-72). CONCLUSIONS: With further psychometric testing, this Best Practice Model and Tool will be ideal for the planning, improvement and national benchmarking of teams managing dementia crises in the future

Dementia: beyond disorders of mood

This editorial will present the growing argument in the research literature that mood disorders, as defined by psychiatric diagnostic criteria, do not well serve individuals with dementia. This is important because anxiety and depression are our most used and most influential ways of understanding a highly prevalent and personally important experience in dementia: emotion. As such, there is a need to review how the disorders are currently conceptualised since they may have limited applicability for individuals with dementia, and consider what alternatives there might be. Agitation is offered as a lesson in how imprecise descriptions of behaviour can exclude the internal world of people with dementia. In our research to explore how the emotional experiences of individuals with dementia are understood, we consider what might lie beyond disorders of mood

Pre-cortical dysfunction of spatial and temporal visual processing in migraine.

This paper examines spatial and temporal processing in migraineurs (diagnosed according to International Headache Society criteria, 1988), using psychophysical tests that measure spatial and temporal responses. These tests are considered to specifically assess precortical mechanisms. Results suggest precortical dysfunction for processing of spatial and temporal visual stimuli in 11 migraineurs with visual aura and 13 migraineurs without aura; the two groups could not be distinguished. As precortical dysfunction seems to be common to both groups of patients, it is suggested that symptoms that are experienced by both groups, such as blurring of vision and photophobia, may have their basis at a precortical level

Is the cerebral cortex hyperexcitable or hyperresponsive in migraine?

peer reviewedAlthough migraineurs appear in general to be hypersensitive to external stimuli, they maybe also have increased daytime sleepiness and complain of fatigue. Neurophisiological studies between attacks have shown that for a number of different sensory modalities the migrainous brain is characterised by a lack of habituation of evoked responses. Whether this is due to increased cortical hyperexcitability, possibly due to decreased inhibition, or to an abnormal responsivity of the cortex due a decreased preactivation level remains disputed. Studies using transcranial magnetic stimulation in particular have yielded contradictory results. We will review here the available data on cortical excitability obtained with different methodological approaches in patients over the migraine cycle. We will show that these data congruently indicate that the sensory cortices of migraineurs react excessively to repetitive, but not to single, stimuli and that the controversy above hyper- versus hypo-excitability is merely a semantic misunderstanding. Describing the migrainous brain as 'hyperresponsive' would fit most of the available data. Deciphering the precise cellular and molecular underpinnings of this hyperresponsivity remains a challenge for future research. We propose, as a working hypothesis, that a thalamo-cortical dysrhythmia might be the culprit