Student health professionals' attitudes and experience after watching 'Ida's diary', a first-person account of living with borderline personality disorder:mixed methods study

BACKGROUND: There is increasing interest in the use of commercial movies in nursing education, or 'cinenurducation'. There is a need for educational interventions which target mental health nurses' attitudes towards people with borderline personality disorder.OBJECTIVES: To investigate and evaluate the experience and effects of attendance at a screening of the movie Ida’s Diary, a first-person account of living with borderline personality disorder.DESIGN: Mixed methods design comprising a within-subjects AB longitudinal survey, and a qualitative analysis of participant-generated data and researcher field notes from a World Ca-fé discussion group.SETTINGS: One university in Scotland.PARTICIPANTS: N=66 undergraduate and postgraduate mental health nursing and coun-selling students.METHODS: Participants completed measures of cognitive and emotional attitudes towards, and knowledge about, people with borderline personality disorder before and after one of two film screenings. We conducted a World Café discussion group after the second screen-ing. Resulting data were subject to a qualitative thematic analysis.RESULTS: Quantitative analysis revealed a five-factor cognitive and a single-factor emo-tional attitude structure. Cognitive-attitudinal items related to treatment deservingness and value of mixed treatment approaches improved across iterations. Total knowledge score did not change, but one item about borderline personality disorder as a precursor to schizophrenia received considerably more incorrect endorsement post-screening. Qualitative analysis re-vealed five themes: Facilitation and inhibition of learning; promotion but not satiation of appe-tite for knowledge; challenging existing understanding; prompting creativity and anxiety; and initiating thinking about the bigger picture.CONCLUSIONS: Participants found the film thought provoking; it increased their appetite for knowledge. Findings suggest that screening should be delivered in conjunction with more didactic information about borderline personality disorder

Mixed methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder

Aims and objectives: To evaluate and explore mental health nurses’ responses to and experience of an educational intervention to improve attitudes towards people with a diagnosis of Borderline Personality Disorder. Report findings are concordant with relevant EQUATOR guidelines (STROBE and COREQ).Background: Attitudes towards people with a diagnosis of Borderline Personality Disorder are poorer than for people with other diagnoses. There is limited evidence about what might improve this situation. One intervention with reportedly good effect uses an underlying biosocial model of borderline personality disorder. No previous intervention has been co-produced with an expert-by-experience. We developed and delivered a 1-day intervention comprising these elements.Design: A mixed-methods design was used comprising prospective uncontrolled cohort intervention and qualitative elements. Participants were mental health nursing staff working in inpatient and community settings in one NHS Board in Scotland, UK.Methods: Measurement of cognitive and emotional attitudes to people with a borderline personality diagnosis at pre- and post- intervention (N =28) and at 4-month follow-up. Focus groups were used to explore participants’ experiences of the intervention (N =11).Results: Quantitative evaluation revealed some sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies, and negative attitudes in general. Qualitative findings revealed some hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert-by-experience. Conclusions: Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. Participants provided contrasting messages about what they think will be useful.Relevance to clinical practice: The study provides further evidence for incorporation of a biosocial model into staff training as well as the benefits of expert-by-experience co-production. Mental health nurses, however, believe that more well-resourced services are the key to improving care. <br/

Cognitive and neural processes in non-clinical auditory hallucinations

BACKGROUND: The nosological status of auditory hallucinations in non-clinical samples is unclear. AIMS: To investigate the functional neural basis of non-clinical hallucinations. METHOD: After selection from 1206 people, 68 participants of high, medium and low hallucination proneness completed a task designed to elicit verbal hallucinatory phenomena under conditions of stimulus degradation. Eight subjects who reported hearing a voice when none was present repeated the task during functional imaging. RESULTS: During the signal detection task, the high hallucination-prone participants reported a voice to be present when it was not (false alarms) significantly more often than the average or low participants (P<0.03, d.f.=2). On functional magnetic resonance imaging, patterns of activation during these false alarms showed activation in the superior and middle temporal cortex (P<0.001). CONCLUSIONS: Auditory hallucinatory experiences reported in non-clinical samples appear to be mediated by similar patterns of cerebral activation as found during hallucinations in schizophrenia

Protocol for a randomised controlled trial of telemonitoring and self-management in the control of hypertension: telemonitoring and self-management in hypertension. [ISRCTN17585681].

BACKGROUND: Controlling blood pressure with drugs is a key aspect of cardiovascular disease prevention, but until recently has been the sole preserve of health professionals. Self-management of hypertension is an under researched area in which potential benefits for both patients and professionals are great. METHODS AND DESIGN: The telemonitoring and self-management in hypertension trial (TASMINH2) will be a primary care based randomised controlled trial with embedded economic and qualitative analyses in order to evaluate the costs and effects of increasing patient involvement in blood pressure management, specifically with respect to home monitoring and self titration of antihypertensive medication compared to usual care. Provision of remote monitoring results to participating practices will ensure that practice staff are able to engage with self management and provide assistance where required. 478 patients will be recruited from general practices in the West Midlands, which is sufficient to detect clinically significant differences in systolic blood pressure between self-management and usual care of 5 mmHg with 90% power. Patients will be excluded if they demonstrate an inability to self monitor, their blood pressure is below 140/90 or above 200/100, they are on three or more antihypertensive medications, have a terminal disease or their blood pressure is not managed by their general practitioner. The primary end point is change in mean systolic blood pressure (mmHg) between baseline and each follow up point (6 months and 12 months). Secondary outcomes will include change in mean diastolic blood pressure, costs, adverse events, health behaviours, illness perceptions, beliefs about medication, medication compliance and anxiety. Modelling will evaluate the impact of costs and effects on a system wide basis. The qualitative analysis will draw upon the views of users, informal carers and professionals regarding the acceptability of self-management and prerequisites for future widespread implementation should the trial show this approach to be efficacious. DISCUSSION: The TASMINH2 trial will provide important new evidence regarding the costs and effects of self monitoring with telemonitoring in a representative primary care hypertensive population.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with suboptimal control and established cardiovascular disease or additional cardiovascular risk diseases (TASMIN-SR).

BACKGROUND: A previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive medication evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease and/or previous cardiovascular disease. DESIGN AND METHODS: A Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year-old 'high risk' patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost-utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years. A subgroup analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management. RESULTS: Base-case results indicated that self-management was cost-effective compared with usual care, resulting in more quality adjusted life years (0.21) and cost savings (-£830) per patient. There was a 99% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 per quality adjusted life year gained. Similar results were found for separate cohorts of men and women. The results were robust to sensitivity analyses, provided that the blood pressure lowering effect of self-management was maintained for more than a year. CONCLUSION: Self-management of blood pressure in high-risk people with poorly controlled hypertension not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of healthcare resources.This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG 0606-1153) and by the NIHR National School of Primary Care Research (NSPCR 16). The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Service support costs were administered through the Primary Care Research Network and collaborating Comprehensive Local Research Networks. Prof McManus was supported by NIHR Career Development and Professional Fellowships, Professors Hobbs, Little and Williams are NIHR senior investigators. Professor McManus and Hobbs receive support from the NIHR CLAHRC Oxford. Professor Hobbs also receives support from the NIHR School for Primary Care Research and the NIHR Oxford BRC.This is the final version of the article. It first appeared from SAGE via https://doi.org/10.1177/204748731561878

Framework engineering to produce dominant T cell receptors with enhanced antigen-specific function

Immunobiology of allogeneic stem cell transplantation and immunotherapy of hematological disease

Effect of Self-monitoring and Medication Self-titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease

IMPORTANCE: Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups. OBJECTIVE: To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease. DESIGN, SETTING, AND PATIENTS: A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013. INTERVENTIONS: Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary. MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit. RESULTS: Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and at 12 months, the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group, with a difference of 8.8 mm Hg (95% CI, 4.9-12.7) for systolic and 3.1 mm Hg (95% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events. CONCLUSIONS AND RELEVANCE: Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months

Cohort profile for the STratifying Resilience and Depression Longitudinally (STRADL) study:A depression-focused investigation of Generation Scotland, using detailed clinical, cognitive, and neuroimaging assessments

Grant information: STRADL is supported by the Wellcome Trust through a Strategic Award (104036/Z/14/Z). GS:SFHS received core support from the CSO of the Scottish Government Health Directorates (CZD/16/6) and the Scottish Funding Council (HR03006). ADM is supported by Innovate UK, the European Commission, the Scottish Funding Council via the Scottish Imaging Network SINAPSE, and the CSO. HCW is supported by a JMAS SIM Fellowship from the Royal College of Physicians of Edinburgh, by an ESAT College Fellowship from the University of Edinburgh, and has received previous funding from the Sackler Trust. LR has previously received financial support from Pfizer (formerly Wyeth) in relation to imaging studies of people with schizophrenia and bipolar disorder. JDH is supported by the MRC. DJM is an NRS Clinician, funded by the CSO. RMR is supported by the British Heart Foundation. ISP-V and MRM are supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health; and MRM is also supported by the MRC MC_UU_12013/6). JMW is supported by MRC UK Dementia Research Institute and MRC Centre and project grants, EPSRC, Fondation Leducq, Stroke Association, British Heart Foundation, Alzheimer Society, and the European Union H2020 PHC-03-15 SVDs@Target grant agreement (666881). DJP is supported by Wellcome Trust Longitudinal Population Study funding (216767/Z/19/Z) the Eva Lester bequest to the University of Edinburgh. AMM is additionally supported by the MRC (MC_PC_17209, MC_PC_MR/R01910X/1, MR/S035818/1), The Wellcome Trust (216767/Z/19/Z ), The Sackler Trust, and has previously received research funding from Pfizer, Eli Lilly, and Janssen. Both AMM and IJD are members of The University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative (MR/K026992/1); funding from the BBSRC and MRC is gratefully acknowledged. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscriptPeer reviewedPublisher PD

Cessation of Smoking Trial in the Emergency Department (COSTED): a multi-centre, randomised controlled trial

Background: Supporting people to quit smoking is one of the most powerful interventions to improve health. The Emergency Department (ED) represents a potentially valuable opportunity to deliver a smoking cessation intervention if it is sufficiently resourced. The objective of this trial was to determine whether an opportunistic ED based smoking cessation intervention can help people to quit smoking.   Methods: In this multi-centre, parallel-group, randomised controlled superiority trial conducted between January and August 2022, adults who smoked daily and attended one of six UK EDs were randomised to intervention (brief advice, e-cigarette starter kit and referral to stop smoking services) or control (written information on stop smoking services). The primary outcome was biochemically validated abstinence at six months.   Results: An intention-to-treat analysis included 972 of 1443 people screened for inclusion (intervention= 484, control= 488). Of 975 participants randomised, 3 were subsequently excluded, 17 withdrew and 287 were lost to follow-up. The six month biochemically verified abstinence rate was 7.2% in the intervention group and 4.1% in the control group (relative risk, 1.76; 95% confidence interval [CI] 1.03 to 3.01; p=0.038]). Self-reported 7-day abstinence at 6 months was 23.3% in the intervention group and 12.9% in the control group (relative risk, 1.80; 95% CI 1.36 to 2.38; p<0.001]). No serious adverse events related to taking part in the trial were reported.   Conclusions: An opportunistic smoking cessation intervention comprising brief advice, an e-cigarette starter kit and referral to stop smoking services is effective for sustained smoking abstinence with few reported adverse events

The Daily Mile makes primary school children more active, less sedentary and improves their fitness and body composition: a quasi-experimental pilot study

Background: The Daily Mile is a physical activity programme made popular by a school in Stirling, Scotland. It is promoted by the Scottish Government and is growing in popularity nationally and internationally. The aim is that each day, during class time, pupils run or walk outside for 15 min (~1 mile) at a self-selected pace. It is anecdotally reported to have a number of physiological benefits including increased physical activity, reduced sedentary behaviour, increased fitness and improved body composition. This study aimed to investigate these reports. Methods: We conducted a quasi-experimental repeated measures pilot study in two primary schools in the Stirling Council area: one school with, and one without, intention to introduce the Daily Mile. Pupils at the control school followed their usual curriculum. Of the 504 children attending the schools, 391 children in primary classes 1–7 (age 4–12 years) at the baseline assessment took part. The follow-up assessment was in the same academic year. Outcomes were accelerometer-assessed average daily moderate to vigorous intensity physical activity (MVPA) and average daily sedentary behaviour, 20-m shuttle run fitness test performance and adiposity assessed by the sum of skinfolds at four sites. Valid data at both time points were collected for 118, 118, 357 and 327 children, respectively, for each outcome. Results: After correction for age and gender, significant improvements were observed in the intervention school relative to the control school for MVPA, sedentary time, fitness and body composition. For MVPA, a relative increase of 9.1 min per day (95% confidence interval or 95%CI 5.1–13.2 min, standardised mean difference SMD = 0.407, p = 0.027) was observed. For sedentary time, there was a relative decrease of 18.2 min per day (10.7–25.7 min, SMD = 0.437, p = 0.017). For the shuttle run, there was a relative increase of 39.1 m (21.9–56.3, SMD = 0.236, p = 0.037). For the skinfolds, there was a relative decrease of 1.4 mm (0.8–2.0 mm, SMD = 0.246, p = 0.036). Similar results were obtained when a correction for socioeconomic groupings was included. Conclusions: The findings show that in primary school children, the Daily Mile intervention is effective at increasing levels of MVPA, reducing sedentary time, increasing physical fitness and improving body composition. These findings have relevance for teachers, policymakers, public health practitioners, and health researchers