Shared care in mental illness: A rapid review to inform implementation

<p>Abstract</p> <p>Background</p> <p>While integrated primary healthcare for the management of depression has been well researched, appropriate models of primary care for people with severe and persistent psychotic disorders are poorly understood. In 2010 the NSW (Australia) Health Department commissioned a review of the evidence on "shared care" models of ambulatory mental health services. This focussed on critical factors in the implementation of these models in clinical practice, with a view to providing policy direction. The review excluded evidence about dementia, substance use and personality disorders.</p> <p>Methods</p> <p>A rapid review involving a search for systematic reviews on The Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects (DARE). This was followed by a search for papers published since these systematic reviews on Medline and supplemented by limited iterative searching from reference lists.</p> <p>Results</p> <p>Shared care trials report improved mental and physical health outcomes in some clinical settings with improved social function, self management skills, service acceptability and reduced hospitalisation. Other benefits include improved access to specialist care, better engagement with and acceptability of mental health services. Limited economic evaluation shows significant set up costs, reduced patient costs and service savings often realised by other providers. Nevertheless these findings are not evident across all clinical groups. Gains require substantial cross-organisational commitment, carefully designed and consistently delivered interventions, with attention to staff selection, training and supervision. Effective models incorporated linkages across various service levels, clinical monitoring within agreed treatment protocols, improved continuity and comprehensiveness of services.</p> <p>Conclusions</p> <p>"Shared Care" models of mental health service delivery require attention to multiple levels (from organisational to individual clinicians), and complex service re-design. Re-evaluation of the roles of specialist mental health staff is a critical requirement. As expected, no one model of "shared" care fits diverse clinical groups. On the basis of the available evidence, we recommended a local trial that examined the process of implementation of core principles of shared care within primary care and specialist mental health clinical services.</p

Sustaining Canadian Marine Biodiversity: Policy and Statutory Progress

A 2012 Expert Panel Report on marine biodiversity by the Royal Society of Canada (RSC) concluded that Canada faced significant challenges in achieving sustainable fisheries, regulating aquacul- ture, and accounting for climate change. Relative to many countries, progress by Canada in fulfilling international obligations to sustain biodiversity was deemed poor. To track progress by Canada since 2012, the RSC struck a committee to track policy and statutory developments on matters pertaining to marine biodiversity and to identify policy challenges, and leading options for implementation that lie ahead. The report by the Policy Briefing Committee is presented here. It concluded that Canada has made moderate to good progress in some areas, such as prioritization of oceans stewardship and strengthening of the evidentiary use of science in decision-making. Key statutes were strengthened through amendments, including requirements to rebuild depleted fisheries (Fisheries Act) and new means of creating marine protected areas (Oceans Act) that allowed Canada to exceed its international obligation to protect 10% of coastal and marine areas by 2020. Public release of mandate letters has strengthened ministerial accountability. However, little or no progress has been made in reducing regulatory conflict with Fisheries and Oceans Canada (DFO), decreasing ministerial discretion under the Fisheries Act, clarifying the role of science in sustainable fisheries policy, and accounting for climate change. Five future policy challenges are identified: (1) Ensure climate change impacts and projections are incorporated into ocean-related decision making and planning processes; (2) Resolve DFO’s regulatory conflict to conserve and exploit biodiversity; (3) Limit ministerial discretionary power in fisheries management decisions; (4) Clarify ambiguities in how the Precautionary Approach is applied in sustainable fisheries policy; and (5) Advance and implement marine spatial planning. Since 2012, there has been progress in recover- ing and sustaining the health of Canada’s oceans. Failure to further strengthen biodiversity conservation threatens the capacity of Canada’s oceans to provide ecosystem services that contribute to the resilience of marine life and the well-being of humankind. Unprecedented and enduring changes in the ocean caused by climate change have made the achievement of meaningful progress all the more urgent

Effects of Disking Versus Feed Patch Management on Northern Bobwhite Brood Habitat and Hunting Success

More than 60 years ago, Herbert Stoddard (1931:376) wrote there is little doubt that such methods [i.e., disking and harrowing] are more practical for Southeastern quail preserves than artificial plantings, which are costly on a large scale and not always effective. Incredibly, this statement, and testing it as an hypothesis, has been ignored by the bobwhite research community until the past 10 years. Therefore, we designed a pilot study to compare measures of northern bobwhite (Colinus virginianus) brood habitat (vegetation composition and arthropod biomass) and direct measures of hunting success (covey finds per half-day hunt) to test whether feed patches were really necessary for bobwhite habitat management in southern Georgia and northern Florida. We applied experimental treatments (disk only versus feed patch planting) by using shooting courses (150-250 ha each) on 2 southeastern shooting plantations during 1994, 1995 and 1996. Overall, results were equivocal between the feed patch and disking treatments; no consistent pattern or difference in brood habitat composition or hunting success was observed. One factor responsible for this pattern may be the relatively fine-grained scale (only 1-3% of the shooting courses were planted or disked) at which treatments were applied were insufficient to significantly influence bobwhite abundance. Further research using increased amounts of ground disturbance and planting (5%, 10%, 20%, etc.) will be required before the actual need for agricultural plantings can be determined in the context of their efficacy for bobwhite management. One potential result of these findings is that significant cost savings can be realized by disking rather than planting agricultural crop plants because at least 70% of the costs of planting are a function of seed, fertilizer and cultivation, whereas only about 30% are attributed to disking

Effects of Seasonal Fire Applications on Northern Bobwhite Brood Habitat and Hunting Success

Since the early part of the 20th century, land managers have used prescribed fire during February and March to maintain and enhance habitat for northern bobwhites (Colinus virginianus) in southern pine forests. During the past 2 decades, some managers have started to shift their use of fire to mimic more natural lightning-season (April to August) ignitions because these fires encourage flowering of plants in intact native ground cover, and are potentially more effective at hardwood control than winter fires. Therefore, we designed a short-term pilot study to evaluate whether seasonal applications of prescribed fire had any effect on bobwhite brood habitat (as measured by vegetation composition and arthropod biomass) or bobwhite abundance (as measured by hunting success) during the subsequent fall. During the first two years of our study (1994 and 1995), results showed that arthropod biomass and bobwhite hunting success were slightly greater on the shooting course burned during lightning-season (May) than the one burned during February and March. These results indicate that applications of lightning-season fire can be used, at least on a small scale (i.e., management blocks \u3c250 ha) in southern pine forests for hardwood control, and possibly enhancement of native ground cover without short-term negative impacts on northern bobwhites

The enablers and barriers for the uptake, utilization, sustainability and spread of primary health care collaboratives in Australia

APHCRI Conversations was a regular program of presentations held at the Department of Health to facilitate exchange between APHCRI Network researchers and Department policymakers. Topics are developed jointly with the Department of Health and involve a range of speakers from APHCRI, including CRE invited experts, CRE Chief Investigators and stream project Chief Investigator

Service network analysis for agricultural mental health

<p>Abstract</p> <p>Background</p> <p>Farmers represent a subgroup of rural and remote communities at higher risk of suicide attributed to insecure economic futures, self-reliant cultures and poor access to health services. Early intervention models are required that tap into existing farming networks. This study describes service networks in rural shires that relate to the mental health needs of farming families. This serves as a baseline to inform service network improvements.</p> <p>Methods</p> <p>A network survey of mental health related links between agricultural support, health and other human services in four drought declared shires in comparable districts in rural New South Wales, Australia. Mental health links covered information exchange, referral recommendations and program development.</p> <p>Results</p> <p>87 agencies from 111 (78%) completed a survey. 79% indicated that two thirds of their clients needed assistance for mental health related problems. The highest mean number of interagency links concerned information exchange and the frequency of these links between sectors was monthly to three monthly. The effectiveness of agricultural support and health sector links were rated as less effective by the agricultural support sector than by the health sector (p < .05). The most highly linked across all areas of activity were Rural Financial Counsellors, the Department of Primary Industry Drought Support Workers and Community Health Centres. Hence for a mental health service network targeting farming families these are three key agencies across the spectrum of case work to program development. The study limitations in describing service networks relate to the accuracy of network bounding, self report bias and missing data from non participants.</p> <p>Conclusion</p> <p>Aligning with agricultural agencies is important to build effective mental health service pathways to address the needs of farming populations. Work is required to ensure that these agricultural support agencies have operational and effective links to primary mental health care services. Network analysis provides a baseline to inform this work. With interventions such as local mental health training and joint service planning to promote network development we would expect to see over time an increase in the mean number of links, the frequency in which these links are used and the rated effectiveness of these links.</p

CMB-S4 Science Book, First Edition

This book lays out the scientific goals to be addressed by the next-generation ground-based cosmic microwave background experiment, CMB-S4, envisioned to consist of dedicated telescopes at the South Pole, the high Chilean Atacama plateau and possibly a northern hemisphere site, all equipped with new superconducting cameras. CMB-S4 will dramatically advance cosmological studies by crossing critical thresholds in the search for the B-mode polarization signature of primordial gravitational waves, in the determination of the number and masses of the neutrinos, in the search for evidence of new light relics, in constraining the nature of dark energy, and in testing general relativity on large scales

The impact of induction and/or concurrent chemoradiotherapy on acute and late patient-reported symptoms in oropharyngeal cancer:Application of a mixed-model analysis of a prospective observational cohort registry

BACKGROUND The goal of this study was to comprehensively investigate the association of chemotherapy with trajectories of acute symptom development and late symptom recovery in patients with oropharyngeal cancer (OPC) by comparing symptom burden between induction chemotherapy followed by concurrent chemoradiotherapy (ICRT), concurrent chemo-radiotherapy (CRT), or radiotherapy (RT) alone.METHODS Among a registry of 717 patients with OPC, the 28-item patient-reported MD Anderson Symptom Inventory-Head and Neck Module (MDASI-HN) symptoms were collected prospectively at baseline, weekly during RT, and 1.5, 3 to 6, 12, and 18 to 24 months after RT. The effect of the treatment regimen (ICRT, CRT, and RT alone) was examined with mixed-model analyses for the acute and late period. In the CRT cohort, the chemotherapy agent relationship with symptoms was investigated.RESULTS Chemoradiation (ICRT/CRT) compared with RT alone resulted in significantly higher acute symptom scores in the majority of MDASI-HN symptoms (ie, 21 out of 28). No late symptom differences between treatment with or without chemotherapy were observed that were not attributable to ICRT. Nausea was lower for CRT with carboplatin than for CRT with cisplatin; cetuximab was associated with particularly higher scores for acute and late skin, mucositis, and 6 other symptoms. The addition of ICRT compared with CRT or RT alone was associated with a significant increase in numbness and shortness of breath.CONCLUSION The addition of chemotherapy to definitive RT for OPC patients was associated with significantly worse acute symptom outcomes compared with RT alone, which seems to attenuate in the late posttreatment period. Moreover, induction chemotherapy was specifically associated with worse numbness and shortness of breath during and after treatment.LAY SUMMARYChemotherapy is frequently used in addition to radiotherapy cancer treatment, yet the (added) effect on treatment-induced over time is not comprehensively investigatedThis study shows that chemotherapy adds to the symptom severity reported by patients, especially during treatment</p

Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy.

BACKGROUND: The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. METHODS: In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n = 213) or carotid endarterectomy (n = 211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis ≥50% during follow-up. RESULTS: Carotid stenosis longer than 0.65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2.79 (1.17-6.65), P = 0.02] and carotid endarterectomy [2.43 (1.03-5.73), P = 0.04], and with increased long-term risk of restenosis in endovascular treatment [hazard ratio 1.68 (1.12-2.53), P = 0.01]. The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P = 0.003). Results remained significant after multivariate adjustment. No associations were found for degree of stenosis and plaque surface. CONCLUSIONS: Increasing stenosis length is an independent risk factor for peri-procedural stroke or death in endovascular treatment and carotid endarterectomy, without favoring one treatment over the other. However, the excess restenosis rate after endovascular treatment compared with carotid endarterectomy increases with longer stenosis at baseline. Stenosis length merits further investigation in carotid revascularisation trials