“We deal here with grey”: a grounded theory of professional boundary development in a forensic inpatient service.

Background: The question of how to maintain appropriate professional boundaries with clients in mental health settings can be complex, particularly for forensic inpatient nurses and healthcare workers. The literature in this area to date has mainly focused on boundary violations with little research on how staff members develop and maintain boundaries in forensic inpatient units, despite safe working relationships being beneficial for staff experience and client recovery. Method: Interviews with eleven psychiatric nurses and healthcare workers from forensic inpatient wards were analysed using a grounded theory methodology. Results: A cyclical model of boundary development was developed in which staff initially acclimatize to the forensic environment using their existing experiences and personal values before entering a calibration phase, where they constantly assess and address professional boundary issues in the course of their daily responsibilities. Staff members use this experience alongside reflection, social learning and clinical supervision to undergo individual learning and team development. In the fourth phase, staff members use this learning to recalibrate their views on boundaries, themselves and how they work with clients. This recalibration impacts on staff members’ further management of daily boundaries providing more material for learning, which leads to further recalibration. Conclusions: This study echoes previous literature suggesting the importance of supervision and reflective spaces in professional boundary understanding. The model is comparable to existing learning theory and highlights the importance of social and experiential learning. There are implications for forensic psychiatric nurses in terms of training, team building, supervision and provision of reflective spaces

Dying of a hundred good symptoms: why good security can still fail - a literature review and analysis

Many organizations suffer serious information security incidents, despite having taken positive steps towards achieving good security standards. The authors hypothesize that these issues are often as a result of security arrangements not being sufficiently integrated with businesses. We believe that adopting an enterprise architecture (EA) approach to implementing information security – commonly referred to as an ‘Enterprise Information Security Architecture’ (EISA) – will deliver substantial benefits. Our paper has reviewed and analyzed literature concerning the root causes of information security incidents and describes a novel approach with 8 domains for ensuring critical factors are considered when building an EISA framework

Effectiveness of Vortioxetine for the Treatment of Emotional Blunting in Patients with Major Depressive Disorder Experiencing Inadequate Response to SSRI/SNRI Monotherapy in Spain: Results from the COMPLETE Study

Michael Cronquist Christensen,1 Francesca Canellas,2,3 Henrik Loft,1 Ángel L Montejo4– 6 1H. Lundbeck A/S, Valby, Denmark; 2Psychiatric Department, Son Espases University Hospital, Palma de Mallorca, Spain; 3Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain; 4Institute of Biomedicine of Salamanca (IBSAL), Salamanca, Spain; 5Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain; 6University of Salamanca, Faculty of Nursing, Salamanca, SpainCorrespondence: Michael Cronquist Christensen, H. Lundbeck A/S, Ottiliavej 9, Valby 2500, Denmark, Tel +45 3083 5168, Email [email protected]: The multinational, open-label COMPLETE study (NCT03835715) investigated the effectiveness of vortioxetine in alleviating emotional blunting in patients with major depressive disorder (MDD) experiencing inadequate response and emotional blunting while being treated with a selective serotonin reuptake inhibitor (SSRI) or serotonin–noradrenaline reuptake inhibitor (SNRI). This paper presents results for the subgroup of patients enrolled in Spain.Methods: Patients with MDD (n = 67) experiencing partial response and emotional blunting during monotherapy with an SSRI or SNRI were switched to vortioxetine (10– 20 mg/day) for 8 weeks. The primary study outcome was emotional blunting, assessed by the Oxford Depression Questionnaire (ODQ).Results: After 8 weeks of vortioxetine, the mean (SE) change in ODQ total score from baseline was − 26.0 (2.9) (P < 0.001). Respective changes in Montgomery–Åsberg Depression Rating Scale (MADRS), Motivation and Energy Inventory, Digit Symbol Substitution Test, and Sheehan Disability Scale (SDS) total scores were − 14.9 (0.8), +34.2 (4.5), +6.3 (1.6), and ‒9.0 (1.3) (all P < 0.001 vs baseline). At week 8, 70.4% of patients no longer reported emotional blunting and 53.7% had achieved remission from their depressive symptoms (defined as a MADRS total score ≤ 10). Mediation analysis showed 77.1% of the change in SDS total score to be a direct effect of the improvement in ODQ total score after switching to vortioxetine. Adverse events were reported by 35 patients (52.2%), most commonly nausea (14 patients, 20.9%). At week 8, 33/54 patients (61.1%) were receiving vortioxetine 20 mg/day.Conclusion: In this study investigating the effectiveness of vortioxetine in Spanish patients with MDD who experienced inadequate response and emotional blunting on SSRI/SNRI monotherapy, significant improvements in emotional blunting, core depressive symptoms (including anhedonia), sleep duration, motivation and energy, cognitive performance, and overall patient functioning were observed during the 8 weeks of treatment. Two-thirds of patients no longer reported emotional blunting and over half were in remission from their depressive symptoms at week 8.Keywords: emotional blunting, energy, major depressive disorder, motivation, patient functioning, vortioxetin

The effect of biliary decompression on bacterial translocation in jaundiced rats

Patients with obstructive jaundice are prone to septic complications after biliary tract operations. Restoring bile flow to the intestine may help to decrease the complication rate. The present study is aimed at evaluating the effect of biliary decompression on bacterial translocation in jaundiced rats. Sixty-six male Sprague-Dawley rats were randomly allocated to six groups subjected to common bile duct ligation (CBDL) and transection (groups 2-6) or sham operation (group 1). In groups 1 and 2 the incidence of enteric bacterial translocation was determined 2 weeks after sham operation or CBDL. In groups 3-6, biliary decompression was achieved by performing a choledochoduodenostomy after 2 weeks of biliary decompression. Bacterial translocation was then studied 1, 2, 3 and 5 weeks following biliary decompression. The rate of bacterial translocation to mesenteric lymph nodes in obstructive jaundice was significantly higher as compared with controls and decreased with time to nil three weeks following biliary decompression. The incidence of bacterial translocation was closely correlated (r = 0.844; p = 0.034) with serum alkaline phosphatase activity and seemed to fit with the morphological changes noted in the small intestine. The decrease in bacterial translocation, however, lags behind the recovery of liver function as measured by routine liver function tests and antipyrine clearance. Obstructive jaundice thus promotes bacterial translocation in the rat. Biliary decompression gradually decreases the rate of bacterial translocation

(68)Ga-DOTATOC PET and gene expression profile in patients with neuroendocrine carcinomas:strong correlation between PET tracer uptake and gene expression of somatostatin receptor subtype 2

Somatostatin receptor expression on both protein and gene expression level was compared with in vivo (68)Ga-DOTATOC PET/CT in patients with neuroendocrine carcinomas (NEC). Twenty-one patients with verified NEC who underwent a (68)Ga-DOTATOC PET/CT between November 2012 and May 2014, were retrospectively included. By real-time polymerase chain reaction, we quantitatively determined the gene expression of several genes and compared with (68)Ga-DOTATOC PET uptake. By immunohistochemistry we qualitatively studied the expression of assorted proteins in NEC. The median age at diagnosis was 68 years (range 41-84) years. All patients had WHO performance status 0-1. Median Ki67 index was 50% (range 20-100%). Gene expression of somatostatin receptor subtype (SSTR) 2 and Ki67 were both positively correlated to the (68)Ga-DOTATOC uptake (r=0.89; p<0.0001 and r=0.5; p=0.021, respectively). Furthermore, SSTR2 and SSTR5 gene expression were strongly and positively correlated (r=0.57; p=0.006). This study as the first verifies a positive and close correlation of (68)Ga-DOTATOC uptake and gene expression of SSTR2 in NEC. SSTR2 gene expression has a stronger correlation to (68)Ga-DOTATOC uptake than SSTR5. In addition, the results indicate that the gene expression levels of SSTR2 and SSTR5 at large follow one another