Acknowledging religion in cognitive behavioural therapy: the effect on alliance, treatment expectations and credibility in a video-vignette study

Objectives: Developing mental health services which are accessible and acceptable to those from minority backgrounds continues to be a priority. In the United Kingdom, individuals who identify with a religion are underrepresented in Talking Therapies services as compared to those with no religion. This necessitates an understanding of how therapy is perceived. This online study explored the impact of explicitly acknowledging religion on anticipated alliance, treatment credibility and expectations of therapy in a non-clinical sample of British Muslims. Methods: A video-vignette experimental design was used in which participants who self-reported as either high or low in religiosity were randomly allocated to receiving information about cognitive behavioural therapy either with or without an explicit mention of religion as a value in the therapeutic process. Results: One hundred twenty-nine British Muslim adults aged 18–70+ years from various ethnic backgrounds participated in the study. Between-subjects ANOVAs showed that scores on the perceived credibility of therapy and treatment expectations were significantly higher when religion was explicitly mentioned by the ‘therapist’, but that acknowledging religion did not impact upon anticipated alliance. Conclusions: These findings suggest that mentioning religion as a value to be considered in therapy has some positive impacts upon how therapy is perceived by British Muslims. Although video vignettes do not provide insight into the complexity of actual therapeutic encounters, acknowledging religion in mental health services more broadly remains an important consideration for improving equity of access and may bear relevance to other minoritized groups

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

A systematic review of obsessive-compulsive disorder symptomatology in religious people of Abrahamic faiths: implications for clinical practice

Critical Review of the Literature This Systematic Literature Review aimed to synthesise literature reporting on symptoms of Obsessive-Compulsive Disorder in Christians, Jews, and Muslims to provide an in-depth understanding of scrupulosity symptom presentation. Keywords related to ‘religion’, ‘scrupulosity’, and ‘OCD’, were searched using electronic databases (PsychINFO, MEDLINE, PUBMED, CINAHL, Embase, and GlobalHealth) in March 2023. Studies which reported information about OCD symptoms on adult Christian, Jewish, or Muslim participants with scrupulosity were included. Quantitative or qualitative methodologies including case studies were screened. Studies that did not report original peer-reviewed research written in English were excluded. The quality of evidence was appraised using The Standard Quality Assessment Criteria for Evaluating Primary Research Papers, and the Joanna Briggs Institute Critical Appraisal Checklists for Case Reports, and for Qualitative Research. A narrative approach was taken to summarise obsessions and compulsions. This study is registered on PROSPERO, number CRD42023395834. Of the 4,314 records identified, 27 were eligible. The risk of overall bias varied. Differences in OCD presentations reflected theological differences in the Abrahamic faiths. In Christian samples, obsessions related to ‘correct’ thought and intention, in Jewish samples there was a focus on behavioural rituals, and in Muslim samples there was a focus on behavioural rituals accompanied with obsessional thoughts about faith. This review highlights the need for clinicians to be familiar with salient religious beliefs and practices when treating scrupulosity OCD. Service Improvement Project The Neonatal Care Unit is a challenging environment for parents. Previous literature documents the need for increased and more specialised understanding of support for fathers. There remains a dearth of literature on the experiences of ethnic minority fathers in particular, who may be less likely to access psychological support available. This project aimed to understand the barriers ethnic minority fathers faced when accessing psychology support at a Neonatal Care Unit in England. Seven fathers from ethnic minority backgrounds participated in semi-structured interviews after their babies were discharged. Data were analysed using a Reflexive Thematic Analysis approach. Three main themes were identified: ‘Psychology is a Threat’, ‘It’s Not Really Talked About in our Culture’, and ‘A Space for Mum, Not Me’. These themes are discussed in reference to the extant literature, and recommendations are provided to improve access to support. There is a need to recognise interacting influences of gender and cultural norms in supporting these fathers, including understanding the role of psychology, consideration of stigma, and knowing families in relation to their cultural context. Theory Driven Research Project The underrepresentation of British Muslims in UK mental health services necessitates an understanding of barriers and facilitators to engagement in therapy. This mixed-methods online study explored the impact of explicitly acknowledging religion on anticipated alliance, treatment credibility, and expectations of therapy in British Muslims. A videovignette experimental design was used in which participants who self-reported as either high or low in religiosity were randomly allocated to receiving information about Cognitive Behavioural Therapy either with or without an explicit mention of religion as a value in the therapeutic process. The results suggest that acknowledging religion does not impact upon anticipated alliance, the primary dependent variable. However, scores on the closely related secondary variables, perceived credibility of therapy and treatment expectation, were significantly higher when religion was explicitly mentioned by the ‘therapist’. A thematic analysis of free text across all participants found three main themes: ‘We are Too Different’, ‘It’s not Worth the Risk’, and ‘What we Need for Therapy to Work’. These findings suggest that mentioning religion as a value to be considered in therapy positively impacts upon how therapy is perceived by British Muslims

Dataset for "(Mis)recognition in the Therapeutic Alliance: The Experience of Mental-Health Interpreters Working with Refugees in UK Clinical Settings"

Mental health interpreters play a crucial role in clinical support for refugees by providing a bridge between client and clinician. Yet research on interpreters’ experiences and perspectives is remarkably sparse. In this study, semi-structured interviews with mental health interpreters explored the experience of working in clinical settings with refugees. The dataset consists of 10 semi-structured interviews conducted with mental health interpreters in London, UK. We conducted inductive analysis informed by a reflexive thematic analytic approach. Our analysis identifies interpreters’ pleasure in being part of people’s recovery; offset by the pain of misrecognition by clinicians that signals low-worth and invisibility. Three sites of tension that create dilemmas for interpreters are identified: maintaining professional boundaries, managing privately shared information; and recognizing cultural norms. These findings are discussed in terms of the implications for clinicians working with interpreters, with a focus on the importance of a relationship of trust founded on recognition of the interpreters’ role and the unique challenges they face.The dataset consists of 10 semi-structured interviews conducted with mental health interpreters in London, UK.Interviews have been anonymised with any information that could identify the participants or others removed.All information on data contained in Methods section of article

Dataset for "(Mis)recognition in the Therapeutic Alliance: The Experience of Mental-Health Interpreters Working with Refugees in UK Clinical Settings"

Mental health interpreters play a crucial role in clinical support for refugees by providing a bridge between client and clinician. Yet research on interpreters’ experiences and perspectives is remarkably sparse. In this study, semi-structured interviews with mental health interpreters explored the experience of working in clinical settings with refugees. The dataset consists of 10 semi-structured interviews conducted with mental health interpreters in London, UK. We conducted inductive analysis informed by a reflexive thematic analytic approach. Our analysis identifies interpreters’ pleasure in being part of people’s recovery; offset by the pain of misrecognition by clinicians that signals low-worth and invisibility. Three sites of tension that create dilemmas for interpreters are identified: maintaining professional boundaries, managing privately shared information; and recognizing cultural norms. These findings are discussed in terms of the implications for clinicians working with interpreters, with a focus on the importance of a relationship of trust founded on recognition of the interpreters’ role and the unique challenges they face

Dataset for "(Mis)recognition in the Therapeutic Alliance: The Experience of Mental-Health Interpreters Working with Refugees in UK Clinical Settings"

Mental health interpreters play a crucial role in clinical support for refugees by providing a bridge between client and clinician. Yet research on interpreters’ experiences and perspectives is remarkably sparse. In this study, semi-structured interviews with mental health interpreters explored the experience of working in clinical settings with refugees. The dataset consists of 10 semi-structured interviews conducted with mental health interpreters in London, UK. We conducted inductive analysis informed by a reflexive thematic analytic approach. Our analysis identifies interpreters’ pleasure in being part of people’s recovery; offset by the pain of misrecognition by clinicians that signals low-worth and invisibility. Three sites of tension that create dilemmas for interpreters are identified: maintaining professional boundaries, managing privately shared information; and recognizing cultural norms. These findings are discussed in terms of the implications for clinicians working with interpreters, with a focus on the importance of a relationship of trust founded on recognition of the interpreters’ role and the unique challenges they face

Thermosensitive Hydrogels Loaded with Resveratrol Nanoemulsion: Formulation Optimization by Central Composite Design and Evaluation in MCF-7 Human Breast Cancer Cell Lines

The second most common cause of mortality among women is breast cancer. A variety of natural compounds have been demonstrated to be beneficial in the management of various malignancies. Resveratrol is a promising anticancer polyphenolic compound found in grapes, berries, etc. Nevertheless, its low solubility, and hence its low bioavailability, restrict its therapeutic potential. Therefore, in our study, we developed a thermosensitive hydrogel formulation loaded with resveratrol nanoemulsion to enhance its bioavailability. Initially, resveratrol nanoemulsions were formulated and optimized utilizing a central composite-face-centered design. The independent variables for optimization were surfactant level, homogenization speed, and time, while the size and zeta potential were the dependent variables. The optimized nanoemulsion formulation was converted into a sensitive hydrogel using poloxamer 407. Rheological studies proved the formation of gel consistency at physiological temperature. Drug loading efficiency and in vitro drug release from gels were also analyzed. The drug release mechanisms from the gels were assessed using various mathematical models. The effect of the optimized thermosensitive resveratrol nanoemulsion hydrogel on the viability of human breast cancer cells was tested using MCF-7 cancer cell lines. The globule size of the selected formulation was 111.54 ± 4.16 nm, with a zeta potential of 40.96 ± 3.1 mV. Within 6 h, the in vitro release profile demonstrated a release rate of 80%. According to cell line studies, the produced hydrogel of resveratrol nanoemulsion was cytotoxic to breast cancer cells. Overall, the results proved the developed nanoemulsion-loaded thermosensitive hydrogel is a promising platform for the effective delivery of resveratrol for the management of breast cancer

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies