The effectiveness of brief cognitive analytic therapy for anxiety and depression: A quasi‐experimental case—control study

Objectives To investigate the effectiveness of an 8‐session cognitive analytic therapy (CAT) protocol for patients with anxiety and depression in the context of relational problems, personality disorder traits, or histories of adverse childhood experiences and then to compare outcomes with cognitive behavioural therapy (CBT). Methods The study was conducted in a single Improving Access to Psychological Therapies (IAPT) service and used sessional outcome monitoring. Propensity score matching was used to derive equivalent CAT (N = 76) and CBT (N = 73) samples through matching intake characteristics. Longitudinal multilevel modelling (LMLM) compared patterns of symptomatic change over time between the two therapies. Results LMLM found no significant differences between CAT and CBT in depression, anxiety, and functional impairment outcomes and showed similar symptom change trajectories. Small between‐therapy post‐treatment effects and medium‐to‐large within‐therapy effects were found. CAT patients attended significantly more sessions, and the CAT dropout rate was significantly lower. Conclusions Brief CAT appears acceptable and effective for patients with anxiety and depression in the context of complex relational problems when delivered within the high intensity tier of an IAPT service. The potential added value of CAT in IAPT services is discussed. Practitioner points Practitioners (under appropriate supervision) could use 8‐session CAT when treating patients with anxiety and depression in the context of clinical complexity. The 8‐session CAT model holds organizational promise in IAPT services. Brief CAT interventions should retain theoretical integrity

The ‘ins and outs’ of faecal microbiota transplant for recurrent Clostridium difficile diarrhoea at Wits Donald Gordon Medical Centre, Johannesburg, South Africa

Background. Clostridium difficile-associated diarrhoea (CDAD) is a potentially life-threatening condition that is becoming increasingly common. A persistent burden of this infectious illness has been demonstrated over the past 4 years at Wits Donald Gordon Medical Centre (WDGMC), Johannesburg, South Africa, through implementation of active surveillance of hospital-acquired infections as part of the infection prevention and control programme. Oral treatment with metronidazole or vancomycin is recommended, but there is a major problem with symptomatic recurrence after treatment. Replacement of normal flora by the administration of donor stool through colonoscopy or nasogastric/duodenal routes is becoming increasingly popular.Objectives. To identify risk factors for the development of CDAD in patients referred for faecal microbiota transplant (FMT) and evaluate the safety of administration of donor stool as an outpatient procedure, including via the nasogastric route.Methods. A retrospective record review of patients with recurrent CDAD referred for FMT at WDGMC between 1 January 2012 and 31 December 2016 was conducted.Results. Twenty-seven patients were identified, all of whom fulfilled the criteria for recurrent CDAD. One-third were aged >65 years, and the majority were female. The most common risk factors were prior exposure to antibiotics or proton-pump inhibitors and underlying inflammatory bowel disease. Three procedures were carried out as inpatients and 24 in the outpatient gastroenterology unit. At 4-week follow-up, all patients reported clinical resolution of their diarrhoea after a single treatment and there were no recurrences. The FMT procedure was associated with no morbidity (with particular reference to the risk of aspiration when administered via the nasogastric route) or mortality.Conclusions. This case series confirms that FMT is a safe and effective therapy for recurrent CDAD. In most cases it can be administered via the nasogastric route in the outpatient department. We propose that the recently published South African Gastroenterology Society guidelines be reviewed with regard to recommendations for the route of administration of FMT and hospital admission. Meticulous prescription practice by clinicians practising in hospitals and outpatient settings, with particular attention to antimicrobials and chronic medication, is urgently required to prevent this debilitating and potentially life-threatening condition

Bridging the gap: an exploration of the use and impact of positive action in the UK

Despite laws in Britain permitting limited positive action initiatives to combat disadvantage faced by minority groups in employment since the mid-1970s, the subject has notoriously been a neglected and highly controversial area in the UK. Notwithstanding the potential provided by sections 158 and 159 of the Equality Act 2010, it still appears that organisations prefer to steer clear of this opportunity to address disadvantage suffered by protected groups. Whilst there is a body of work considering the theoretical importance of positive action in the UK, there is a lack of empirical exploration of the practical implications of these provisions. This paper will provide a brief overview of the theoretical context and current positive action legislative provisions within the UK. In light of this context, the early findings of a small-scale qualitative study carried out by the authors will be discussed looking at the experiences of a purposive sample of public and private employers in relation to the positive action provisions of the Equality Act 2010. Early research findings suggest that whilst there was a clear willingness and openness by employers to use of outreach measures in order to redress disadvantage, there was evident wariness regarding a move towards preferential treatment as expounded by section 159. Whilst respondents appeared to appreciate the business case for and utility of the positive action measures under section 158, there was far less enthusiasm for more direct preferential treatment, with many respondents raising serious concerns regarding this. These concerns often reflected a highly sensitive risk-based approach towards any action that could expose their organisation to the possibility of “reverse discrimination”

Establishing a meaningful human rights due diligence process for corporations : learning from experience of human rights impact assessment

The United Nations Special Representative of the Secretary-General on Business and Human Rights, Professor John Ruggie, has constructed a new international framework, which is set to become the cornerstone for all action on human rights and business at the international level. The principle of human rights due diligence (HRDD) is the central component of the corporate duty to respect human rights within that framework. This article argues that Ruggie's HRDD principle contains the majority of the core procedural elements that a reasonable human rights impact assessment (HRIA) process should incorporate. It is likely that the majority of corporations will adopt HRIA as a mechanism for meeting their due diligence responsibilities. However, in the context of the contentious debate around corporate human rights performance, the current state of the art in HRIA gives rise to concerns about the credibility and robustness of likely practice. Additional requirements are therefore essential if HRDD is to have a significant impact on corporate human rights performance – requirements in relation to transparency; external participation and verification; and independent monitoring and review

Combatting disability discrimination: a comparison of France and Great Britain

This article examines disabled people’s employment in Great Britain and France. Although both countries have poor rates of employment for disabled people compared to non-disabled people, Great Britain’s disabled people’s employment rate is lower than France’s. Possible explanations include weak enforcement mechanisms in Great Britain, British judicial resistance, the lack of an institutional role for British trade unions resulting in an implementation gap and the proactive form of French law, a quota-levy scheme, which has no British parallel. The conclusions suggest which of these explanations are the most plausible and propose that Great Britain considers adopting some French provisions, thus tempering Britain’s voluntarist approach

Performance of the 2007 WHO Algorithm to diagnose Smear-negative Pulmonary Tuberculosis in a HIV prevalent setting

The 2007 WHO algorithm for diagnosis of smear-negative pulmonary tuberculosis (PTB) including Mycobacterium tuberculosis (MTB) culture was evaluated in a HIV prevalent area of Kenya

'Education, education, education' : legal, moral and clinical

This article brings together Professor Donald Nicolson's intellectual interest in professional legal ethics and his long-standing involvement with law clinics both as an advisor at the University of Cape Town and Director of the University of Bristol Law Clinic and the University of Strathclyde Law Clinic. In this article he looks at how legal education may help start this process of character development, arguing that the best means is through student involvement in voluntary law clinics. And here he builds upon his recent article which argues for voluntary, community service oriented law clinics over those which emphasise the education of students