Advanced clinical practitioners in primary care in the UK: A qualitative study of workforce transformation

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Escalating costs and changing population demographics are putting pressure on primary care systems to meet ever more complex healthcare needs. Non-medical ‘advanced clinical practitioner’ (ACP) roles are increasingly being introduced to support service transformation. This paper reports the findings of a qualitative evaluation of nursing ACP roles across General Practices in one region of the UK. Data collection involved telephone interviews with 26 participants from 3 different stakeholder groups based in 9 practice sites: ACPs (n = 9), general practitioners (n = 8) and practice managers (n = 9). The data was analysed thematically. The study found a high degree of acceptance of the ACP role and affirmation of the important contribution of ACPs to patient care. However, significant variations in ACP education, skills and experience led to a bespoke approach to their deployment, impeding system-wide innovation and creating challenges for recruitment and ongoing professional development. In addition, a context of high workforce pressures and high service demand were causing stress and there was a need for greater mentorship and workplace support. System wide changes to ACP education and support are required to enable ACPs to realise their full potential in primary care in the UK

Piezoelectric performance of PZT-based materials with aligned porosity::experiment and modelling

A new micromechanical model is proposed to analyse the piezoelectric properties of freeze-cast porous composite materials based on a ferroelectric lead zirconate titanate-type (PZT) ceramics. The important influence of the composite microgeometry and the porous ceramic matrix on the piezoelectric coefficients d∗ 3j and g∗ 3j and the piezoelectric anisotropy factor d∗ 33/|d∗ 31 in the porosity range of mp = 0.2-0.6 is evaluated and discussed. The resulting piezoelectric parameters of parallel-connected freeze-cast composites with highly aligned pore channels are then compared to those of PZT-based porous materials with randomly distributed porosity. Due to the relatively large piezoelectric coefficients d∗ 33 ∼ 102 pC N-1, g∗ 33 ≈ 40-100 mV m N-1, anisotropy factor d∗ 33/|d∗ 31 ≈ 3-5 and the presence of aligned porous channels, the parallel-connected freeze-cast composite has advantages over conventional monolithic PZT-type ceramics (e.g. g 33 = 24.2 mV m N-1 and d 33/|d 31| = 2.2 in the PZT-5 ceramic) and is suitable for piezoelectric transducer, sensor, acoustic, and energy-harvesting applications.</p

Features of successful interventions to improve adherence to Inhaled Corticosteroids in children with asthma:A narrative systematic review

INTRODUCTION: Nonadherence to inhaled corticosteroids (ICSs) in children with asthma leads to significant morbidity and mortality. Few adherence interventions have been effective and little is known about what contributes to intervention effectiveness. This systematic review summarizes the efficacy and the characteristics of effective interventions. METHODS: Six databases were systematically searched on October 3, 2020 for randomized control trials measuring adherence to ICS in children with asthma. A narrative synthesis was conducted focusing on intervention efficacy and study reliability. Intervention content was coded based on the National Institute for Health and Care Excellence guidelines for medicines adherence (the Perceptions and Practicalities Approach, PAPA) and behavior change techniques (BCTs), to determine the effective aspects of the intervention. RESULTS: Of 240 studies identified, 25 were eligible for inclusion. Thirteen of the 25 studies were categorized as being highly reliable. Nine of the 13 interventions were effective at increasing adherence and 6 of those met the criteria for a PAPA intervention. Techniques targeting perceptions and practicalities in successful interventions included rewards, reminders, feedback and monitoring of adherence, pharmacological support, instruction on how to take their ICS/adhere, and information about triggers for symptoms and nonadherence. CONCLUSION: Adherence interventions in children with asthma have mixed effectiveness. Effective intervention studies were more frequently of higher quality, were tailored to individuals' perceptual and practical adherence barriers, and used multiple BCTs. However, due to the small number of included studies and varying study design quality, conclusions drawn here are preliminary. Future research is needed to test a PAPA‐based intervention with a rigorous study design

Features of successful interventions to improve adherence to Inhaled Corticosteroids in children with asthma

INTRODUCTION: Non-adherence to inhaled corticosteroids (ICS) in children with asthma leads to significant morbidity and mortality. Few adherence interventions have been effective, and little is known about what contributes to intervention effectiveness. This systematic review summarises the efficacy and the characteristics of effective interventions. METHODS: Six databases were systematically searched on 3rd October 2020 for randomised control trials measuring adherence to ICS in children with asthma. A narrative synthesis was conducted focusing on intervention efficacy and study reliability. Intervention content was coded based on the NICE guidelines for medicines adherence (The Perceptions and Practicalities Approach, PAPA) and Behaviour Change Techniques (BCT), to determine the effective aspects of the intervention. RESULTS: Of 240 studies identified, 25 were eligible for inclusion. Thirteen of the twenty-five studies were categorised as being highly reliable. Nine of the thirteen interventions were effective at increasing adherence and six of those met the criteria for a PAPA intervention. Techniques targeting perceptions and practicalities in successful interventions included rewards; reminders; feedback and monitoring of adherence; pharmacological support; instruction on how to take their ICS/adhere and information about triggers for symptoms and non-adherence. CONCLUSION: Adherence interventions in children with asthma have mixed effectiveness. Effective intervention studies were more frequently of higher quality, were tailored to individuals' perceptual and practical adherence barriers, and used multiple BCTs. However, due to the small number of included studies and varying study design quality, conclusions drawn here are preliminary. Future research is needed to test a PAPA-based intervention with a rigorous study design. This article is protected by copyright. All rights reserved

The effect of the COVID-19 pandemic on mental health in individuals with pre-existing mental illness

BACKGROUND: There is evidence that the COVID-19 pandemic has negatively affected mental health, but most studies have been conducted in the general population. AIMS: To identify factors associated with mental health during the COVID-19 pandemic in individuals with pre-existing mental illness. METHOD: Participants (N = 2869, 78% women, ages 18–94 years) from a UK cohort (the National Centre for Mental Health) with a history of mental illness completed a cross-sectional online survey in June to August 2020. Mental health assessments were the GAD-7 (anxiety), PHQ-9 (depression) and WHO-5 (well-being) questionnaires, and a self-report question on whether their mental health had changed during the pandemic. Regressions examined associations between mental health outcomes and hypothesised risk factors. Secondary analyses examined associations between specific mental health diagnoses and mental health. RESULTS: A total of 60% of participants reported that mental health had worsened during the pandemic. Younger age, difficulty accessing mental health services, low income, income affected by COVID-19, worry about COVID-19, reduced sleep and increased alcohol/drug use were associated with increased depression and anxiety symptoms and reduced well-being. Feeling socially supported by friends/family/services was associated with better mental health and well-being. Participants with a history of anxiety, depression, post-traumatic stress disorder or eating disorder were more likely to report that mental health had worsened during the pandemic than individuals without a history of these diagnoses. CONCLUSIONS: We identified factors associated with worse mental health during the COVID-19 pandemic in individuals with pre-existing mental illness, in addition to specific groups potentially at elevated risk of poor mental health during the pandemic

Associations between comorbid anxiety and sleep disturbance in people with bipolar disorder: Findings from actigraphy and subjective sleep measures

Background Studies show that comorbid anxiety disorders are common in people with bipolar disorder. However, little is known about whether this anxiety is associated with sleep disturbance. We investigated, in individuals with bipolar disorder, whether comorbid anxiety disorder is associated with sleep disturbance. Methods Participants were 101 (64% female) currently euthymic individuals with a history of bipolar disorder. Sleep disturbances were assessed using self-report measures of sleep quality (Pittsburgh Sleep Quality Index, PSQI) and six weeks of sleep monitoring using actigraphy. Bipolar disorder and comorbid anxiety diagnoses were assessed using the Mini International Neuropsychiatric Interview. Multiple regression analyses examined associations between comorbid anxiety and sleep disturbance, whilst controlling for confounding covariates known to impact on sleep. Results A comorbid anxiety disorder was associated with increased sleep disturbance as measured using the PSQI global score (B = 3.58, 95% CI 1.85–5.32, P < 0.001) but was not associated with sleep metrics (total sleep time, sleep onset latency, sleep efficiency, and wake after sleep onset) derived using actigraphy. Limitations Objective measures of sleep were limited to actigraphy, therefore we were not able to examine differences in sleep neurophysiology. Conclusions Clinicians should be aware that comorbid anxiety may increase the risk of experiencing subjective sleep disturbance in people with bipolar disorder. Research should assess for evidence of comorbid anxiety when examining associations between sleep and bipolar disorder. Future research should explore the mechanisms by which comorbid anxiety may contribute to subjective sleep disturbances in bipolar disorder using neurophysiological measures of sleep (i.e., polysomnography)

Posttraumatic growth related to the COVID-19 pandemic among individuals with lived experience of psychiatric disorder

Although the COVID-19 pandemic has been shown to be detrimental to mental health, it may hold a parallel potential for positive change. Little is known about posttraumatic growth (PTG) as a potential outcome for individuals with lived experience of psychiatric disorders following trauma exposure, especially in the context of the COVID-19 pandemic. Participants were 1,424 adults with lived experience of a psychiatric disorder who took part in a longitudinal study of mental health during the COVID-19 pandemic conducted by the National Centre for Mental Health. PTG was measured using the Posttraumatic Growth Inventory–Short Form (PTGI-SF). Factors hypothesized to be associated with PTG were investigated using linear regression. The mean participant PTGI score was 12.64 (SD = 11.01). On average, participants reported the highest scores on items related to appreciation of life and lowest on those related to spiritual change subscale. We found the strongest evidence of associations between higher levels of PTG and higher scores on assessment items related to perceived social support, B = 2.86; perceptions of the pandemic as traumatic, B = 4.89; and higher psychological well-being, B = 0.40. Taken together, we did not observe evidence of widespread PTG related to the COVID-19 pandemic among individuals with lived experiences of psychiatric disorders