John M. Daniel Editor of the \u3ci\u3eRichmond Examiner\u3c/i\u3e and Gadfly of the Confederacy

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Design and pilot evaluation of an evidence-based worksheet and clinician guide to facilitate nutrition counselling for patients with severe mental illness.

BACKGROUND: Schizophrenia spectrum disorders (SSD) are severe, persistent mental illnesses resulting in considerable disability and premature mortality. Emerging evidence suggests that diet may be a modifiable risk factor in mental illness; however, use of nutritional counselling as a component of psychiatric clinical practice is limited. The objective of this project is the design and evaluate a worksheet and clinician guide for use in facilitating nutritional counseling in the context of existing mental health care. METHODS: The worksheet and clinician guide were developed based on the results of a recent scoping review on the relationship between diet and mental health symptoms among individuals with SSD. A feedback process involved a focus group with psychiatrists and interviews with individuals with lived experience with psychosis. Participants were asked a series of structured and open-ended questions. Interviews were transcribed and data units were allocated to categories from an existing framework. The comments were used to guide modifications to the worksheet and clinician guide. A brief interview with all participants was completed to gather feedback on the final version. RESULTS: Five psychiatrist participants and six participants with lived experience completed interviews. Participants provided positive comments related to the worksheet design, complexity and inclusion of interactive components. A novel theme emerged relating to the lack of nutritional counselling in psychiatric training and clinical practice. Many constructive comments were provided which resulted in meaningful revisions and improvements to the worksheet and clinician guide design and content. All participants were satisfied with the final versions. CONCLUSIONS: A worksheet and clinician guide designed to facilitate nutritional counselling with individuals with SSD was found to be acceptable to all participants following a process of feedback and revision. Further research and dissemination efforts aimed at increasing the use of nutritional counselling in psychiatric practice are warranted

Establishing an international research collaborative for naturopathy: The International Research Consortium of Naturopathic Academic Clinics (IRCNAC)

© 2017 Elsevier Ltd Naturopathy is a system of healthcare through which practitioners apply core philosophies, theories and principles to integrate medical knowledge with natural treatment options. In recent years the naturopathic community has developed a stronger international coherence. Alongside this growing connectivity in the global naturopathic profession, there have been a number of calls for more systematic research attention to be devoted to naturopathy as a substantive research topic, as well as a need for the naturopathic profession to hone a culture of research and evidence-based practices and skillsets. Progress in this area has been made through the development of more pragmatic and whole systems naturopathic research. One aspect which is currently missing in the global naturopathic research landscape despite this growing pattern of practice-based, whole systems research is the application of international multicentre research projects. In response, we have established a research consortium for naturopathic academic clinics in four countries and across multiple world regions. This paper serves to overview the mission, scope and membership of the research consortium and explore some of the research designs and questions which it may support

Elicitation of stakeholder viewpoints about medical cannabis research for pain management in critically ill ventilated patients: A Q-methodology study

Objectives: To determine acceptability of medical cannabis research in critically ill patients. Design: Q-methodology survey. Setting: Sonvenience sample of healthcare providers and the general public were recruited at an acute care community hospital in Ontario, Canada. Participants: In the first phase, 63 respondents provided 197 unique viewpoints in response to a topic statement about medical cannabis use in critically ill patients. Twenty-five viewpoints were selected for the q-sample. In the second phase, 99 respondents ranked these viewpoints according to an a priori quasi normal distribution ranging from +4 (most agree) to -4 (least agree). Factor analysis was combined with comments provided by survey respondents to label and describe the extracted factors. Results: The factor labels were hoping and caring (factor 1), pragmatic progress (factor 2), and cautious/conservative and protectionist (factor 3). Factor 1 describes a viewpoint of unequivocal support for medical cannabis research in this population with few caveats. Factor 2 describes a viewpoint of cautious support with a need to monitor for unintended adverse effects. Factor 3 describes a viewpoint of ensuring that current analgosedation techniques are optimized before exposing patients to another potentially harmful drug. Conclusions: Using a q-methodology design, we were able to sample and describe the viewpoints that exist about medical cannabis research in critically ill patients. Three factors emerged that seemed to adequately describe the relative ranking of q-statements by the majority of respondents. Combining the distinguishing statements along with respondent comments allowed us to determine that the majority support medical cannabis research in critically ill patients

Tunneling study of cavity grade Nb: possible magnetic scattering at the surface

Tunneling spectroscopy was performed on Nb pieces prepared by the same processes used to etch and clean superconducting radio frequency (SRF) cavities. Air exposed, electropolished Nb exhibited a surface superconducting gap delta=1.55 meV, characteristic of clean, bulk Nb. However the tunneling density of states (DOS) was broadened significantly. The Nb pieces treated with the same mild baking used to improve the Q-slope in SRF cavities, reveal a sharper DOS. Good fits to the DOS were obtained using Shiba theory, suggesting that magnetic scattering of quasiparticles is the origin of the gapless surface superconductivity and a heretofore unrecognized contributor to the Q-slope problem of Nb SRF cavities.Comment: 3 pages, 3 figure

Dietary modification in the treatment of schizophrenia spectrum disorders: A systematic review.

BackgroundSchizophrenia spectrum disorders impact functioning, reduce quality of life and increase the risk of physical illness and premature mortality. Nutritional intervention studies aimed at decreasing body weight have demonstrated efficacy in improving metabolic outcomes; however, few studies have explored the impact of interventions designed to modify diet on mental health outcomes.AimTo synthesize the existing experimental studies of adjunctive diet modification as an intervention in the treatment of psychotic disorders, analyze findings related to effectiveness and safety, highlight knowledge gaps and limitations, and set forward recommendations for future research studies.MethodsAn extensive a priori search strategy was developed and the databases Embase, Embase Classic, Ovid MEDLINE were searched. Screening and data extraction were completed in duplicate. Studies included in this analysis were experimental studies of an adjunctive dietary intervention (overall dietary pattern or education on dietary change) for treatment of schizophrenia spectrum disorders. No restrictions were placed on control groups or blinding. The studies were required to report a mental health outcome.ResultsTwenty-five clinical trials were identified, along with two additional protocols and two meta-analyses. Nineteen of the clinical trials reported improvement in one or more mental health domain including psychosis symptoms, cognition, and quality of life. A high level of heterogeneity was found with respect to patient population, intervention, and study design. All of the studies included lifestyle or psychosocial components in addition to dietary modification. The nutrition advice provided to participants was poorly described overall and compliance was not assessed. The studies that showed benefit tended to have a smaller sample size and were less likely to be randomized but were more likely to use a group delivery intervention.ConclusionFurther research assessing effectiveness and efficacy of clearly reported dietary interventions is warranted, especially those using rigorous methodology, modifying diet in isolation and assessing participant compliance