Unlocking medical leadership’s potential:a multilevel virtuous circle?

Background and aim: Medical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled. Method: Couched in extant international literature, this paper provides a conceptual framework to analyse ML's potential in the context of healthcare's complex, multifaceted setting. Results: We identify four interrelated levels of analysis, or domains, that influence ML's potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems

Morphological development and cytochrome c oxidase activity in Streptomyces lividans are dependent on the action of a copper bound Sco protein

Copper has an important role in the life cycle of many streptomycetes, stimulating the developmental switch between vegetative mycelium and aerial hyphae concomitant with the production of antibiotics. In streptomycetes, a gene encoding for a putative Sco-like protein has been identified and is part of an operon that contains two other genes predicted to handle cellular copper. We report on the Sco-like protein from Streptomyces lividans (Sco Sl ) and present a series of experiments that firmly establish a role for Sco Sl as a copper metallochaperone as opposed to a role as a thiol-disulphide reductase that has been assigned to other bacterial Sco proteins. Under low copper concentrations, a Δ sco mutant in S. lividans displays two phenotypes; the development switch between vegetative mycelium and aerial hyphae stalls and cytochrome c oxidase (CcO) activity is significantly decreased. At elevated copper levels, the development and CcO activity in the Δ sco mutant are restored to wild-type levels and are thus independent of Sco Sl . A CcO knockout reveals that morphological development is independent of CcO activity leading us to suggest that Sco Sl has at least two targets in S. lividans . We establish that one Sco Sl target is the dinuclear Cu A domain of CcO and it is the cupric form of Sco Sl that is functionally active. The mechanism of cupric ion capture by Sco Sl has been investigated, and an important role for a conserved His residue is identified. </jats:p

Cognitive therapy and EMDR for reducing psychopathology in bereaved people after the MH17 plane crash:Findings from a randomized controlled trial

Experiencing a sudden/violent loss of a significant other is a risk factor for developing persistent complex bereavement disorder (PCBD), depression, and/or posttraumatic stress disorder (PTSD). Cognitive therapy (CT) combined with eye movement desensitization and reprocessing (EMDR) might be an effective treatment for bereaved people with PCBD, depression, and/or PTSD symptoms after sudden/violent loss. We tested the effects of CT + EMDR versus waitlist controls in disaster-bereaved people. In a multicenter randomized controlled trial, changes in self-rated PCBD, depression, and PTSD levels were compared between an immediate treatment and waitlist control group in 39 Dutch people who experienced loss(es) in the disaster with flight MH17, using multilevel modeling. Associations between reductions in symptom levels and reductions in maladaptive cognitive- behavioral variables were examined using regression analyses. The immediate treatment group showed a significantly stronger decline in depression (Hedges' g = 0.61) compared with waitlist controls (Hedges' g = 0.15). No significant between-groups differences were found in PCBD and PTSD levels. Symptom reductions were correlated with reductions in maladaptive cognitive- behavioral variables. Although CT + EMDR coincided with symptom reductions associated with reductions in negative cognitions and avoidance behaviors, more research with larger samples is needed to further examine the effectiveness of CT + EMDR in bereaved people after sudden/violent loss

Cognitive behavioural therapy for psychopathology in relatives of missing persons:Study protocol for a pilot randomised controlled trial

Background It is hypothesized that the grieving process of relatives of missing persons is complicated by having to deal with uncertainty about the fate of their loved one. We developed a cognitive behavioural therapy (CBT) with mindfulness that focuses on dealing with this uncertainty. In this article, we elucidate the rationale of a pilot randomised controlled trial (RCT) for testing the feasibility and potential effectiveness of this CBT for reducing symptoms of psychopathology in relatives of missing persons. Methods A pilot RCT comparing participants of the CBT condition (n = 15) with waiting list controls (n = 15) will be executed. Individuals suffering from psychopathology related to the long-term disappearance of a loved one are eligible to participate. The treatment consists of eight individual sessions. Questionnaires tapping psychological constructs will be administered before, during, and after the treatment. The feasibility of the treatment will be evaluated using descriptive statistics (e.g., attrition rate). The primary analysis consists of a within-group analysis of changes in mean scores of persistent complex bereavement disorder from baseline to immediately post-treatment and follow-up (12 and 24 weeks post-treatment). Discussion A significant number of people experience the disappearance of a loved one. Surprisingly, an RCT to evaluate a treatment for psychopathology among relatives of missing persons has never been conducted. Knowledge about treatment effects is needed to improve treatment options for those in need of help. The strengths of this study are the development of a tailored treatment for relatives of missing persons and the use of a pilot design before exposing a large sample to a treatment that has yet to be evaluated. Future research could benefit from the results of this study

Treatment gap in bereavement care:(Online) bereavement support needs and use after traumatic loss

People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self‐report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important

Online treatment of persistent complex bereavement disorder, posttraumatic stress disorder, and depression symptoms in people who lost loved ones during the COVID-19 pandemic:study protocol for a randomized controlled trial and a controlled trial

Background: Losing a loved one during the COVID-19 pandemic is a potentially traumatic loss that may result in symptoms of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression. To date, grief-specific cognitive-behavioural therapy (CBT) has mostly been delivered through individual face-to-face formats, while studies have shown that online treatment also yields promising results. Offering treatment online is now more than ever relevant during the pan demic and may offer important benefits compared with face-to-face CBT, such as lower costs and higher accessibility. Our expectation is that grief-specific online CBT is effective in reducing PCBD, PTSD, and depression symptoms. Objective: Our aim is to evaluate the short-term and long-term effectiveness of grief-specific online CBT in reducing PCBD, PTSD, and depression symptom-levels for adults who lost a loved one during the COVID-19 pandemic. Method: This study consists of two parts. In part 1, a two-armed (unguided online CBT versus waitlist controls) randomized controlled trial will be conducted. In part 2, a two-armed (guided online CBT versus unguided online CBT) controlled trial will be conducted. Symptoms of PCBD, PTSD, and depression will be assessed via telephone interviews at pre-treatment/pre-waiting period, post-treatment/post-waiting period, and six months post-treatment. Potential participants are people who lost a loved one at least three months earlier during the COVID-19 pandemic with clinically relevant levels of PCBD, PTSD, and/or depression. Analysis of covariance and multilevel modelling will be performed. Discussion: This is one of the first studies examining the effectiveness of online grief-specific CBT. More research is needed before implementing online grief-specific CBT into clinical practice

Concurrent associations of dimensions of anger with posttraumatic stress, depression, and functional impairment following non-fatal traffic accidents

Background: Anger is associated with dysfunction following potentially traumatic events. It is still unclear to what extent different types of anger are differentially related to poor outcomes. To advance knowledge in this area, the Posttraumatic Anger Questionnaire (PAQ) was designed, measuring anger directed at (i) the justice system, (ii) other people, (iii) the self, (iv) people held accountable for the potential traumatic event, and (v) a desire for revenge to those held responsible. Preliminary evidence shows that these types of anger are distinguishable and differentially associated with posttraumatic stress (PTS). No studies have yet examined whether such findings can be generalized to victims of non-fatal traffic accidents, one of the most common potentially traumatic events. Objective: This study’s aims were (i) to establish if the five-factor structure of the PAQ found in prior studies could be replicated, (ii) to explore whether the intensity of emerging types of anger differed, and (iii) to explore the associations of anger-types with levels of PTS, depression, and functional impairment. Method: Two-hundred and fifty adults who experienced a traffic accident completed the PAQ and instruments measuring PTS, depression, and functional impairment. They also answered questions about their socio-demographic characteristics and features of the accident. Results: Confirmatory factor analysis confirmed that the PAQ measures five types of anger. Levels of anger at people held accountable were the highest. Structural equation modelling showed that both anger at others and anger at the self, but not the other three anger types, were associated with PTS, depression, and functional impairment, when controlling for the shared variance between the anger types, socio-demographic variables, and features of the accident. Conclusions: Findings illustrate the potential importance of considering different types of anger when assessing and treating PTS following traffic accidents. HIGHLIGHTS: Based on data from people confronted with a traffic accident, we found the Posttraumatic Anger Questionnaire (PAQ) to represent distinguishable dimensions of anger. Anger dimensions were: anger directed at (i) the justice system, (ii) other people, (iii) the self, (iv) people held accountable for the event, and (v) a desire for revenge to those held responsible. Scores on items measuring anger at people held accountable for the event were significantly higher than scores on items measuring other anger types. Anger at the self and other people were most strongly associated with posttraumatic stress, depression, and functional impairment