A pilot trial to assess the effect of a structured COMmunication approach on QUality Of Life in secure mental health settings (Comquol)

Forensic mental health services have largely ignored examining users’ views on the nature of the service offered to them. Priebe and colleagues have developed a structured communication approach placing the service users’ perspective of their care at the heart of the discussions between service users and clinicians. This approach was used as the basis of a pilot study to evaluate a structured six-month approach designed to increase the quality of life of service users in secure settings. The specific objectives of the study were to: • Establish the feasibility of the trial design as the basis for determining the viability of a large full-scale trial • Determine the variability of the outcomes of interest • Estimate the costs of the intervention • If necessary, to refine the intervention following the study based upon the experiences of the clinicians and service users. A 36 month pilot trial was undertaken. Participants were recruited from 6 medium secure in–patient services with 55 patients in the intervention group and 57 in the control group as well as 92 nurses (47 in the intervention group and 45 in the control group). The intervention was based on the structured communication approach. Assessments took place prior to the intervention (baseline), at 6 months (post intervention) and at 12 months (follow-up). A review of the trial design indicated this approach was viable as the basis for a large full-scale trial; no refinements were needed to the intervention. The variability of the outcomes can be used start thinking about how large a full scale trial needs to be. A full trial would be able to estimate the effect of the intervention whereas this small pilot study cannot. The total cost of the intervention was £29,100 (£529 per patient) when assuming the intervention was part of the nurses normal work. Disturbed behaviour was also found to be costly since it was associated with significant use of NHS resources and police

Study to assess the effect of a structured communication approach on quality of life in secure mental health settings (Comquol): study protocol for a pilot cluster randomized trial

Background Forensic mental health services have largely ignored examining patients’ views on the nature of the service offered to them. A structured communication approach (DIALOG) has been developed with the aim of placing the patient’s perspective of their care at the heart of the discussions between patients and clinicians. The effectiveness of the structured communication approach in community mental health services has been demonstrated but no trial taken place in a secure psychiatric setting. This pilot study is evaluating a six-month intervention combining DIALOG with principles of Solution Focused Therapy (SFT) on quality of life in medium secure settings. Methods/design A cluster randomized controlled trial design is being employed to conduct a 36 months pilot study. Participants are recruited from six medium secure in–patient services with 48 patients in the intervention group and 48 in the control group. The intervention uses a structured communication approach. It comprises of six meetings between patient and nurse over held once a month a six month period. During each meeting patients rate their satisfaction with a range of life and treatment domains with responses displayed on a tablet. The rating is followed by a discussion on how to improve the current situation in those domains identified by the patient. Assessments take place prior to the intervention (baseline), at 6 months (post intervention) and at 12 months (follow-up). The primary outcome is self reported Quality of Life. Discussion: The study aims to a) establish the feasibility of the trial design as the basis for determining the viability of a large full-scale trial, b) determine the variability of the outcomes of interest (quality of life, levels of satisfaction, disturbance, ward climate, and engagement with services) c) estimate the costs of the intervention and d) refine the intervention following the outcome of the study based upon the experiences of the nurses and patients. The intervention allows patients to have a greater say in how they are treated and targets care on areas that patients identify as important to them. It is intended to establish systems that support meaningful patient (and carer) involvement and participation. Trial registration: Current Controlled Trials ISRCTN34145189 Keywords: Comquol, DIALOG, Forensic, Mental Health, Quality of Life, Solution Focused Brief Therapy

A pilot cluster randomised trial to assess the effect of a structured communication approach on quality of life in secure mental health settings: the Comquol study

Background There is a lack of research in forensic settings examining therapeutic relationships. A structured communication approach, placing patients’ perspectives at the heart of discussions about their care, was used to improve patients’ quality of life in secure settings. The objectives were to: • Establish the feasibility of the trial design • Determine the variability of the outcomes of interest • Estimate the costs of the intervention • If necessary, refine the intervention Methods A pilot cluster randomised controlled trial was conducted. Data was collected from July 2012 to January 2015 from participants in 6 medium secure in–patient services in London and Southern England. 55 patients and 47 nurses were in the intervention group with 57 patients and 45 nurses in the control group. The intervention comprised 6 nurse-patient meetings over a 6 month period. Patients rated their satisfaction with a range of domains followed by discussions on improving patient identified problems. Assessments took place at baseline, 6 months, and 12 months. Participants were not blind to their allocated group. The primary outcome was self-reported quality of life collected by a researcher blind to participants’ allocation status. Results The randomisation procedures and intervention approach functioned well. The measures used were understood by the participants and gave relevant outcome information. The response rates were good with low patient withdrawal rates. The quality of life estimated treatment effect was 0.2 (95% CI: -0.4 to 0.8) at 6 months and 0.4 (95% CI: -0.3 to 1.1) indicating the likely extreme boundaries of effect in the main trial. The estimated treatment effect of the primary outcome is clinically important, and a positive effect of the intervention is not ruled out. The estimate of the ICC for the primary outcome at 6 and 12 months was 0.04 (0.00 to 0.17) and 0.05 (0.00 to 0.18). The cost of the intervention was £529 per patient. Conclusions The trial design was viable as the basis for a full-scale trial. A full trial is justified to estimate the effect of the intervention with greater certainty. The variability of the outcomes could be used to calculate numbers needed for a full-scale trial. Ratings of need for therapeutic security may be useful in any future study

Salivary and Serum Adiponectin and C-Reactive Protein Levels in Acute Myocardial Infarction Related to Body Mass Index and Oral Health

Background and Objective Adiponectin is produced by adipose cells and is considered an anti‐inflammatory molecule. In contrast, C‐reactive protein (CRP) has been identified as a hallmark of systemic inflammation and used as a risk marker of cardiovascular disease (CVD). Of interest was the relationship of these two biomarkers to oral health and CVD risk. Material and Methods This investigation examined these two molecules in serum and unstimulated whole saliva of patients within 48 h of an acute myocardial infarction (AMI) compared to control subjects. We hypothesized a differential response in these biomolecules resulting from the heart attack that would be affected by both the body mass index and oral health characteristics of the individuals. Results Significantly lower adiponectin levels were observed in the serum of patients with AMI. Serum adiponectin in both groups and salivary adiponectin in patients with AMI decreased with increasing body mass index. Oral health was significantly worse in patients with AMI, and both serum and salivary adiponectin were elevated with better oral health in control subjects. Serum CRP levels were increased in patients with AMI regardless of their oral health, and both serum and salivary CRP were significantly elevated in S‐T wave elevated patients with MI. Conclusions These initial data provide evidence relating obesity and oral health to salivary and serum analyte levels that occur in association with cardiac events. Relationships have been described between CVD risk and periodontal disease. Additionally, various systemic inflammatory biomarkers appear to reflect both the CVD risk and the extent/severity of periodontitis. Our findings indicated that oral health and obesity contribute to altering levels of these salivary and serum analytes in association with cardiac events. The potential that serum and/or salivary biomarkers could aid in evaluating CVD risk requires knowledge regarding how the oral health of the individual would impact the effectiveness of these biological measures

Domain-wall pinning, nonadiabatic spin-transfer torque, and spin-current polarization in permalloy wires doped with vanadium

Copyright © 2010 The American Physical SocietyUsing pulsed-current measurements we investigate the domain-wall depinning via spin-transfer torque from pinning potentials in V-doped Ni80Fe20 wires. The domain-wall depinning boundary, showing the variation of threshold current density with longitudinal magnetic field is measured and reproduced using micromagnetic simulations. This method allows us to determine the spin-current polarization and nonadiabaticity parameter in these materials. By increasing the V concentration we show that the nonadiabaticity parameter is increased while the Gilbert damping is unaffected. On the other hand the spin-current polarization is decreased, resulting in larger threshold current densities

Control of superconductivity with a single ferromagnetic layer in niobium/erbium bilayers

Superconducting spintronics in hybrid superconductor{ferromagnet (S{F) heterostructures provides an exciting potential new class of device. The prototypical super-spintronic device is the superconducting spin-valve, where the critical temperature, Tc, of the S-layer can be controlledby the relative orientation of two (or more) F-layers. Here, we show that such control is also possible in a simple S/F bilayer. Using eld history to set the remanent magnetic state of a thin Er layer, we demonstrate for a Nb/Er bilayer a high level of control of both Tc and the shape of the resistive transition, R(T), to zero resistance. We are able to model the origin of the remanent magnetization, treating it as an increase in the e ective exchange eld of the ferromagnet and link this, using conventional S{F theory, to the suppression of Tc. We observe stepped features in the R(T) which we argue is due to a fundamental interaction of superconductivity with inhomogeneous ferromagnetism, a phenomena currently lacking theoretical description