Carers of forensic mental health in-patients: what factors influence their satisfaction with services?

Background Families are the main caring resource for service users with severe mental health problems. There has been limited work examining the needs of carers of people using forensic mental health services. Aims This study aimed to gain an understanding of carers satisfaction with services in forensic mental health inpatient settings. Method A survey design was used with 63 carers interviewed by telephone using a structured interview schedule. The data was analysed both qualitatively and quantitatively. Results Most carers were pleased with the service provided although some negative views were expressed with specific types of contact. Giving appropriate information to carers was strongly associated with satisfaction with the service being provided. Conclusions Carer satisfaction with forensic mental health services is likely to be higher with services that address carers’ information needs. New ways of providing this information may offer greater opportunities for working with carers

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

Porphyromonas gingivalis induce apoptosis in human gingival epithelial cells through a gingipain-dependent mechanism

<p>Abstract</p> <p>Background</p> <p>The oral pathogen <it>Porphyromonas gingivalis </it>has been shown to modulate apoptosis in different cell types, but its effect on epithelial cells remains unclear.</p> <p>Results</p> <p>We demonstrate that primary human gingival epithelial cells (HGECs) challenged with live <it>P. gingivalis </it>for 24 hours exhibit apoptosis, and we characterize this by M30 epitope detection, caspase-3 activity, DNA fragmentation and Annexin-V staining. Live bacteria strongly upregulated intrinsic and extrinsic apoptotic pathways. Pro-apoptotic molecules such as caspase-3, -8, -9, Bid and Bax were upregulated after 24 hours. The anti-apoptotic Bcl-2 was also upregulated, but this was not sufficient to ensure cell survival. The main <it>P. gingivalis </it>proteases arginine and lysine gingipains are necessary and sufficient to induce host cell apoptosis. Thus, live <it>P. gingivalis </it>can invoke gingival epithelial cell apoptosis in a time and dose dependent manner with significant apoptosis occurring between 12 and 24 hours of challenge via a gingipain-dependent mechanism.</p> <p>Conclusion</p> <p>The present study provides evidence that live, but not heat-killed, <it>P. gingivalis </it>can induce apoptosis after 24 hours of challenge in primary human gingival epithelial cells. Either arginine or lysine gingipains are necessary and sufficient factors in <it>P. gingivalis </it>elicited apoptosis.</p

In vitro modeling of host-parasite interactions: the 'subgingival' biofilm challenge of primary human epithelial cells

BACKGROUND: Microbial biofilms are known to cause an increasing number of chronic inflammatory and infectious conditions. A classical example is chronic periodontal disease, a condition initiated by the subgingival dental plaque biofilm on gingival epithelial tissues. We describe here a new model that permits the examination of interactions between the bacterial biofilm and host cells in general. We use primary human gingival epithelial cells (HGEC) and an in vitro grown biofilm, comprising nine frequently studied and representative subgingival plaque bacteria. RESULTS: We describe the growth of a mature 'subgingival' in vitro biofilm, its composition during development, its ability to adapt to aerobic conditions and how we expose in vitro a HGEC monolayer to this biofilm.Challenging the host derived HGEC with the biofilm invoked apoptosis in the epithelial cells, triggered release of pro-inflammatory cytokines and in parallel induced rapid degradation of the cytokines by biofilm-generated enzymes. CONCLUSION: We developed an experimental in vitro model to study processes taking place in the gingival crevice during the initiation of inflammation. The new model takes into account that the microbial challenge derives from a biofilm community and not from planktonically cultured bacterial strains. It will facilitate easily the introduction of additional host cells such as neutrophils for future biofilm:host cell challenge studies. Our methodology may generate particular interest, as it should be widely applicable to other biofilm-related chronic inflammatory diseases