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

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 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

The elevated Curie temperature and half-metallicity in the ferromagnetic semiconductor Lax_{x}Eu1−x_{1-x}O

Here we study the effect of La doping in EuO thin films using SQUID magnetometry, muon spin rotation ($\mu$SR), polarized neutron reflectivity (PNR), and density functional theory (DFT). The $\mu$SR data shows that the La$_{0.15}$Eu$_{0.85}$O is homogeneously magnetically ordered up to its elevated $T_{\rm C}$. It is concluded that bound magnetic polaron behavior does not explain the increase in $T_{\rm C}$ and an RKKY-like interaction is consistent with the $\mu$SR data. The estimation of the magnetic moment by DFT simulations concurs with the results obtained by PNR, showing a reduction of the magnetic moment per La$_{x}$Eu$_{1-x}$O for increasing lanthanum doping. This reduction of the magnetic moment is explained by the reduction of the number of Eu-4$f$ electrons present in all the magnetic interactions in EuO films. Finally, we show that an upwards shift of the Fermi energy with La or Gd doping gives rise to half-metallicity for doping levels as high as 3.2 %.Comment: 7 pages, 11 figure

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

A randomized-controlled trial of low-dose doxycycline for periodontitis in smokers

Background/Aim : Tobacco use reduces the effect of non-surgical periodontal therapy. Host-modulation with low-dose doxycycline (LDD) might favour repair and promote an improved treatment response. The aim of this study was to investigate the effect of LDD in smokers on non-surgical periodontal therapy. Material and Methods : This was a parallel arm, randomized, identical placebo-controlled trial with masking of examiner, care-giver, participant and statistician and 6 months of follow-up. Patients received non-surgical therapy and 3 months of test or control drug. Statistical analysis used both conventional methods and multilevel modelling. Results : Eighteen control and 16 test patients completed the study. The velocity of change was statistically greater for the test group for clinical attachment level −0.19 mm/month (95% CI=−0.34, 0.04; p =0.012) and probing depth 0.30 mm/month (95% CI=−0.42, −0.17; p <0.001). However, no differences were observed for absolute change in clinical or biochemical markers at 6 months. Conclusions : This study does not provide evidence of a benefit of using LDD as an adjunct to non-surgical periodontal therapy in smokers.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74791/1/j.1600-051X.2007.01058.x.pd

Influence of the liquid helium meniscus on neutron reflectometry data

Neutron reflectometry offers a unique opportunity for the direct observation of nano-stratification in 3He-4He mixtures in the ultra-low temperature limit. Unfortunately the results of recent experiments could not be well-modelled on account of a seemingly anomalous variation of reflectivity with momentum transfer. We now hypothesize that this effect is attributable to an optical distortion caused by the liquid’s meniscus near the container wall. The validity of this idea is tested and confirmed through a subsidiary experiment on a D2O sample, showing that the meniscus can significantly distort results if the beam size in the horizontal plane is comparable with, or bigger than, the diameter of the container. The meniscus problem can be eliminated if the beam size is substantially smaller than the diameter of the container, such that reflection takes place only from the flat region of the liquid surface thus excluding the meniscus tails. Practical measures for minimising the meniscus distortion effect are discussed

Interface-Coupled BiFeO<inf>3</inf>/BiMnO<inf>3</inf> Superlattices with Magnetic Transition Temperature up to 410 K

This research was funded by the Engineering and Physical Sciences Research Council, (EP/P50385X/1), the European Research Council (ERC-2009-AdG 247276 NOVOX). The work at Texas A&M was funded by the U.S. National Science Foundation (DMR-1401266). The work at Los Alamos was supported by the U.S. Department of Energy through the LANL/LDRD program and was performed, in part, at the Center for Integrated Nanotechnologies, a U.S. Department of Energy, Office of Basic Energy Sciences user facility. Use of the National Synchrotron Light Source, Brookhaven National Laboratory, was supported by the U.S. Department of Energy, Office of Science, Office of Basic Energy Sciences, under Contract No. DE-AC02-98CH10886.This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/admi.20150059