Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: A study protocol for a randomised controlled trial

© Author(s) (or their employer(s)) 2019. Introduction It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being. Methods and analysis Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be ≥18 years screened as potentially having palliative care needs and at risk of dying in 6-12 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient's health-related quality-of-life and quality of chronic disease care; (ii) caregiver's health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff's self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention. Ethics and dissemination Approved by South-East Sydney Local Health District Human Research Ethics Committee and NSW Population and Health Services Research Ethics Committee. Results will be disseminated via conference presentations, journal publications, seminars and invited talks

Mechanisms of Psychological Distress following War in the Former Yugoslavia: The Role of Interpersonal Sensitivity

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.This study was funded by a grant from the European Commission, contract number INCO-CT-2004-509176. AN was supported by a Clinical Early Career Research Fellowship (113295) and a Project Grant (104288

Posttraumatic growth among suicide-loss survivors : an updated systematic review and meta-analysis protocol

Background: Losing a loved one to suicide is an event which can have strong and potentially traumatic impacts on the lives of the bereaved survivors, especially regarding their grief which can be complicated. These bereaved individuals are also less likely to receive social support following their bereavement. However, besides these adverse impacts, there is growing evidence to support the concept of posttraumatic growth following suicide bereavement. Posttraumatic growth is personal improvement that occurs as a consequence of experiencing a traumatic or extremely challenging event or crisis. Only one systematic review and meta-analysis on posttraumatic growth following suicide bereavement has been conducted; this protocol is for the planned systematic review and meta-analysis update of the original systematic review and meta-analysis, as the original review collected its data in 2018.Method: This protocol outlines the planned procedures of the updated systematic review and meta-analysis. This review and its protocol have been registered with PROSPERO(Registration Number: CRD42024485421). MEDLINE, PsycINFO, Embase, CINAHL, Scopus, and Web of Science (Core Collection) will be examined, and the search results will be imported to Covidence where title and abstract screenings, full text screenings, and data extraction will occur. The inclusion and exclusion criteria for this updated review match those in the original review: i) the study population must contain participants bereaved by suicide, ii) the study data must be quantitative, iii) the study must report data on posttraumatic or stress-related growth. The original review conducted its search prior to 2019; thus, this updated review searched databases for the timeframe of January 2019 to January 2024. The updated meta-analysis will synthesise data from both the original and updated reviews to examine trends over time. Discussion: The results of this updated systematic review and meta-analysis will be used to examine key relationships and findings regarding posttraumatic growth in individuals bereaved by suicide. The discussion will also investigate the findings of this updated review in comparison to the findings of the original review. Any differences would be highlighted

Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children

<p>Abstract</p> <p>Background</p> <p>Post-traumatic stress disorder (PTSD) is diagnosed in 20% to 53% of sexually abused children and adolescents. Living with PTSD is associated with a loss of health-related quality of life. Based on the best available evidence, the NICE Guideline for PTSD in children and adolescents recommends cognitive behavioural therapy (TF-CBT) over non-directive counselling as a more efficacious treatment.</p> <p>Methods</p> <p>A modelled economic evaluation conducted from the Australian mental health care system perspective estimates incremental costs and Quality Adjusted Life Years (QALYs) of TF-CBT, TF-CBT combined with selective serotonin reuptake inhibitor (SSRI), and non-directive counselling. The "no treatment" alternative is included as a comparator. The first part of the model consists of a decision tree corresponding to 12 month follow-up outcomes observed in clinical trials. The second part consists of a 30 year Markov model representing the slow process of recovery in non-respondents and the untreated population yielding estimates of long-term quality-adjusted survival and costs. Data from the 2007 Australian Mental Health Survey was used to populate the decision analytic model.</p> <p>Results</p> <p>In the base-case and sensitivity analyses, incremental cost-effectiveness ratios (ICERs) for all three active treatment alternatives remained less than A$7,000 per QALY gained. The base-case results indicated that non-directive counselling is dominated by TF-CBT and TF-CBT + SSRI, and that efficiency gain can be achieved by allocating more resources toward these therapies. However, this result was sensitive to variation in the clinical effectiveness parameters with non-directive counselling dominating TF-CBT and TF-CBT + SSRI under certain assumptions. The base-case results also suggest that TF-CBT + SSRI is more cost-effective than TF-CBT.</p> <p>Conclusion</p> <p>Even after accounting for uncertainty in parameter estimates, the results of the modelled economic evaluation demonstrated that all psychotherapy treatments for PTSD in sexually abused children have a favourable ICER relative to no treatment. The results also highlighted the loss of quality of life in children who do not receive any psychotherapy. Results of the base-case analysis suggest that TF-CBT + SSRI is more cost-effective than TF-CBT alone, however, considering the uncertainty associated with prescribing SSRIs to children and adolescents, clinicians and parents may exercise some caution in choosing this treatment alternative.</p

Suicide Postvention Service Models and Guidelines 2014-2019: A Systematic Review.

Background: Suicide bereavement can have a lasting and devastating psychosocial impact on the bereaved individuals and communities. Many countries, such as Australia, have included postvention, i.e., concerted suicide bereavement support, in their suicide prevention policies. While little is known of the effectiveness of postvention, this review aimed to investigate what is known of the effects of postvention service delivery models and the components that may contribute to the effectiveness. Method: Systematic review and quality assessment of peer reviewed literature (Medline, PsycINFO, Embase, EBM Reviews) and gray literature and guidelines published since 2014. Results: Eight studies and 12 guidelines were included, with little evidence of effectiveness. Still, providing support according to the level of grief, involvement of trained volunteers/peers, and focusing the interventions on the grief, seem promising components of effective postvention. Conclusions: Adopting a public health approach to postvention can allow to tailor the service delivery to needs of the bereaved individuals and to align postvention with suicide prevention programs

Psychologia i eutanazji: Przypadek dr Jack Kevorkian

Wydawca: Polskie Towarzystwo Higieny Psyc Zjawisko agresji i przemocy istnieje od zarania dziejów ludzkości. Problem ten jednakże znalazł odzwierciedlenie w systemowych badaniach dopiero w drugiej połowie XX wieku. Problematykę tego zjawiska należy rozpatrywać w perspektywie interdyscyplinarnych studiów. Współcześnie agresja i przemoc stają się problemem dnia codziennego. Zjawiska te możemy obserwować w domu, szkole, w miejscu pracy, na boiskach sportowych, w instytucjach o charakterze zamkniętym itp. Niniejsza praca zawiera artykuły poświęcone agresji i przemocy w różnych dziedzinach życia. W treści: Część 1. Zachowania agresywne wobec dzieci (21 specjalistycznych artykułów) Część 2. Społeczne i medyczne skutki agresji i przemocy (22 artykuły) Słowa kluczowe: patologia zdrowie środowisk

Problem solving in suicidal individuals

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