Using evidence to improve Psychological Therapies Services

Psychological therapy services offer help to clients with many different sorts of mental health problems using a variety of therapies provided by a range of different professional groups and are supported by a large amount of research evidence. However, applying evidence-based practice in routine clinical settings presents particular challenges. This paper outlines some of the difficulties applying research findings to routine settings and argues for a more inclusive approach to linking evidence with practice. It describes a systematic approach to service evaluation and practice based evidence within a large psychological therapies service. This approach is integrated into the service delivery. It enables clinicians to become engaged in the process of reflecting on evidence in a non-threatening way and allows innovative ways of enhancing reflective practice by linking evidence with practice in routine settings

'MMR talk' and vaccination choices: an ethnographic study in Brighton

In the context of the high-profile controversy that has unfolded in the UK around the measles, mumps and rubella (MMR) vaccine and its possible adverse effects, this paper explores how parents in Brighton, southern England, are thinking about MMR for their own children. Research focusing on parents’ engagement with MMR has been dominated by analysis of the proximate influences on their choices, and in particular scientific and media information, which have led health policy to focus on information and education campaigns. This paper reports ethnographic work including narratives by mothers in Brighton.Our work questions such reasoning in showing how wider personal and social issues shape parents’ immunisation actions. The narratives by mothers show how practices around MMR are shaped by personal histories, by birth experiences and related feelings of control, by family health histories, by their readings of their child’s health and particular strengths and vulnerabilities, by particular engagements with health services,by processes building or undermining confidence,and by friendships and conversations with others,which are themselves shaped by wider social differences and transformations. Although many see vaccination as a personal decision which must respond to the particularities of a child’s immune system, ‘MMR talk’, which affirms these conceptualisations, has become a social phenomenon in itself. These perspectives suggest ways in which people’s engagements with MMR reflect wider changes in their relations with science and the state

Using CORE to research outcome measurement

Chris Leach and Mike Lucock have been involved with CORE from its beginning. Jointly responsible for the development of one of the first large databases of the use of CORE in routine clinical practice, they have published a number of key papers looking at the relationship between CORE and other outcome measures, and its use to track client progress during therapy

Testing the human factor: Radiocarbon dating the first peoples of the South Pacific

Archaeologists have long debated the origins and mode of dispersal of the immediate predecessors of all Polynesians and many populations in Island Melanesia. Such debates are inextricably linked to a chronological framework provided, in part, by radiocarbon dates. Human remains have the greatest potential for providing answers to many questions pertinent to these debates. Unfortunately, bone is one of the most complicated materials to date reliably because of bone degradation, sample pretreatment and diet. This is of particular concern in the Pacific where humidity contributes to the rapid decay of bone protein, and a combination of marine, reef, C₄, C₃ and freshwater foods complicate the interpretation of ¹⁴C determinations. Independent advances in bone pretreatment, isotope multivariate modelling and radiocarbon calibration techniques provide us, for the first time, with the tools to obtain reliable calibrated ages for Pacific burials. Here we present research that combines these techniques, enabling us to re-evaluate the age of burials from key archaeological sites in the Pacific

Controlled Clinical Trial of a Self-Help for Anxiety Intervention for Patients Waiting for Psychological Therapy

This study was a controlled clinical trial in which patients were offered a brief low cost, low intensity self-help intervention while waiting for psychological therapy. A CBT based self-help pack was given to patients with significant anxiety problems and no attempt was made to exclude patients on the basis of severity or co-morbidity. The treatment group received the intervention immediately following assessment and the control group after a delay of 8 weeks so comparisons between the two groups were made over 8 weeks. Although there was some support for the effectiveness of the self help intervention, with a significant time x group interaction for CORE-OM scores, this was not significant with the intention to treat analysis, nor for HADS anxiety and depression scores and the effect size was low. A follow up evaluation suggested some patients attributed significant goal attainment to the intervention. The findings suggest the routine use of self-help interventions in psychological therapies services should be considered although further more adequately powered research is required to identify the type of patients and problems that most benefit, possible adverse effects and the effect on subsequent uptake of and engagement in therapy

Nodular lymphocyte predominant Hodgkin lymphoma behaves as a distinct clinical entity with good outcome: evidence from 14-year followup in the West of Scotland Cancer Network

Clinically and biologically, nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) has much more in common with germinal-center derived B-cell non-Hodgkin lymphoma (NHL) than with classical Hodgkin lymphoma (cHL). Management of NLPHL remains controversial. In a 14-year multicenter series, 69 cases were analyzed, and the median follow-up was 53 months (range 11–165.) B-symptoms were present in only 4.3% of patients, and 81.1% of patients had stage I/II disease. Treatment was with radiotherapy (53.6%), chemotherapy (21.7%), combined modality (17.4%), and observation (7.2%). In all, 10.1% of patients relapsed and 2.9% of patients developed high-grade transformation to DLBCL. All relapses and transformations were salvageable. No patient died of their disease. The 5-year relapse-free survival was 92%, transformation-free survival 98.4%, and overall survival 100%. We conclude that NLPHL behaves as a distinct clinical entity, often presenting at an early stage without risk factors. It has an excellent outcome. It may be possible, in early-stage disease, to reduce the intensity of therapy in NLPHL, to single-modality radiotherapy, without affecting OS