Understanding the extent of, and reasons for, diagnostic delay in inflammatory bowel disease

Background: Inflammatory Bowel Disease (IBD) is a complex chronic condition affecting the gastrointestinal (GI) system and is sub-classified into Crohn’s Disease (CD) and Ulcerative Colitis (UC). Patients with IBD can present with a multitude of symptoms, making the diagnosis challenging and frequently resulting in delays. Aim & objective: The aim of this research was to better understand the extent of, and reasons for, diagnostic delay in IBD. The first objective was to establish the extent of which the diagnosis of IBD is typically delayed and any characteristics which may be related to this. The second objective was to explore the individual experience of delay, including possible contributing factors for delay as well as any impact of delay on the patient. Methods: Two distinct methods were used. A systematic review was conducted to identify articles that reported a time-period of diagnostic delay of IBD. A narrative synthesis was then used to present the extent of IBD and explore consultation and healthcare factors for delay, which is defined below. Secondly, interviews were conducted with participants who self-reported a delay in IBD diagnosis, in order to explore this delay from their perspective. Participants were asked their opinions on factors which may have contributed to their delay and any consequences of this delay. Misdiagnoses they had been given before their IBD diagnosis was also discussed. Thematic analysis was applied to this dataset. Results: For the systematic review, 7570 articles were sourced from the search following de-duplication. 5127 and 2143 articles were excluded following title and abstract review respectively. Of the remaining 284 articles for full-text review, 35 met the inclusion criteria. The median values of diagnostic delay were between 2 and 5.3 months for IBD, 2 to 26.4 months for CD and 2 to 12 months for UC. Consultation delays, defined as the time between the onset of patient symptoms and them seeking medical advice, ranged from 1 to 8.6 months in CD and 0.7 to 1.9 months in UC. Healthcare delays, the time between patients seeking medical advice to receiving a diagnosis, were 0.7 to 20.8 months and 0.2 to 1.1 months for CD and UC respectively. From interviews with sixteen participants, irritable bowel syndrome (IBS), gastroenteritis and mental health conditions were commonly reported misdiagnoses. Participants cited a perceived insignificance of symptoms, fear and embarrassment as reasons why they delayed seeking medical advice. Patient-reported reasons for healthcare delays included GP reluctance to refer to secondary care and prolonged, ineffective management. Participants described experiencing issues with waiting lists for appointments and delayed diagnostic procedures. Some participants felt their delay had negatively impacted on their diagnosis, including a need for stronger medication or surgery. Discussion: The overall diagnostic delay of IBD is extensive but varies considerably. Delay seems to be worse in CD than UC, particularly regarding healthcare delays. This is also supported by the interview findings

Thoughts from a committee chairman

Thoughts from C. Louise Cross, chairman of the Natural Resources and Agriculture Committee.https://scholarworks.umt.edu/montanaconstitution/1377/thumbnail.jp

Behavioural Responses of Varanids to Mine Site Restoration

Animals play critical roles in ecosystems, yet they are often overlooked in assessments of habitat restoration success. I mapped habitat usage and used camera trapping and VHF/GPS tracking to assess the ecological and behavioural responses of varanids to habitat restoration. Although restored habitats were in use, these areas were used less frequently and with altered behaviour in comparison to reference sites. Providing increased fauna refuges to areas undergoing restoration may aid in returning varanid populations

C. Louise Cross\u27 statement on the environment

C. Louise Cross\u27 statement at the joint hearing of the Committee on the Bill of Rights and the Committee on Natural Resources and Agriculture.https://scholarworks.umt.edu/montanaconstitution/1376/thumbnail.jp

The Battle for the Environmental Provisions in Montana\u27s 1972 Constitution

The Battle for the Environmental Provisions in Montana\u27s 1972 Constitutio

Difficult knowledge and uncomfortable pedagogies : student perceptions and experiences of teaching and learning in critical indigenous Australian studies

University of Technology Sydney. Faculty of Arts and Social Sciences.This research presents a grounded interrogation of students’ perceptions and experiences of teaching and learning in two mandatory stand-alone Critical Indigenous Australian Studies subjects at an Australian university. The study proffers rare empirical insight into the student experience of teaching and learning about colonialism, racism, whiteness and privilege. It contributes to building a better understanding of the complexities, opportunities, challenges and risks of four specific pedagogical approaches: critical anticolonialism, critical race theory, critical whiteness and intersectional privilege studies. The research was conducted by way of a critical ethnographic process involving in-depth interviews with students and teachers, focus group discussions with students and classroom observations. The research design was built on critical social constructionist foundations informed by poststructural and critical hermeneutical theoretical perspectives. The study produced two key findings. The first is that learning in Critical Indigenous Australian Studies is inherently affective. Affectivity plays a determinant role in the opportunities, challenges and risks of teaching about colonialism, racism, whiteness and privilege. This finding signposts the need to take into serious consideration the emotionally onerous task of teaching and learning in Critical Indigenous Australian Studies and the need for compassionate pedagogical approaches and strategies that can productively navigate and manage affectivity. The second key finding is that if Critical Indigenous Australian Studies is to inspire and motivate students to act for social justice and social change, teaching and learning must focus equally on both the ‘know-what’ and the ‘know-how’. Knowing what the urgent matters are without the cultivation of practical skills to engage in social change action falls short of meeting teaching and learning objectives. A dedicated and substantive focus on cultivating practical social change skills such as discursive counter-narrative skills is a pedagogical pathway toward empowering, inspiring and motivating students to act for social change

Dance training shapes action perception and its neural implementation within the young and older adult brain

How we perceive others in action is shaped by our prior experience. Many factors influence brain responses when observing others in action, including training in a particular physical skill, such as sport or dance, and also general development and aging processes. Here, we investigate how learning a complex motor skill shapes neural and behavioural responses among a dance-naïve sample of 20 young and 19 older adults. Across four days, participants physically rehearsed one set of dance sequences, observed a second set, and a third set remained untrained. Functional MRI was obtained prior to and immediately following training. Participants’ behavioural performance on motor and visual tasks improved across the training period, with younger adults showing steeper performance gains than older adults. At the brain level, both age groups demonstrated decreased sensorimotor cortical engagement after physical training, with younger adults showing more pronounced decreases in inferior parietal activity compared to older adults. Neural decoding results demonstrate that among both age groups, visual and motor regions contain experience-specific representations of new motor learning. By combining behavioural measures of performance with univariate and multivariate measures of brain activity, we can start to build a more complete picture of age-related changes in experience-dependent plasticity

Mental health nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient psychiatric units : a non-participant observation study

National mental health policies accentuate the importance of having positive attitudes, skills, and knowledge among mental health professionals to facilitate recovery-oriented practices in all areas of mental health care. However, evidence suggests that mental health professionals' negative attitudes towards mental illness are still evident and that recovery-oriented practice in acute inpatient units may be poorly implemented. At the same time, there is also a paucity of research to understand Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice specifically. Therefore, this non-participant observation study aimed to explore Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient units by observing the interactions between the consumers and nurses. The Mental Illness Clinicians Attitudes Scale-v4 and The Recovery Attitudes Questionnaire inspired the development of a non-participant observation chart for this study and the observations were recorded on the chart. Six observations were conducted in three acute inpatient units. Observations focused on Mental Health Nurses' knowledge about mental illness, communication, dignity, respect, anxiety, fear, punishment, facilitation of real choices for consumers, physical care, cooperation with consumers' families and others and recovery orientation. Interpretive descriptive analysis was used to analyse the data. The results show that Mental Health Nurses generally have positive attitudes towards mental illness and recovery-oriented practice. Some deficits in the physical care of people with mental illness in the acute inpatient units were observed. Therefore, future research could address the adequate preparation of Mental Health Nurses to provide physical care to people with mental illnesses. © 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd

Nursing education to enhance culturally and linguistically diverse (CALD) community access to mental health services : a scoping review

Research has found that training health care professionals can enhance the access of the culturally diverse community to appropriate mental health services. Yet, little research has been conducted that explicitly focuses on improving nursing knowledge, skills, attitudes, and behaviours that can enhance the access of the Culturally and Linguistically Diverse (CALD) community. This scoping review aims to locate, summarise, and recap what is known in the academic literature about educational interventions and programs to improve mental health nurses’ cultural competence. Examining how educational interventions and programs can improve mental health nurses’ knowledge, skills, attitudes, and behaviours to facilitate Culturally and Linguistically Diverse (CALD) community access to mental health services can also identify gaps in knowledge to report future research areas. Fifteen studies included in the review reported a positive effect of cultural competence interventions; however, it was difficult to establish a single effective intervention method due to the significant heterogenicity in cultural competence intervention strategies. Most studies in this scoping review included nurses as participants. However, only one study solely focussed on cultural competence intervention for mental health nurses. Two other studies included mental health nurses as participants, along with other mental health professionals. Henceforth, there is a prerequisite for more research focussing on enhancing mental health nurses’ cultural competency. Additional research is required to evaluate educational interventions’ impact on improving cultural competence attributes on specific practitioner behaviours and the effects on health care and health care outcomes. This review can form a basis for future research studies that will emphasise the impact of cultural competence interventions for mental health nurses. © 2021 Taylor & Francis Group, LLC

Effect of recovery-based interventions on recovery knowledge and attitudes of mental health professionals, regarding recovery-oriented practice : a quantitative narrative review

Mental health recovery is an enabling process encouraging consumers to live a productive life, notwithstanding the presence of debilitating symptoms of illness. The recovery model has been integrated into all areas of mental health. However, literature shows that mental health professionals are not equipped to provide recovery-oriented care to consumers. Researchers have recommended recovery-based interventions to develop knowledge, attitudes and skills to promote recovery-oriented practice in mental health, yet there is a paucity of research regarding the effect of recovery-oriented interventions on the knowledge and attitudes of mental health professionals to improve recovery-oriented practice. Therefore, the purpose of the current review is to understand the effectiveness of interventions on recovery knowledge and attitudes of mental health professionals regarding recovery-oriented practice. The papers were identified through the Population Intervention Comparison and Outcome strategy. The heterogeneity of the selected papers led to a narrative review instead of a systematic review with meta-analysis. The analysis suggested that recovery-based interventions are effective in enhancing the recovery knowledge and attitudes of mental health professionals. Recovery-based interventions have the potential to reduce the use of physical restraints and improve work satisfaction among mental health professionals. The limitations of the studies were the heterogeneity of the selected populations and the absence of strong methodologies to assess the effect of the interventions. Therefore, future investigations should be focused on the effect of interventions on a homogeneous group using randomised controlled trials. Keywords: mental health professionals, mental health nurses, practice, recovery knowledge and attitude, recovery-based interventions