Evaluation of the impact of a psycho-educational intervention for people diagnosed with schizophrenia and their primary caregivers in Jordan: A randomized controlled trial

© Hasan et al. Background: Psycho-educational interventions for people diagnosed with schizophrenia (PDwS) and their primary caregivers appear promising, however, the majority of trials have significant methodological shortcomings. There is little known about the effects of these interventions delivered in a booklet format in resource-poor countries. Methods: A randomized controlled trial was conducted from September, 2012 to July, 2013 with 121 dyads of PDwS and their primary caregivers. Participants aged 18 years or older with DSM-IV schizophrenia or schizoaffective disorder, and their primary caregivers, from four outpatient mental health clinics in Jordan, were randomly assigned to receive 12 weeks of a booklet form of psycho-education, with follow-up phone calls, and treatment as usual [TAU] (intervention, n = 58), or TAU (control, n = 63). Participants were assessed at baseline, immediately post-intervention (post-treatment1) and at three months follow-up. The primary outcome measure was change in knowledge of schizophrenia. Secondary outcomes for PDwS were psychiatric symptoms and relapse rate, with hospitalization or medication (number of episodes of increasing antipsychotic dosage), and for primary caregivers were burden of care and quality of life. Results: PDwS in the intervention group experienced greater improvement in knowledge scores (4.9 vs -0.5; p <0.001) at post-treatment and (6.5 vs -0.7; p <0.001) at three month-follow-up, greater reduction in symptom severity (-26.1 vs 2.5; p <0.001: -36.2 vs -4.9; p <0.001, at follow-up times respectively. Relapse rate with hospitalization was reduced significantly at both follow-up times in the intervention group (p <0.001), and relapse with medication increased in the intervention group at both follow-up times (p <0.001). Similarly there was a significant improvement in the primary caregivers knowledge score at post-treatment (6.3 vs -0.4; P < 0.001) and three month-follow-up (7.3 vs -0.7; p <0.001). Primary caregivers burden of care was significantly reduced in the intervention group (-6.4 vs 1.5; p <0.001; -9.4 vs 0.8; p <0.001), and their quality of life improved (9.2 vs -1.6; p = 0.01; 17.1 vs -5.3; p <0.001) at post-treatment and three month-follow-up. Conclusions: Psycho-education and TAU was more effective than TAU alone at improving participants' knowledge and psychological outcomes

Qualitative process evaluation of a psycho-educational intervention targeted at people diagnosed with schizophrenia and their primary caregivers in Jordan

Background Schizophrenia is a serious form of mental illness that often requires long term care. Empirical findings indicate that combining a psycho-educational intervention (PEI) with neuroleptic medication to treat schizophrenia is effective. However, there is little information on the therapeutic mechanism of PEIs. Methods A qualitative process evaluation was conducted with a purposive sample of people diagnosed with schizophrenia (PDwS, n = 8) and their Primary Caregivers (PCs, n = 9) who had received PEI as a part of an exploratory randomized controlled trial. Semi-structured interviews were conducted to explore potential processes underpinning any observed effect. Thematic analysis was used to analyze and identify prominent patterns in the data. Interviews were conducted between April 2013 and August 2013. Results Three themes emerged from the qualitative interviews, ‘Awareness of schizophrenia’, ‘Positive impact on health and wellbeing’, ‘empowerment and enhanced confidence’, which described the variety of experiences with the intervention, although most reported that the intervention was acceptable and valued. Conclusion This study identified that individual understanding varied between PDwS and PCs and led to differences in the ways that they used knowledge gained from the PEI in everyday situations. These data support the importance of improving understanding of schizophrenia by PDwS and their PCs to enable them to benefit more fully from medication

Co-producing a digital educational programme for registered children’s nurses to improve care of children and young people admitted with self-harm

Despite the increasing prevalence of hospital admissions for self-harm in children and young people (CYP), there is paucity of registered children’s nurse (rCN) training or involvement of children to improve care for this often stigmatized patient group. This article describes a participatory approach towards using co-production with CYP and rCN to develop a digital educational programme to improve nurses’ knowledge, attitudes and confidence in caring for CYP with self-harm injuries. A priority-setting workshop with rCNs was used to establish consensus of information needs. This was followed by an e-learning content development workshop undertaken with CYP whom had previously experienced hospital admissions for self-harm injuries. Findings from the nurse priority-setting workshop identified three educational priorities: (1) knowledge of self-harm, (2) effective communication and (3) risk management. The CYP subsequently developed these topic areas to ensure the contents and design of the e-learning resource had fidelity by reflecting the experiences of CYP and needs when cared for in hospital. This article illustrates that involving service users to co-develop educational materials is a feasible and important step in designing educational resources and ensures the content is relevant, appropriate and sensitive to both the recipient of care and those responsible for its delivery

The impact of care experience prior to commencing pre-registration nurse education and training: A scoping review.

OBJECTIVES: Compassion in nursing and interventions to support it are of international relevance and concern. Prior care experience as a prerequisite for entry into pre-registration nurse education is suggested as a means of improving compassion. The impact of prior care experience has not been comprehensively reviewed, therefore the potential effectiveness of prior care experience as a means of improving compassion is unknown. The scoping review question was 'What is known about the impact of care experience prior to commencing pre-registration nurse education and training?' The primary objective was to scope and synthesise existing literature relating to the topic and ascertain key themes pertaining to impact. A secondary objective was to appraise literature, to contextualise findings and assess the state and stage of knowledge and research in the area. DESIGN: The review was guided by Arksey and O'Malley's methodological framework and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist. DATA SOURCES: Health sciences databases CINAHL, Medline and PubMed. METHODS: Databases were searched in February 2019, updated August 2021. Data (study characteristics, findings, methodological observations) were extracted from papers meeting inclusion criteria (including peer-reviewed empirical papers with English language, electronic full-text available) and findings thematically analysed. RESULTS: Forty-five papers from 14 countries were included. The majority (64.4 %) were published in Europe (31.1 % in the United Kingdom) between 2010 and 2021 (69 %), 60 % from 2013. Four qualitative themes (compassionate care, commitment, competence and communication) describe the impact of prior care experience, which was variable. CONCLUSIONS: Evidence to support the effectiveness of prior care experience as a prerequisite for entry into nurse education to improve compassion, is inconsistent and insufficient. The literature displays methodological limitations and conclusions should be interpreted in light of these caveats. Recommendations are made for future research, to improve quality and comparability

Pharmacology as a foreign language: A preliminary evaluation of podcasting as a supplementary learning tool for non-medical prescribing students

<p>Abstract</p> <p>Background</p> <p>Nurses and other health professionals in the U.K. can gain similar prescribing rights to doctors by undertaking a non-medical prescribing course. Non-medical prescribing students must have a thorough understanding of the pharmacology of prescribing to ensure safe practice. Pharmacology education at this level is complicated by the variation in students' prior subject knowledge of, and anxiety about, the subject. The recent advances in technology, particularly the potential for mobile learning, provide increased opportunities for students to familiarise themselves with lecture materials and hence promote understanding. The objective of this study was therefore to evaluate both the subjective (student perception) and objective (student use and exam results) usefulness of podcasts of pharmacology lectures which were provided as an extra learning tool to two cohorts (n = 69) of non-medical prescribing students.</p> <p>Methods</p> <p>The podcasts were made available to students through the virtual learning environment WebCT. Use of podcasts by two successive cohorts of nurse prescribing students (n = 69) was tracked through WebCT. Survey data, which was collected from 44 of these students, investigated patterns of/reasons for podcast use and perceived usefulness of podcasts as a learning tool. Of these 69 students, 64 completed the pharmacology exam. In order to examine any impact of podcasts on student knowledge, their exam results were compared with those of two historical cohorts who did not have access to podcasts (n = 70).</p> <p>Results</p> <p>WebCT tracking showed that 91% of students accessed at least one podcast. 93% of students used the podcasts to revisit a lecture, 85% used podcasts for revision, and 61% used the podcasts when they had a specific question. Only 22% used the podcasts because they had missed a pharmacology session. Most students (81%) generally listened to the entire podcast rather than specific sections and most (73%) used them while referring to their lecture handouts. The majority of students found the podcasts helpful as a learning tool, as a revision aid and in promoting their understanding of the subject. Evaluation of the range of marks obtained, mode mark and mean mark suggested improved knowledge in students with access to podcasts compared to historical cohorts of students who did not have access to pharmacology podcasts.</p> <p>Conclusions</p> <p>The results of this study suggest that non-medical prescribing students utilised podcasts of pharmacology lectures, and have found the availability of these podcasts helpful for their learning. Exam results indicate that the availability of podcasts was also associated with improved exam performance.</p

A Role for Thrombospondin-1 Deficits in Astrocyte-Mediated Spine and Synaptic Pathology in Down's Syndrome

Down's syndrome (DS) is the most common genetic cause of mental retardation. Reduced number and aberrant architecture of dendritic spines are common features of DS neuropathology. However, the mechanisms involved in DS spine alterations are not known. In addition to a relevant role in synapse formation and maintenance, astrocytes can regulate spine dynamics by releasing soluble factors or by physical contact with neurons. We have previously shown impaired mitochondrial function in DS astrocytes leading to metabolic alterations in protein processing and secretion. In this study, we investigated whether deficits in astrocyte function contribute to DS spine pathology.Using a human astrocyte/rat hippocampal neuron coculture, we found that DS astrocytes are directly involved in the development of spine malformations and reduced synaptic density. We also show that thrombospondin 1 (TSP-1), an astrocyte-secreted protein, possesses a potent modulatory effect on spine number and morphology, and that both DS brains and DS astrocytes exhibit marked deficits in TSP-1 protein expression. Depletion of TSP-1 from normal astrocytes resulted in dramatic changes in spine morphology, while restoration of TSP-1 levels prevented DS astrocyte-mediated spine and synaptic alterations. Astrocyte cultures derived from TSP-1 KO mice exhibited similar deficits to support spine formation and structure than DS astrocytes.These results indicate that human astrocytes promote spine and synapse formation, identify astrocyte dysfunction as a significant factor of spine and synaptic pathology in the DS brain, and provide a mechanistic rationale for the exploration of TSP-1-based therapies to treat spine and synaptic pathology in DS and other neurological conditions

Problem-based learning and larger student groups: mutually exclusive or compatible concepts - a pilot study

BACKGROUND: Problem-based learning is recognised as promoting integration of knowledge and fostering a deeper approach to life-long learning, but is associated with significant resource implications. In order to encourage second year undergraduate medical students to integrate their pharmacological knowledge in a professionally relevant clinical context, with limited staff resources, we developed a novel clustered PBL approach. This paper utilises preliminary data from both the facilitator and student viewpoint to determine whether the use of this novel methodology is feasible with large groups of students. METHODS: Students were divided into 16 groups (20–21 students/group) and were allocated a PBL facilitator. Each group was then divided into seven subgroups, or clusters, of 2 or 3 students wh each cluster being allocated a specific case. Each cluster was then provided with more detailed clinical information and studied an individual and distinct case-study. An electronic questionnaire was used to evaluate both student and facilitator perception of this clustered PBL format, with each being asked to rate the content, structure, facilitator effectiveness, and their personal view of the wider learning experience. RESULTS: Despite initial misgivings, facilitators managed this more complex clustered PBL methodology effectively within the time restraints and reported that they enjoyed the process. They felt that the cases effectively illustrated medical concepts and fitted and reinforced the students' pharmacological knowledge, but were less convinced that the scenario motivated students to use additional resources or stimulated their interest in pharmacology. Student feedback was broadly similar to that of the facilitators; although they were more positive about the scenario stimulating the use of additional resources and an interest in pharmacology. CONCLUSION: This clustered PBL methodology can be successfully used with larger groups of students. The key to success lies with challenging and well situated clinically relevant cases together with enthusiastic facilitators. Facilitator enjoyment of the PBL process may be related to adequate training and previous PBL experience, rather than academic background. The smaller number of facilitators required using this clustered PBL approach allows for facilitators with 'a belief in the philosophy of PBL' to volunteer which would again impact on the success of the process

Evaluation of the impact of a psycho-educational intervention on knowledge levels and psychological outcomes for people diagnosed with Schizophrenia and their caregivers in Jordan: A randomized controlled trial

Background: Schizophrenia is one of the most serious forms of mental illness among people being treated in psychiatric clinics in developing and developed countries. Providing care for people diagnosed with schizophrenia can be stressful for their caregivers. Psycho-educational interventions may improve patients' and primary caregivers' knowledge of schizophrenia and impact positively on patients' physical and psychological outcomes and primary caregivers' burden of care and quality of life. Studies thus far have shown that these interventions may improve patients' and caregivers' outcomes, but the quality of included randomized controlled trials (RCTs) is poor and it is difficult to draw firm conclusions as to the effectiveness of such interventions on patients and primary caregivers' outcomes, hence the current study. Methods/Design: A randomized controlled trial in four outpatient mental health clinics in Jordan comparing psycho-educational interventions in the form of six booklets every fortnight, with treatment as usual in people diagnosed with schizophrenia and their primary caregivers. The primary outcome for participants is knowledge of Schizophrenia; secondary outcomes for patients are positive and negative symptoms of schizophrenia and relapse rate, while secondary outcomes for primary caregivers are burden of care and quality of life. All measures are assessed at baseline, immediately post-intervention and at three months follow-up. Discussion: This randomized control trial, conducted in Jordan among people living with schizophrenia and their primary caregivers, will assess the effect of psycho-educational interventions on knowledge of Schizophrenia, patients' positive and negative symptoms and quality of life, and caregivers' burden of care. Trial registration: Current Controlled Trials ISRCTN78084871. © 2014 Hasan et al.; licensee BioMed Central Ltd

Hearing the unheard voice-puberty experiences of young Pakistani men: A qualitative study

Introduction Puberty experiences of male adolescents can have significant impacts on physical and psychological health outcomes. This qualitative study explored the puberty experiences of young males in Pakistan, as there are limited accounts of what shapes these puberty experiences, especially for adolescent males living in a restrictive culture. Methods Twenty-two young Pakistani men (aged 18–21 years) from two urban sites in Karachi participated in individual face-to-face (n=19) and Skype (n=3) interviews. Qualitative thematic analysis was conducted using an inductive approach to identity and examine the patterns emerging from the data. Results Participants described puberty as a challenging phase for which they were unprepared with a combination of various socio-cultural factors exposing them to negative impacts. As a result, young men expressed feelings of anxiety, embarrassment and isolation. Societal and gender norms around masculinity, sexuality and the roles and responsibilities of young men had a significant impact on how participants experienced puberty. While negative reactions towards puberty were dominant, participants described adopting coping strategies (e.g. social support) to help them deal with negative experiences. Conclusions Findings highlight the significance of culturally appropriate puberty education and various facilitating factors that may improve the puberty experiences for future young men. While extending current literature, this study also identifies key factors that could inform the development of health promotion programmes, which may aid adolescent males’ puberty transition and positively influence their long-term health, well-being and identity