Considering Premenstrual Dysphoric Disorder as a Differential Diagnosis in the Psychiatric Population An Educational Intervention Project

Background:The assessment and treatment of Premenstrual Dysphoric Disorder (PMDD) in the female population is an important issue to be examined. Upward to thirty percent of all females’ report symptoms of moderate to severe PMDD. Proper assessment, identification and treatment of PMDD as a differential diagnosis by healthcare providers is essential for the effective treatment PMDD. Purpose:To provide evidenced based education to mental health professionals for the assessment and treatment of PMDD in order to help improve the quality of life for patient’s living with this disorder. Methods: The PMDD education intervention took place at a inpatient psychiatric unit from October 2019 to April 2020 to a multidisciplinary team consisting of psychiatrists, psychologists, nurses, mental health counselors, and social workersduring a Grand Rounds presentation at a state-run psychiatric facility in the Northeast.The participants completed a Likert survey that assessed the effectiveness of the presentation and the participant’s attitudes towards the treatment of PMDD. Results: Post intervention, participants reported improved knowledge regarding assessment and evidence based modalities for the treatment of PMDD Conclusion: Ongoing education about PMDD of psychiatric professionals will improve health outcomes for patients with PMDD Keywords: Premenstrual Dysphoric Disorder, Adolescents, Self-harm and Depressio

Moving from the couch to the mat : clinicians and the practice of yoga, their practice and recommendations of yoga as an adjunct to therapy

The purpose of this exploratory/descriptive survey was to inquire of therapists who might or might not have a personal yoga practice, whether they recommend it to their clients as an adjunct to therapy. There has been an increasing research literature regarding the treatment of both physical and mental health issues with body work modalities that go beyond traditional –talking cure– interventions; yoga has been shown in some such studies to have positive influence on the lives of those who practice it, including clinicians themselves for purposes of self-care and avoiding burnout. Questions posed by the current survey were –Do clinicians recommend yoga to clients? Do they do so more often when they themselves actively practice yoga? Are there limitations to whether, and when, clinicians responding to this survey recommend yoga?– The study was primarily a quantitative study, conducted through an online survey provider, but qualitative data were gathered through dialogue boxes for richer context. Of the 69 respondents who completed the survey, 43 recommended yoga to clients in therapy. The therapists who are making this recommendation as an adjunct to therapy are doing so with great care and sensitivity. Those who do not make a recommendation of yoga thoughtfully addressed their reasons for the limitations they place on making recommendations of any kind

What works in community health education for adults with learning disabilities: A scoping review of the literature

Background Research suggests there is insufficient good quality information regarding the effectiveness of health education aimed at adults with intellectual disabilities. By analysing the literature, this review aimed to identify what constituted effectiveness in this context. Method Relevant evaluations were extracted from bibliographic databases according to pre‐specified criteria. Papers were analysed using QSR NVivo 11 by developing a narrative synthesis and analytic framework that identified and explored text addressing the research question. Results Twenty‐two studies were included. The review identified two broad components of effective health education: mechanisms and context. Mechanisms included embedded programme flexibility, appropriate and accessible resources, and motivational delivery. An effective context included an accessible and supportive environment and longer term opportunities for reinforcement of learning. Conclusions Important gaps in the literature highlighted a need for further research addressing community learning experiences of adults with intellectual disabilities as well as the effectiveness of infection prevention programmes

Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial

Background Accelerated partner therapy (APT) is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings. Methods Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013. Results 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy. Conclusions The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation

Promoting chlamydia screening with posters and leaflets in general practice - a qualitative study

<p>Abstract</p> <p>Background</p> <p>General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening.</p> <p>Methods</p> <p>Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach.</p> <p>Results</p> <p>Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets.</p> <p>Conclusion</p> <p>The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice.</p

Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines

Objectives: To evaluate antibiotic therapy durations for common infections in English primary care and to compare this with guidelines. Design: Cross-sectional study. Setting: General practices contributing to The Health Improvement Network database, 2013-2015. Participants: 931,015 consultations that resulted in an antibiotic prescription for one of the following indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), acute otitis media, acute cystitis, prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever and gastroenteritis. Main outcome measures: The main outcomes were the percentage of antibiotic prescriptions with a duration exceeding the guideline recommendation and the total number of days beyond the recommended duration for each indication. Results: The most common reasons for the prescriptions were patients consulting with acute bronchitis and cough (386,972), acute sore throat (239,231), acute otitis media (83,054), and acute sinusitis (76,683). Antibiotic treatments for upper respiratory indications and acute bronchitis accounted for more than two thirds of the total prescriptions considered, and ≥80% of these treatment courses exceeded guideline recommendations. Notable exceptions were acute sinusitis, where only 9.6% (95% CI 9.4 to 9.9%) of prescriptions exceeded 7 days and acute sore throat where only 2.1% (95% CI 2.0 to 2.1) exceed 10 days (recent guidance recommends 5 days). More than half of antibiotic prescriptions were longer than guidelines recommend for acute cystitis among females (54.6%, 95% CI 54.1 to 55.0%). The percentage of antibiotic prescriptions exceeding the recommended duration was lower for most non-respiratory infections. For the 931,015 included consultations resulting in antibiotic prescriptions, approximately 1.3 million days were beyond the durations recommended by the guidelines. Conclusion: For most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in guidelines. Substantial reductions in antibiotic exposure can be accomplished by aligning antibiotic prescription durations with guidelines