Where there is no evidence: use of expert consensus methods to fill the evidence gap in low-income countries and cultural minorities

<p>Abstract</p> <p>Background</p> <p>In both developing countries and in relation to cultural minorities there have been calls to scale up mental health services and for evidence-informed policy and practice.</p> <p>Evidence based medicine</p> <p>The evidence based medicine movement has had a major influence in improving practice. However, implementation of this approach has some major difficulties. One that has been neglected is the situation where there is no relevant evidence. This situation is more likely to occur for healthcare decisions in developing countries or for cultural minorities within developed countries, because resources do not exist for expensive research studies.</p> <p>Consensus methods</p> <p>Consensus methods, such as the Delphi process, can be useful in providing an evidence base in situations where there is insufficient evidence. They provide a way of systematically tapping the expertise of people working in the area and give evidence that is readily applicable for a particular country and culture. Although consensus methods are often thought of as low in the hierarchy of evidence, consensus is central to the scientific process. We present four examples where the Delphi method was used to assess expert consensus in situations where no other evidence existed: estimating the prevalence of dementia in developing countries, developing mental health first aid guidelines in Asian countries, mental health first aid guidelines for Australian Aboriginal people, and modification of the concept of 'recovery' for Australian immigrant communities.</p> <p>Conclusion</p> <p>Consensus methods can provide a basis for decision-making and considered action when there is no evidence or when there are doubts about the applicability of evidence that has been generated from other populations or health system settings.</p

Evaluation of Mental Health First Aid training with members of the Vietnamese community in Melbourne, Australia

<p>Abstract</p> <p>Background</p> <p>The aim of this project was to investigate in members of the Vietnamese community in Melbourne the impact of Mental Health First Aid (MHFA) training on attitudes to people with mental illness and on knowledge about mental disorders. Our hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and their treatments, and decreased negative attitudes towards people with mental disorders.</p> <p>Methods</p> <p>Respondents were 114 participants in two-day MHFA training workshops for the Vietnamese community in Melbourne conducted by two qualified MHFA trainers. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed negative attitudes towards people with mental illness (as described in four vignettes), ability to recognise the mental disorders described in the vignettes, and knowledge about how to assist someone with one of these disorders. Responses to open-ended questions were content analysed and coded. To evaluate the effect of the training, answers to the structured questions and to the coded open-ended questions given at pre- and post-test were compared using McNemar tests for dichotomous values and Wilcoxon tests for other scores.</p> <p>Results</p> <p>Between pre- and post-test there was significant improvement in recognition of mental disorders; more targeted and appropriate mental health first aid responses, and reduction in inappropriate first aid responses; and negative attitudes to the people described in the vignettes declined significantly on many items of the stigma scale.</p> <p>Conclusion</p> <p>A two-day, MHFA training course for general members of the Vietnamese community in Melbourne demonstrated significant reductions in stigmatising attitudes, improved knowledge of mental disorders and improved knowledge about appropriate forms of assistance to give to people in the community with mental disorder. There is sufficient evidence to scale up to a population level program for the Vietnamese community, and a need for longitudinal evaluation of such a scaled up program.</p

Lab-on-a-chip for biological fluids analysis by spetrophotometry

The healthcare sector is nowadays one of the most dynamic and where the novelty is a strategic and operational imperative. The possibility of increase the quantity and quality of clinical analysis, performed with instantaneous results and outside the clinical laboratories, contributes to a better quality in the health care services and also a better efficiency in the clinical and administrative processes [1]. This possibility can be achieved with the presented lab-on-a-chip for spectrophotometric analysis of biological fluids. It allows the selective measurement of the concentration of several biomolecules in biological fluids, with instantaneous results, at any location, with small quantities of reagents and samples and with low-cost. That measurement is based on colorimetric detection by the optical absorption in a part of the visible spectrum defined by the reaction of the specific biomolecule with a specific reagent. The device comprises a highly efficient and selective optical filtering and colorimetric detection system. This system allows the measurement with a regular white light illumination, thus avoiding the use of complex and expensive analysis systems like the ones that comprise spectrophotometers, for example. This feature highly facilitates portability and ensures analysis within consultation time, at a patient house (allowing a first trial) and in clinical laboratories or hospitals.Fundação para a Ciência e a Tecnologia (FCT) SFRH/BD/1281/2000 Escola de Engenharia da Universidade do Minho - Projecto IN2TEC. Centro Algoritmi da Universidade do Minh

First aid guidelines for psychosis in Asian countries: A Delphi consensus study

BACKGROUND: Guidelines for how a member of the public should give first aid to a person who is becoming psychotic have been developed for English-speaking countries. However, these guidelines may not be appropriate for use in other cultures. A study was therefore carried out to examine whether it was possible to achieve consensus on guidelines that could apply in a range of Asian countries. METHODS: A Delphi consensus study was carried out with a panel of 28 Asian mental health clinicians drawn from Cambodia, China, Hong Kong, Indonesia, Japan, Malaysia, Mongolia, South Korea, Sri Lanka, Taiwan, Thailand and Vietnam. The panel was given a 211 item questionnaire about possible first aid actions and asked to rate whether they thought these should be included in guidelines. Panel members were invited to propose additional items. RESULTS: After three Delphi rounds, there were 128 items that were rated as "essential" or "important" by 80% or more of the panel members. These items covered: recognition of psychosis, encouraging and assisting the person to seek help, how to interact with the person, responding to acute psychosis, responding to aggression, and what to do if the person refuses to get professional help. CONCLUSION: Despite the diversity of the countries involved, there was consensus on a core set of first aid items that were considered as suitable for assisting a psychotic person. Future work is needed to develop guidelines for specific countries

Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in India

<p>Abstract</p> <p>Background</p> <p>This study aimed to develop guidelines for how a member of the Indian public should provide mental health first aid to a person who is suicidal.</p> <p>Methods</p> <p>The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of Indian mental health clinicians to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. Experts were recruited by SC, EC and HM. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms.). Responses to the open-ended questions were used to generate new items.</p> <p>Results</p> <p>The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 30 new items were written based on suggestions from panel members and, of these 168 items, 71 met the consensus criterion. These statements were used to develop the guidelines appended to this paper. Translated versions of the guidelines will be produced and used for training.</p> <p>Conclusions</p> <p>There are a number of actions that are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to non-mental health professionals working in health and welfare settings.</p

Biosystem with 16 highly selective optical channels for biological fluids analysis in the visible spectrum

This paper reports a biosystem (biological system) for analyzing biochemical substances in biological fluids. Rather than one channel, it comprises 16 highly selective optical channels that enable the measurement of the concentration of 16 different biochemical substances. An array of 16 optical filters with high reflectivity and low absorption loss has been designed using dielectric films. Each filter is sensitive in a single wavelength with a FWHM (Full Width Half Maximum) 52%. A commercially available band pass optical filter with a band pass wavelength in 450 600 nm is used to enable the use of a white light source for biosystem illumination. Preliminary tests with a single channel are successfully demonstrated.Fundação para a Ciência e a Tecnologia (FCT) - SFRH/BD/1281/2000, POCTI/33747/ESE/ /1999), FEDER

Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in the Philippines

<p>Abstract</p> <p>Background</p> <p>This study aimed to develop guidelines for how a member of the Filipino public should provide mental health first aid to a person who is suicidal.</p> <p>Methods</p> <p>The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of 34 Filipino mental health clinicians to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms). Responses to these open-ended questions were used to generate new items.</p> <p>Results</p> <p>The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 48 new items were written based on suggestions from panel members and, of these 186 items, 102 met the consensus criterion. These statements were used to develop the guidelines appended to this paper. The guidelines are currently being translated into local languages.</p> <p>Conclusions</p> <p>There are a number of actions that are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to non-mental health professionals working in health and welfare settings.</p

Magnetic resonance imaging findings in children with Parry-Romberg syndrome and en coup de sabre

BACKGROUND: The aim of this study was to: (i) describe the abnormalities seen on brain imaging in a group of children with en coup de sabre (EDCS) with/without Parry-Romberg syndrome (PRS); and (ii) identify clinical predictors of brain imaging abnormalities. METHODS: This was a single centre (Great Ormond Street Hospital, London) retrospective case series of patients with ECDS/PRS seen from 2000 to 2018. We identified patients with cutaneous manifestations consistent with the clinical descriptions of ECDS/PRS. Presenting clinical, laboratory, and radiological brain findings are described. Results are expressed as medians and ranges or frequencies and percentages. Fisher's exact test was used to identify clinical associations with magnetic resonance imaging (MRI) abnormalities. RESULTS: Fourteen patients were studied: 6 males and 8 females; median age 14 years (range 3-20). We observed neuroimaging abnormalities in 2/6 ECDS and 5/8 ECDS/PRS patients. White matter signal abnormality, dystrophic calcification, leptomeningeal enhancement, and sulcal crowding were the typical findings on brain imaging. A total of 50% of patients had no MRI abnormality despite some of these patients having neurological symptoms. The presence of seizures was significantly associated with ipsilateral enhanced white matter signalling on MRI (p < 0.05). CONCLUSIONS: In summary, we observed several distinct radiographic patterns associated with ECDS/PRS. Seizure disorder was strongly associated with the presence of ipsilateral enhanced white matter signalling. Improved neuroimaging techniques that combine morphological with functional imaging may improve the detection rate of brain involvement in children with ECDS/PRS in the future

Personal attributes and competencies required by community health workers for a role in integrated mental health care for perinatal depression: voices of primary health care stakeholders from Surabaya, Indonesia.

BACKGROUND: Non-professional community health workers have been widely reported as possibly having a role in mental health. In Indonesia, their role is currently being introduced in the national health system for perinatal depression. Prior publications have shown that it is generally considered feasible and acceptable by key stakeholders for community health workers to identify and refer women experiencing mental health issues during their perinatal phase to primary care. However, characteristics and competencies required for these workers have not yet been identified. METHODS: 62 participants from four groups of stakeholders in primary health care in Surabaya were interviewed, including program managers, health workers, community health workers (CHWs), mental health specialists, and pregnant and postpartum women. Semi-structured questions were used to explore participants' views about characteristics and competencies required by CHWs to identify and refer perinatal depression. RESULTS: Literacy and social skills were seen as basic characteristics required for CHWs to contribute to perinatal identification, together with willingness to volunteer and time availability. Participants identified females in the age range 30-50 years who have experienced pregnancy as being preferable. To ensure competency, training addressing knowledge about maternal life and depression, and communication skills are regarded as prerequisites for the role. CONCLUSIONS: The results are consistent with WHO guidelines for informal workers working with people with mental disorders in non-specialised settings. The results provide a rationale for the criteria to be met when informal workers are to be involved in primary care mental health area and provide information for the development of training in the identification of perinatal depression