Family-inclusive approaches to reablement in mental health:models, mechanisms and outcomes

This paper reports on a national study of ‘whole-family’ models of practice—and how these may (or may not) contribute to the reablement of people with mental health difficulties. Using a capabilities-based perspective, it is argued that, within the context of mental health, reablement may best be defined in terms of empowerment and social participation. Framed within a realist evaluation methodology, the study employs a comparative case study design to explore the relationships between contexts of intervention, mechanisms of change and the achievement (or otherwise) of reablement outcomes. Four distinct practice approaches in current use were examined: Systemic Family Therapy, Behavioural Family Therapy, Family Group Conferencing and an Integrated Systemic/Behavioural approach. Using a sample of twenty-two families, separate interviews were undertaken with service users, family members and practitioners, and narrative accounts were triangulated with scaled responses to scorecard questions. From an analysis of these data, heuristic models of change are derived for each approach. From this, a composite schema is developed that charts how, with different starting points and routes, engaging with whole families may lead to the construction of a secure and empowering base from which service users may reconnect with wider social worlds

Human factors in clinical handover: development and testing of a ‘handover performance tool' for doctors' shift handovers

Objective To develop and test a handover performance tool (HPT) able to help clinicians to systematically assess the quality and safety of shift handovers. Design The study used a mixed methods approach. In the development phase of the tool, a review of the literature and a Delphi process were conducted to sample five generic non-technical skills: communication, teamwork, leadership, situation awareness and task management. Validity and reliability of the HPT were evaluated through direct observation and during simulated handover video sessions. Setting This study was conducted in the Paediatrics, Obstetrics and Gynaecology wards of a UK district hospital. Participants Thirty human factor experts participated in the development phase; 62 doctors from various disciplines were asked to validate the tool. Main Outcome Measures Item development, HPT validity and reliability. Results The tool developed consisted of 25 items. Communication, teamwork and situation awareness explained, respectively, 55.5, 47.2 and 39.6% of the variance in doctors rating of quality. Internal consistency and inter-rater reliability of the HPT were good (Cronbach's alpha = 0.77 and intra-class correlation = 0.817). Conclusions Communication determined the majority of handover quality. Teamwork and situation awareness also provided an independent contribution to the overall quality rating. The HPT has demonstrated good validity and reliability providing evidence that it can be easily used by raters with different backgrounds and in several clinical settings. The HPT could be utilized to assess doctors' handover quality systematically, as well as teaching tool in medical schools or in continuing professional development programmes for self-reflective practic

Cooling low-dimensional electron systems into the microkelvin regime.

Two-dimensional electron gases (2DEGs) with high mobility, engineered in semiconductor heterostructures host a variety of ordered phases arising from strong correlations, which emerge at sufficiently low temperatures. The 2DEG can be further controlled by surface gates to create quasi-one dimensional systems, with potential spintronic applications. Here we address the long-standing challenge of cooling such electrons to below 1 mK, potentially important for identification of topological phases and spin correlated states. The 2DEG device was immersed in liquid 3He, cooled by the nuclear adiabatic demagnetization of copper. The temperature of the 2D electrons was inferred from the electronic noise in a gold wire, connected to the 2DEG by a metallic ohmic contact. With effective screening and filtering, we demonstrate a temperature of 0.9 ± 0.1 mK, with scope for significant further improvement. This platform is a key technological step, paving the way to observing new quantum phenomena, and developing new generations of nanoelectronic devices exploiting correlated electron states

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Human factors in clinical handover : development and testing of a ‘Handover Performance Tool’ for doctors’ shift handovers

Objective: To develop and test a handover performance tool (HPT) able to help clinicians to systematically assess the quality and safety of shift handovers. Design: The study used a mixed methods approach. In the development phase of the tool, a review of the literature and a Delphi process were conducted to sample five generic non-technical skills: communication, teamwork, leadership, situation awareness and task management. Validity and reliability of the HPT were evaluated through direct observation and during simulated handover video sessions. Setting: This study was conducted in the Paediatrics, Obstetrics and Gynaecology wards of a UK district hospital. Participants: Thirty human factor experts participated in the development phase; 62 doctors from various disciplines were asked to validate the tool. Main Outcome: Measures Item development, HPT validity and reliability. Results: The tool developed consisted of 25 items. Communication, teamwork and situation awareness explained, respectively, 55.5, 47.2 and 39.6% of the variance in doctors rating of quality. Internal consistency and inter-rater reliability of the HPT were good (Cronbach's alpha = 0.77 and intra-class correlation = 0.817). Conclusions: Communication determined the majority of handover quality. Teamwork and situation awareness also provided an independent contribution to the overall quality rating. The HPT has demonstrated good validity and reliability providing evidence that it can be easily used by raters with different backgrounds and in several clinical settings. The HPT could be utilized to assess doctors' handover quality systematically, as well as teaching tool in medical schools or in continuing professional development programmes for self-reflective practice.Peer reviewe

Does clinical handover promote situation awareness? : Implications for person-centered healthcare

Background: Doctors’ handover has been the subject of investigation since the implementation of the European Working Time Directive in 2004. Little is known regarding handover quality and safety in clinical practice. This study aims to systematically assess handover practice across different clinical settings and to consider its implications for person-centered healthcare. Method: Prospective observational study of handover practice over a period of three weeks in the Obstetrics-Gynaecology, Acute Care Unit and General Surgery departments of one UK General District Hospital. Checklists developed on the basis of the Royal Colleges of Surgeons’ and Physicians’ guidelines were used to assess clinical practice. Results: A total of 306 patients were admitted in the departments during the study period; 45 patients (15%) were not handed over during the change of the shift. Accuracy of handover compared to our gold standard were: Obstetrics-Gynaecology (45%); Acute Medicine (51%); General Surgery (52%). Information less likely to be handed over was related to patients’ management plan in all specialities. Medicine and Surgery rarely discussed aims and limitations of treatments while Obstetrics-Gynaecology handed over tasks to be done only in 43% of patients. All specialties performed well during the handover of current diagnosis and list of patient problems Conclusions: A number of weaknesses were identified in handover practice across the clinical settings explored. The existing handover process focuses on the current status of patients, whereas safety concerns, time critical actions. Anticipated next steps should address the lack of the so called ‘third level’ of situation awareness as one method aimed at improving the person-centeredness of clinical services.Peer reviewe

Student, Teacher, and Observer Perceptions of the Classroom Environment Before and after the Transition to Junior High School

Student and teacher perceptions of the classroom environment were assessed during mathematics instruction in 117 sixth grade elementary school classrooms and the following year in 138 seventh grade junior high school classrooms. Observer perceptions were collected in a subset of these classrooms. As hypothesized, after the transition students were given fewer opportunities for input, interaction and cooperation; whole class task organization and the use of social comparison increased; and student/teacher relationships deteriorated. Contrary to predictions, competition was more prevalent before than after the transition and the frequency of grading did not change. It is suggested that a "developmental mismatch" may exist between maturing children and the classroom environments they experience before and after the transition to junior high school.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67243/2/10.1177_0272431688082003.pd

Handedness modulates proprioceptive drift in the rubber hand illusion

Preference for use of either the left or right hand (‘handedness’) has been linked with modulations of perception and sensory processing—both of space and the body. Here we ask whether multisensory integration of bodily information also varies as a function of handedness. We created a spatial disparity between visual and somatosensory hand position information using the rubber hand illusion, and use the magnitude of illusory shifts in hand position (proprioceptive ‘drift’) as a tool to probe the weighted integration of multisensory information. First, we found drift was significantly reduced when the illusion was performed on the dominant vs. non-dominant hand. We suggest increased manual dexterity of the dominant hand causes greater representational stability and thus an increased resistance to bias by the illusion induction. Second, drift was generally greatest when the hand was in its habitual action space (i.e., near the shoulder of origin), compared to when it laterally displaced towards, or across the midline. This linear effect, however, was only significant for the dominant hand—in both left- and right-handed groups. Thus, our results reveal patterns of habitual hand action modulate drift both within a hand (drift varies with proximity to action space), and between hands (differences in drift between the dominant and non-dominant hands). In contrast, we were unable to find conclusive evidence to support, or contradict, an overall difference between left- and right-handers in susceptibility to RHI drift (i.e., total drift, collapsed across hand positions). In sum, our results provide evidence that patterns of daily activity—and the subsequent patterns of sensory input—shape multisensory integration across space