Project of a European dictionary of sientific terminology

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Understanding ‘emerging’ Borderline Personality Disorder: early interventions, and clinicians’ perspectives.

Aims: This work aims to increase our understanding of the use of the diagnosis ‘emerging’ Borderline Personality Disorder (BPD) diagnosis in young people under the age of 18. It contains a review of the evidence around early psychological intervention for BPD followed by an empirical exploration of clinicians’ perspectives on how this diagnosis is used clinically. Design: This project is structured as a portfolio briefly comprising of; an overall introduction to the topic, a systematic review and meta-analysis of the psychosocial outcomes of early intervention for BPD, a qualitative empirical paper exploring the experiences of clinicians working in child and adolescent mental health services in England, an extended methodology, and an overall discussion and critical evaluation. Findings: Multiple models of intervention exist for BPD in adolescence. The meta-analysis provides some tentative evidence that early interventions for BPD might have a positive impact, particularly on quality of life outcomes. However, there was little overall benefit of intervention over and above standard clinical care. In the empirical paper, clinicians expressed a number of dilemmas surrounding the use of BPD diagnosis, including how diagnosis impacts on the young person and the way services understand them. This topic is seen as controversial, with polarised perspectives leading to ‘debate’ among team members. Value of this work: There is clearly a lack of evidence supporting early intervention for BPD symptomatology, and a need for more robust research exploring the mechanisms, acceptability, and potential outcomes. This work also highlights conflicts and dynamics that can arise in services and may be helpful for thinking about if and how to use BPD diagnosis in adolescents in the future. It is hoped that this could be useful to front-line clinicians involved in the assessment, diagnosis and treatment of children and/or adolescents with mental health difficulties, and to commissioners and those involved in service development

Understanding psoriasis: the development of the immune pathogenesis

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Diagnosis and dilemma: Clinician experiences of the use of ‘borderline personality disorder’ diagnosis in children and adolescents

Borderline personality disorder (BPD) diagnosis in adolescents is a relatively recent concept and a fast-emerging research area. Regarded by some as controversial, it is important for research to provide greater understanding of differing perspectives and their impact on the use of this diagnosis. Perspectives of 13 clinicians (therapists, psychiatrists and mental health nurses) were explored, to provide a contemporary understanding of perceptions and use of BPD diagnosis within child and adolescent mental health services in England. A particular focus was to explore dilemmas faced by clinicians and how these dilemmas were negotiated. This research took a qualitative, social constructionist approach to explore the in-depth views and experiences of each participant. Interviews were analysed using thematic analysis, to seek out patterns and commonalities across these clinical perspectives. Three overarching themes were generated: ‘Who holds the power?’, ‘Dilemmas within the multidisciplinary team (MDT)’ and ‘The weightiness of making this decision’. Professional opinions of an adolescent BPD diagnosis are influenced by dominant and less dominant mental health discourses, including the impact of power, and availability of resources within the service context. The role of meaningful collaboration with young people, clinical implications and directions for future research are discussed

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Physical and mental health of women exposed to intimate partner violence in the 10 years after having their first child: an Australian prospective cohort study of first-time mothers

Objective To investigate mental and physical health of mothers exposed to recent and early postpartum intimate partner violence (IPV) in the 10 years after having their first child.Design Prospective pregnancy cohort study.Setting Women were recruited at six metropolitan public maternity hospitals in Melbourne, Australia and followed up at 1, 4 and 10 years post partum.Study measures Exposure to physical and/or emotional IPV was measured using the Composite Abuse Scale at 1, 4 and 10 years. At 10-year follow-up, mothers reported on physical and mental health, and functional health status.Participants 1507 first-time mothers enrolled at mean of 15 weeks’ gestation.Results One in three women experienced IPV during the 10 years after having their first child. Women experiencing recent IPV (19.1%) reported worse physical and mental health than women not reporting IPV. Compared with women not reporting IPV, women experiencing recent IPV had higher odds of poor functional health status (Adj OR=4.5, 95% CI 3.2 to 6.3), back pain (Adj OR=2.0, 95% CI 1.4 to 2.9), incontinence (Adj OR=1.8, 95% CI 1.2 to 2.6), depressive symptoms (Adj OR=4.9, 95% CI 3.2 to 7.5), anxiety (Adj OR=5.1, 95% CI 3.0 to 8.6) and post-traumatic stress symptoms (Adj OR=7.2, 95% CI 4.6 to 11.1) at 10 years. Women with past IPV at 1 and/or 4 years (15.7% of the cohort) also had higher odds of physical and mental health problems. There was evidence of a gradient in health outcomes by recency of exposure to IPV.Conclusions Both recent and past exposure to IPV are associated with poor maternal physical and mental health 10 years after a first birth. Health services and advocacy organisations providing support to women need to be aware of the consistent relationship between IPV and a range of physical and mental health conditions, which may persist even after IPV appears to have ceased

Commonly utilized physiotherapy treatment approaches in the management of Sub-Acute sciatica:A pilot study using the Delphi process

There is limited evidence for the utilization of physiotherapy in the management of sub-acute sciatica. The aim of this pilot study was to explore the Delphi method to attempt to reach consensus on physiotherapeutic approaches to the management of sub-acute sciatica amongst a panel of clinicians experienced in this field. The panel included senior physiotherapists (n = 10) working within an outpatient setting at a specialized orthopedic trust. Iteration 1 consisted of the open-ended question "List the treatment approaches/techniques/modalities you employ when treating a patient with sub-acute sciatica and provide justifications". Themes reaching 70% consensus progressed to the second iteration which followed up with the question "Please indicate how frequently you would employ the following treatments in the management of sub-acute sciatica" using a 5-point likert scale ranging from 1 (never) to 5 (always). The mean score was calculated for each treatment and those themes achieving a mean of 3.5 or greater progressed to iteration 3 "Please rank in order of preference which of the following treatments you would employ in the treatment of sub-acute sciatica". The response rate at iteration 3 was 60%. This pilot study achieved consensus on five treatment approaches to be employed in the management of sub-acute sciatica. In order of preference these treatments were advice (regarding staying active, staying at work, reassurance, analgesia), advice (time scale of recovery, natural course of sciatica, self-limiting condition, hurt does not equal harm), lumbar joint mobilizations (rotations, PA's, ilial mobs [distractions], transverse glides), direction specific stretches and nerve mobilizations. This pilot study provides preliminary evidence of commonly used treatment approaches for sub acute sciatica amongst physiotherapists.</jats:p