Parent-perceived isolation and barriers to psychosocial support: A qualitative study to investigate how peer support might help parents of burn-injured children

Introduction: Burn injuries can be traumatic and distressing for the affected child and family, with a prolonged period of recovery. This research explores parents’ experiences of support following their child’s injury and their thoughts on peer support specifically.Methods: Thirteen semi-structured interviews were conducted with parents/caregivers, a mean of three years after their child’s injury, either face-to-face or remotely. Responses were analysed using thematic analysis.Results: Analysis produced four themes and 11 sub-themes. These described parents’ experiences of loss, change, isolation and access to psychosocial support. This paper focuses on themes of isolation and parents’ access to psychosocial support.Discussion: Findings indicate that parents access psychosocial support following their child’s injury and often find it helpful; however, there is a prevailing sense of isolation. Parents often seek information online and find that this is lacking. Many parents reported that peer support would be valuable to them, particularly the sharing of experiential knowledge.Conclusion: An online resource may be beneficial for parents, but further research is needed to confirm the exploratory data gained to date, ensuring that any resource developed would meet the identified needs of parents

Withdrawal-induced delirium associated with a benzodiazepine switch: a case report

<p>Abstract</p> <p>Introduction</p> <p>Introduced in the early 1960s, diazepam remains among the most frequently prescribed benzodiazepine-type sedatives and hypnotics. Patients with chronic use of short-acting benzodiazepines are frequently switched to diazepam because the accumulating, long-acting metabolite, N-desmethyl-diazepam, prevents benzodiazepine-associated withdrawal symptoms, which can occur during trough plasma levels of short-acting benzodiazepines. Although mild to moderate withdrawal symptoms are frequently observed during benzodiazepine switching to diazepam, severe medical complications associated with this treatment approach have thus far not been reported.</p> <p>Case presentation</p> <p>A 64-year-old female Caucasian with major depression, alcohol dependence and benzodiazepine dependence was successfully treated for depression and, after lorazepam-assisted alcohol detoxification, was switched from lorazepam to diazepam to facilitate benzodiazepine discontinuation. Subsequent to the benzodiazepine switch, our patient unexpectedly developed an acute delirious state, which quickly remitted after re-administration of lorazepam. A newly diagnosed early form of mixed dementia, combining both vascular and Alzheimer-type lesions, was found as a likely contributing factor for the observed vulnerability to benzodiazepine-induced withdrawal symptoms.</p> <p>Conclusion</p> <p>Chronic use of benzodiazepines is common in the elderly and a switch to diazepam often precedes benzodiazepine discontinuation trials. However, contrary to common clinical practice, benzodiazepine switching to diazepam may require cross-titration with slow tapering of the first benzodiazepine to allow for the build-up of N-desmethyl-diazepam, in order to safely prevent severe withdrawal symptoms. Alternatively, long-term treatment with low doses of benzodiazepines may be considered, especially in elderly patients with chronic use of benzodiazepines and proven vulnerability to benzodiazepine-associated withdrawal symptoms.</p

Development of a measure of model fidelity for mental health Crisis Resolution Teams

Background Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a fidelity scale to assess adherence to a model of best practice for CRTs, based on best available evidence. Methods A concept mapping process was used to develop a CRT fidelity scale. Participants (n = 68) from a range of stakeholder groups prioritised and grouped statements (n = 72) about important components of the CRT model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day fidelity review process. Trained reviewers (n = 16) rated CRT service fidelity in a vignette exercise to test the scale’s inter-rater reliability. Results There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT model. A 39-item measure of CRT model fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT model fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). Conclusions The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability

Luminosity functions for galaxies and quasars in the Spitzer Wide-area Infrared Extragalactic Legacy Survey

We construct rest-frame luminosity functions (LFs) at 3.6, 4.5, 5.8, 8 and 24 μm over the redshift range 0 < z < 2 for galaxies and 0 < z < 4 for optical quasi-stellar objects (QSOs), using optical and infrared (IR) data from the Spitzer Wide-area Infrared Extragalactic (SWIRE) Survey. The 3.6- and 4.5-μm galaxy LFs show evidence for moderate positive luminosity evolution up to z∼ 1.5, consistent with the passive ageing of evolved stellar populations. Their comoving luminosity density was found to evolve passively, gradually increasing out to z∼ 0.5–1 but flattening, or even declining, at higher redshift. Conversely, the 24-μm galaxy LF, which is more sensitive to obscured star formation and/or active galactic nuclei (AGN) activity, undergoes strong positive evolution, with the derived IR energy density and star formation rate (SFR) density ∝ (1 +z)γ with γ= 4.5+0.7−0.6 and the majority of this evolution occurring since z∼ 1. Optical QSOs, however, show positive luminosity evolution in all bands, out to the highest redshifts (3 < z < 4). Modelling as L*∝ (1 +z)γ gave γ= 1.3+0.1−0.1 at 3.6 μm, γ= 1.0+0.1−0.1 at 4.5 μm and stronger evolution at the longer wavelengths (5.8, 8 and 24 μm), of γ∼ 3. Comparison of the galaxy LFs to predictions from a semi-analytic model based on cold dark matter (CDM) indicates that an initial mass function (IMF) skewed towards higher mass star formation in bursts compared to locally be preferred. As a result, the currently inferred massive SFRs in distant submm sources may require substantial downwards revision

A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality

<p>Abstract</p> <p>Background</p> <p>Generic community mental health teams (CMHTs) currently deliver specialist mental health care in England. Policy dictates that CMHTs focus on those patients with greatest need but it has proved difficult to establish consistent referral criteria. The aim of this study was to explore the referral process from the perspectives of both the referrers and the CMHTs.</p> <p>Methods</p> <p>Qualitative study nested in a randomised controlled trial. Interviews with general practitioner (GP) referrers, CMHT Consultant Psychiatrists and team leaders. Taping of referral allocation meetings.</p> <p>Results</p> <p>There was a superficial agreement between the referrers and the referred to on the function of the CMHT, but how this was operationalised in practice resulted in a lack of clarity over the referral process, with tensions apparent between the views of the referrers (GPs) and the CMHT team leaders, and between team members. The process of decision-making within the team was inconsistent with little discussion of, or reflection on, the needs of the referred patient.</p> <p>Conclusion</p> <p>CMHTs describe struggling to deal with GPs who are perceived as having variable expertise in managing patients with mental health problems. CMHT rhetoric about defined referral criteria is interpreted flexibly with CMHT managers and Psychiatrists concentrating on their own capacity, roles and responsibilities with limited consideration of the primary care perspective or the needs of the referred patient.</p> <p>Trial Registration number</p> <p>ISRCTN86197914</p

Treatment and outcomes of crisis resolution teams: a prospective multicentre study

<p>Abstract</p> <p>Background</p> <p>Crisis resolution teams (CRTs) aim to help patients in acute mental health crises without admitting them to hospital. The aims of this study were to investigate content of treatment, service practice, and outcomes of crises of CRTs in Norway.</p> <p>Methods</p> <p>The study had a multicentre prospective design, examining routine data for 680 patients and 62 staff members of eight CRTs. The clinical staff collected data on the demographic, clinical, and content of treatment variables. The service practices of the staff were assessed on the Community Program Practice Scale. Information on each CRT was recorded by the team leaders. The outcomes of crises were measured by the changes in Global Assessment of Functioning scale scores and the total scores on the Health of the Nation Outcome Scales between admission and discharge. Regression analysis was used to predict favourable outcomes.</p> <p>Results</p> <p>The mean length of treatment was 19 days for the total sample (N = 680) and 29 days for the 455 patients with more than one consultation; 7.4% of the patients had had more than twice-weekly consultations with any member of the clinical staff of the CRTs. A doctor or psychologist participated in 55.5% of the treatment episodes. The CRTs collaborated with other mental health services in 71.5% of cases and with families/networks in 51.5% of cases. The overall outcomes of the crises were positive, with a small to medium effect size. Patients with depression received the longest treatments and showed most improvement of crisis. Patients with psychotic symptoms and substance abuse problems received the shortest treatments, showed least improvement, and were most often referred to other parts of the mental health services. Length of treatment, being male and single, and a team focus on out-of-office contact were predictors of favourable outcomes of crises in the adjusted model.</p> <p>Conclusions</p> <p>Our study indicates that, compared with the UK, the Norwegian CRTs provided less intensive and less out-of-office care. The Norwegian CRTs worked more with depression and suicidal crises than with psychoses. To be an alternative to hospital admission, the Norwegian CRTs need to intensify their treatment and meet more patients outside the office.</p

Psychological consultancy in mental health services: A systematic review of service, staff, and patient outcomes

Objectives Psychological consultation in mental health is an organizational intervention aiming to enable mental health care to be delivered in a more efficient manner. This review sought to: (1) clarify what theoretical models underpin consultancy, (2) define how consultancy is implemented, (3) assess the methodological rigour of the evidence base, and (4) define the outcomes achieved for services, staff, and patients. The review was focal to direct and indirect forms of consultation. Method PRISMA guidelines were followed. Three databases were searched identifying N = 17 studies, and these were quality assessed using the QualSyst quality ratings checklist. Studies were grouped by model of consultation and outcome. A thematic analysis then clustered the patient, staff, and service outcomes into either discrepant or confirmatory evidence. Results The most frequently adopted theoretical models underpinning psychological consultation are cognitive‐behavioural and cognitive‐analytic. Method of consultancy implementation is typically via case formulation meetings. Study quality varied from limited to strong. The main confirmatory and positive outcomes for staff are an increase in understanding and also more positive feelings towards patients, and for the service, there is a reduced need for other interventions. Conclusions Psychological consultation appears a useful and worthwhile aspect of leadership by psychological therapists. Training in delivering consultancy needs to be well integrated into the core curricula of clinical training programmes. The evidence base is still in its infancy, and further well‐controlled research is required. Practitioner points Psychological consultation improves staff insight and understanding of patients. Psychological consultants need to remain visible and accessible to teams and use a theoretical model to guide consultation. Training and supervision in consultation are necessary to support psychological therapists in these roles