Cross-Sector Partnership Formation

A cross-sector partnership is a collaborative effort in which parties from different societal sectors pool resources to provide solutions to (perceived) common problems.These partnerships are often rather complex because of a number of reasons: (1) they address complex issues, (2) they are implemented under (often) uncertain circumstances, and (3) they bring together parties that each have a different language, a different culture, and different interests and strategies. This knowledge is not new, but has been poorly understood so far. Complexity is further increased by the factors that influence the actual formation of a partnership when they are not well understood or managed as well

Cross-Sector Partnership Formation

A cross-sector partnership is a collaborative effort in which parties from different societal sectors pool resources to provide solutions to (perceived) common problems. These partnerships are often rather complex because of a number of reasons: (1) they address complex issues, (2) they are implemented under (often) uncertain circumstances, and (3) they bring together parties that each have a different language, a different culture, and different interests and strategies. This knowledge is not new, but has been poorly understood so far. Complexity is further increased by the factors that influence the actual formation of a partnership when they are not well understood or managed as well

Effects of age and cognitive reserve on cognitive remediation therapy outcome in patients with schizophrenia

OBJECTIVES:: Older people with a diagnosis of schizophrenia seem to show fewer benefits following cognitive remediation therapy (CRT). It is not clear whether cognitive reserve modifies the relationship with age. METHODS:: A total of 134 individuals with schizophrenia were pooled from one randomized control trial and one observational trial. Eighty-five participants received more than 20 sessions of CRT and 49 participants received fewer than 20 sessions of CRT or treatment as usual. Participants were divided into two groups according to their age (younger than 40 years: younger, N = 77; and 40 years or older: older, N = 57). Cognition (working memory, cognitive flexibility, and planning) was assessed at baseline and posttreatment. Premorbid IQ and vocabulary at baseline were used as cognitive reserve proxies. RESULTS:: There was a significant effect of CRT on working memory in younger but not older participants. Better premorbid IQ was associated with better working memory performance in younger participants irrespective of treatment. No significant effects of treatment or cognitive reserve were revealed in older participants. Cognitive reserve proxies did not modify CRT treatment effect. CONCLUSION:: In conclusion, the effects of CRT were limited in older people with schizophrenia. Cognitive reserve could not be shown to influence the relationship of age with CRT efficacy. Better premorbid IQ was associated with increased practice effects on working memory in younger but not older individuals

Does age matter? Effects of cognitive rehabilitation across the age span

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldBACKGROUND: Cognitive remediation (CR) therapy in its various disguises can be helpful for people with schizophrenia but it is not clear if patient characteristics are likely to interfere with its effectiveness. METHODOLOGY: This paper describes the assessment of one putative moderating variable, age, on the outcome of CRT in a rigorous randomised control trial with memory, cognitive flexibility and planning as primary outcomes and social behaviour, symptoms and self-esteem as secondary outcomes. Calendar age was divided into younger (< 40; N55) and older (40 or more years; N30). There were no differences between the groups at baseline in their cognitive, social or demographic data except on predicted variables. RESULTS: Younger people benefited more from cognitive remediation in two of the three cognitive domains tested. In the memory domain both groups benefited. Only negative symptoms showed a moderating effect of age on CRT, where again the younger group showed improvements in the context of CRT but the older group did not. When older people did show a cognitive advantage in memory following therapy this cognitive improvement benefited social behaviour. CONCLUSION: CRT needs some modification to increase the benefits to older participants. However, any cognitive improvements do still seem to have a beneficial effect

Developing models of how cognitive improvements change functioning:Mediation, moderation and moderated mediation

AbstractBackgroundCognitive remediation (CRT) affects functioning but the extent and type of cognitive improvements necessary are unknown.AimTo develop and test models of how cognitive improvement transfers to work behaviour using the data from a current service.MethodParticipants (N49) with a support worker and a paid or voluntary job were offered CRT in a Phase 2 single group design with three assessments: baseline, post therapy and follow-up. Working memory, cognitive flexibility, planning and work outcomes were assessed.ResultsThree models were tested (mediation — cognitive improvements drive functioning improvement; moderation — post treatment cognitive level affects the impact of CRT on functioning; moderated mediation — cognition drives functioning improvements only after a certain level is achieved). There was evidence of mediation (planning improvement associated with improved work quality). There was no evidence that cognitive flexibility (total Wisconsin Card Sorting Test errors) and working memory (Wechsler Adult Intelligence Scale III digit span) mediated work functioning despite significant effects. There was some evidence of moderated mediation for planning improvement if participants had poorer memory and/or made fewer WCST errors. The total CRT effect on work quality was d=0.55, but the indirect (planning-mediated CRT effect) was d=0.082ConclusionPlanning improvements led to better work quality but only accounted for a small proportion of the total effect on work outcome. Other specific and non-specific effects of CRT and the work programme are likely to account for some of the remaining effect. This is the first time complex models have been tested and future Phase 3 studies need to further test mediation and moderated mediation models

Anxiety and depression in patients with non-site-specific cancer symptoms:data from a rapid diagnostic clinic

BACKGROUND: Rapid diagnostic clinics (RDCs) provide a streamlined holistic pathway for patients presenting with non-site specific (NSS) symptoms concerning of malignancy. The current study aimed to: 1) assess the prevalence of anxiety and depression, and 2) identify a combination of patient characteristics and symptoms associated with severe anxiety and depression at Guy's and St Thomas' Foundation Trust (GSTT) RDC in Southeast London. Additionally, we compared standard statistical methods with machine learning algorithms for predicting severe anxiety and depression.METHODS: Patients seen at GSTT RDC between June 2019 and January 2023 completed the General Anxiety Disorder Questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-8) questionnaires, at baseline. We used logistic regression (LR) and 2 machine learning (ML) algorithms (random forest (RF), support vector machine (SVM)) to predict risk of severe anxiety and severe depression. The models were constructed using a set of sociodemographic and clinical variables.RESULTS: A total of 1734 patients completed GAD-7 and PHQ-8 questionnaires. Of these, the mean age was 59 years (Standard Deviation: 15.5), and 61.5% (n:1067) were female. Prevalence of severe anxiety (GAD-7 score ≥15) was 13.8% and severe depression (PHQ-8 score≥20) was 9.3%. LR showed that a combination of previous mental health condition (PMH, Adjusted Odds Rario (AOR) 3.28; 95% confidence interval (CI) 2.36-4.56), symptom duration &gt;6 months (AOR 2.20; 95%CI 1.28-3.77), weight loss (AOR 1.88; 95% CI 1.36-2.61), progressive pain (AOR 1.71; 95%CI 1.26-2.32), and fatigue (AOR 1.36; 95%CI 1.01-1.84), was positively associated with severe anxiety. Likewise, a combination PMH condition (AOR 3.95; 95%CI 2.17-5.75), fatigue (AOR 2.11; 95%CI 1.47-3.01), symptom duration &gt;6 months (AOR 1.98; 95%CI 1.06-3.68), weight loss (AOR 1.66; 95%CI 1.13-2.44), and progressive pain (AOR 1.50; 95%CI 1.04-2.16), was positively associated with severe depression. LR and SVM had highest accuracy levels for severe anxiety (LR: 86%, SVM: 85%) and severe depression (SVM: 89%, LR: 86%).CONCLUSION: High prevalence of severe anxiety and severe depression was found. PMH, fatigue, weight loss, progressive pain, and symptoms &gt;6 months emerged as combined risk factors for both these psychological comorbidities. RDCs offer an opportunity to alleviate distress in patients with concerning symptoms by expediting diagnostic evaluations.</p