Bactericide effect of powerful Ultrasonic Bone Surgery device (piezo-surgery) : Oral surgey application in BRONJ treatment: (Biphosphonate Related osteonecrosis of the jaws)

I farmaci Bifosfonati sono composti chimici analoghi del pirofosfato e sono in grado di determinare un rallentamento del riassorbimento osseo agendo sul metabolismo degli osteoclasti. L’Osteonecrosi dei mascellari(8-9-10) è stata classificata come una potenziale reazione avversa legata all’uso di farmaci Amino-Bifosfonati ed è da lungo tempo considerata una condizione di difficile risoluzione a causa del rallentato turn-over del metabolismo osseo. L’obiettivo di questo lavoro è stato quello di identificare eventuali presidi chirurgici in grado di risolvere il problema dell’osteonecrosi(11) ed eventualmente impedirne la recidiva, riportata in letteratura come una evenienza frequente. Nel presente studio sono stati trattati 16 pazienti (11 donne e 5 maschi) di età compresa tra 59 e 82 anni,(69aa media). Di questi: 10 pazienti erano stati sottoposti a terapia con bifosfonati a causa di neoplasie metastatizzate, di cui 9 con Acido Zoledronico e 1 con Acido Pamidronico; invece, 6 pz. erano stati trattati per osteoporosi con Acido Alendronico. Undici pazienti riportavano lesioni osteonecrotiche a carico dell’osso mandibolare (10 nella regione anteriore e 1 in quella posteriore); quattro pazienti avevano lesioni a carico del mascellare superiore; un paziente ha avuto una osteonecrosi a carico della mandibola prima ed a distanza di 4 mesi a carico del mascellare superiore; due sul mascellare anteriore, ed altri due sul mascellare posteriore. Per il trattamento chirurgico delle lesioni necrotiche sono state utilizzate attrezzature per la chirurgia ossea ad ultrasuoni ad alta potenza ( 90 Watt) e bassa frequenza (24-32kz) (Ultrasonic-Bone Surgery -U.B.S.). I risultati ottenuti hanno dimostrato che tutti i pazienti trattati avevano avuto una remissione dei sintomi ed una chiusura completa per prima o per seconda intenzione delle ferite entro le prime due settimane dall’intervento. Durante il follow-up (che va da un minimo di 6 mesi fino a 12 mesi) cui sono stati sottoposti tutti i pazienti, non si è manifestata ad oggi alcuna recidiva. Dovrebbero essere presi in considerazione altri pazienti ma gli attuali risultati incoraggiano ulteriori esperimenti in vivo/in vitro in merito all’uso della chirurgia ad ultrasuoni nel trattamento delle osteonecrosi

Cues and knowledge structures used by mental-health professionals when making risk assessments

Background: Research into mental-health risks has tended to focus on epidemiological approaches and to consider pieces of evidence in isolation. Less is known about the particular factors and their patterns of occurrence that influence clinicians’ risk judgements in practice. Aims: To identify the cues used by clinicians to make risk judgements and to explore how these combine within clinicians’ psychological representations of suicide, self-harm, self-neglect, and harm to others. Method: Content analysis was applied to semi-structured interviews conducted with 46 practitioners from various mental-health disciplines, using mind maps to represent the hierarchical relationships of data and concepts. Results: Strong consensus between experts meant their knowledge could be integrated into a single hierarchical structure for each risk. This revealed contrasting emphases between data and concepts underpinning risks, including: reflection and forethought for suicide; motivation for self-harm; situation and context for harm to others; and current presentation for self-neglect. Conclusions: Analysis of experts’ risk-assessment knowledge identified influential cues and their relationships to risks. It can inform development of valid risk-screening decision support systems that combine actuarial evidence with clinical expertise

‘Perceptions of non-accidental child deaths as preventable events: The impact of probability heuristics and biases on child protection work'

Anxiety about the possibility of non-accidental deaths of children has had a major influence on child care policy and practice over the last 40 years. The formal inquiry reports and media coverage of these rare events serve to maintain the perception that these are regular incidents that happen far too often and that they could have been prevented. This focus on individual events tends to distort a clear view of the actual probability of non-accidental deaths and serves to reinforce the notion that potentially all child care cases are risky and that any social work practitioner could be involved in such a case. As a result, work with children has become highly risk averse. However, in statistical terms, the probability of non-accidental child deaths is very low and recently has averaged about 55 deaths a year. Children are at considerably higher risk of being killed on the roads. This paper examines the way in which perceptions of the ‘high’ level of risk of possible child deaths are maintained despite the very low statistical probability of such incidents. It draws on thinking from behavioural psychology and, in particular the work of Kahneman and Tversky, to consider some of the biases in probability reasoning affecting people’s perception of risk and explores how inquiry reports into single past events reconfirm risk perceptions. It is suggested that recognition of the essentially unpredictable nature of future non-accidental child deaths would free up childcare professionals to work in a more positive and less risk-averse manner in the present

‘Perceptions of non-accidental child deaths as preventable events: The impact of probability heuristics and biases on child protection work'

Anxiety about the possibility of non-accidental deaths of children has had a major influence on child care policy and practice over the last 40 years. The formal inquiry reports and media coverage of these rare events serve to maintain the perception that these are regular incidents that happen far too often and that they could have been prevented. This focus on individual events tends to distort a clear view of the actual probability of non-accidental deaths and serves to reinforce the notion that potentially all child care cases are risky and that any social work practitioner could be involved in such a case. As a result, work with children has become highly risk averse. However, in statistical terms, the probability of non-accidental child deaths is very low and recently has averaged about 55 deaths a year. Children are at considerably higher risk of being killed on the roads. This paper examines the way in which perceptions of the ‘high’ level of risk of possible child deaths are maintained despite the very low statistical probability of such incidents. It draws on thinking from behavioural psychology and, in particular the work of Kahneman and Tversky, to consider some of the biases in probability reasoning affecting people’s perception of risk and explores how inquiry reports into single past events reconfirm risk perceptions. It is suggested that recognition of the essentially unpredictable nature of future non-accidental child deaths would free up childcare professionals to work in a more positive and less risk-averse manner in the present

Psychopolitics: Peter Sedgwick’s legacy for mental health movements

This paper re-considers the relevance of Peter Sedgwick's Psychopolitics (1982) for a politics of mental health. Psychopolitics offered an indictment of ‘anti-psychiatry’ the failure of which, Sedgwick argued, lay in its deconstruction of the category of ‘mental illness’, a gesture that resulted in a politics of nihilism. ‘The radical who is only a radical nihilist’, Sedgwick observed, ‘is for all practical purposes the most adamant of conservatives’. Sedgwick argued, rather, that the concept of ‘mental illness’ could be a truly critical concept if it was deployed ‘to make demands upon the health service facilities of the society in which we live’. The paper contextualizes Psychopolitics within the ‘crisis tendencies’ of its time, surveying the shifting welfare landscape of the subsequent 25 years alongside Sedgwick's continuing relevance. It considers the dilemma that the discourse of ‘mental illness’ – Sedgwick's critical concept – has fallen out of favour with radical mental health movements yet remains paradigmatic within psychiatry itself. Finally, the paper endorses a contemporary perspective that, while necessarily updating Psychopolitics, remains nonetheless ‘Sedgwickian’

The E Sibling Project - exploratory randomised controlled trial of an online multi-component psychoeducational intervention for siblings of individuals with first episode psychosis

Background:Siblings of individuals with first episode psychosis are natural partners to promote service users’recovery and are themselves vulnerable to mental ill health due to the negative impact of psychosis withinthe family. This study aims to develop and undertake a preliminary evaluation of the efficacy of an onlinemulti-component psychoeducational intervention for siblings of individuals with first episode psychosis. Theimpetus for the intervention arose from siblings' expressed needs for peer support and information on psychosis,coping and management strategies for common symptoms and ways to promote recovery. Methods/Design:The project design draws on the Medical Research Council framework for the design andevaluation of complex interventions. Mixed methods comprising collection of qualitative focus group data,systematic review and expert advisory group consultation are used to develop the theoretical basis for and designof the intervention. This protocol focuses on the modelling and piloting phase which uses a randomised controlledtrial with factorial design to test the efficacy of the intervention. Outcome data on participants’mental wellbeing,knowledge, perceived self-efficacy and experiences of caregiving will be assessed at baseline, at end of theintervention (10 weeks later) and at 10 week follow-up. In addition, a post-intervention semi-structured interviewwith 20% of the participants will explore their experiences and acceptability of the intervention. Discussion:This multi-component online psychoeducational intervention aims to enhance siblings' knowledgeabout psychosis and their coping capacity, thus potentially improving their own mental wellbeing and promotingtheir contribution to service users’recovery. The factorial design randomised controlled trial with a supplementaryprocess evaluation using semi-structured interviews and usage-monitoring will collect preliminary evidence ofefficacy, feasibility and acceptability, as well as feedback about the barriers and strategies to using such aninnovative resource. The RCT will provide data for estimating the likely effect size of the intervention on outcomesfor siblings and inform the development of a definitive future trial

Wellbeing, mental health knowledge and caregiving experiences of siblings of people with psychosis, compared to their peers and parents: An exploratory study

Purpose The wellbeing and caregiving experiences of family carers supporting people with psychosis has garnered increasing interest. Evidence indicates that the burden of caregiving can adversely impact on parents’ wellbeing, few studies have investigated whether this is also the case for siblings, who often take on caregiving responsibilities. This exploratory study investigated the wellbeing, mental health knowledge, and appraisals of caregiving in siblings of individuals with psychosis. Method Using a cross-sectional design, 90 siblings completed three validated questionnaires: Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS), Mental Health Knowledge Schedule (MAKS), and Experience of Caregiving Inventory (ECI). Data obtained were compared to general population norms and parent-carers’ scores. Multi-variable regression analyses were conducted to examine relationships between questionnaire scores and demographic characteristics including age, sex, birth order, marital status, accommodation and educational level. Results Siblings, especially sisters, had significantly poorer mental wellbeing, compared to normative scores. Conversely, they had better mental health knowledge. Siblings and parent-carers had comparable high levels of negative appraisals of caregiving experiences, but siblings reported more satisfaction with personal experiences and relationships. Education level was a significant predictor for better mental health knowledge; there were no other relationships between siblings’ demographic factors and outcomes. Conclusion Study findings suggest that siblings have overlapping as well as distinct needs, compared to parent-carers. Further research is required to better understand siblings’ experiences so as to inform development of targeted interventions that enhance wellbeing and caregiving capacity

Different forms of informal coercion in psychiatry: a qualitative study.

OBJECTIVES: The objective of the study was to investigate how mental health professionals describe and reflect upon different forms of informal coercion. RESULTS: In a deductive qualitative content analysis of focus group interviews, several examples of persuasion, interpersonal leverage, inducements, and threats were found. Persuasion was sometimes described as being more like a negotiation. Some participants worried about that the use of interpersonal leverage and inducements risked to pass into blackmail in some situations. In a following inductive analysis, three more categories of informal coercion was found: cheating, using a disciplinary style and referring to rules and routines. Participants also described situations of coercion from other stakeholders: relatives and other authorities than psychiatry. The results indicate that informal coercion includes forms that are not obviously arranged in a hierarchy, and that its use is complex with a variety of pathways between different forms before treatment is accepted by the patient or compulsion is imposed

Understanding psychiatric institutionalization: a conceptual review

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