The Sonographic Progression of Non-Alcoholic Fatty Liver Disease into Non-Alcoholic Cirrhosis of the Liver

Cirrhosis is quickly becoming a prevalent disease in the United States alone and affects 1 in every 400 Americans. Cirrhosis occurs when the liver\u27s fibrous bands are no longer fibrous in response to the liver being scarred and no longer being able to filter toxins from the blood. Ultrasound is a key tool along with blood tests that allows cirrhosis to definitively be detected and diagnosed in patients. Cirrhosis can be either non-alcoholic or alcoholic depending on the patient’s history and there are distinct differences in appearance of the liver sonographically as well as symptoms and treatment of this disease as it progresses. It is essential to determine sonographic findings of the progression of the normal liver to cirrhosis of the liver and to comprehend the difference between treating alcoholic and non-alcoholic cirrhosis of the liver. It is also crucial to understand the diagnosis, disease process, complications, symptoms, prognosis, and reversal of cirrhosis of the liver in order to both recognize this disease and be able to care for anyone with this disease. Keywords: liver, cirrhosis, fatty infiltration, sonography, non-alcoholic, elastographyhttps://digitalcommons.misericordia.edu/research_posters2020/1080/thumbnail.jp

Person-centered planning in mental health : a transatlantic collaboration to tackle implementation barriers

Collaborative, person-centered approaches to care planning are increasingly recognized as instrumental in supporting attainment of personal recovery outcomes. Yet, while much is known about factors which support person-centered planning, successful implementation often remains an elusive goal. This paper reviews international efforts to promote Person-Centered Care Planning (PCCP) in the context of a randomized clinical trial in the United States and in the “Meaningful and Measurable” initiative, a collaborative action research project involving diverse provider organizations in Scotland. The authors review the history of international efforts to implement PCCP and offer preliminary evidence regarding its positive impact on both process outcomes (i.e., the nature of the primary therapeutic relationship and the service-user’s experience) and personal recovery outcomes (e.g., quality of life, community belonging, and valued roles). PCCP will be defined through description of key principles and practices as they relate to both relational aspects (i.e., shifts in stakeholder roles and conversations) and documentation/recording aspects (i.e., how person-centered relationships are captured in written or electronic records). Similarities and differences across the US and Scottish experience of person-centered care planning will be highlighted and a series of recommendations offered to further implementation of this essential recovery-oriented practice

Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial

Background: Mental health policy in many countries is oriented around recovery. The evidence base for service-level pro-recovery interventions is lacking. Methods: Two-site cluster randomised controlled trial in England (ISRCTN02507940). REFOCUS is a one-year team-level intervention targeting staff behaviour (increasing focus on patient values, preferences, strengths, goal-striving) and staff-patient relationships (coaching, partnership). 27 community-based adult mental health teams were randomly allocated to treatment-as-usual (n=13) or treatment-as-usual plus REFOCUS (n=14). Baseline (n=403) and one-year follow-up (n=297) outcomes were assessed for randomly selected patients with psychosis, representing 88% of target recruitment. Primary outcome was recovery, assessed using Questionnaire about Processes of Recovery (QPR). Findings: Intention-to-treat analysis using multiple imputation found no difference in QPR Total (control 40·0 (s.d.10·2), intervention 40·6 (s.d.10·1), adjusted difference 0·68, 95%CI: 1·7 to 3·1, p=·58), or sub-scales. Secondary outcomes which improved in the intervention group were functioning (adjusted difference 6·96, 95%CI 2·8 to 9·2, p<·001) and staff-rated unmet need (adjusted difference 0·80, 95%CI 0·2 to 1·4, p=·01). This pattern remained after covariate adjustment and completer analysis (n=275). Higherparticipating teams had higher staff-rated pro-recovery behaviour change (adjusted difference -0·4, 95%CI -0·7 to -0·2, p=·001) and patients had higher QPR Interpersonal scores (adjusted difference -1·6, 95%CI -2·7 to -0·5, p=·005) at follow-up. Interventiongroup patients incurred £1,062 (95%CI -£1,103 to £3,017) lower adjusted costs. Interpretation: Supporting recovery may, from the staff perspective, improve functioning and reduce needs. Overcoming implementation barriers may increase staff pro-recovery behaviours and interpersonal aspects of patient-rated recovery

Shared decision making within the context of recovery-oriented care

Purpose: This article will consider the role of shared decision-making as one component of recovery-oriented care. Design/Methodology/Approach: This article is conceptual and reviews literature relevant to recovery-oriented care, person-centered recovery planning, and shared decision-making. Findings: To the degree to which shared decision-making offers tools for sharing useful information about treatment options with service users and family members or other loved ones, it can be considered a valuable addition to the recovery-oriented armamentarium. It is important to emphasize, though, that recovery-oriented practice has a broader focus on the person’s overall life in the community and is not limited to formal treatments or other professionally-delivered interventions. Within the more holistic context of recovery, shared decision-making regarding such interventions is only one tool among many, which needs to be integrated within an overall person-centered recovery planning process. More emphasis is given within recovery-oriented care to activating and equipping persons for exercising self-care and for pursuing a life they have reason to value, and the nature of the relationships required to promote such processes will be identified. In describing the nature of these relationships, it will become evident that decision-making is only one of many processes that need to be shared between persons in recovery and those who accept responsibility for promoting and supporting that person’s recovery. Originality/Value: By viewing shared decision-making within the context of recovery, this article provides a framework that can assist in the implementation of shared decision-making in routine mental health care

The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice

BACKGROUND: Recovery-oriented language has been widely adopted in mental health policy; however, little is known about how recovery practices are implemented within individual services, such as psychosocial clubhouses. AIMS: To explore how recovery practices are implemented in a psychosocial clubhouse. METHOD: Qualitative case study design informed by self-determination theory was utilised. This included 120 h of participant observation, interviews with 12 clubhouse members and 6 staff members. Field notes and interview transcripts were subject to theoretical thematic analysis. RESULTS: Two overarching themes were identified, each comprising three sub-themes. In this paper, the overarching theme of ‘social environment’ is discussed. It was characterised by the sub-themes, ‘community and consistency’, ‘participation and opportunity’ and ‘respect and autonomy’. CONCLUSIONS: Social environment was used to facilitate recovery-oriented practice within the clubhouse. Whether recovery is experienced by clubhouse members in wider society, may well depend on supports and opportunities outside the clubhouse. DECLARATION OF INTERESTS: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence