The Effectiveness of Mindfulness-based Programs on Physical Symptoms and Psychological Distress in Patients with Fibromyalgia: A Systematic Review

Objective: Research into and the clinical use of mindfulness as a therapeutic intervention have increased in recent years and the results have been promising in a range of illness populations. One area in which mindfulness has been trialled is fibromyalgia, a chronic pain condition currently with poor treatment outcomes. The aim of this systematic review was to examine the effectiveness of mindfulness-based interventions on physical symptoms and psychological distress in patients with fibromyalgia. Methods: Systematic review: PubMed, PsycINFO, Embase and Scopus were searched for randomised controlled trials and prospective and retrospective studies. A quality assessment and synthesis of the quantitative data (based on guidelines from the Joanna Briggs Institute) was completed on studies using a mindfulness-based intervention with patients with fibromyalgia on outcomes related to physical symptoms and psychological distress and wellbeing. Results: Ten studies met the inclusion criteria. All included studies used a mindfulness-based group program design. Although outcome measures and data presentation varied, making statistical pooling impossible, the narrative synthesis resulted in overall positive evidence for the efficacy of mindfulness-based interventions for patients with fibromyalgia on a range of physical symptom and psychological distress outcome measures. Conclusion: Mindfulness is a favourable treatment option for patients with fibromyalgia. Whilst demonstrated efficacy was generally positive, the number of studies addressing this topic is small and there was wide variation in outcome measures and data presentation. More research is needed, particularly large-scale randomised controlled trials with consistent methodology, outcome measures and sufficient follow-up time periods

Digital resources for pain management: Psychologists\u27 perspectives and suggestions

Chronic pain has high prevalence, complexity, psychosocial and economic impact. There is a growing interest in the development and use of digital resources accessed through electronic devices for pain management. Qualitative interviews with eight registered psychologists explored their perspectives of and suggestions regarding digital resources for pain management. Six overarching themes were identified, indicating that digital resources are perceived as useful. Difficulties were identified pertaining to digital social support and client-decision making, plus perceived barriers and facilitators for digital resource use. Participants offered suggestions about what an ideal digital resource would incorporate. These findings may inform the modification of existing resources, and the formulation of additional appropriate and tailored co-designed digital resources for the management of chronic pain

Palliative medicine practitioners' views on the concept of depression in the palliative care setting

Background: Despite its clinical importance in palliative care, depression remains an ambiguous concept. Objective: The purpose of this study was to explore how medical practitioners working in palliative care conceptualize depression in that setting. Design: Medical practitioners who attended a palliative medicine conference (N=185) were invited to respond to a questionnaire, which explored their views on the concept of depression in the palliative care context. Descriptive statistics were used to summarize responses, and comparison between groups was conducted using nonparametric statistics. Themes in free-text comments were identified. Results: Seventy-nine responses were obtained (response rate 43%). Depression was not a unified concept, but was generally considered to be an illness with psychological, spiritual, and existential causes. Respondents were more uncertain about depression being an illness in the palliative care setting compared with other settings, and were ambivalent about its causality. Treatment preferences leaned towards psychological interventions. Depression being different in the palliative care setting was a theme. It was considered to be more prevalent, different in quality, harder to define, and associated with greater barriers to diagnosis and treatment. Conceptual differences were associated with the respondents' area of work, work position, duration of practice, and previous mental health training. Conclusions: Depression in the palliative care setting is a variable concept for palliative medicine practitioners. The conceptual diversity and complexities of depression in this setting must be acknowledged and further explored in order to develop nuanced approaches in clinical practice and in research.Felicity Ng, Gregory B. Crawford and Anna Chur-Hanse

Medical student self-reported confidence in obstetrics and gynaecology: development of a core clinical competencies document

Background: Clinical competencies in obstetrics and gynaecology have not been clearly defined for Australian medical students, the growing numbers of which may impact clinical teaching. Our aim was to administer and validate a competencies list, for self-evaluation by medical students of their confidence to manage common clinical tasks in obstetrics and gynaecology; to evaluate students’ views on course changes that may result from increasing class sizes. Methods: A draft list of competencies was peer-reviewed, and discussed at two student focus groups. The resultant list was administered as part of an 81 item online survey. Results: Sixty-eight percent (N = 172) of those eligible completed the survey. Most respondents (75.8%) agreed or strongly agreed that they felt confident and well equipped to recognise and manage most common and important obstetric and gynaecological conditions. Confidence was greater for women, and for those who received a higher assessment grade. Free-text data highlight reasons for lack of clinical experience that may impact perceived confidence. Conclusions: The document listing competencies for medical students and educators is useful for discussions around a national curriculum in obstetrics and gynaecology in medical schools, including the best methods of delivery, particularly in the context of increasing student numbers.Kristen Pierides, Paul Duggan, Anna Chur-Hansen and Amaya Gilso

An investigation of the English language proficiency and academic and clinical performance of University of Adelaide Medical School undergraduates / Anna Chur-Hansen.

Author's revision to her thesis is in envelope on back page.Copies of author's previously published works inserted.Bibliography: leaves 472-502.xvi, 502 leaves : ill. ; 30 cm.The first aim of this thesis is to investigate the English language proficiency of several cohorts of undergraduate medical students enrolled at the University of Adelaide, South Australia, employing both quantitative and qualitative measures. The second is to consider the influence of students' English language proficiency upon their academic and clinical performance. The thesis puts forward recommendations for future teaching and learning strategies and research opportunities in the medical education arena.Thesis (Ph.D.)--University of Adelaide, Dept. of Psychiatry, 199

An umbrella review of the evidence for equine‐assisted interventions

Objective To establish the evidence base for animal‐assisted interventions, and specifically, hippotherapy and other interventions involving horses, in the context of improving biological, physical, psychological and social functioning, and outcomes in humans. Method A review of systematic reviews (an umbrella review) was carried out using a modified Joanna Briggs Institute methodology and following PRISMA guidelines. Inclusion criteria were any interventions that included a live horse, for humans of any age and for any therapeutic purpose. Service and assistance horses and people who were incarcerated were excluded. Systematic reviews with a clearly articulated and comprehensive search strategy, with evidence of critical appraisal, both qualitative and quantitative and mixed methods, and in English were considered. Results Of 19 systematic reviews considered eligible for inclusion, 13 were included in this umbrella review. These 13 systematic reviews covered 79 individual studies of equine‐assisted interventions, including primarily hippotherapy and therapeutic horse riding. Participants included children with cerebral palsy, children and adolescents with autism spectrum disorder, adults with multiple sclerosis, elderly people, adults post‐stroke, people with spinal cord injury, adults with serious mental illness, adults with balance problems, people with brain disorders, breast cancer survivors, and obese women. Conclusions The evidence for equine‐assisted interventions for adults and children across a range of conditions and presentations is equivocal. The current evidence base is marred by multiple methodological weaknesses and thus, therapeutic interventions that include a horse cannot be asserted as best practice at this time. Rigorous research is indicated to determine the utility of equine‐assisted interventions

Human Health Benefits of Non-Conventional Companion Animals: A Narrative Review

Research investigating health benefits from household human–animal bonds has focused mostly on bonds with companion dogs, cats, and horses. Wellbeing benefits associated with other companion animal species such as birds, fish, and reptiles are described and anecdotally reported, but there is little empirical literature supporting this. The literature suggests that health benefits of companion animals are predicated on human perceptions of the animal rather than the animal’s species. Therefore, relationships with non-conventional companion animals of diverse species may benefit the health of their human guardians as do dogs, cats, and horses. This narrative review summarizes the current literature exploring perceived health benefits gained from non-conventional companion animals. Searches were conducted for published literature and grey literature up to October 2022 across PsycINFO and PubMed databases, and Newsbank media database for commercial media publications. Nineteen studies and 10 media articles were included in the review. Gaps in the literature include a lack of rigorous research to investigate the health benefits of non-conventional companion animals. Non-conventional companion animals may benefit their guardians by providing social support through acting as attachment figures, facilitating social opportunities and daily routines, fulfilling cognitive needs, and recreating restorative capacities of mindfully observing natural landscapes. Further high-quality research into the human-non-conventional companion animal bond is warranted

The Information Needs and Experiences of People Living With Cardiac Implantable Electronic Devices: Qualitative Content Analysis of Reddit Posts

BackgroundCardiac implantable electronic devices (CIEDs) are used to treat a range of cardiovascular diseases and can lead to substantial clinical improvements. However, studies evaluating patients’ experiences of living with these devices are sparse and have focused mainly on implantable cardioverter defibrillators. In addition, there has been limited evaluation of how people living with a CIED use social media to gain insight into their condition. ObjectiveThis study aims to analyze posts from web-based communities called subreddits on the website Reddit, intended for people living with a CIED, to characterize the informational needs and experiences of patients. MethodsReddit was systematically searched for appropriate subreddits, and we found 1 subreddit that could be included in the analysis. A Python-based web scraping script using the Reddit application programming interface was used to extract posts from this subreddit. Each post was individually screened for relevancy, and a register of participants’ demographic information was created. Conventional qualitative content analysis was used to inductively classify the qualitative data collected into codes, subcategories, and overarching categories. ResultsOf the 484 posts collected using the script, 186 were excluded, resulting in 298 posts from 196 participants being included in the analysis. The median age of the participants who reported this was 33 (IQR 22.0-39.5; range 17-72) years, and the majority had a permanent pacemaker. The content analysis yielded 5 overarching categories: use of the subreddit by participants, questions and experiences related to the daily challenges of living with a CIED, physical sequelae of CIED implantation, psychological experiences of living with a CIED, and questions and experiences related to health care while living with a CIED. These categories provided insight into the diverse experiences and informational needs of participants living with a CIED. The data predominantly represented the experiences of younger and more physically active participants. ConclusionsSocial media provides a platform through which people living with a CIED can share information and provide support to their peers. Participants generally sought information about the experiences of others living with a CIED. This was often done to help overcome a range of challenges faced by participants, including the need to adapt to living with a CIED, difficulties with navigating health care, psychological difficulties, and various aversive physical sequelae. These challenges may be particularly difficult for younger and physically active people. Health care professionals may leverage peer support and other aid to help people overcome the challenges they face while living with a CIED

Trainee psychiatrists' views about their supervisors and supervision

ObjectiveSupervision is fundamental to the trainee experience in psychiatry, but few researchers have considered this in a systematic way. In this paper, we explore trainees' perceptions of the supervisor-trainee relationship and the supervision process. This is the first of two papers, with the second focussing on supervisors' perceptions of supervision and trainees.MethodFifteen trainees were interviewed and the resultant data subjected to qualitative analysis.ResultsTrainees described the characteristics of a 'good' supervisor, as well as what they considered to be evident in a 'poor' supervisor.ConclusionsThe results of this study would be useful in designing training programs for both experienced and novice supervisors. Future research is needed to evaluate the efficacy of such training programs, as currently very little investigation into postgraduate clinical supervision has been undertaken.Anna Chur-Hansen, Steve McLea