Sensitivity of the Mini-Mental State Examination, Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination III to everyday activity impairments in dementia: an exploratory study

ObjectiveThe Mini-Mental State Examination (MMSE) is one of the most frequently used cognitive measures for dementia severity and linked to deficits in everyday functioning. Recently, the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination III (ACE-III) increasingly substitute for the MMSE. However, there are no specific cutoffs in the ACE-III for mild dementia. The objectives of this exploratory study were to assess the sensitivity of each scale to everyday functioning and to examine the cutoffs between mild and moderate dementia on the ACE-III.MethodsPeople with mild dementia completed the MMSE, MoCA and ACE-III, whilst informal carers completed the Revised Interview for Deteriorations in Daily Living Activities for Dementia to rate their relative's initiative and performance of instrumental activities of daily living and the Katz activities of daily living scale. Data were analysed using correlation analysis, raw score comparisons, Cohen's kappa and receiver operating characteristics analysis.ResultsThirty-three dyads completed the measures. The ACE-III was the most sensitive tool for everyday functioning performance, whilst its language subscale was specifically related to initiation of activities. The most suitable cutoff on the ACE-III between mild and moderate dementia was 61.ConclusionsFindings suggest the ACE-III more efficiently identifies everyday functional impairments. Further research is required to confirm these exploratory analyses of the cutoff between mild and moderate dementia on the ACE-III. Both functional impairment and stage of dementia are needed in the diagnostic process and in the clinical assessment of people with dementia

Care coordination for older people in England: Does context shape approach?

© The Author(s) 2018. Summary: Policy and practice developments in adult social care in England and elsewhere recognise the increasing role of the non-statutory sector. Care coordination services are central to the delivery of tailored support. This qualitative study focuses on support for older people and reports an analysis of 13 non-statutory sector services providing care coordination, grouped into four service types. Semi-structured interviews explored the influence of service context on the nature of practice. Findings: Particular elements of care coordination (e.g. assessment) were found to be shaped by the specific aims and purpose of each service type, such as extent to which they had a commissioning or provider role and the nature of their target group. Aspects of a range of case and care management approaches were in use throughout the sample, varying in relation to the distinct features of the service type. A set of overarching standards was found to be relevant to all services considered. Non-statutory sector services were found to provide innovative support which both complemented and sometimes substituted for the statutory sector. Applications: Findings point to the continued importance of social work values and methods to the work of non-statutory sector services providing care coordination and to current limitations in relation to what the sector can provide. These are issues which employers and service commissioners need to address to ensure that non-statutory sector services have the capacity and standards of practice to meet the demands made of them. Further areas of research are identified

Evaluating the effectiveness of different approaches to home support for people in later stage dementia:A protocol for an observational study

Background: Dementia is a major health problem with a growing number of people affected by the condition, both directly and indirectly through caring for someone with dementia. Many live at home but little is known about the range and intensity of the support they receive. Previous studies have mainly reported on discrete services within a single geographical area. This paper presents a protocol for study of different services across several sites in England. The aim is to explore the presence, effects and cost-effectiveness of approaches to home support for people in later stage dementia and their carers. Methods: This is a prospective observational study employing mixed methods. At least 300 participants (people with dementia and their carers) from geographical areas with demonstrably different ranges of services available for people with dementia will be selected. Within each area, participants will be recruited from a range of services. Participants will be interviewed on two occasions and data will be collected on: their characteristics and circumstances; quality of life; carer health and burden; and informal and formal support for the person with dementia. The structured interviews will also collect qualitative data to explore the perceptions of older people and carers. Conclusions: This national study will explore the components of appropriate and effective home support for people with late stage dementia and their carers. It aims to inform commissioners and service providers across health and social care

Demographic and clinical characteristics of UK military veterans attending a psychological therapies service

© 2014 The Authors. Aims and method To investigate the demographic and clinical characteristics of subgroups of UK veterans attending a dedicated psychological therapies service following the Improving Access to Psychological Therapies (IAPT) treatment model. Veterans accessing a newly established service in the north-west were categorised into three groups: early service leavers, those with a physical disability, and substance and/or alcohol misusers. Anxiety, depression and social functioning were measured pre- and post-treatment. Results Veterans vary in their demographic and clinical characteristics as well as in treatment efficacy, as measured by the post-treatment scores on probable depression and anxiety. Therapy appears to be most effective in early service leavers, whereas veterans with a physical disability or a substance or alcohol misuse problem tend not to do as well in terms of symptoms of depression or anxiety. Clinical implications This study highlights the importance of targeting different veteran subgroups for dedicated psychological therapy

Stair-case in the north trancept, Cathedral of Burgos [Material gráfico]

Copia digital. Valladolid : Junta de Castilla y León. Consejería de Cultura y Turismo, 2009-201

Seeking industry perspectives to enhance experiential education in university-industry partnerships: going beyond mere assumptions

Setting up and running a program with an industry experiential learning component is based on certain core assumptions. A shared vision of what constitutes a satisfying placement is essential. In this paper we present findings from research into the operation of an Australian Bachelor of Business Information Technology program. In-depth interviews were held with 10 experienced industry sponsors/mentors and one member of a relevant professional body. Industry mentors identify pragmatic reasons for industry involvement in experiential learning programs. They identify some seven skills required of a good industry mentor, and report eight features of a meaningful/satisfying placement<br /

Conceptualising best practices in cooperative industry-based learning in information systems and information technology: an inter-institutional investigation in Australian higher education

The professional fields of information systems and information technology are drivers and enablers of the global economy. Moreover, their theoretical scope and practices are global in focus. University graduates need to develop a range of leadership, conceptual and technical capacities to work effectively in, and contribute to, the shaping of companies, business models and systems which operate in globalised settings. This paper reports a study of the operation of industry-based learning (IBL) at three Australian universities, which employ different models and approaches, as part of a series of investigations of the needs, circumstances and perspectives of various stakeholders (program coordinator, faculty teaching staff, the students, industry mentors, and the professional body which has supported the most recent stage of this study). The focus of this paper is a discussion of salient pragmatic considerations as we attempt to conceptualise what constitutes best practice in offering industry-based learning for higher education students in the disciplines of information systems and information technology.<br /

The knowledge, a collection of poetry, and, The poem noir : film noir in contemporary poetry

This thesis consists of a collection of poetry, The Knowledge, and the first critical investigation into the ‘poem noir’, an unidentified and unexplored mode within contemporary poetry that exhibits thematic and visual echoes from the body of films known as film noir. Taking its title from the London taxi driver’s rigorous examination, The Knowledge’s key theme is displacement: from social class, education and from a sense of home. It echoes the quest of the doomed film noir protagonist, who, in a thirst for knowledge, is drawn into a psychological descent into a metaphorical underworld. Like the poems noir analysed in the critical section, these possess an anxious, pessimistic and obsessive engagement with the world, and are set within noirish locales to excavate the autobiographical and the imaginative. Inspired by film noir’s portrayal of individuals whose identity is called into conflict, the poems take the lid off the works of memory and place, to examine a personal and public moral compass, and to dramatize the past and the present. After providing a definition of film noir, the critical section outlines a model for reading a poem noir by analysing a selection of seminal American films noir of the classic 1941 to 1958 period, along with several neo-noir films produced from the 1970s onwards. It then provides close readings of Paul Muldoon’s hard-boiled Chandleresque poem, ‘Immram’ (1980), Deryn Rees-Jones’ book-length murder-mystery poem, Quiver (2004), and David Harsent’s nightmarish labyrinthine poem, ‘Elsewhere’ (2011), and introduces them as poems noir. In conclusion I consider how writing poetry is a noirish act, sharing a similarity with Seamus Heaney’s notion that the role of writing poetry is to unearth revelations about the self, and with Henrik Gustafsson’s thesis that film noir is concerned with taking the lid off the works to expose whatever truth lies beneath

Reconfiguring in-patient services for adults with mental health problems: Changing the balance of care

© The Royal College of Psychiatrists 2018. Background Research suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require. Aims To identify which individuals require what services, at what cost. Method A 'balance of care' (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach. Results Community care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week. Conclusions The findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used. Declaration of interest None

Identifying alternatives to old age psychiatry inpatient admission: an application of the balance of care approach to health and social care planning.

BACKGROUND: Mental health problems in older people are common and costly, posing multiple challenges for commissioners. Against this backdrop, a series of initiatives have sought to shift resources from institutional to community care in the belief that this will save money and concurs with user preferences. However, most of this work has focused on the use of care home beds and general hospital admissions, and relatively little attention has been given to reducing the use of mental health inpatient beds, despite their very high cost. METHODS: The study employed a 'Balance of Care approach' in three areas of North-West England. This long-standing strategic planning framework identifies people whose needs can be met in more than one setting, and compares the costs and consequences of the possible alternatives in a simulation modelling exercise. Information was collected about a six-month cohort of admissions in 2010/11 (n = 216). The sample was divided into groups of people with similar needs for care, and vignettes were formulated to represent the most prevalent groups. A range of key staff judged the appropriateness of these admissions and suggested alternative care for those considered least appropriate for hospital. A public sector costing approach was used to compare the estimated costs of the recommended care with that people currently receive. RESULTS: The findings suggest that more than a sixth of old age psychiatry inpatient admissions could be more appropriately supported in other settings if enhanced community services were available. Such restructuring could involve the provision of intensive support from Care Home Outreach and Community Mental Health Teams, rather than the development of crisis intervention and home treatment teams as currently advocated. Estimated savings were considerable, suggesting local agencies might release up to £1,300,000 per annum. No obvious trade-off between health and social care costs was predicted. CONCLUSIONS: There is considerable potential to change the mix of institutional and community services provided for older people with mental health problems. The conclusions would be strengthened by further studies and the incorporation of evidence about relative outcomes. However, the utility of the approach in challenging established patterns of resource allocation and building local ownership for change is apparent