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Lived experiences of caregivers with a family member living with a severe mental health condition in South Africa
Get PDF© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and
the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this
article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included
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need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.BACKGROUND: In low- and middle-income countries (LMIC) such as South Africa, people with severe mental health conditions (SMHC) typically reside with family members, who serve as their primary caregivers. This study aimed to explore the lived experiences, needs and coping strategies of caregivers with a family member with SMHC in a low-resource setting in South Africa, and their perspectives on the provision of a support group programme. METHODS: An exploratory qualitative study was conducted, which included 22 in-depth individual interviews, 15 of them being females and 7 males ranging from 26 to 72 years of age. These caregivers were recruited through the service user presenting at the health facility. The interview guide covered caregiving experiences, coping strategies, perceptions on recovery, and acceptability of peer-led mutual support groups. Written informed consent was obtained before conducting interviews. Interviews were audio recorded, translated from isiXhosa to English and transcribed. Thematic analysis using NVivo 12 was used to analyze findings. RESULTS: Caregivers reported being socially excluded from family and community gatherings, as well as experiencing financial and emotional hardship because of their responsibilities. This influenced their overall well-being and ability to cope. Inadequate time for their own social activities and fulfilment were frequently described, and this was linked to their level of responsibility for the needs of others in their homes, as caregiving obligations were rarely shared among family members. Although some caregivers had developed ways to cope, such as hobbies and spiritual endeavours, some nevertheless reported less healthy coping strategies, including alcohol use. Whilst most caregivers indicated they would be interested in a peer-led mutual support programme, some said they would not be able to participate because of work or other responsibilities. CONCLUSION: Caregivers of people with SMHC in South Africa face considerable challenges, and supportive interventions are needed. Peer-led mutual support groups may hold the potential for providing this support.https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-06989-
Peer-supported Open Dialogue : a qualitative study of peer practitioners' experiences and non-peer practitioners' perspectives on peer involvement
Get PDFBACKGROUND: Peer-supported Open Dialogue (POD) integrates peer practitioners within mental health teams, fostering a collaborative, person-centred and social network approach to care. Although peer practitioners are increasingly involved in Open Dialogue, the role of peer practitioners within such teams remains underexplored. AIMS: This study aimed to explore (a) the experiences of peer practitioners working within Open Dialogue teams in the Open Dialogue: Development and Evaluation of a Social Intervention for Severe Mental Illness trial, and (b) the perspectives of non-peer Open Dialogue practitioners regarding peer involvement. Our further objectives were to understand the nature, degree and perceived impact of peer practitioner involvement in Open Dialogue. METHOD: A qualitative study was conducted using semi-structured interviews and joint interviews with peer practitioners (n = 9). Additionally, excerpts from 11 interviews and 4 focus groups (n = 18), in which non-peer practitioners discussed peer practitioners' contributions in Open Dialogue, were analysed. Thematic analysis was employed to identify key themes. RESULTS: Three themes were developed. The first focuses on the perceived influence of peer practitioners on Open Dialogue network meetings; the second explores the opportunities and challenges of working as a peer practitioner in Open Dialogue, while the third details the perceived impact of peer practitioners on team and organisational culture. CONCLUSIONS: Open Dialogue's emphasis on a flattened hierarchy facilitates the integration of peer practitioners, enabling them to contribute meaningfully to network meetings and team culture. Despite the overall positive experiences, peers still faced common challenges faced by those in other services, such as low pay and occasional instances of a compromised, flattened hierarchy.https://www.cambridge.org/core/journals/bjpsych-open/article/peersupported-open-dialogue-a-qualitative-study-of-peer-practitioners-experiences-and-nonpeer-practitioners-perspectives-on-peer-involvement/C2CAB4A0647E26AED43D0EA1846BB61
Orbital Atherectomy in Calcified Coronary Lesions: a 1-year retrospective observational outcome study
No full textBackground Percutaneous coronary intervention (PCI) has advanced rapidly since its inception. Not only in stent technology, but there have been advancements in adjunctive tools including intra-coronary imaging, stent delivery tools and calcium modification techniques. The interventional community is well aware of the difficulties posed by calcified coronary lesions and their impact on outcomes. More recently, orbital atherectomy (OA) has seen itself on the fore front of managing such complex and challenging situations. Aims This retrospective study analyses a 1-year experience of using OA in a high-volume primary PCI center in a UK district general hospital. Methods Patient demographics, procedural details, and outcomes, including MACE rates and procedural success, were reviewed in all-comers undergoing OA between January 1 and December 31, 2024. Results A total 53 patients were identified that had undergone OA in a 1-year period. Procedural success was achieved in 98.1% of patients. Thirty-days MACE was 5.7% (three patients). One patient experiencing in-hospital procedural related myocardial infarction and two patients had major bleeding events during the follow up period which is not related to OA. No-flow/slow-flow were observed in seven patients (13.2%), and seven patients (13.2%) experienced coronary dissection that were successfully treated with stent implantation. Conclusion OA is a new but safe and effective tool for calcium modification in an all-comers cohort of patients treated in a high-volume UK district general hospital setting.https://onlinelibrary.wiley.com/doi/10.1002/ccd.3150
Total knee arthroplasty in a knee locked in extension: a case report
No full textA native arthritic knee locked in full extension is a rare presentation to an orthopaedic clinic. Often, fixed deformity cases present with an element of fixed flexion due to either a mechanical or non-mechanical block, but a full extension deformity has not been reported in the literature. The treatment of these complex cases often involves consideration of the biopsychosocial impact of the deformity, and holistic patient care is warranted. This case report explores the symptoms, investigations, management, and postoperative recovery of a 60-year-old patient presenting with a rare fixed extension deformity. The condition had a significant impact on the patient's physical and psychological state, and its impact on quality of life should not be dismissed. Multiple imaging modalities and surgical options were considered prior to surgical management with total knee arthroplasty. The management of this condition was demonstrated to be suitably treated with total knee arthroplasty with good postoperative function and recovery. However, further larger study series are required to provide more robust evidence as to the optimal management strategy.https://www.cureus.com/articles/337856-total-knee-arthroplasty-in-a-knee-locked-in-extension-a-case-report#!
The clinical and cost effectiveness of a STAndardised DIagnostic Assessment for children and adolescents with emotional difficulties: The STADIA multi-centre randomised controlled trial
Get PDF2025 The Author(s). Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and
Adolescent Mental Health.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited.BACKGROUND: Standardised Diagnostic Assessment tools, such as the Development and Well-Being Assessment (DAWBA), may aid detection and diagnosis of emotional disorders but there is limited real-world evidence of their clinical or cost effectiveness. METHODS: We conducted a multicentre, two-arm parallel group randomised controlled trial in eight large National Health Service Trusts in England providing multidisciplinary specialist Child and Adolescent Mental Health Services (CAMHS). Participants (5-17 year-olds with emotional difficulties referred to CAMHS) were randomly assigned (1:1), following referral receipt, to either receive the DAWBA and assessment-as-usual (intervention group) or assessment-as-usual (control group). Data were self-reported by participants (parents and/or young person, depending on age) at baseline, 6- and 12-month post-randomisation and collected from clinical records up to 18 months post-randomisation. The primary outcome was a clinician-made diagnosis decision about the presence of an emotional disorder within 12 months of randomisation. TRIAL REGISTRATION: ISRCTN15748675. RESULTS: In total, 1,225 children and young people (58% female sex) were randomised (615 intervention; 610 control). Adherence to the intervention (full/partial completion) was 80% (494/615). At 12 months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group (adjusted risk ratio (RR) 0.94 [95% CI 0.70, 1.28]). The intervention was not cost effective. There was no evidence of any differences between groups for service-related or participant-reported secondary outcomes, for example, CAMHS acceptance of the index referral (intervention 277 (45%) versus control 262 (43%); RR: 1.06 [95% CI: 0.94, 1.19]) was similar between groups. CONCLUSIONS: As delivered in this pragmatic trial, we found no evidence for the effectiveness or cost effectiveness of using a Standardised Diagnostic Assessment tool in aiding the detection of emotional disorders or clinical outcomes in clinically referred children and young people. Despite regular efforts to encourage clinicians to view the DAWBA report and consider its findings as part of assessment and diagnosis, we did not collect data on usage and therefore cannot confirm the extent to which clinicians did this. As a pragmatic trial that aimed to test the effectiveness of incorporating the DAWBA into usual practice and clinical care, our study found that, in the format as delivered in this trial, there was no impact on diagnosis or clinical outcomes.https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.14090?af=
An item-level systematic review of the presentation of ADHD in females
No full textPrevious studies examining sex differences in attention deficit hyperactivity disorder (ADHD) have primarily examined total or subscale scores. This systematic review aimed to examine which symptoms contribute to the female presentation of ADHD at an item-level. Six research literature databases were searched for studies comparing ADHD symptoms and their impact at an item-level in females with ADHD compared with: 1) males with ADHD and 2) females without ADHD. Thirteen studies were included. In childhood, females were more likely to display the symptoms 'fails to sustain attention in tasks' and 'often easily distracted', whereas males were more likely to display the symptoms 'often fidgets', 'difficulty remaining seated when required', 'runs/climbs in situations when inappropriate', 'always on the go', 'often noisy in playing', 'difficulty waiting turn', 'often blurts out answers' and 'often interrupts others'. In adulthood, females were more likely to endorse the symptoms 'easily distracted', 'difficulty organising tasks', 'blurts out answers' and 'talks excessively', as well as to report mind wandering and adverse home impacts. Females with ADHD differ in their symptom profile to males with ADHD, highlighting the need for future research to identify and characterise symptoms typical of female ADHD.https://www.sciencedirect.com/science/article/pii/S0149763425000648?via%3Dihu
Navigating the medical journey: Insights into medical students' psychological wellbeing, coping, and personality
Get PDF© 2025 Hawsawi et al. This is an
open access article distributed under the terms
of the Creative Commons Attribution License,
which permits unrestricted use, distribution,
and reproduction in any medium, provided the
original author and source are credited.BACKGROUND AND AIMS: In recent years, increased awareness of the psychological wellbeing of healthcare professionals and students has become a pressing public health issue affecting care delivery. Medical students undergo rigorous training programs that can affect their psychological wellbeing. Despite increased awareness of mental health issues among medical students, research often focuses on negative aspects, overlooking potential positive contributors to wellbeing. This study aims to explore both negative and positive factors influencing medical students' psychological wellbeing, considering coping strategies and personality traits to inform targeted support measures for diverse student needs. METHODS: A mixed-methods approach was employed to investigate medical students' psychological wellbeing, coping strategies, and personality traits. Quantitative data was gathered via self-report questionnaires and analysed using regression models. Additionally, qualitative insights were obtained from semi-structured interviews and analysed thematically to capture students' perceptions and experiences. RESULTS: The analysis revealed moderate to high levels of stress, anxiety, and depression among medical students, along with decreased life satisfaction. Regression analysis showed that problem-focused coping positively impacted medical students' psychological wellbeing, whereas emotion-focused and avoidance coping showed less favourable effects. Notably, problem-focused coping partially mediated the relationship between stress and depression. Furthermore, personality traits, particularly agreeableness and conscientiousness, played a pivotal role in shaping medical students' coping strategies and mental health outcomes. Based on thematic analysis, codes gave rise to three overarching themes and corresponding subthemes. CONCLUSIONS: The study underscores the significance of addressing both positive and negative factors impacting medical students' wellbeing and highlights the need for tailored support considering individual personality traits that influence coping strategies and mental health. It also identifies challenges within medical education, emphasising the necessity for stress management programs, mental health support, and curricula promoting problem-solving skills. Prioritising medical students' wellbeing may not only foster good mental health among future professionals but may also enhance future healthcare quality.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.031839
Improving collateral history taking in the geriatric population.
No full textIntroduction The geriatric population has a high incidence of dementia, delirium and frailty meaning often these patients cannot give comprehensive histories themselves. We are left with missing pieces of the puzzle; we might not know their ‘normal’ and frequently ask: ‘Are they always like this?’ A collateral history becomes a valuable tool, contributing to a Comprehensive Geriatric Assessment and assisting the whole MDT to make informed decisions for patient-centred care. The primary aim of this project was to improve the quality of collateral histories taken for patients admitted to the geriatric wards, with content measured against 8 domains. A secondary aim was to encourage timely collateral histories within 48 hours of admission to the ward. Method Using PDSA methodology, collateral histories were analysed before and after implementation of a poster and teaching session. Results At baseline each domain was covered a mean of 40.5% of the time (range 9%—81%). Following intervention this increased by 22% to 62.5% (range 18%—89%), demonstrating a significant improvement (paired t-test, P < 0.05). It was already common practice to take collateral histories within 48 hours of admission to the ward (91%) which was sustained post-intervention (88%). Conclusion Use of a poster as a prompt, and delivering teaching, led to more thorough collateral histories. This suggests two barriers are knowing what to ask and perceived importance, elements which could be integrated into early postgraduate education. The impact on patient care has the potential to be significant and multidimensional but further work would be needed to understand this.https://academic.oup.com/ageing/article-abstract/54/Supplement_1/afae277.052/7985005?login=tru
Improving the integration of care for trans adults: ICTA a mixed-methods study
Get PDFThis article relates to a research study that included patients or members of the workforce as study participants from GP practices in Nottingham and Nottinghamshire.Background: This research concerns improving the National Health Service health services trans adults need. These include the national specialist Gender Identity Clinics that support people making a medical transition. Not all trans people need to make a medical transition, and transition can take many different paths. Waits to be seen by Gender Identity Clinics are, however, several years long, and there may be significant problems of co-ordination between different aspects of transition-related care, and between transition-related care and general health care. Objectives: The main objectives were to understand which factors make services more or less accessible and acceptable to the variety of trans adults and how initiatives for providing more person-centred and integrated care can be successfully implemented and further improved. Design, data sources and participants: An online and paper screening survey was used to gather data on demographics and service use of trans people across the United Kingdom, with 2056 responses. Researchers used survey data to construct five purposive subsamples for individual qualitative interviews, identifying groups of people more likely to experience social exclusion or stigma. There were 65 online interviews. In addition, 23 trans Black people and people of colour attended focus groups. Results: The following undermine person-centred co-ordinated care and can lead to experiences of harm: • lack of respectful treatment of trans people by general practitioner practices; • inadequate funding of services; • lack of support during waiting; • the extended and challenging nature of Gender Identity Clinic diagnostic assessments, sometimes experienced as adversarial; • breakdowns in collaboration between Gender Identity Clinics and general practitioner practices over hormone therapy; • lack of National Health Service psychological support for trans people
Sex-specific fall trajectories and associated self-reported risk factors: A prospective analysis of the 3-year 5-country DO-HEALTH trial
Get PDFOBJECTIVE: Few studies have explored specific trajectories or patterns of falls over time in older adults, and the role of sex and self-reported risk factors for these trajectories were overlooked. This study aimed to identify sex-specific fall trajectories over 3 years and the self-reported risk factors associated with each trajectory in European older adults., DESIGN: Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial., SETTING AND PARTICIPANTS: Multicenter trial conducted in 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without major health events in the 5 years prior to enrollment, with sufficient mobility and good cognitive status., METHODS: Falls were recorded prospectively via phone calls and in-person assessments every 3 months over 3 years of follow-up. Group-based trajectory modeling was used to identify sex-specific trajectories based on the number of falls experienced over the follow-up, and penalized logistic regression models identified the self-reported risk factors most associated with each trajectory., RESULTS: A total of 1958 participants were included in this analysis (mean age: 74.9 years, 61.7% women). We identified a "lower fall trajectory" and a "higher fall trajectory" among women and a "lower fall trajectory" and an "increasing fall trajectory" among men. In women, living alone was the only self-reported risk factor associated with the higher fall trajectory. In men, living alone (marginal), as well as reporting fatigue, pain or discomfort, mobility issues, and higher self-rated health, were significantly associated with experiencing the increasing fall trajectory., CONCLUSIONS AND IMPLICATIONS: This study provides a comprehensive assessment of falls over 3 years, highlighting differences in fall patterns and associated self-reported risk factors between men and women. These findings may offer valuable insights for developing sex-specific fall risk prediction models and targeted fall prevention strategies. Copyright © 2025. Published by Elsevier Inc.https://doi.org/10.1016/j.jamda.2025.10554