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A systematic environmental intervention, nidotherapy, given to whole communities : protocol for a randomised stepped-wedge trial
Get PDF© The Author(s), 2025. Published by Cambridge University Press
on behalf of Royal College of Psychiatrists. This is an Open
Access article, distributed under the terms of the Creative
Commons Attribution licence (https://creativecommons.org/
licenses/by/4.0/), which permits unrestricted re-use, distri bution and reproduction, provided the original article is
properly citedBACKGROUND: Environmental changes can be positive in mental illness. Systematic, planned and guided environmental change in all its aspects is called nidotherapy. It has shown some benefit but has not been extended to whole communities. AIMS: A cluster-randomised step-wedge trial is planned in six village communities in Nottinghamshire, England, covering an adult population of 400. METHOD: Adults in six villages will be offered a full personal environmental assessment followed by agreed change in different 3-month periods over the course of 1 year. All six villages have populations between 51 and 100 residents and are similar demographically. Assessments of mental health, personality status, social function, quality of life and environment satisfaction will be made. After the initial baseline period of 3 months, two villages will be randomised to nidotherapy for 3 months, a further two at 6 months and the last two at 9 months. RESULTS: The primary outcome will be change in social function; secondary outcomes include health-related quality of life, anxiety and depressive symptoms, personality status, costs of nidotherapy and life satisfaction. Adverse events will also be recorded. The analysis will be carried out using a multimodal statistical approach examining (a) the change in scores of the primary outcome (social function); (b) change in scores of all secondary outcomes, including costs; and (c) changes in environmental satisfaction. CONCLUSIONS: The findings of this study should help to determine whether nidotherapy has a place in the early detection and treatment of mental pathology.https://www.cambridge.org/core/journals/bjpsych-open/article/systematic-environmental-intervention-nidotherapy-given-to-whole-communities-protocol-for-a-randomised-steppedwedge-trial/A6963C02A29D5602CAF99BD19FD40A4
Use of a violence risk prediction tool (Oxford Mental Illness and Violence) in early intervention in psychosis services : mixed methods study of acceptability, feasibility and clinical role
Get PDF© The Author(s), 2025. Published by Cambridge University Press
on behalf of Royal College of Psychiatrists. This is an Open
Access article, distributed under the terms of the Creative
Commons Attribution licence (https://creativecommons.org/lice
nses/by/4.0/), which permits unrestricted re-use, distribution
and reproduction, provided the original article is properly citedBackgroundScalable assessment tools for precision psychiatry are of increasing clinical interest. One clinical risk assessment that might be improved by such approaches is assessment of violence perpetration risk. This is an important adverse outcome to reduce for some people presenting to services for first-episode psychosis. A prediction tool (Oxford Mental Illness and Violence (OxMIV)) has been externally validated in these services, but clinical acceptability and role need to be examined and developed.AimsThis study aimed to understand clinical use of the OxMIV tool to support violence risk management in early intervention in psychosis services in terms of acceptability to clinicians, patients and carers, practical feasibility, perceived utility, impact and role.MethodA mixed methods approach integrated quantitative data on utility and patterns of use of the OxMIV tool over 12 months in two services with qualitative data from interviews of 20 clinicians and 12 patients and carers.ResultsThe OxMIV tool was used 141 times, mostly in new assessments. Required information was available, with only family history items scored unknown to any notable degree. The OxMIV tool was deemed helpful by clinicians in most cases, especially if there were previous risk concerns. It was acceptable practically, and broadly for the service, for which its concordance with clinical judgement was important. Patients and carers thought it could improve openness. There was some limited impact on plans for clinical support.ConclusionsThe OxMIV tool met an identified clinical need to support clinical assessment for violence risk. Linkage to intervention pathways is a research priority.https://www.cambridge.org/core/product/E443A2DCD6AB7D16DFEA088B9BE1CA3
“Why shouldn’t I expect a lot from life?” – a qualitative study of what facilitates long-term recovery in first-episode psychosis
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
in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Qualitative research frequently characterises recovery, but more knowledge on subjective experiences of facilitators of long-term recovery in psychosis is needed. This interview study aimed to explore what people with first-episode psychosis (FEP) highlight as important for their long-term recovery.https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-06681-
"You like to be in control of your own destiny to a degree, don't you?" : conscientious autonomy and planning for future care with dementia
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 in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will 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: We explored people with dementia and their family carers' experiences of future care planning, guided by Kukla's model of conscientious autonomy. This relational autonomy concept focuses on the alignment of self-managed health-care practices with people's authentic goals and values. It involves people adopting recommended practices for their own authentic reasons, questioning them where necessary, and being supported by the health and care system to understand their rationale and implement them effectively. METHODS: In-depth interviews were conducted with 16 people recently diagnosed with dementia and 31 family carers, purposively and selectively sampled from a large research cohort on the basis of their 'conscientiousness,' using the indicator of already having had informal family conversations about future care. Data were analysed thematically using NVivo software and methods informed by interpretive grounded theory. FINDINGS: Participants sought to feel secure by following recommended practices, manage uncertainty, avoid crises, share burdens within families, and avoid poor end-of-life experiences. However, support was often lacking. Many were unable to speak with specialists and described limited conversations with GPs, leaving them with unaddressed questions. Some described feelings of abandonment. Disease progression was commonly poorly explained, with some participants later encountering information they found confronting. Carers who continued researching the condition felt responsible but under-resourced for discussing disease progression with their relative and believed this should be undertaken by a professional. Formal processes-e.g. Lasting Power of Attorney (LPAs), advance care planning, Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) could prompt informal discussions but gaining an overview was difficult, with confusion about how they would be utilised, what information to include and apparent overlap between processes. Misunderstandings about medical and end-of-life decision-making were commonplace. CONCLUSION: If even those who are most conscientious about planning for future care struggle to access adequate support, others likely face greater challenges. Clearer communication, at an individual and public level, about disease progression, the practical challenges of medical and end-of-life decision-making, and palliative care options is urgently needed. Early group education sessions and communication strategies that engage with existing lay concepts and public discourse are likely to be helpful. Formal care planning processes should be clearer, more streamlined, and better aligned with the practical goals of people with dementia and their family carers.https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-025-01782-
Musculoskeletal trauma readmissions and reoperations at a level 3 trauma unit in the UK
Get PDFAbstract: Background This study explores patterns of readmissions to a trauma service in the United Kingdom (UK), where expansion of the national trauma database to include all levels of trauma unit has been underway since early in 2024 and is in the pilot phase of redevelopment. Patterns of readmissions have not been clearly defined in the UK especially for level 3 units and these can proactively be managed by institutions if recognised. Early signposting of those at risk may avoid prolonged treatment and is an opportunity to enhance patient care and recovery within the UK but also further afield. The 5535 readmissions over the last 16 years presenting to the level three trauma unit were identified from the 24, 162 presentations kept prospectively on a local trauma database. Patients were identified as having further injuries, staged operations, and complications of elective and trauma care. Descriptive statistics and univariate analysis were examined to look at factors that predict readmission and the type of cases affected with any modifications to the care pathway to improve care. Results The proportion of cases admitted once was 72.5 %, 5 % further injury in an unrelated area, 10 % had staged care and 12.5 % had complications. In those that presented with complications of care 34 % had the index operation in another hospital and 46 % were in patients who had an elective operation, mainly arthroplasty surgery. Osteoporotic refracture accounted for 15 % of the readmissions. Only 491 trauma cases (2 % of the total) had a complication of care. Conclusion Whilst improved surgical delivery and aftercare in trauma cases maybe important to prevent readmission and improve the patient's journey, it also appears equal consideration is needed in prevention of reinjury, improved definitive care rates through resource development in trauma care and enhanced elective aftercare pathways to reduce the readmissions rates into the trauma service within the UK
An Exploration of Online Positive Feedback in Relation to Mental Health Nursing Practice
Get PDFThis 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.
© 2025 The Author(s). International Journal of Mental Health Nursing published by John Wiley & Sons Australia, LtdWeb-based databases of service user feedback have become an important resource for the task of understanding the quality of healthcare provision, both in the UK and internationally. This research explores positive feedback submitted to the Care Opinion website (https://www.careopinion.org.uk/), some of which can provide insights into effective mental health nurse practices. An iterative search was undertaken using the Care Opinion website on 7 March 2025. A set of tags which frequently identified effective mental health nursing practices was identified, and then 51 items of feedback were taken forward for full analysis. The data was then analysed in relation to the deductively selected domains of tone, form, and intent. These were identified in a typology produced by a previous study of 200 positive feedback items across multiple sources. In relation to tone, most pieces of feedback were entirely positive with a small number being mixed. The intent of the feedback was often to express gratitude but also functioned to emphasise change and contrast the helpfulness of certain staff or organisations against others which were experienced as less helpful. A typology of form was established, comprised of (1) Narratives of being there; (2) Narratives of listening and being heard; Narratives of therapeutic relationships; and Narratives of recovery. Positive feedback can provide a valuable insight into the experiences of service users. This research provides proof of concept evidence that knowledge can be gained about the impact of mental health nursing through the analysis of online feedback gathered through websites such as Care Opinion.https://onlinelibrary.wiley.com/doi/10.1111/inm.7011
Can an ECG performed during emergency department triage and interpreted as normal by computer analysis safely wait for clinician review until the time of patient assessment? A pilot study.
No full textINTRODUCTION: Electrocardiograms (ECGs) are frequently performed during patient triage in Emergency Departments (EDs). Emergency Physicians (EPs) are interrupted during other tasks to review ECGs. Critics believe this practice could lead to distraction with consequent medical error and decision fatigue. ECGs can be interpreted by computer software at the time of capture; some evidence exists to suggest that an ECG performed during ED triage with an immediate computer interpretation (ICI) of 'normal' will seldom contain information necessitating a change to triage management. MATERIAL AND METHODS: All ED triage ECGs performed in the Royal Derby Hospital between 13th July 2017 and 12th July 2018 in patients without chest pain and with an ICI of 'normal' were identified through a database search. Forty were randomly selected and reviewed by two EPs (blinded to patient details, ICI and outcome) who were asked to identify those that required a change to triage management.RESULTS: The study processes were feasible. At least one of the two EP reviewers felt that a change to triage management was required in 48% of cases (e.g. "review patient", "obtain blood gas", "review old ECGs"); they agreed on the need for change of management in 13% of cases. An ICI of normal had a NPV of 53% (95% CI 37-67%) for the need for a change to triage management based upon ECG findings. Inter-observer agreement was poor (kappa = 0.17). CONCLUSIONS: Based on these results, ED triage ECGs should still be presented to EPs for immediate review regardless of the ICI. Inter-observer agreement between EPs was poor. Further research is required to link triage ECG interpretation, need for intervention and patient outcome
Evaluating the effectiveness of Improving Access to Psychological Therapies (IAPT) ‘Step 2’ interventions in addressing older people’s psychological distress: A service evaluation of one IAPT Service in the East Midlands
No full textDespite evidence that Improving Access to Psychological Therapies (IAPT; now NHS Talking Therapies) interventions can be effective for older people, ageism and stigma appear to block access. This research evaluated ‘Step 2’ clinical outcomes for older people and explored ‘drop out’ and ‘stepped up’ rates in one IAPT service. Outcome measure data from 226 people who completed a Step 2 intervention in 2022 were analysed. Significance of changes of low mood and anxiety scores, and any correlation between age and degree of change were explored. Results showed Step 2 clients were significantly older than those in Step 3. For Step 2 interventions, anxiety and low mood scores were significantly lower post-therapy than pre-therapy, with large pre- to post-effect sizes. Older people showed a similar degree of change regardless of age. Disparities in access were suggested for the oldest older people, older clients from racialised backgrounds, those identifying as lesbian, gay, or bisexual, and males, with all appearing marginally under-represented in the service’s caseload. Step 2 interventions were deemed not appropriate for a significant minority. Overall, Step 2 interventions were effective for many older people, suggesting services should be promoting IAPT for adult clients, regardless of age. Future research could explore possible barriers for the oldest older people and minoritised clients, and whether alternative outcome measures may be beneficial.https://explore.bps.org.uk/content/bpsfpop/1/170/6
Screening of the risk of eating disorders among medical students in the MENA region and its associated factors: a multinational cross-sectional study
No full textBackground Eating disorders (EDs) are a group of mental diseases marked by disrupted eating behaviors, and are associated with several factors. Medical students are highly exposed to this mental disorder with a prevalence of 17.35% in 2022. Objective To evaluate the risk of EDs and its associated factors among medical students in the Middle East and North Africa (MENA) region. Methods A web-based cross-sectional study was conducted among medical students in the MENA region during the months of June and July 2024. The primary data collection instrument was a comprehensive questionnaire that contained the Eating Attitudes Test (EAT-26) and sociodemographic and clinical features and designed using Google Forms and distributed via social media platforms. Results The total number of participants was 5061. The mean age in our population was 22.58 ± 3.27. Our population's average EAT-26 score was 13.87 ± 10.7, with ranges varying from 0 to 72. Based on their EAT-26 scores being 20 or above, 1254 people (24.8%) were deemed to be at risk of EDs. Among the participants, 8% were underweight. The multivariable logistic regression model revealed several eating disorder risk factors such as T1DM, schizophrenia, autism, female gender, IBD, and daily exposure to thin body ideal. Regular sports practice and weight satisfaction were protective factors. Conclusion There exists a higher prevalence of individuals at risk for the development of EDs in the MENA region especially females, students with comorbidities, and those having conflictual relationships with their parents. Regular sports practice and weight satisfaction are protective factors.https://onlinelibrary.wiley.com/doi/10.1002/brb3.7041
Understanding patient pathways to Mother and Baby Units : a longitudinal retrospective service evaluation in the UK
No full textCopyright © 2025 Jovanović et al. This work was produced by
Jovanović et al. under the terms of a commissioning contract
issued by the Secretary of State for Health and Social Care. This
is an Open Access publication distributed under the terms of the
Creative Commons Attribution CC BY 4.0 licence, which permits
unrestricted use, distribution, reproduction and adaptation in
any medium and for any purpose provided that it is properly
attributed. See: https://creativecommons.org/licenses/by/4.0/.
For attribution the title, original author(s), the publication source
– NIHR Journals Library, and the DOI of the publication must
be citedBACKGROUND: Mother and Baby Units are specialised psychiatric facilities for women during and after pregnancy. In the United Kingdom, efforts have been made to expand the Mother and Baby Unit availability and establish care guidelines. However, the accessibility of these services for ethnic minority women remains relatively unexplored despite well-documented disparities. AIMS: To explore patient pathways to Mother and Baby Units in three UK localities, with a focus on variations in pathways between services and among ethnic groups. METHODS: This is a three-site, longitudinal retrospective service evaluation conducted in Birmingham, London and Nottingham during a 12-month period (1 January-31 December 2019). Electronic records were accessed to extract data on the type of admission, the referral process and the type of pathway (simple or complex). The simple pathway entailed contact with one clinician/service prior to admission to the Mother and Baby Unit, while the complex pathway involved interactions with two or more clinicians/services before Mother and Baby Unit admission. Data were collected using the adapted World Health Organization Encounter form and were analysed using uni- and multivariable analyses. RESULTS: Electronic records from 198 patients were analysed, with participants distributed proportionally across three sites: Birmingham (n = 70, 35.4%), London (n = 62, 31.3%) and Nottingham (n = 66, 33.3%). All Mother and Baby Units were nationally commissioned and received referrals from across England. Most patients were in the post partum period, admitted for the first time through emergency, informal and complex pathways. The average length of admission was 6 weeks. Significant differences in admission characteristics were observed between services. Patients of Asian ethnicity had more emergency admissions compared to those of Black and White ethnicities. Ethnicity was the only significant factor associated with the simple/complex care pathway. After controlling for pathway-level and patient-level factors, Black patients were 6.24 times less likely to experience a complex care pathway than White patients. No evidence was found that patients from the Black ethnic background are detained more often than White patients. LIMITATIONS: The heterogeneity among categorised ethnic groups, data extracted solely from electronic records without validation through patients' personal accounts of their care pathways, unanalysed declined referrals and the utilisation of pre-COVID-19 pandemic data. The ethnic composition of the study sample matched that of the UK maternity population in the Nottingham subsample, but Black and Asian populations were over-represented in the Birmingham and London subsamples. CONCLUSION: The study provides valuable insights into patient journeys to Mother and Baby Units, highlighting significant differences between services. It also emphasises the role of ethnicity in care pathways. For example, Black patients were less likely to encounter more than two services before Mother and Baby Unit admission, suggesting either more direct access to specialist care or insufficient community-based interventions. This dual interpretation calls for future research to explore whether pathway differences among ethnic groups result from optimal clinical decision-making or gaps in care provision. FUTURE WORK: Should further examine the role of ethnicity in shaping care pathways; explore the link between care pathway types and treatment outcomes; investigate if simple or complex pathways result from optimal clinical decisions or gaps in the healthcare system and explore admissions to general wards versus Mother and Baby Units and transitions between these units. FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14. Mother and Baby Units are special psychiatric facilities designed to provide inpatient care for women dealing with serious mental health problems during pregnancy or after giving birth. In recent years, there have been attempts to improve these services. However, we still do not have much information about how patients get to these units. In this study, we wanted to learn how women reach Mother and Baby Units in the United Kingdom. We studied three different locations: Birmingham, London and Nottingham. We reviewed the electronic records of 198 women who used Mother and Baby Units in these locations during 2019. Here is what we found: Most patients were admitted to the Mother and Baby Unit after giving birth, and they were usually admitted in an emergency. On average, they stayed in the Unit for about 6 weeks. We found differences between services in how patients were admitted, how long they stayed, the reasons they were admitted and how long it took them to reach the Unit. When we looked at what affects a patient’s journey to the Mother and Baby Unit, we found that ethnicity played an important role. For example, more Asian women were admitted in emergencies, and black women went through fewer services before reaching the Unit. The study sheds light on how patients access Mother and Baby Units, showing that the process varies by location. It also found that ethnicity plays a role. For example, black patients had fewer steps to reach the Unit compared to White British patients. This could mean direct access to care or a lack of community-based support. More research is needed to determine whether this is due to clinical decisions or gaps in the care system. enghttps://www.journalslibrary.nihr.ac.uk/hsdr/published-articles/GDVS242