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Enhancing depression management in people with learning disabilities
No full textSupporting people with learning disabilities who have depression is a complex area of nursing practice. Studies have highlighted concerns about the overuse of antipsychotics and antidepressants in people with learning disabilities. Learning disability nurses have the necessary skills and expertise to address the factors contributing to the overprescribing of psychotropics to people with learning disabilities. Diagnosing depression in a person with a learning disability often requires specialist skills and experience, as depression may manifest in atypical ways and its signs and symptoms may not be easily recognised. A successful management strategy will need to be tailored to the person’s specific needs. Beyond emotional support, management options include antidepressants and psychological therapies. Learning disability nurses have an important role in providing optimal care for people with learning disabilities who have depression by communicating the benefits and risks of medicines to service users, involving their families and carers, and coordinating care as part of the multidisciplinary team.https://journals.rcni.com/learning-disability-practice/cpd/enhancing-depression-management-in-people-with-learning-disabilities-ldp.2025.e2281/ab
A quantitative investigation of inequalities in out-of-area admissions in child and adolescent mental health services
No full textBackgroundUnderstanding inequalities in mental health care is vital for the development of more equitable services. This study investigates inequalities in out-of-area admissions to general adolescent units, a controversial but necessary part of Child and Adolescent Mental Health care in England.MethodsAnonymised data on 279 out-of-area (at-distance or out-of-region) admissions to general adolescent units in England between February 2021-2022 were analysed for an association between demographics (age, sex, ethnicity) or clinical characteristics (diagnosis and risks) and admission characteristics (7+ day wait for a bed, distance from home, admission out-of-region, compulsory admission and length of stay >6 months).ResultsNo association was found between demographic characteristics and admission characteristics. Personality disorder was the only diagnosis associated with admission greater distance from home. Young people with personality disorder or neurodevelopmental disorder were more likely to be admitted compulsorily (OR = 8.89 and OR = 1.93 respectively). Those with suicide risk were more likely to be admitted non-compulsorily (OR = 2.06) but more likely to be admitted out-of-region (OR = 2.25).DiscussionWithin these data, the clinical presentation of the young person influenced their out-of-area admission characteristics. Young people with a diagnosis of personality disorder may be particularly likely to experience more negative aspects of out-of-area admission. Due to the number and uneven spread of specialist mental health beds throughout the country, young people may be admitted far-away from where they live (more than 50 miles from their home address or out of their local region). Previous research has shown inequalities in the care received by young people based on their demographics and diagnoses. This study looks at whether there is evidence of this unequal treatment based on demographics, diagnoses, and risks within a sample of young people admitted far-away from home. Statistical tests were used to look for whether there was evidence that the demographics (age, sex and ethnicity) or presentation (diagnoses or risks) of a young person were associated with negative aspects of an admission (having to wait for a week or more for a bed, longer distance from home, being admitted out-of-region, spending more than 6 months in hospital and having to be admitted against their will). The researchers found no links between demographics and negative aspects of the admission in this data. However, they found that young people with a diagnosis of a personality disorder were sent on average further away than those who did not have this diagnosis, they were also more likely to be admitted against their will. Young people with a neurodevelopmental disorder (autism spectrum disorder, attention-deficit hyperactive disorder or Tourette’s syndrome) were also more likely to be admitted against their will. Young people judged to be at high risk of suicide were more likely to be sent out-of-region and less likely to be admitted against their will. These findings do not show evidence of unequal treatment based upon demographics but potential inequalities due to diagnosis and risks. The reason for these differences may represent stigma against young people with certain diagnoses such as personality disorder. enghttps://journals.sagepub.com/doi/abs/10.1177/1359104525136647
Recovery-oriented psychiatry : oxymoron or catalyst for change?
No full textThis Personal View provides a normative and conceptual analysis of the intersection between the recovery movement and psychiatry. Although recovery emerged as a grassroots social justice movement emphasising empowerment and systemic change, psychiatry remains rooted in the medical paradigm. We aim to develop a nuanced conceptual framework that fosters academic debate and meaningful implementation, while avoiding superficial or tokenistic adoption of recovery principles. Our analysis explores the contrasting values, ontologies, and epistemologies of these perspectives, identifying points of tension and areas of compatibility. We examine and discuss integrative and non-integrative pluralistic approaches, and we conclude with actionable recommendations for transformation at different organisational levels.https://www.sciencedirect.com/science/article/abs/pii/S221503662500092
Assessment of the diabetic foot in inpatients
No full textDiabetic foot disease is a severe complication of diabetes, leading to significant morbidity and lower limb amputations. This review explores the pathophysiology of diabetic foot disease, highlighting the roles of peripheral neuropathy, peripheral arterial disease and immunosuppression in the development of foot ulcers and infections. Key intrinsic and extrinsic risk factors, including long-standing diabetes, poor glycaemic control, inappropriate footwear and trauma are discussed. The importance of comprehensive diabetic foot assessments using diagnostic tools such as the Ipswich Touch Test and Doppler studies is emphasised for early detection and management. Challenges such as delays in referral to specialist care, limited access to multidisciplinary foot teams, and staffing shortages are identified as critical barriers to effective care. The review builds upon extant literature by integrating the most recent evidence, including the 2023 guidelines from the International Working Group on the Diabetic Foot. It emphasises practical application, detailed referral pathways and multidisciplinary care strategies, offering updated tools and insights to improve clinical outcomes and address the often overlooked aspects within inpatient services. Future directions encompass advances in imaging, telemedicine and patient education, which may further optimise preventive and therapeutic strategies for diabetic foot disease.https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2024.034
Early versus late surgical stabilisation of unstable thoracolumbar spine fractures in adult polytrauma patients: A systematic review and meta-analysis
No full text© 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/bync-
nd/4.0/ ).Controversy remains with regards to the timing of surgical stabilisation of unstable thoracolumbar fractures in adult polytrauma patients. We aimed to compare early versus late fixation of thoracolumbar spine fractures focusing on length of hospital stay (HLOS), length of stay in ICU (ICULOS), respiratory complications, mortality, and long-term functional outcome measures. Electronic database search was conducted on PubMed, Cochrane, CENTRAL, and Embase spanning 1999 to 2023 using a developed search strategy. The time cut off used to distinguish between early and late stabilisation was 72 h from injury. Statistical analysis of primary outcome data was performed with Comprehensive Meta-analysis software using the standardised difference in means as the effect size index. 2082 articles were retrieved, eighty screened by full text and a final eleven studies comprising 3874 patients deemed eligible for inclusion in this review. The overall level of evidence of included studies was low with only one prospective cohort study. A subgroup meta-analysis using a random effects model showed that early fixation of unstable thoracolumbar spinal fractures leads to a statistically significant decrease in HLOS compared to late fixation with a mean effect size of -0.502. Early fixation was also associated with reduced ICULOS and respiratory complications. Early surgical stabilisation of unstable thoracolumbar spine fractures within 72h of injury is safe and associated with favorable short-term outcomes in adult polytrauma patients with unstable thoracolumbar spine fractures. Further high-level prospective studies are recommended to investigate whether the short-term gains shown can translate to superior long-term functional outcomes.https://www.sciencedirect.com/science/article/pii/S277263202500009
Case Study : the use of subcutaneous clonidine for pain relief in complex cancer pain
No full textPain is a common symptom in the terminal phase of a cancer patient, and the World Cancer Declaration sets a target for universally available pain control by 2025. Cancer pain can be complex to manage due to the different pathological mechanisms occurring, particularly as it advances and is progressively resisting current analgesia. This case report focuses on the use of clonidine in the palliative care setting, where opioid and non-opioid approaches to analgesia have not controlled the intensifying pain. Sharing this study aims to further the experience base of its utility in complex cancer pain management. The a2A-adrenergic receptor agonist, clonidine, is increasingly being recognised as an effective adjuvant medication for pain and agitation in patients in end-of-life care. This is due to its anti-nociceptive properties and non-opioid action. Evidence of its use in a palliative setting, and relevant pharmacokinetic safety profile, is limited. However, a recent retrospective study in the UK has shown it to be a promising drug due to being well tolerated and its symptomatic benefits. Clonidine was titrated in response to reported and observed pain behaviours, to serve as an adjuvant to opioids. It was noted that there was a significant decrease in opioid usage in correlation with an increased dosage of clonidine. Despite the complicating factor of COVID-19, the patient reported a clinical benefit of clonidine in terms of their pain and comfort. Review of the patient's integrated Palliative Care Outcome Scale indicated maintained scores with introduction of clonidine compared to prior use of opioids. This report highlights the positive clinical experience of the use of clonidine for complex cancer pain as a 'rescue' analgesia and a continuous subcutaneous infusion. Further high-level research to establish its role and efficacy in this field is recommended.https://spcare.bmj.com/content/15/Suppl_2/A70.
How can citizen science enhance mental health research quality : theory of change development
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employer(s)) 2025. Re-use
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Published by BMJ GroupObjective Public involvement in mental health research enhances research quality. The use of citizen science methods in mental health research has been described as a conclusion of a movement towards increased public involvement; however, this field is in its early stages of development. Our objective was to create a theory of change (ToC) for how citizen science can be used to enhance mental health research quality. Design Iterative consultation with the stakeholders of an existing citizen mental health science study, that is, change for citizen science to achieve co-production at scale (C-STACS: https://www.researchintorecovery.com/research/c-stacs/) Methods We co-developed a ToC through an iterative consultation with C-STACS stakeholders who were (a) representatives of mental health community organisations (n=10), individuals with public involvement experience (n=2) and researchers (n=5). In keeping with established ToC practice, entities were identified, including long-term impacts, outcomes needed to create an impact, stakeholder assumptions and indicators for tracking progress. Results A desired primary long-term impact of greater co-production of research was identified between researchers and members of the public, which would create a secondary impact of enhancing public capacity to engage in citizen mental health science. We proposed long-term outcomes needed to enable this impact: (1) greater co-production of research objectives and pathways between researcher and the public, (2) greater embedment of citizen mental health science into funder processes (eg, the creation of specific funding calls for citizen mental health science proposals, (3) greater clarity on the boundaries between citizen science and other participatory approaches (eg, so that there is not loss of impact due to conceptual confusion between these, (4) increased knowledge around effective frameworks to enable mass public participation and (5) greater availability of technology platforms, enabling safe and accessible engagement with citizen mental health science projects. Conclusion The proposed ToC is grounded in the C-STACS project, but intended to be broadly applicable. It allows the continued formation of a community of practice around citizen mental health science and should be reviewed, as greater knowledge is developed on how citizen mental health science creates change. Copyright © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.https://bmjopen.bmj.com/content/15/9/e09100
Reflections on using the power threat meaning framework on an acute inpatient male ward
No full textThis reflective piece examines the authors’ experiences of introducing the Power Threat Meaning Framework on a men’s acute inpatient ward aiming to promote more collaborative psychologically informed approaches to understanding distress Working within a system traditionally dominated by the medical model the authors consider how the Ptmf offered a shared language for understanding distress in ways that emphasised personal meaning power dynamics contextual factors. The paper reflects on the, opportunities challenges of applying the Ptmf in this setting, including tensions between psychological diagnostic, approaches the importance of relationship-building, curiosity cultural sensitivity. The authors also describe how the, Ptmf can inform trauma-aware practices help shift team discussions around, formulation care planning. The paper concludes with thoughts on the implications for clinical work, team collaboration broader application of the, PTMF.https://explore.bps.org.uk/content/bpscpf/1/391/15CTL
Web-Based interactive training for managers (Managing Minds at Work) to promote mental health at work : pilot feasibility cluster randomized controlled trial
Get PDF©Juliet Hassard, Holly Blake, Teixiera Mishael Dulal-Arthur, Alexandra Frost, Craig Bartle, Joanna Yarker, Fehmidah Munir,
Ben Vaughan, Guy Daly, Caroline Meyer, Sean Russell, Louise Thomson. Originally published in JMIR Mental Health
(https://mental.jmir.org), 02.09.2025. This is an open-access article distributed under the terms of the Creative Commons Attribution
License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic
information, a link to the original publication on https://mental.jmir.org/, as well as this copyright and license information must
be includedBACKGROUND: Line managers play a key role in preventing poor mental health but often lack necessary skills and knowledge. Existing interventions typically focus on mental health awareness rather than practical skills. The evidence-based Managing Minds at Work (MMW) web-based training program was developed to address this gap by enhancing line managers' confidence and competence in prevention. OBJECTIVE: This study piloted the MMW intervention to assess its feasibility. Objectives included evaluating (1) uptake potential across small, medium, and large companies; (2) perceived suitability and effectiveness of the intervention; and (3) feasibility of outcome data collection methods. METHODS: We conducted a 2-arm pilot cluster randomized controlled trial of a self-guided, web-based training intervention for line managers. Twenty-four organizations were randomly assigned to the MMW intervention or a 3-month waitlist. A total of 224 line managers completed baseline measures (intervention: n=141, 62.9%; control: n=83, 37.1%), along with 112 of their direct reports (intervention: n=74, 66.1%; control: n=38, 33.9%). Follow-up data were collected at 3 and 6 months. Semistructured interviews with line managers and stakeholders (n=20) explored experiences with the study and intervention, and qualitative data were analyzed thematically. Line managers also completed feedback forms after each of the 5 MMW modules. RESULTS: The recruitment of organizations and line managers exceeded targets, and retention rates of line managers were good at 3 months (161/224, 71.9%) but not at the 6-month follow-up (55/224, 24.6%). Feedback on the intervention was very positive, indicating that line managers and organizational stakeholders found the intervention acceptable, usable, and useful. We observed significant improvements with moderate to large effect sizes for all trial outcomes for line managers in the intervention arm from baseline to the 3-month follow-up. Line managers completed a variety of questionnaires, which showed increased scores for confidence in creating a mentally healthy workplace (intervention group: mean change 3.8, SD 3.2; control group: mean change 0.6, SD 3.2), mental health knowledge (intervention group: mean change 1.9, SD 3.0; control group: mean change 0.2, SD 2.9), psychological well-being (intervention group: mean change 3.6, SD 8.3; control group: mean change -0.7, SD 7.7), and mental health literacy at work (intervention group: mean change 11.8, SD 8.9; control group: mean change 0.8, SD 6.2). Collecting data from direct reports in both study arms was challenging, with results inconclusive regarding observed changes in trial outcomes. Time constraints and workload were commonly cited barriers to completion of the intervention. CONCLUSIONS: This pilot feasibility trial provides strong evidence for the usability and acceptability of the MMW digital training and the research design. MMW shows potential to improve line managers' confidence and competencies in promoting mental health. The study also identified key considerations for future large-scale implementation and evaluation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019.https://mental.jmir.org/2025/1/e7637
ColoRobotica: Structured training in robotic colorectal surgery
No full textThe adoption of robotic surgery has increased rapidly. The robotic surgery market is projected to reach $14 billion globally by 2026, with an increasing number of robotic platforms entering the market. Structured training remains an important issue in robotic colorectal surgery. ColoRobotica at the European School of Coloproctology, the European Society of Coloproctology, was established in 2018 to benchmark robotic colorectal training in Europe. A multidisciplinary team was formed, and a framework was established. Building the infrastructure of the programme took 2 years. A training pathway was designed to provide a structured training programme with quality assurance interventions embedded in the programme. The programme was launched in 2022. Preliminary results showed clinical outcomes of trainees are comparable to those of expert robotic surgeons. The model could serve as a template for both other scientific societies and different specialties to provide structured robotic surgical training