European Resuscitation Council Guidelines for Resuscitation.

Interpreting qualitative data

/pdf/treating-tb-in-people-with-hiv-45po9049i7.pdf

Treating TB in people with HIV

The majority of people experiencing mental-health problems do not seek help, and the stigma of mental illness is considered a major barrier to seeking appropriate treatment. More targeted interventions (e.g. at the workplace) seem to be a promising and necessary supplement to public campaigns, but little is known about their effectiveness. The aim of this systematic review is to provide an overview of the evidence on the effectiveness of interventions targeting the stigma of mental illness at the workplace. Sixteen studies were included after the literature review. The effectiveness of anti-stigma interventions at the workplace was assessed by examining changes in: (1) knowledge of mental disorders and their treatment and recognition of signs/symptoms of mental illness, (2) attitudes towards people with mental-health problems, and (3) supportive behavior. The results indicate that anti-stigma interventions at the workplace can lead to improved employee knowledge and supportive behavior towards people with mental-health problems. The effects of interventions on employees’ attitudes were mixed, but generally positive. The quality of evidence varied across studies. This highlights the need for more rigorous, higher-quality evaluations conducted with more diverse samples of the working population. Future research should explore to what extent changes in employees’ knowledge, attitudes, and supportive behavior lead to affected individuals seeking help earlier. Such investigations are likely to inform important stakeholders about the potential benefits of current workplace anti-stigma interventions and provide guidance for the development and implementation of effective future interventions.

/pdf/the-effectiveness-of-interventions-targeting-the-stigma-of-yemvbti3h4.pdf

The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review

Marienthal: The Sociography of an Unemployed Community

‘There are few things we should keenly desire if we really knew what we wanted.’ Francois de la Rochefoucauld (French writer 1613–1680) Social prescribing is about expanding the range of options available to GP and patient as they grapple with a problem. Where that problem has its origins in socioeconomic deprivation or long-term psychosocial issues, it is easy for both patient and GP to feel overwhelmed and reluctant to open what could turn out to be a can of worms. Settling for a short-term medical fix may be pragmatic but can easily become a conspiracy of silence which confirms the underlying sense of defeat. Can or should we try to do more during the precious minutes of a GP consultation?

Where there are psychosocial issues GPs do suggest social avenues, such as visiting a Citizens Advice Bureau for financial problems, or a dance class for exercise and loneliness, but without a supportive framework this tends to be a token action. The big picture difficulty with leaving underlying psychosocial problems largely hidden in the consulting room is the medicalisation of society's ills. This ranges from using antidepressants for the misery of a difficult life, to the complex pharmaceutical regimes prescribed to patients with obesity and type 2 diabetes. This sort of medicalisation may help immediate problems (including driving the economy through jobs in the healthcare industries) but it is not enough if our society is to have a sustainable future.

Another way of looking at this is in terms of choice. The consumerist type of choice of provider beloved of the government, is what Canadian philosopher Charles Taylor calls ‘weak evaluation’.1 By this he means a utilitarian ‘weighing-up’ of generally short-term consequences of a choice. These choices represent ‘second-order desires’, such as to feel more cheerful, or to relieve a …

/pdf/social-prescribing-in-general-practice-adding-meaning-to-3kgp1soxl3.pdf

Social prescribing in general practice: adding meaning to medicine

/pdf/investigation-into-the-feasibility-of-a-social-prescribing-29dfaq0cby.pdf

Investigation into the feasibility of a social prescribing service in primary care:a pilot project

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a common developmental disorder, often persisting into adulthood. Whilst medication is first-line treatment for ADHD, there is a need for evidence-based non-pharmacological treatment options for adults with ADHD who are either still experiencing significant symptoms or for those who have made the informed choice not to start medication.MethodsWe systematically searched PsycINFO, MEDLINE (Ovid), EMBASE, CINAHL and CENTRAL for randomised controlled trials of non-pharmacological treatments for ADHD in adults. After screening of titles and abstracts, full text articles were reviewed, data extracted and bias assessed using a study proforma.ResultsThere were 32 eligible studies with the largest number of studies assessing cognitive behavioural therapy (CBT). CBT consisted of either group, internet or individual therapy.ConclusionsThe majority found an improvement in ADHD symptoms with CBT treatment. Additionally, mindfulness and cognitive remediation have evidence as effective interventions for the core symptoms of ADHD and there is evidence for the use of group dialectical behavioural therapy and hypnotherapy. However, evidence for these is weaker due to small numbers of participants and limitations due to the lack of suitable control conditions, and a high risk of bias.

/pdf/non-pharmacological-interventions-for-adult-adhd-a-3oe4m8zk0l.pdf

Non-pharmacological interventions for adult ADHD: a systematic review.

There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA. The aim of this research to explore the influences on UK Emergency Medical Services provider decision-making when commencing and ceasing resuscitation attempts in OHCA. Four focus groups were convened with 16 clinically active EMS providers. Four case vignettes were discussed to explore decision-making within the focus groups. Thematic analysis was used to analyse transcripts. This research found that there are three stages in the decision-making process when EMS providers consider whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These influences are: factual information available to the EMS provider; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs. An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in clinical practice could inform the development of more effective clinical guidelines, education and clinical decision support in OHCA. These changes have the potential to lead to greater consistency. and EMS provider confidence, with the potential for improved patient outcome from OHCA.

/pdf/emergency-medical-service-provider-decision-making-in-out-of-34h42vquiv.pdf

Emergency medical service provider decision-making in out of hospital cardiac arrest: an exploratory study.

Nursing handover has traditionally been performed orally and apart from patients. Results of an audit undertaken at the Royal United Hospital, Bath, suggest that record-keeping standards there were poor. To improve these standards, a method of 'reading handover', in which the main method of communication between nurses on different shifts is written rather than oral, was introduced on one ward. This article discusses the results of this pilot study and suggests that the new handover method has improved standards of record keeping.

Janet Brandling

Papers

Social prescribing in general practice: adding meaning to medicine

Investigation into the feasibility of a social prescribing service in primary care:a pilot project

Non-pharmacological interventions for adult ADHD: a systematic review.

Emergency medical service provider decision-making in out of hospital cardiac arrest: an exploratory study.

Improved record-keeping with reading handovers.