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Objective. The objective of this paper was to evaluate breakaway technique training with neuroscience nursing staff as a measure of increased confidence and safety in managing aggression. Methods. A quasi experimental design was used in a sample of neuroscience nursing staff (n=31), participating in 2×1h breakaway technique workshops. The workshops consisted of supervised skills training in safe breakaway techniques. A pre- and postintervention-matched questionnaire measuring confidence and safety around managing aggressive patients, and exposure to and confidence in dealing with breakaways, was self administered. Results. Statistically significant increases in confidence and safety in working with aggressive patients, and confidence levels for safe breakaways were reported. Qualitative comments demonstrated a desire for ongoing skills workshops. Conclusions. This study provides early evidence of the importance of incorporating breakaway training into existing training programs which aim to minimise and manage aggression and violence in generalist settings. What is known about the topic? Workplace violence is acknowledged internationally as a major occupational problem within healthcare and is reportedly increasing. The need for extensive training programs for healthcare staff is supported in the literature. What does this paper add? This would appear to be the first evaluation of breakaway training with a population of neuroscience nursing staff. Significant increases in confidence in managing aggression can be demonstrated following brief practical skills training. What are the implications for practitioners? This study provides early evidence for incorporating breakaway training into mandatory training programs for generalist health staff. Generalist health services may consider employing certified trainers to facilitate this specific skills training. [ABSTRACT FROM AUTHOR]

Background: The LiGHT trial (Laser-1st versus Drops-1st for Glaucoma and Ocular Hypertension Trial) is a multicentre randomised controlled trial of two treatment pathways for patients who are newly diagnosed with open-angle glaucoma (OAG) and ocular hypertension (OHT). The main hypothesis for the trial is that lowering intraocular pressure (IOP) with selective laser trabeculoplasty (SLT) as the primary treatment ('Laser-1st') leads to a better health-related quality of life than for those started on IOP-lowering drops as their primary treatment ('Medicine-1st') and that this is associated with reduced costs and improved tolerability of treatment. This paper describes the statistical analysis plan for the study.Methods/design: The LiGHT trial is an unmasked, multi-centre randomised controlled trial. A total of 718 patients (359 per arm) are being randomised to two groups: medicine-first or laser-first treatment. Outcomes are recorded at baseline and at 6-month intervals up to 36 months. The primary outcome measure is health-related quality of life (HRQL) at 36 months measured using the EQ-5D-5L. The main secondary outcome is the Glaucoma Utility Index. We plan to analyse the patient outcome data according to the group to which the patient was originally assigned. Methods of statistical analysis are described, including the handling of missing data, the covariates used in the adjusted analyses and the planned sensitivity analyses.Trial Registration: The trial was registered with the ISRCTN register on 23/07/2012, number ISRCTN32038223 . [ABSTRACT FROM AUTHOR]

The negative impacts of parental mental health problems on children and adolescents are well known, but the relationship between a child's depression and their parents' health is not so well understood. Being a carer/parent of someone with mental illness can be associated with negative outcomes for the caregiver. This paper reports the associations between the mental health of adolescents with major depression and their parents, before and after treatment of the adolescent's depression. Data were collected as part of the Adolescent Depression Antidepressants and Psychotherapy Trial, a randomised controlled trial of selective serotonin reuptake inhibitors with and without cognitive behaviour therapy in 208 clinic-recruited adolescents with major depression. The baseline severity of depression in the adolescent was significantly associated with both maternal and paternal mental health (as rated by the General Health Questionnaire). This effect was not confounded by other psychiatric symptoms. The degree of improvement in parental and child mental health was positively correlated across time. Our results support the hypothesis that there is a significant association between parental mental health and adolescent depressive symptoms. This study was not able to establish the direction of this association. In clinical practice, the findings demonstrate the importance of considering the mental health of the parents when treating depressed adolescents. [ABSTRACT FROM AUTHOR]

Primary objective: Operant conditioning interventions are effective in the management of post-acute ABI challenging behaviour. However, when this serves an avoidance or escape function, reinforcement approaches may be ineffective. In this paper the utility of a range of operant-derived ABI interventions is considered specifically with regard to behaviour whose prime function is avoidance or escape from rehabilitation activities. Methods and procedures: Efficacy of three operant interventions was determined by describing a single case study whose aggressive behaviour served an avoidance-escape function. Two interventions comprised variants of differential reinforcement: differential reinforcement of incompatible behaviour (DRI) and differential reinforcement of low rates of responding (DRL). The third intervention comprised situational time out (STO) and sustained verbal prompting. Main outcome: Despite reports of the efficacy of DRI and DRL, neither was beneficial in this case. However, STO and sustained verbal prompting proved highly effective in reducing aggression. Conclusions: Results are discussed in relation to two levels of explanation: function and cognition. Special emphasis is laid upon the extent to which interventions actively involve the patient and the degree of intrusiveness necessary for staff to implement therapeutic procedures. The case demonstrates how a scientifically-derived formulation regarding behaviour disorder can support multiple treatment options. [ABSTRACT FROM AUTHOR]

Background Insertion of an acupuncture needle into an acupuncture point typically generates a range of sensations called 'de qi'. Most acupuncturists are taught that obtaining de qi is important when treating patients with pain but this can be quite uncomfortable for patients. Objective This study assesses the importance of the strength of de qi, on the clinical outcome in osteoarthritic pain. Method This study was part of a larger randomised, single-blind, multifactorial trial involving three interventions: real acupuncture (RA), Streitberger needle (SN) and mock electrical stimulation for the treatment of patients with osteoarthritis (OA) of the hip and knee. Patients were treated twice a week for 4 weeks. The two outcomes relevant to this study were pain reduction assessed by visual analogue scale and the Park needling sensation questionnaire, both measured at completion of the study. Two arms of the trial were analysed (RA and SN). Reduction in pain was correlated against strength of de q¡ for both RA and SN. Those who felt de qi were compared with those who did not. Results 147 patients were recruited to the study (140 completed) with a mean pain reduction of 15.2 mm and mean de qi score of 6.2. There was no significant correlation between the strength of de qi and improvement in pain (p = 0.49). There was also no significant difference in pain relief (p = 0.52) between those who felt de qi and those who did not using the de qi subscale of the Park questionnaire. Conclusion These data suggest that the presence and intensity of de qi has no effect on the pain relief obtained for patients with OA. This result may have implications for both acupuncture treatment and for future trial methodology. [ABSTRACT FROM AUTHOR]

Purpose: To explore exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type and to explore patient experiences of physiotherapy. Methods: A cross sectional questionnaire survey design was used to collect quantitative and qualitative data from adult members of the Hypermobility Syndromes Association and Ehlers-Danlos Syndrome Support UK. Descriptive and inferential statistics were used to analyse the data. Qualitative data was analysed thematically. Results: 946 questionnaires were returned and analysed. Participants who received exercise advice from a physiotherapist were 1.75 more likely to report high volumes of weekly exercise (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.30-2.36, p < 0.001) than those with no advice. Participants who believed that exercise is important for long-term management were 2.76 times more likely to report a high volume of weekly exercise compared to the participants who did not hold this belief (OR = 2.76, 95% CI = 1.38-5.50, p = 0.004). Three themes emerged regarding experience of physiotherapy; physiotherapist as a partner, communication - knowledge, experience and safety. Conclusion: Pain, fatigue and fear are common barriers to exercise. Advice from a physiotherapist and beliefs about the benefits of exercise influenced the reported exercise behaviours of individuals with Ehlers-Danlos syndrome - hypermobility type in this survey. Implications for rehabilitation: Exercise is a cornerstone of treatment for Ehlers-Danlos syndrome/Ehlers-Danlos syndrome - hypermobility type. Pain, fatigue and fear of injury are frequently reported barriers to exercise. Advice from physiotherapists may significantly influence exercise behaviour. Physiotherapists with condition specific knowledge and good verbal and non-verbal communication facilitate a positive therapeutic experience. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to examine perceived barriers to assessment of delirium for critical care nurses, and the impact of education on their knowledge and practice. Background: Delirium is a significant problem in critical care, leading to increased morbidity and mortality. Many authors have found variations in assessment by critical care nurses, but there has been limited analysis of the reasons for this. Education on the topic improves knowledge and practice, but the best approach has not been examined. Design: A questionnaire survey design. Methods: A self-reported questionnaire was distributed to critical care nurses (n=31) at a district general hospital. Data were analysed with descriptive statistics. Results: Knowledge and practice were variable, but correlation was seen between nursing band and years of experience with better scores. Any type of education led to significantly improved scores. Several barriers to assessment were found, with the most common being lack of knowledge and difficulty in assessing intubated patients. Conclusion: It is essential to improve practice in delirium assessment and management. Education is vital to improve the knowledge and practice of critical care nurses regarding delirium. [ABSTRACT FROM AUTHOR]

This UK cohort analysis of a European survey evaluated the differences between health professionals and cancer patients regarding the perceived incidence, impact and drug management of chemotherapy/radiotherapy-induced nausea/vomiting (CINV/RINV). The UK healthcare system is unique in that it has dedicated oncology clinical nurse specialists. The analysis found that more patients experienced nausea following their most recent treatment cycle than vomiting. Health professionals overestimated the incidence of CINV/RINV but underestimated its impact on patients’ daily lives, particularly in cases of mild and moderate nausea/vomiting. The level of antiemetic cover initiated and degree of symptom control was often suboptimal. Patients under-reported symptoms, primarily because they considered nausea/vomiting an inevitable side effect of treatment. Altogether, 42% of patients reported full adherence to their antiemetic regimen. Leading factors for non-adherence included not having a ‘preventive mindset’, low symptom severity and a reluctance to increase pill burden. In conclusion, there is a perceptual gap between health professionals and patients around experiences of CINV/RINV. Advances in management depend on enhancing health professional–patient communication, and reporting and understanding nausea as a distinct issue. [ABSTRACT FROM AUTHOR]

In the UK,low-intensitycognitive-behavioural therapy (LICBT) is offered as cost-effective intervention for anxiety and depression in primary care. Whilst research with Latino migrants in the USA highlights the suitability of CBT interventions with this group, these findings may not be generalisable to the UK, due to different sociopolitical circumstances. This mixed-method study explores theeffectivenessandmeaningof an LICBT group-intervention for Latino migrants in London. Eight participants attended a four-week workshop on anxiety management in Spanish, and pre- and post-intervention scores in CORE-OM, PHQ-9 and GAD-7 were compared. Additionally, focus groups about the intervention were thematically analysed. Although not statistically significant, a trend towards decreasing anxiety levels was identified (p= 0.06). Three of the four themes generated from participants' analysis of their experience are summarised and discussed. These include positive aspects of the intervention and its limitations. Whilst valuing LICBT interventions, participants considered further input necessary. Potential clinical implications as well as recommendations for further research are discussed. [ABSTRACT FROM PUBLISHER]

Background Increasing fruit and vegetable consumption is a goal for the UK. Therefore, the effectiveness of a fruit and vegetable voucher scheme coupled with key 'five-a-day' consumption messages as a brief intervention in primary care consultations was assessed in the present study. Methods One thousand one hundred and eighty-eight vouchers as a prescription for fruits and vegetables were routinely distributed to patients attending a primary healthcare centre in a deprived area, and 124 volunteer patients routinely attending the centre were included. Telephone-based questionnaires were used to examine changes in consumption over the short and medium term. Other key aspects assessed in the evaluation related to fruit and vegetable purchasing behaviour, knowledge relating to what constitutes a portion size, the relationship between food and health, and barriers to consumption. Results Although 76.2% of participants used the prescription vouchers when purchasing fruits and vegetables, a significant change in the consumption or purchasing behaviour was not observed ( P > 0.05). Participants' level of knowledge relating to the number of portions recommended and the portion size of different fruits and vegetables showed a moderate increase from baseline over the short and medium term. The primary barriers to fruit and vegetable consumption were reported as 'the quality of fresh fruits and vegetables' and 'the money available to spend on food'. Conclusions The use of 'the fruit and vegetable on prescription' scheme was an effective method of engaging participants in improving awareness of key diet-related health messages. However, further intervention is required to produce a significant impact on the actual behaviour change. [ABSTRACT FROM AUTHOR]

Background: Computerised Cognitive Behaviour Therapy (cCBT) offers the potential to make evidence based interventions more available and accessible for children and young people. Research is currently limited and proof of concept studies are required to explore the viability and possible therapeutic benefits of cCBT as a universal or targeted intervention in schools. Method: In Study 1, cCBT was provided as a universal intervention to 13 participants who were assigned to either group cCBT or a matched computer gaming condition. In Study 2, cCBT was provided as a targeted intervention by trained school nurses to 12 participants with mild or moderate emotional problems. Results: Both studies found cCBT to result in immediate post intervention benefits and feedback about the programme was very positive. Conclusion: This study provides proof of concept that cCBT provided as a universal or targeted emotional health intervention in schools is viable and may result in immediate therapeutic benefits. These findings are limited by the small sample size and absence of follow-up but suggest that more methodologically robust evaluations should be pursued. [ABSTRACT FROM AUTHOR]