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Background: Early identification and treatment of chronic disease is associated with better clinical outcomes, lower costs, and reduced hospitalisation. Primary care is ideally placed to identify patients at risk of, or in the early stages of, chronic disease and to implement prevention and early intervention measures. This paper evaluates the implementation of a technological intervention called Future Health Today that integrates with general practice EMRs to (1) identify patients at-risk of, or with undiagnosed or untreated, chronic kidney disease (CKD), and (2) provide guideline concordant recommendations for patient care. The evaluation aimed to identify the barriers and facilitators to successful implementation. Methods: Future Health Today was implemented in 12 general practices in Victoria, Australia. Fifty-two interviews with 30 practice staff were undertaken between July 2020 and April 2021. Practice characteristics were collected directly from practices via survey. Data were analysed using inductive and deductive qualitative analysis strategies, using Clinical Performance - Feedback Intervention Theory (CP-FIT) for theoretical guidance. Results: Future Health Today was acceptable, user friendly and useful to general practice staff, and supported clinical performance improvement in the identification and management of chronic kidney disease. CP-FIT variables supporting use of FHT included the simplicity of design and delivery of actionable feedback via FHT, good fit within existing workflow, strong engagement with practices and positive attitudes toward FHT. Context variables provided the main barriers to use and were largely situated in the external context of practices (including pressures arising from the COVID-19 pandemic) and technical glitches impacting installation and early use. Participants primarily utilised the point of care prompt rather than the patient management dashboard due to its continued presence, and immediacy and relevance of the recommendations on the prompt, suggesting mechanisms of compatibility, complexity, actionability and credibility influenced use. Most practices continued using FHT after the evaluation phase was complete. Conclusions: This study demonstrates that FHT is a useful and acceptable software platform that provides direct support to general practice in identifying and managing patients with CKD. Further research is underway to explore the effectiveness of FHT, and to expand the conditions on the platform. [ABSTRACT FROM AUTHOR]

An interview with lawyer Sandra Davidson is presented, wherein she discusses her favorite aspect of being a lawyer, the best advice someone gave her, and her desire to have dinner with political activist-lawyer Myra Bradwell.

Aim: To explore undergraduate nursing students' understanding of fundamental care and identify educational leadership opportunities to deepen students' understanding of fundamental care concepts. Design: Sequential‐explanatory mixed methods study. Methods: We conducted a cross sectional survey (n = 202) and focus groups (n = 24) to explore undergraduate nursing students' ability to identify fundamental care needs. All data were collected between November 2020 and April 2021. Survey data were analysed using descriptive and inferential statistics and focus group data were thematically analysed. Results: Year One students scored significantly lower in their ability to identify fundamental care needs compared with students in other years, even after controlling for route, gender and age. Post‐degree students scored significantly higher than direct entry or transfer students. Students ≤19 years of age had significantly lower scores compared with students ≥25 years of age. Our focus group findings highlighted that students were often unable to define fundamental care, but they identified learning about various components of fundamental care in a variety of ways. While students understood that fundamental care was required in all settings, they were challenged in providing this care in acute and virtual settings. Students shared several suggestions to support fundamental care skills development across the curriculum. Conclusions: There is a need for a clear definition and description of the fundamentals of care that is used consistently by faculty, students and curriculum documents. It is important to encourage and support educators to share real‐world nursing stories, offer students time to share their personal experiences, develop creative learning opportunities and foster student reflection to deepen students' understanding of the fundamentals of care. Impact Educators need support to meaningfully incorporate fundamentals of care learning opportunities across multiple care settings. Educational leaders can use these findings to develop or adapt their curricula to support fundamental care skill development. [ABSTRACT FROM AUTHOR]

This study examined consumers' experiences and opinions of a videoconference with a primary healthcare professional, and estimated the value of travel and time savings for consumers compared with face-to-face consultations. The online survey was conducted in Melbourne, Australia, between October 2020 and May 2021. The sample (n = 499) was highly educated (Bachelor degree or higher, 79%; 393/499), predominately female (70%; 347/499), mainly spoke English at home (78%; 390/499) and had a mean age of 31.8 years (s.d. 11.40). Reduced travel time (27%; 271/499) and avoiding exposure to COVID-19 (23%; 228/499) were the main reasons consumers chose a videoconference. Mental health and behavioural issues were the main reason for the consultation (38%; 241/499) and 69% (346/499) of consultations were with a general practitioner. Perceptions of the quality of care were uniformly high, with 84% (419/499) of respondents believing videoconference was equivalent to a face-to-face consultation. No association was found between reporting that telehealth was equivalent to a face-to-face consultation and education, language, health status, reason for consultation or provider type. The average time saved per consultation was 1 h and 39 min, and the average transport-related saving was A$14.29. High rates of acceptance and substantial cost savings observed in this study warrant further investigation to inform the longer-term role of videoconferences, and telehealth more broadly, in the Australian primary care system. [ABSTRACT FROM AUTHOR]

Background: In light of emerging evidence questioning the safety of antidepressants, it is timely to investigate the appropriateness of antidepressant prescribing. This study estimated the prevalence of possible over- and under-treatment with antidepressants among primary care attendees and investigated the factors associated with potentially inappropriate antidepressant use. Methods: In all, 789 adult primary care patients with depressive symptoms were recruited from 30 general practices in Victoria, Australia, in 2005 and followed up every 3 months in 2006 and annually from 2007 to 2011. For this study, we first assessed appropriateness of antidepressant use in 2007 at the 2-year follow-up to enable history of depression to be taken into account, providing 574 (73%) patients with five yearly assessments, resulting in a total of 2870 assessments. We estimated the prevalence of use of antidepressants according to the adapted National Institute for Health and Care Excellence guidelines and used regression analysis to identify factors associated with possible over- and under-treatment. Results: In 41% (243/586) of assessments where antidepressants were indicated according to adapted National Institute for Health and Care Excellence guidelines, patients reported not taking them. Conversely in a third (557/1711) of assessments where guideline criteria were unlikely to be met, participants reported antidepressant use. Being female and chronic physical illness were associated with antidepressant use where guideline criteria were not met, but no factors were associated with not taking antidepressants where guideline criteria were met. Conclusions: Much antidepressant treatment in general practice is for people with minimal or mild symptoms, while people with moderate or severe depressive symptoms may miss out. There is considerable scope for improving depression care through better allocation of antidepressant treatment. [ABSTRACT FROM AUTHOR]

An obituary for veterinarian Sandra L. Harris-Davidson is presented.

Over half of all new cancer cases in Alberta are diagnosed among people aged 65+ years, a group that encompasses vast variation. Patient-reported experience measures are routinely collected within Cancer Care Alberta; however, the specific consideration of the needs and concerns of older Albertans with cancer is lacking. In 2021, 2204 adults who had received treatment at a cancer centre in Alberta completed the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). In this study, we explored the age differences in satisfaction across six dimensions of person-centred care and in the proportions of unmet needs across eight types of issues, with specific attention to older adults. Using three age groups (18–39, 40–64, 65+), only the physical comfort dimension showed significantly lower satisfaction among those aged 65+ years. Using five age groups (18–39, 40–64, 65–74, 75–84, 85+), significantly lower levels of satisfaction were found related to 'physical comfort' for those aged 65–74 and 75–84, 'coordination and continuity of care' for those aged 75–84 and 85+, and 'information, communication, and education' for those aged 85+. Therefore, grouping together all older adults aged 65+ years obscured lower levels of satisfaction with some dimensions of person-centred care among those aged 75–84 and 85+ years. Unmet needs generally increased with age for all types of issues, with significant differences across age groups for emotional, financial, social/family, and sexual health issues. The lower levels of satisfaction and higher proportions of unmet needs call for tailored interventions to promote optimal care experiences and outcomes among older adults receiving cancer care in Alberta and their families. [ABSTRACT FROM AUTHOR]

Objectives: The taxi industry relies on a male-dominated, predominately immigrant workforce who face multiple risk factors for poor mental health including shift work, low pay and threats of violence. Despite these risk factors, no previous study has documented the prevalence of psychological distress in the taxi industry. We investigated psychological distress among urban taxi drivers and explored the factors associated with high levels of distress. Method: A total of 380 taxi drivers were surveyed at the Melbourne Airport holding yard between September 2016 and March 2017. Psychological distress was measured using the K10. Logistic regression models were used to estimate the association between high levels of psychological distress and migration, work patterns, potentially traumatic events, health care use and social connectedness. Results: A third (33%) of drivers had very high (K10 ⩾ 30) levels of distress and 28% had high (K10 = 22-29) levels of distress. Trauma was significantly associated with high levels of psychological distress, and rates of trauma were much higher among drivers than among the Australian population. Despite high levels of distress, drivers were no more likely than other Australian men to visit a health professional. Conclusion: Urban taxi drivers are at very high risk for mental health problems, yet the mental health needs of this largely immigrant workforce has gone largely unnoticed. Interventions tailored to the unique characteristics of the job and the demographic composition of the workforce are urgently needed. [ABSTRACT FROM AUTHOR]

Background: Depression trajectories among primary care patients are highly variable, making it difficult to identify patients that require intensive treatments or those that are likely to spontaneously remit. Currently, there are no easily implementable tools clinicians can use to stratify patients with depressive symptoms into different treatments according to their likely depression trajectory. We aimed to develop a prognostic tool to predict future depression severity among primary care patients with current depressive symptoms at three months.Methods: Patient-reported data from the diamond study, a prospective cohort of 593 primary care patients with depressive symptoms attending 30 Australian general practices. Participants responded affirmatively to at least one of the first two PHQ-9 items. Twenty predictors were pre-selected by expert consensus based on reliability, ease of administration, likely patient acceptability, and international applicability. Multivariable mixed effects linear regression was used to build the model.Results: The prognostic model included eight baseline predictors: sex, depressive symptoms, anxiety, history of depression, self-rated health, chronic physical illness, living alone, and perceived ability to manage on available income. Discrimination (c-statistic =0.74; 95% CI: 0.70-0.78) and calibration (agreement between predicted and observed symptom scores) were acceptable and comparable to other prognostic models in primary care.Limitations: More complex model was not feasible because of modest sample size. Validation studies needed to confirm model performance in new primary care attendees.Conclusion: A brief, easily administered algorithm predicting the severity of depressive symptoms has potential to assist clinicians to tailor treatment for adult primary care patients with current depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: High rates of persistent depression highlight the need to identify the risk factors associated with poor depression outcomes and to provide targeted interventions to people at high risk. Although social relationships have been implicated in depression course, interventions targeting social relationships have been disappointing. Possibly, interventions have targeted the wrong elements of relationships. Alternatively, the statistical association between relationships and depression course is not causal, but due to shared variance with other factors. We investigated whether elements of social relationships predict major depressive episode (MDE) when multiple relevant variables are considered.Method: Data is from a longitudinal study of primary care patients with depressive symptoms. 494 participants completed questionnaires at baseline and a depression measure (PHQ-9) two years later. Baseline measures included functional (i.e. quality) and structural (i.e. quantity) social relationships, depression, neuroticism, chronic illness, alcohol abuse, childhood abuse, partner violence and sociodemographic characteristics. Logistic regression with generalised estimating equations was used to estimate the association between social relationships and MDE.Results: Both functional and structural social relationships predicted MDE in univariate analysis. Only functional social relationships remained significant in multivariate analysis (OR: 0.87; 95%CI: 0.79-0.97; p=0.01). Other unique predictors of MDE were baseline depression severity, neuroticism, childhood sexual abuse and intimate partner violence.Limitations: We did not assess how a person's position in their depression trajectory influenced the association between social relationships and depression.Conclusions: Interventions targeting relationship quality may be part of a personalised treatment plan for people at high risk due of persistent depression due to poor social relationships. [ABSTRACT FROM AUTHOR]

Background: Power has traditionally been studied and experienced within organizations from a hierarchical and positivist perspective. However, organizational complexity has never been greater, and in our attempts to find new ways to live amid this complexity we seek alternative theoretical perspectives that may better represent and inform our experiences of organizational life. Aims: This article summarizes the positivist view of power within organizations and the limitations of attempting to study power from this perspective. Power is then reconceptualized and explored using the complex responsive process (CRP) analysis. Methods: This is an exemplar of how narrative inquiry guided by CRP may be used as a frame for reflexivity and reflection amid organizational power dynamics. Settings: The narrative description used in this paper was based on the author's experience and reflection upon a nursing faculty meeting in a large public university. Conclusions: By becoming aware of the power relations in which we engage, and by reflecting upon them using CRP, we may come to understand power relations in a different way. In the act of examining and reflecting on our habitual roles in power relations, we may open up the potential for personal and organizational transformation. Davidson [ABSTRACT FROM AUTHOR]

Background Subthreshold depression is prevalent in primary care and is associated with poorer quality of life, higher health care use and increased risk of major depressive disorder (MDD). Currently, it is unclear how subthreshold depression should be managed in primary care and no studies have investigated the relationship between current models of care and the development of MDD. This study aimed to describe usual care over a six month follow-up for primary care patients with subthreshold depression and to investigate the relationship between usual care and the development of MDD. Methods Data were derived from 250 participants with subthreshold depression from the diamond study, a longitudinal cohort study of primary care patients. Participants completed questionnaires at three and six months on their health care use, the interventions they received and their depression status. Interventions were categorised according to the NICE guidelines for the management of depression in adults. Generalised estimating equation (GEE) models and logistic regression were used to estimate the association between receiving an intervention and MDD over six months. Results Four fifths (80.8%) of participants received a mental health intervention. Therapeutic listening, reassurance, pharmacotherapy and advice to exercise were most common. Subsequent MDD was predicted by history of depression, baseline depressive symptom severity and receiving a mental health intervention. Limitations Usual care was assessed via patient self-report. Conclusions Primary care physicians deliver mental health interventions to most subthreshold patients. However, it appears that current interventions are not averting MDD. Further research to identify effective interventions which are feasible in primary care is needed. [ABSTRACT FROM AUTHOR]

The article focuses on the Missouri's law for providing damages against individuals for disclosing the name of executioners supplying lethal injection drugs. Topics discussed include the claims of violating the First Amendment of the U.S. Constitution on disclosing names of executioners, judicial opinion of the U.S. Supreme Court on the case Bartnicki v. Vopper, and the laws regulating cruel punishment through lethal injection.

Purpose: The aim of this study was to explore the psychometric properties of the 22-item Social Participation Questionnaire (SPQ). Methods: The SPQ was administered to 789 adult primary care patients with depressive symptoms. As the items were intended to be summed together to provide total score, Rasch analysis (partial credit model) was applied to assess the overall fit of the model, individual item fit, differential item functioning (DIF), targeting of persons, response dependency, unidimensionality and person separation. Results: To improve the scale’s fit, it was necessary to re-score the response format. Two items demonstrated some DIF for gender and eight items showed DIF for age. To support the assumption of unidimensionality post hoc principal component analysis was performed. The analysis showed two subtests of the residuals with positive and negative loadings, but the person estimates derived from these two subtests were not statistically different to that derived from all items taken together. The response dependence between two items was identified; however, the magnitude of difficulty was very small. Although the questionnaire appeared to have insufficient items to assess the full spectrum of informal social contact, the SPQ was reasonably well targeted. Conclusion: The SPQ is a promising questionnaire for the measurement of social participation although it could benefit from the inclusion of further items to measure informal social contact. This study found support for the internal validity, internal consistency reliability, and unidimensionality. A future study will investigate whether targeting can be improved when additional items are included. [ABSTRACT FROM AUTHOR]

Seeds of several agriculturally important legumes are rich sources of the only halogenated plant hormone, 4-chloroindole-3-acetic acid. However, the biosynthesis of this auxin is poorly understood. Here, we show that in pea (Pisum sativum) seeds, 4-chloroindole-3-acetic acid is synthesized via the novel intermediate 4-chloroindole-3-pyruvic acid, which is produced from 4-chlorotryptophan by two aminotransferases, TRYPTOPHAN AMINOTRANSFERASE RELATED1 and TRYPTOPHAN AMINOTRANSFERASE RELATED2. We characterize a tar1 mutant, obtained by Targeting Induced Local Lesions in Genomes, the seeds of which contain dramatically reduced 4-chloroindole-3-acetic acid levels as they mature. We also show that the widespread auxin, indole-3-acetic acid, is synthesized by a parallel pathway in pea. [ABSTRACT FROM AUTHOR]

PROBLEM. Health care is currently in the midst of an age change. Leadership styles and organizational structures that were prevalent in the twentieth century no longer apply in twenty-first-century health care. Leaders of health care must embrace and help others to embrace new ways of being and relating in twenty-first-century organizations. METHODS. This paper introduces a new framework through which leaders can see their organizations differently. Complex responsive processes (CRPs) focus on the interactions between people that take place in the living present as the building block of transformative organizations. This paper also introduces the seven da Vincian principles as a personal tool that twenty-first-century leaders might use to increase their capacity for creativity and to develop their ability to thrive in uncertainty. FINDINGS. The power to shape the preferred future of health care lies within our relationships with others that take place locally and in the living present. CONCLUSIONS. Viewing organizations through the lens of CRPs and developing practices around the seven da Vincian principles provides directions and a starting point for traditional leaders to move away from rationalist, twentieth-century practices toward transformative leadership practices. [ABSTRACT FROM AUTHOR]

The article discusses fictional and factual stories in which coincidence and the deus ex machina play a role. Fictional stories include episodes of the Harry Potter series and of J.R.R. Tolkien's "Lord of the Rings" trilogy and the novel "Jaws." Real-life stories that rival these include a story of dolphins protecting a surfer from a shark attack, the maiden voyage of the ship Titanic, and the coincidental deaths on the same day of John Adams and Thomas Jefferson on the 50th birthday of the U.S.

Depression is more common in elderly people residing in nursing homes than it is in people of the same age residing in the community. In Australia, general practitioners (GPs) are the primary providers of medical services to the elderly in nursing homes; however, they often under-diagnose and/or inadequately treat depression in this population. The difficulties experienced by GPs are confounded by the breakdown in the continuity of care that is evident when a patient is admitted into a nursing home, by inadequate communication between GPs and nursing home staff, and systems within the nursing home that are not conducive to general practice. This paper discusses the challenges GPs face in diagnosing and treating depression in nursing home residents, and provides suggestions for strategies that may overcome these challenges. [ABSTRACT FROM AUTHOR]

Aim To examine the feasibility of a brief intervention training general practitioners (GPs) in the administration of a depression screening instrument for use among nursing home residents. Intervention GPs attended a single education session on late-life depression and were trained in the use of the Cornell Scale for Depression in Dementia. Following the intervention GPs reviewed their patients for depression. Outcome measures Diagnosis of depression pre and post intervention; changes in antidepressant medications post intervention. Results Ten GPs and 38 patients completed all components of the study. GPs identified that 24% of their patients had Cornell Scores indicative of probable major depression that was either unrecognised or inadequately treated. 88% of these patients had been previously diagnosed with depression. A further 32% of patients exhibited depression symptoms, half (50%) of whom had a previous diagnosis of depression. Reviewing patients had an effect on antidepressant prescribing for patients with probable major depression, with GPs making changes to the antidepressant medication of 29% of patients. Conclusions The high rate of residents presenting with probable major depression despite being prescribed antidepressants indicate that depression symptoms are inadequately recognised and treated in nursing homes. This study demonstrated that a single education session on late-life depression was feasible and was associated with an improvement in GPs' recognition of depression among nursing home patients. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In Mosely v. V Secret Catalogue, Inc., the Supreme Court of the United States unanimously ruled that unless a plaintiff can prove damage, a trademark dilution case under the Federal Trademark Dilution Act will fail. Mental association of "Victor's Little Secret" with "Victoria 'S Secret" does not necessarily mean blurring or tarnishing of the plaintiffs trademark or trade name. The case continues the Court's acceptance of puckis creativity, but while the Court appears to be granting greater freedom to commercial speech, some legal restraints remain untouched. This article examines the Court's decision, applies it to other" cases and attempts a synthesis of law. It argues that the uncertain standards of the FTDA created a chilling effect that the Court has decried in other areas of law. The article then examines how outcomes might have been different under the Moseley standards and what legal freedoms and restraints remain the same after Moseley. [ABSTRACT FROM AUTHOR]

The pea (Pisum sativum) homolog, PsKO1, of the Arabidopsis GA3 gene was isolated. It codes for a cytochrome P450 from the CYP701A subfamily and has ent-kaurene oxidase (KO) activity, catalyzing the three step oxidation of ent-kaurene to ent-kaurenoic acid in the gibberellin (GA) biosynthetic pathway when expressed in yeast (Saccharomyces cerevisiae). PsKO1 is encoded by the LH gene because in three independent mutant alleles, lh-1, lh-2, and lh-3, PsKO1 has altered sequence, and the lh-1 allele, when expressed in yeast, failed to metabolize ent-kaurene. The lh mutants of pea are GA deficient and have reduced internode elongation and root growth. One mutant (lh-2) also causes a large increase in seed abortion. PsKO1 (LH) is expressed in all tissues examined, including stems, roots, and seeds, and appears to be a single-copy gene. Differences in sensitivity to the GA synthesis inhibitor, paclobutrazol, between the mutants appear to result from the distinct nature of the genetic lesions. These differences may also explain the tissue-specific differences between the mutants. [ABSTRACT FROM AUTHOR]

This study examined the relationship between students' attitudes to consultation skills, their confidence in performing those skills and their academic results. Final-year medical students completed a questionnaire before and after the year 6 general practice attachment, which teaches holistic, patient-centred clinical management and emphasizes core verbal and non-verbal communication skills. When underlying academic ability was taken into account only pre-attachment attitudes regarding the importance of consultation skills remained significantly correlated with at least one measure of performance. Student confidence in performing a skill was not associated with academic measures of performance. These results show that students perform better on those skills that they value and this may be influenced by underlying motivation to master the skill. In contrast, students' confidence in performing a skill is not related to their assessed performance and using confidence as a performance measure may misrepresent the quality of learning being assessed. [ABSTRACT FROM AUTHOR]

Examines the capability of the pea gene, na to encode ent-kaurenoic acid oxidase (KAO). Detection of the additional products of the pea KAO activity; Alteration of the sequences and the five-base deletion in PsKAO1 associated with the na-1 allele cosegregated with the dwarf na phenotype; Explanation of the normal seed development and gibberellin biosynthesis in seeds of na plants.

Context A substantial proportion of medical students enter their intern year without any basic skills experience. Lack of experience is a significant source of stress for many junior doctors. Objectives To evaluate the effect of a basic procedural skills tutorial for Year 3 medical students on their competence in relevant skills at Year 5. Subjects The control group consisted of 93 medical students who completed Year 3 in 1996. The intervention group consisted of 92 medical students who completed Year 3 in 1997. The intervention group received a practical skills tutorial in Year 3; the control group did not. Both groups were assessed on their practical skills competence during Year 5. Methods A 3-hour practical tutorial on injection and suturing techniques was delivered to the intervention group. The effectiveness of the intervention was assessed by self-reported experience of giving injections, inserting sutures and sustaining needlestick injuries, and by teacher-rated competency in four basic procedural skills. Results Students who received the Year 3 tutorial were significantly more likely to record a satisfactory assessment for their performance in all four basic skills compared with students who did not receive the tutorial. They were less likely than controls to refuse invitations to give injections, but not invitations to insert a suture, during Years 4 and 5. Conclusions A single session of formalised teaching in procedural skills in the early stages of a medical degree can have long-term effectiveness in basic skills competence and may increase students' confidence to practise their skills. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to document the prevalence of risk factors for HIV/AIDS and hepatitis C among people with chronic mental illness treated in a community setting. Method: 234 patients attending four community mental health clinics in the North-western Health Care Network in Melbourne, Australia, completed an interviewer-administered questionnaire which covered demographics, risk behaviour and psychiatric diagnosis. Results: The sample was 58% male, and 79% of the sample had a primary diagnosis of schizophrenia. Forty-three per cent of mentally ill men and 51% of mentally ill women in the survey had been sexually active in the 12 months preceding the survey. One-fifth of mentally ill men and 57% of mentally ill women who had sex with casual partners never used condoms. People with mental illness were eight times more likely than the general population to have ever injected illicit drugs and the mentally ill had a lifetime prevalence of sharing needles of 7.4%. Conclusions: The prevalence of risk behaviours among the study group indicate that people with chronic mental illness should be regarded as a high-risk group for HIV/AIDS and hepatitis C. It is essential that adequate resources and strategies are targeted to the mentally ill as they are for other high-risk groups. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to document the prevalence of risk factors for cardiovascular disease among people with chronic mental illness. Method: A cross-sectional survey was conducted of 234 outpatients attending a community mental health clinic in the North-western Health Care Network in Melbourne, Australia. Prevalence of smoking, alcohol consumption, body mass index, hypertension, salt intake, exercise and history of hypercholesterolemia was assessed. Results: Compared with a community sample, the mentally ill had a higher prevalence of smoking, overweight and obesity, lack of moderate exercise, harmful levels of alcohol consumption and salt intake. No differences were found on hypertension. Men, but not women, with mental illness were less likely to undertake cholesterol screening. Conclusions: Psychiatric outpatients have a high prevalence of cardiovascular risk factors which may account for the higher rate of cardiovascular mortality among the mentally ill. Further research is needed to trial and evaluate interventions to effectively modify risk factors in this vulnerable population. [ABSTRACT FROM AUTHOR]

Analyzes the etiology and characteristics of Afro-American patients with congestive heart failure (CHF). Identification of the most common cause of CHF; Measurement of the left ventricular ejection fraction; Frequency of idiopathic dilated cardiomyopathy; Risk factors of cardiac mortality and morbidity.

Background: Subthreshold depression is common in primary care, but there is little information about the self‐help strategies that patients use and the perceived benefits of these. Aim: This study sought to elicit the self‐help strategies that primary care attendees identified as beneficial for the self‐management of subthreshold depressive symptoms and the implications for general practitioners. Method: Semi‐structured telephone interviews were conducted with 14 people (April–May 2017) from the Target‐D randomised controlled trial (RCT). Target‐D investigated whether using a patient‐centred clinical prediction tool and an e‐health platform to match mental health management options to prognosis was beneficial for improving depressive symptoms at 3 months compared to usual care. Interviews were thematically analysed to identify self‐help strategies and their perceived benefits. Results: Four overarching domains for the self‐management strategies were identified: social, cognitive, behavioural and restorative. Interviewees reported using strategies across multiple domains, which included undertaking enjoyable, immersive activities, that provided relief from automatic negative thoughts and had a perceived cognitive benefit. Differences in the perceived sense of agency were noted around the self‐regulation of mood, which indicated more explicit direction to patient‐identified self‐help management strategies by general practitioners for some may be of benefit in routine care. Conclusion: Some of the reported self‐management strategies aligned with evidence‐based approaches such as physical activity and mindfulness for mental health symptom management. These findings can inform low‐intensity interventions within stepped care models for mental health in primary care, social prescribing models and, help to guide the management of patients by GPs for subthreshold depression. [ABSTRACT FROM AUTHOR]

Microwave digestion of a variety of low-sodium dinners was evaluated for determining sodium content. Dinners containing a meat, vegetable and dessert portion were blended, digested with strong acid in the microwave oven, and read by atomic absorption. Sodium values were compared with those obtained by an FDA method. Also, a sodium standard of known concentration was added to some samples, and the recoveries measured for two different amounts added. Reproducibility of microwave digestion was, tested on replicates analyzed on the same day, on consecutive days and on consecutive weeks. Of the ten dinner types tested no matrix effects or interferences were noted, and we concluded that microwave digestion is a rapid means of preparing a complex matrix such as a frozen dinner for sodium analysis. [ABSTRACT FROM AUTHOR]

Aim: To describe ways in which a hospital context, physically and culturally, influences nurses' abilities to promote and engage with environmentally responsible practice. Design: A focused ethnographic study. Methods: Data were collected during May and August, 2019. Nurses (n = 22) working in the emergency room and three medicine units within a large Western Canadian hospital were invited to participate. Semi‐structured interviews were conducted, and observations were collected. Reporting is in accordance with the consolidated criteria for reporting qualitative research. Results: Three themes were identified: patient care not environmental care, organizational role and operational efficiency. Overall, participants indicated patient care was their primary priority, and due to their workload, they were unable to simultaneously consider the environmental impact of their work. Participants stated they had difficulties practicing in environmentally responsible ways because they felt unsupported by their hospital organization. Regardless, there was a desire for the organization to support environmentally responsible practices. Conclusion: Climate change is a major health concern, and partnership between hospitals and nurses is necessary to ensure environmentally responsible healthcare is delivered. We suggest both a top‐down and bottom‐up approach to help develop hospital contexts that are relevant and environmentally responsible. Impact: Nurses have a professional responsibility to address climate change, yet this study identified that nurses found it challenging to practice in environmentally responsible ways within the hospital context. Challenges they faced are related to their workload, their misaligned nursing priorities and, more importantly, because they felt unsupported by their hospital. Findings are important to both the nursing profession as well as other hospital leaders so that a culture of environmentally responsible healthcare can be developed within hospitals. [ABSTRACT FROM AUTHOR]

Introduction: The organ donation and transplantation (ODT) system in Canada is complex and can be challenging for individuals to navigate. We thus aimed to illuminate the experiences of individuals on transplant journeys using a patient‐oriented convergent parallel mixed‐methods approach. Methods: We captured data on adult patients, living donors, and caregivers on transplant journeys across Canada through an online survey (n = 935) and focus groups (n = 21). The survey was comprised of 48 questions about the individuals' experiences with the living donation and transplantation system, which were analyzed descriptively. Qualitative data were analyzed using an inductive conventional content analysis approach. Results: Most participants were female (70.1%), English speaking (92.6%) and White (87.8%). Participants' experiences were represented across six key themes: holistic person‐centred care, accountable care, collective impact, navigating uncertainty, connection and advocacy. Quantitative and qualitative data were integrated to identify five opportunities to improve the organ donation and transplantation system in Canada: enhancing mental health support, establishing formal peer support programmes, improving continuity of care, improving knowledge acquisition, and expanding resources and support. Conclusion: It is imperative that the ODT system commits to asking, listening, and learning from individuals on transplant journeys and to provide them opportunities to help improve it. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The purpose of this study was to explore Canadian nurses' perspectives on climate change, health, nursing practice and the relationships between these concepts. Background: Climate change negatively impacts human health. With a mandate to promote health, nurses have a professional and ethical responsibility to address climate change. Little is known about Canadian nurses' perspectives on climate change or how they perceive of their professional responsibility towards addressing it. Methods: A focused ethnography was conducted in three medicine units and the emergency room at a Canadian hospital. Nurses (n = 22) participated in semi‐structured interviews, and observations were collected. Data were analysed via thematic analysis. Reporting is in accordance with the COREQ guideline. Results: Three themes were identified: muddled terminology, climate change and health, and nursing's relationship to climate change. Conclusion: Participants had varying levels of knowledge about climate change and its relationship to health or practice. Climate change was a personal concern, and nursing's role in addressing it was not understood. Relevance to Practice: This study highlighted that practising nurses did not readily recognise their role in addressing climate change. More work is needed to clarify this role and bring it into the consciousness of every‐day nursing practice. Furthermore, more work is needed to examine how healthcare organisations can better support environmentally responsible nursing practice. [ABSTRACT FROM AUTHOR]

The article explains the need to foster early and mid-career research (EMCR) on affective disorders in Australia. The authors discuss the number of and mid-career research fellowships received by the National Health and Medical Research Council (NHMRC) and the importance of mentorship and funding to high-impact research. They suggest to lobby for affective disorder-specific fellowship and project grant funding in order to enhance EMCR outcomes.

This paper offers a theoretical discussion on why the nursing profession has had a delayed response to the issue of climate change. We suggest this delay may have been influenced by the early days of nursing's professionalization. Specifically, we examine nursing's professional mandate, the generally accepted metaparadigm, and the grand theorists' conceptualizations of both the environment and the nurse–environment relationship. We conclude that these works may have encouraged nurses to conceptualize the environment, as well as their relationship with it, mainly in terms of the individual patient, and as such, nurses have not been encouraged to understand these concepts from a broader perspective. By not having the philosophical and theoretical foundations to understand the environment in relation to society, it is not surprising that nurses have had a delayed response to climate change and may not have viewed it as a professional concern. A planetary health perspective is suggested as a theoretical basis for nursing education, research and practice. Taking on a planetary health perspective could help nurses progress the profession and move healthcare systems towards supporting a climate‐resilient future. [ABSTRACT FROM AUTHOR]

The Primary Care Audit, Teaching and Research Open Network (Patron) is an Australian database of de-identified electronic medical records from primary care patients. It includes over 3.5 million patients from 129 primary care practices in Victoria and Queensland. The database contains a wide range of de-identified data, including reason for visit, clinical observations, diagnosis, medications, and referrals. The data can be used by government, educational institutions, researchers, and industry with approved applications. The database aims to inform research, policy questions, and medical training. However, it acknowledges limitations, such as the concentration of data in Victoria and the underrepresentation of First Nations Australians. Access to the data requires approval from the Data Governance Committee and an ethics committee. [Extracted from the article]

What is Known on the Subject: Research has shown effectiveness of nonpharmacological interventions in improving or maintaining cognition, mood, functioning, self‐efficacy and quality of life for persons with mild‐to‐moderate dementia (PWDs).These interventions are critical during the earlier stages of dementia. However, Canadian and international literature report underutilization of and difficulty accessing the interventions. What this Paper Adds to Existing Knowledge: To our knowledge, this is the first review that explored factors influencing seniors' utilization of nonpharmacological interventions in the earlier stages of dementia. This review contributed to the discovery of unique factors such as PWDs' beliefs, fears, perceptions, and acceptability of nonpharmacological interventions and environmental influences on intervention provision.PWDs' intervention uptake may appear as a matter of personal choices related to individuals' knowledge, beliefs and perceptions. However, the analysis of the research evidence suggests that PWDs' choices are shaped by environmental factors such as formal and informal caregiver support, acceptability and accessibility of nonpharmacological interventions, dementia care workforce, community's attitudes towards dementia and funding. The complex interplay among factors highlights the importance of targeting health promotion strategies at both individuals and their environments. What are the Implications for Practice: The review findings feature opportunities for healthcare practitioners, including mental health nurses, in advocating for PWDs' evidence‐informed decision‐making and access to desired nonpharmacological treatments. Involvement of patients and families in care‐planning through ongoing assessment of health and learning needs, as well as enablers and barriers to using interventions, continuing information provision, and personalized referrals to appropriate services can promote PWDs' rights to healthcare. Introduction: Despite the significance of nonpharmacological interventions in optimal management of mild‐to‐moderate dementia, it remains unclear in the literature how persons with mild‐to‐moderate dementia (PWDs) view, understand and access nonpharmacological interventions. Aim: The purpose of this review was to explore the extent and nature of evidence concerning factors that influence the use of nonpharmacological interventions for community‐dwelling seniors with mild‐to‐moderate dementia. Method: An integrative review was undertaken following Toronto and Remington (A step‐by‐step guide to conducting an integrative review, 2020)'s instruction which expanded Torraco (Human Resource Development Review, 2016, 15, 404)'s and Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546)'s guidance. Results: The review of 16 studies suggests that PWDs' use of nonpharmacological interventions is shaped by a complex interplay of various personal, interpersonal, organizational, community and political influences. Discussion: The findings highlight the complex, interrelated relationships among multiple factors and subsequent limitations of behaviour‐oriented health promotion strategies. To assist PWDs in making healthier choices, health promotion strategies need to direct attention to both individuals' behaviours and environmental conditions impacting the behaviours. Implications for Practice: The findings of this review can inform multidisciplinary health practitioners' (including mental health nurses) practice with seniors living with mild‐to‐moderate dementia. We recommend actionable ways in which they can empower patients and their families in dementia management. [ABSTRACT FROM AUTHOR]

Background: Target-D, a new person-centred e-health platform matching depression care to symptom severity prognosis (minimal/mild, moderate or severe) has demonstrated greater improvement in depressive symptoms than usual care plus attention control. The aim of this study was to evaluate the cost-effectiveness of Target-D compared to usual care from a health sector and partial societal perspective across 3-month and 12-month follow-up. Methods and findings: A cost-utility analysis was conducted alongside the Target-D randomised controlled trial; which involved 1,868 participants attending 14 general practices in metropolitan Melbourne, Australia. Data on costs were collected using a resource use questionnaire administered concurrently with all other outcome measures at baseline, 3-month and 12-month follow-up. Intervention costs were assessed using financial records compiled during the trial. All costs were expressed in Australian dollars (A$) for the 2018–19 financial year. QALY outcomes were derived using the Assessment of Quality of Life-8D (AQoL-8D) questionnaire. On a per person basis, the Target-D intervention cost between $14 (minimal/mild prognostic group) and $676 (severe group). Health sector and societal costs were not significantly different between trial arms at both 3 and 12 months. Relative to a A$50,000 per QALY willingness-to-pay threshold, the probability of Target-D being cost-effective under a health sector perspective was 81% at 3 months and 96% at 12 months. From a societal perspective, the probability of cost-effectiveness was 30% at 3 months and 80% at 12 months. Conclusions: Target-D is likely to represent good value for money for health care decision makers. Further evaluation of QALY outcomes should accompany any routine roll-out to assess comparability of results to those observed in the trial. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000537459). [ABSTRACT FROM AUTHOR]

Models describing plant hormone interactions are often complex and web-like. Here we assess several suggested interactions within one experimental system, elongating pea internodes. Results from this system indicate that at least some suggested interactions between auxin, gibberellins (GAs), brassinosteroids (BRs), abscisic acid (ABA) and ethylene do not occur in this system or occur in the reverse direction to that suggested. Furthermore, some of the interactions are relatively weak and may be of little physiological relevance. This is especially true if plant hormones are assumed to show a log-linear response curve as many empirical results suggest. Although there is strong evidence to support some interactions between hormones (e.g. auxin stimulating ethylene and bioactive GA levels), at least some of the web-like complexities do not appear to be justified or are overstated. Simpler and more targeted models may be developed by dissecting out key interactions with major physiological effects. [ABSTRACT FROM AUTHOR]

To examine the attitudes and practices of case managers working in Area Mental Health Services (AMHS) towards the physical health of people with chronic mental illness. Case managers at four AMHS in Melbourne participated in focus groups and completed a survey questionnaire. Case managers generally believed that mental illness, psychotropic medication and lifestyle factors contributed to the poor physical health status of their patients. Although many case managers attempted interventions aimed at improving physical health, there was inconsistency regarding the areas targeted. Preventive health measures were often neglected. Overall, there was a sense of pessimism around whether improved physical health was possible for people with chronic mental illness. Lack of coordination among health professionals and the health system may contribute to the poor general health of people with mental illness. Patients often have difficulty accessing general practitioners and the culture within the AMHS can exclude considerations of physical health. Case management should include aspects addressing the physical health issues of AMHS clients. [ABSTRACT FROM AUTHOR]

Background: Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses—the largest and most trusted group of healthcare professionals—to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies. Methods: To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies. Discussion: Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses' perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging—older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts. [ABSTRACT FROM AUTHOR]

Objectives: Bipolar disorder is a complex illness often requiring combinations of therapies to successfully treat symptoms. In recent years, there have been significant advancements in a number of therapies for bipolar disorder. It is therefore timely to provide an overview of current adjunctive therapeutic options to help treating clinicians to inform their patients and work towards optimal outcomes. Methods: Publications were identified from PubMed searches on bipolar disorder and pharmacotherapy, nutraceuticals, hormone therapy, psychoeducation, interpersonal and social rhythm therapy, cognitive remediation, mindfulness, e‐Health and brain stimulation techniques. Relevant articles in these areas were selected for further review. This paper provides a narrative review of adjunctive treatment options and is not a systematic review of the literature. Results: A number of pharmacotherapeutic, psychological and neuromodulation treatment options are available. These have varying efficacy but all have shown benefit to people with bipolar disorder. Due to the complex nature of treating the disorder, combination treatments are often required. Adjunctive treatments to traditional pharmacological and psychological therapies are proving useful in closing the gap between initial symptom remission and full functional recovery. Conclusions: Given that response to monotherapy is often inadequate, combination regimens for bipolar disorder are typical. Correspondingly, psychiatric research is working towards a better understanding of the disorder's underlying biology. Therefore, treatment options are changing and adjunctive therapies are being increasingly recognized as providing significant tools to improve patient outcomes. Towards this end, this paper provides an overview of novel treatments that may improve clinical outcomes for people with bipolar disorder. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics of primary care attendees with depressive symptoms who use mental health websites.Methods: 789 individuals with depressive symptoms recruited and followed up annually for nine years. Self-reported written surveys included mental health, professional and self-help use, e-mental health interventions or therapeutic websites. Marginal logistic regression examined association between mental health website (MHW) use and patient's mental health, health services use, anti-depressant use and self-help strategies.Results: 36% of participants used an MHW at least once. MHW users were more likely to be female, younger, highly educated and employed. MHW use increased with depressive symptom severity; reported in 16% of assessments when minimal symptoms were present and 28% when severe symptoms were present. MHW use was associated with: GP mental health visits, psychologist and psychiatrist visits and other self-help strategies including self-help books and telephone helplines.Conclusion(s): Mental health websites were more likely to be used by those with severe depressive symptoms rather than those with mild depression as recommended in current guidelines.Practice Implication(s): Whilst mental health websites offer potential to support the high volume of people with mild depression new strategies may be required to ensure uptake. [ABSTRACT FROM AUTHOR]

In recent years the biosynthesis of auxin has been clarified with the aid of mutations in auxin biosynthesis genes. However, we know little about the effects of these mutations on the seed-filling stage of seed development., Here we investigate a key auxin biosynthesis mutation of the garden pea, which results in auxin deficiency in developing seeds. We exploit the large seed size of this model species, which facilitates the measurement of compounds in individual seeds., The mutation results in small seeds with reduced starch content and a wrinkled phenotype at the dry stage. The phenotypic effects of the mutation were fully reversed by introduction of the wild-type gene as a transgene, and partially reversed by auxin application., The results indicate that auxin is required for normal seed size and starch accumulation in pea, an important grain legume crop. [ABSTRACT FROM AUTHOR]

Background: Depression is a highly prevalent and costly disorder. Effective treatments are available but are not always delivered to the right person at the right time, with both under- and over-treatment a problem. Up to half the patients presenting to general practice report symptoms of depression, but general practitioners have no systematic way of efficiently identifying level of need and allocating treatment accordingly. Therefore, our team developed a new clinical prediction tool (CPT) to assist with this task. The CPT predicts depressive symptom severity in three months' time and based on these scores classifies individuals into three groups (minimal/mild, moderate, severe), then provides a matched treatment recommendation. This study aims to test whether using the CPT reduces depressive symptoms at three months compared with usual care.Methods: The Target-D study is an individually randomized controlled trial. Participants will be 1320 general practice patients with depressive symptoms who will be approached in the practice waiting room by a research assistant and invited to complete eligibility screening on an iPad. Eligible patients will provide informed consent and complete the CPT on a purpose-built website. A computer-generated allocation sequence stratified by practice and depressive symptom severity group, will randomly assign participants to intervention (treatment recommendation matched to predicted depressive symptom severity group) or comparison (usual care plus Target-D attention control) arms. Follow-up assessments will be completed online at three and 12 months. The primary outcome is depressive symptom severity at three months. Secondary outcomes include anxiety, mental health self-efficacy, quality of life, and cost-effectiveness. Intention-to-treat analyses will test for differences in outcome means between study arms overall and by depressive symptom severity group.Discussion: To our knowledge, this is the first depressive symptom stratification tool designed for primary care which takes a prognosis-based approach to provide a tailored treatment recommendation. If shown to be effective, this tool could be used to assist general practitioners to implement stepped mental-healthcare models and contribute to a more efficient and effective mental health system.Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR 12616000537459 ). Retrospectively registered on 27 April 2016. See Additional file 1 for trial registration data. [ABSTRACT FROM AUTHOR]

The tryptamine pathway is one of five proposed pathways for the biosynthesis of indole-3-acetic acid (IAA), the primary auxin in plants. The enzymes AtYUC1 (Arabidopsis thaliana), FZY (Solanum lycopersicum), and ZmYUC (Zea mays) are reported to catalyze the conversion of tryptamine to N-hydroxytryptamine, putatively a rate-limiting step of the tryptamine pathway for IAA biosynthesis. This conclusion was based on in vitro assays followed by mass spectrometry or HPLC analyses. However, there are major inconsistencies between the mass spectra reported for the reaction products. Here, we present mass spectral data for authentic N-hydroxytryptamine, 5-hydroxytryptamine (serotonin), and tryptamine to demonstrate that at least some of the published mass spectral data for the YUC in vitro product are not consistent with N-hydroxytryptamine. We also show that tryptamine is not metabolized to IAA in pea (Pisum sativum) seeds, even though a PsYUC-like gene is strongly expressed in these organs. Combining these findings, we propose that at present there is insufficient evidence to consider N-hydroxytryptamine an intermediate for IAA biosynthesis. [ABSTRACT FROM AUTHOR]

Light regulation of gibberellin (GA) biosynthesis occurs in several species, but the signaling pathway through which this occurs has not been clearly established. We have isolated a new pea (Pisum sativum) mutant, long1, with a light-dependent elongated phenotype that is particularly pronounced in the epicotyl and first internode. The long1 mutation impairs signaling from phytochrome and cryptochrome photoreceptors and interacts genetically with a mutation in LIP1, the pea ortholog of Arabidopsis thaliana COP1. Mutant long1 seedlings show a dramatic impairment in the light regulation of active GA levels and the expression of several GA biosynthetic genes, most notably the GA catabolism gene GA2ox2. The long1 mutant carries a nonsense mutation in a gene orthologous to the ASTRAY gene from Lotus japonicus, a divergent ortholog of the Arabidopsis bZIP transcription factor gene HY5. Our results show that LONG1 has a central role in mediating the effects of light on GA biosynthesis in pea and demonstrate the importance of this regulation for appropriate photomorphogenic development. By contrast, LONG1 has no effect on GA responsiveness, implying that interactions between LONG1 and GA signaling are not a significant component of the molecular framework for light-GA interactions in pea. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) accounts for 40% of the excess mortality identified in people with severe mental illness (SMI). Modifiable CVD risk factors are higher and can be exacerbated by the cardiometabolic impact of psychotropic medications. People with SMI frequently attend primary care presenting a valuable opportunity for early identification, prevention and management of cardiovascular health. The ACCT Healthy Hearts Study will test a coproduced, nurse-led intervention delivered with general practitioners to reduce absolute CVD risk (ACVDR) at 12 months compared with an active control group. ACCT is a two group (intervention/active control) individually randomised (1:1) controlled trial (RCT). Assessments will be completed baseline (pre-randomisation), 6 months, and 12 months. The primary outcome is 5-year ACVDR measured at 12 months. Secondary outcomes include 6-month ACVDR; and blood pressure, lipids, HbA1c, BMI, quality of life, physical activity, motivation to change health behaviour, medication adherence, alcohol use and hospitalisation at 6 and 12 months. Linear mixed-effects regression will estimate mean difference between groups for primary and secondary continuous outcomes. Economic cost-consequences analysis will be conducted using quality of life and health resource use information and routinely collected government health service use and medication data. A parallel process evaluation will investigate implementation of the intervention, uptake and outcomes. ACCT will deliver a coproduced and person-centred, guideline level cardiovascular primary care intervention to a high need population with SMI. If successful, the intervention could lead to the reduction of the mortality gap and increase opportunities for meaningful social and economic participation. Trial registration ANZCTR Trial number: ACTRN12619001112156. • A cardiovascular risk reduction intervention was coproduced with people living with severe mental illness. • Multi-factorial risks will be targeted with tailored pharmacological and non-pharmacological evidence-based therapies. • A conversation aide, healthy heart action plan, tailored SMS messages, and a healthy heart resource were coproduced. • The ACCT intervention employs Assertive Community Treatment and Motivational Interviewing principles with frequent contact. • The ACCT study is a comprehensive evaluation of the Assertive Cardiac Care intervention on ACVDR in primary care. • An economic and process evaluation will be conducted to determine the costs, implementation, uptake and outcomes. [ABSTRACT FROM AUTHOR]