Search

BackgroundRelapse in schizophrenia is a major cause of distress and disability and is predicted by changes in symptoms such as anxiety, depression, and suspiciousness (early warning signs [EWSs]). These can be used as the basis for timely interventions to prevent relapse. However, there is considerable uncertainty regarding the implementation of EWS interventions. ObjectiveThis study was designed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) against treatment as usual (TAU). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, safety, and outcome signals of a digital health intervention as an adjunct to usual care that is deliverable in the UK National Health Service and Australian community mental health service (CMHS) settings. We will assess the feasibility of candidate primary outcomes, candidate secondary outcomes, and candidate mechanisms for a definitive trial. MethodsWe will randomize CMHSs to EMPOWER or TAU. We aim to recruit up to 120 service user participants from 8 CMHSs and follow them for 12 months. Eligible service users will (1) be aged 16 years and above, (2) be in contact with local CMHSs, (3) have either been admitted to a psychiatric inpatient service or received crisis intervention at least once in the previous 2 years for a relapse, and (4) have an International Classification of Diseases-10 diagnosis of a schizophrenia-related disorder. Service users will also be invited to nominate a carer to participate. We will identify the feasibility of the main trial in terms of recruitment and retention to the study and the acceptability, usability, safety, and outcome signals of the EMPOWER intervention. EMPOWER is a mobile phone app that enables the monitoring of well-being and possible EWSs of relapse on a daily basis. An algorithm calculates changes in well-being based on participants’ own baseline to enable tailoring of well-being messaging and clinical triage of possible EWSs. Use of the app is blended with ongoing peer support. ResultsRecruitment to the trial began September 2018, and follow-up of participants was completed in July 2019. Data collection is continuing. The database was locked in July 2019, followed by analysis and disclosing of group allocation. ConclusionsThe knowledge gained from the study will inform the design of a definitive trial including finalizing the delivery of our digital health intervention, sample size estimation, methods to ensure successful identification, consent, randomization, and follow-up of participants, and the primary and secondary outcomes. The trial will also inform the final health economic model to be applied in the main trial. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 99559262; http://isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID)DERR1-10.2196/15058

In the United States, principal investigators of the National Science Foundation's Noyce Scholars program are challenged with identifying college STEM majors who have a fledgling interest in science teaching and preparing them to teach in high-needs school districts. The purpose of this longitudinal research project was to quantitatively and qualitatively identify STEM majors' self-view on becoming a science teacher when they applied to one college campus based, Noyce Scholars program, and to describe how their self-view on becoming a science teacher in a high-needs school district evolved from their college years into their early careers as science teachers. To address the purpose of the study, researchers quantitatively analyzed emergent themes in a series of three reflective essays written by sixteen Noyce Scholars over a five-year period. The first essay was part of their Noyce Scholars program application; the second essay was written approximately three-years later during their undergraduate coursework; and the final essay was written during their induction year as a science teacher in a high-needs school district. Essay analyses revealed that the Noyce scholars' self-view of teaching science in high-needs schools spreads from a narrow focus on personal experiences as students, to an in-service self-view characterized by broad understandings of some of the challenges, rewards and pedagogical competencies needed to teach science in a high-needs school.

Background: Understanding inequalities in outcomes between demographic groups is a necessary step in addressing them in clinical care. Inequalities in treatment uptake between demographic groups may explain disparities in outcomes in people with first-episode psychosis (FEP). Aims: To investigate disparities between broad demographic groups in symptomatic improvement in patients with FEP and their relationship to treatment uptake. Method: We used data from 6813 patients from the 2021–2022 National Clinical Audit of Psychosis data-set. Data were grouped by category type to obtain mean outcomes before adjustment to see whether disparities in outcomes remained after differences in treatment uptake had been accounted for. After matching, the average effect of each demographic variable in terms of outcome change was calculated. Moderator effects on specific treatments were investigated using interaction terms in a regression model. Results: Observational results showed that patients aged 18–24 years were less likely to improve in outcome, unless adjusted for intervention uptake. Patients classified as Black and Black British were less likely to improve in outcome (moderation effect 0.04, 95% CI 0–0.07) after adjusting for treatment take-up and demographic factors. Regression analysis showed the general positive effect of supported employment interventions in improving outcomes (coefficient −0.13, 95% CI −0.07 to −0.18, P < 0.001), and moderator analysis suggested targeting particular groups for interventions. Conclusions: Inequalities in treatment uptake and psychotic symptom outcome of FEP by social and demographic factors require monitoring over time. Our analysis provides a framework for monitoring health inequalities across national clinical audits in the UK. [ABSTRACT FROM AUTHOR]

Introduction: Inequity in access to healthcare in the United Kingdom can have a profound impact on people's ability to manage their health problems. Link work interventions attempt to overcome the socioeconomic and structural barriers that perpetuate health inequalities. Link workers are typically staff members without professional clinical qualifications who support patients to bridge the gap between services. However, little is currently known about how and why link work interventions might be effective. This realist review attempts to understand the contexts and resultant mechanisms by which link work interventions affect access to community healthcare services. Methods: The authors completed a systematic search of empirical literature in Embase, CINAHL, Medline, PsychInfo and SocIndex, as well as grey literature and CLUSTER searches. Context, mechanism and outcome (CMO) configurations were generated iteratively in consultation with an expert panel and grouped into theory areas. Results: Thirty‐one eligible manuscripts were identified, resulting in nine CMO configurations within three theory areas. These pertained to adequate time in time‐pressured systems; the importance of link workers being embedded across multiple systems; and emotional and practical support for link workers. Conclusion: Although link work interventions are increasingly utilised across community healthcare settings, the contexts in which they operate vary considerably, triggering a range of mechanisms. The findings suggest that careful matching of resources to patient need and complexity is important. It affords link workers the time to develop relationships with patients, embed themselves in local communities and referring teams, and develop knowledge of local challenges. Patient or Public Contribution: The team included people with lived experience of mental health conditions and a carer who were involved at all stages of the review. [ABSTRACT FROM AUTHOR]

Background: People with new psychotic symptoms may be managed in an Early Intervention in Psychosis (EIP) service. They may be discharged back to primary care at the end of their time in an EIP service. Aim: To explore the role of primary care in supporting people with psychosis in an EIP service. Design and setting: Qualitative study, within a programme of work to explore the optimum duration of management in an EIP service in England. Method: Semi-structured interviews were carried out with people in EIP services, carers, GPs, and EIP practitioners between September 2022 and September 2023. Data collection continued until information power was achieved. Data were thematically analysed using principles of constant comparison. Results: While most service users and carers described their experiences of EIP services as positive, there are issues around access to and discharge from the services. GPs reported difficulties in referring people into EIP services, having little contact with people who are supported by EIP services, and not being included in planning discharge from EIP services to primary care. Service users and carers described challenges at the point of discharge from EIP services to primary care, associated with feelings of abandonment. Conclusion: This study suggests that GPs should have a role in the support of people in EIP services (in particular, monitoring and managing physical health) and their carers. Inclusion of GPs in managing discharge from EIP services is vital. We suggest that a joint consultation with the service user, their carer (if they wish), along with the EIP care coordinator and GP would make this transition smoother. [ABSTRACT FROM AUTHOR]

Introduction: Oral diseases are more prevalent in people with severe mental illness (SMI) compared to those without mental illnees. A greater focus on oral health is needed to reverse unacceptable but often neglected oral health inequality in people with SMI. This provided the impetus for developing 'The Right to Smile' consensus statement. We aimed to develop and disseminate a consensus statement to address oral health inequality, highlighting the main areas for concern and recommending an evidence‐based 5‐year action plan to improve oral health in people with SMI. Methods: The Right to Smile consensus statement was developed by experts from several professional disciplines and practice settings (mental, dental and public health) and people with lived experience, including carers. Stakeholders participated in a series of online workshops to develop a rights‐based consensus statement. Subsequent dissemination activities were conducted to maximise its reach and impact. Results: The consensus statement was developed to focus on how oral health inequalities could be addressed through a set of 5‐year improvement targets for practice, policy and training. The consensus was reached on three 5‐year action plans: 'Any assessment of physical health in people experiencing SMI must include consideration of oral health', 'Access to dental services for people with SMI needs to improve' and 'The importance of oral health for people experiencing SMI should be recognised in healthcare training, systems, and structures'. Conclusion: This consensus statement urges researchers, services and policymakers to embrace a 5‐year action plan to improve oral health for people with SMI. Patient or Public Contribution: The team included people with lived experience of SMI, their carers/family members and mental and dental health service providers. They were involved in every stage of developing the consensus statement, from conception to development and dissemination. [ABSTRACT FROM AUTHOR]