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Suicide is a leading preventable cause of death (Centers for Disease Control and Prevention, 2018). Recent research identifies the time following hospital discharge after a suicide attempt as a critical window whereby suicide risk is heightened. As a result, suicide aftercare services that emphasize timely follow-up intervention are increasingly popular. There is a lack of research exploring the role of peer-workers in the context of suicide prevention aftercare. This is surprising given that peer-work has been hypothesized to promote belongingness, engagement, and hope; all factors theorized as critical to suicide ideation and behavior. This project aimed to address this research gap by exploring the perspectives of six peer-workers and five clinicians (n = 11) employed in a suicide prevention aftercare program. Qualitative data were collected via an online survey and telephone interviews. Interviews explored what processes were perceived by peer-workers and clinicians as critical in facilitating change within the context of a suicide prevention service. Thematic analysis identified four themes encapsulating factors that promote change: (1) utilizing lived experience; (2) emotional availability of peers; (3) building lives worth living; and (4) consumer driven care. Our analysis also identified an additional, but less direct, mechanism of change: Consultation in the context of risk. Our findings show that peer-work in suicide prevention is regarded as largely positive by both peer-workers and clinicians. Peer-workers and clinicians highlighted the importance of collaboration and consultation to facilitate effective management of risk and supervision given the complex nature of suicide prevention work. Finally, workers emphasized the importance of promoting agency amongst service-users, which they viewed as particularly important within the context of suicide prevention. Implications for suicide prevention services are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This integrative literature review summarizes recent literature relating to patient adjustment to stoma. The search strategy included 5 databases (CINAHL Plus, PsychINFO, Web of Science, Scopus, and MEDLINE); 65 articles meeting criteria were retrieved. Eleven were removed as duplicates, and a further 29 were removed when read in full, yielding 25 elements. Three were randomized controlled trials; 2 were prospective descriptive studies; 15 were cross-sectional descriptive studies; and 5 were qualitative studies. The quality of studies was evaluated using the Mixed Methods Appraisal Tool (MMAT). The calculated mean quality score was 97%, and no studies were excluded on quality grounds. Limited evidence suggests that adjustment occurs over time and provides some insight concerning how rehabilitation leads to resumption of an altered normality. Some evidence suggests that long-term adjustment is associated with demographic and pre- and postoperative factors. A knowledge gap was identified regarding the role of support groups, which in other fields has been shown to positively benefit psychological well-being. This review revealed a paucity of interventional studies seeking to test ways to address adjustment-related problems. Longitudinal studies are recommended as ostomy care nurses work to facilitate adjustment in the person with a stoma over time.

Background & aims Vascular function, blood pressure and inflammation are involved in the pathogenesis of major chronic diseases, including both cardiovascular disease (CVD) and mild cognitive impairment (MCI). This study investigated the effects of food anthocyanins on microvascular function, 24-h ambulatory blood pressure (ABP) and inflammatory biomarkers in older adults with MCI. Methods and results Thirty-one participants with MCI [19 female, 12 male, mean age 75.3 (SD 6.9) years and body mass index 26.1 (SD 3.3) kg/m2], participated in a randomized, controlled, double-blind clinical trial (Australian New Zealand Clinical Trials Registry: ACTRN12618001184268). Participants consumed 250 mL fruit juice daily for 8 weeks, allocated into three groups: a) high dose anthocyanins (201 mg); b) low dose anthocyanins (47 mg); c) control. Microvascular function (Laser Speckle Contrast Imaging combined with a post-occlusive reactive hyperaemia test), 24h ABP and serum inflammatory biomarkers were assessed before and after the nutritional intervention. Results Participants in the high anthocyanins group had a reduction in serum tumor necrosis factor alpha (TNF-α) (P = 0.002) compared to controls and the low anthocyanins group (all P's > 0.05). Serum IL-6, IL-1β, c-reactive protein, and parameters of microvascular function and 24h ABP were not altered by any treatment. Conclusion A daily high dose of fruit-based anthocyanins for 8 weeks reduced concentrations of TNF-α in older adults with MCI. Anthocyanins did not alter other inflammatory biomarkers, microvascular function or blood pressure parameters. Further studies with a larger sample size and longer period of follow-up are required to elucidate whether this change in the immune response will alter CVD risk and progression of cognitive decline.

BACKGROUND Focus group discussions (FGDs) have been used as an effective method to capture consumers’ needs, experiences and expectations for the design of future digital health solutions. However, engaging consumers in FGDs is challenging. To date, there is little guidance for the best practice of moderating FGDs. OBJECTIVE This study describes the development of a 6P framework for effectively engaging consumers in FGDs to identify their needs, experiences and expectations for future digital health solutions. METHODS A 6P framework – prototype, people, protocol, place, parity and parallelism – for consumer engagement in FGDs was developed by a multidisciplinary team via synthesizing the evidence in the literature. The 6P framework was implemented in two FGDs at a hospital in South-West New South Wales, Australia. Patients with obesity (35kg/m2) who were undergoing weight-loss treatment at the hospital were recruited using purposive sampling. Discussions collected user needs, experiences, and expectations with a prototype mobile health app to support self-management of obesity. The FGD recordings were transcribed verbatim and content analysis was conducted. RESULTS Twelve adult participants (5 men, 7 women) participated in two FGDs. The well-prepared prototype (a mHealth app), people (developing team, moderator, observers, and technical assistants), protocol (interview guide, plan and handout), and place (physical and virtual friendly one) enabled the participants to actively engage in FGDs to express their needs, experiences and expectations. Participants expressed positive thoughts about the overall usability and usefulness of the app. They provided suggestions for further improvement of the app in terms of information quality (the presence of some irrelevant, incomprehensible, or incomplete information) and system quality (difficulty of using app functions). Participants also expressed an expectation to see more personalized graphical designs that are easy to comprehend. The moderator used the two techniques – parity and parallelism, to control the dominant participants and encourage silent participants, so that they can express their opinions as objectively as possible. CONCLUSIONS Following the 6P framework to moderate FGDs is conducive for consumers to understand the discussion topic, engage in peer interaction about a prototype and relate the interactional experience with their previous digital solution usage experiences. The framework provides insight for managing dominant participants and eliciting further functions. It also enables consumers to effectively reflect, understand and express their needs, experiences and expectations in digital solution co-design in FGDs.

To determine the rate of cognitive screening undertaken with patients undergoing amputation and to determine the demographics of the sample.Retrospective medical record audit.The medical records of a convenience sample of persons who had undergone amputation, upper and lower limb, from one local health district were reviewed. The sample date range was between January 1st, 2017, and December 31st, 2018. The incidence and type of cognitive screening were also recorded. Descriptive statistics were used to describe the results.A total of 178 episodes of amputation care were identified during retrospective medical record auditing (mean age, 69.7 years). Thirty nine of the 178 (21.9%) episodes of care had a cognitive screening measure completed during that inpatient admission (24.2% vascular etiology and 12% nonvascular etiology). All cognitive screens were completed in persons with lower-limb amputations and were completed postoperatively.Cognitive screening is not a routine part of the health care journey for patients with an amputation in this health care district.

Background Despite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions. Objective This study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery. Methods We adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases. Results In stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient’s risk level, as informed by the person’s response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions. Conclusions This study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions.

BACKGROUND Despite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions. OBJECTIVE This study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery. METHODS We adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases. RESULTS In stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient’s risk level, as informed by the person’s response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions. CONCLUSIONS This study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions.

With increasing focus on the treatment of mental health problems the need for clinical psychologists is expanding, driving strong demand for postgraduate clinical psychology training programs. Alth...

Background Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed ‘aftercare’ interventions). Methods A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. Discussion The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. Trial registration ACTRN12618001701213. Registered on 16 October 2018. Retrospectively registered.

Background: The Community of Practice Research was established as a new local health district service initiative. The community comprises novice and experienced multidisciplinary health researchers. Aims: This paper reflects our experience of being Community of Practice Research members and aims to explore the practice development principles aligned to the purpose, progress and outcomes of this community. Conclusions: The journey is compared to walking a tightrope from the beginning to the end. Success in moving forward is attributed to positive leadership and group dynamics enabling a supportive environment. This environment allowed for different types of learning: new research skills and new understandings about oneself. Competing demands such as fluctuating membership and leadership, and the selection of a large initial project were identified as barriers to the Community of Practice Research. Implications for practice: As well as contributing to communities’ shared goals members should identify and make explicit their own learning goals to themselves, the community and their managers Community of practice meetings should include regular facilitated reflection about the learning that is occurring, the challenges and assumptions being made by the group, and the way forward A community of practice uses social processes to aid learning and collaboration across disciplines and organisations and therefore has potential to promote local culture change

The study evaluated a neuropsychological assessment battery used to assess fitness to drive in cognitively impaired individuals and hypothesized that the battery would be associated with on-road outcome measures. A secondary aim was to explore the relationships between individual neuropsychological tests and driving performance.The study used a cross-sectional design in which a sample of individuals with various types of cognitive impairment completed the test battery and an on-road driving test.Performance on the test battery was compared to on-road driving performance in 104 individuals with acquired cognitive impairment.The battery had 73% sensitivity and 76% specificity in terms of agreement with the 'pass/fail' classification of the on-road driving test. Scores on the battery accounted for 18% of the variance in the total number of corrective interventions performed by a driving instructor during the on-road test. Most tests correlated significantly with driving test outcomes. While one test, the Rey Complex Figure Test, emerged as an independent predictor of driving performance in multiple regression analyses, the variance explained by this single test was small.The results provide support for the use of a battery approach to assess fitness to drive.

Purpose. This study explores the effects of anxiety on driving performance in a sample of 35 individuals with cognitive impairment who underwent driving reassessment 2 weeks after neuropsychological assessment.Method. Participants completed measures of test, state and driving anxiety prior to the neuropsychological assessment. Measures of state anxiety were re-administered immediately before and after the on-road driving test.Results. Higher anxiety before the on-road test was associated with fewer errors, although regression analyses showed that anxiety was not a unique predictor of driving performance.Conclusions. The results suggest that anxiety has a positive influence on driving performance but does not predict driving assessment outcome. Occupational therapists and driving instructors were better judges of the effects of anxiety on driving performance than were the participants themselves. Implications of these findings for clinical and medico-legal contexts are discussed.

Graded exposure in vivo (GEXP) treatment has been successfully used to reduce levels of pain-related fear and disability in some chronic pain patients, but its effectiveness has not been evaluated in general clinical settings using group-design studies. The purpose of this study was to determine if the systematic incorporation of GEXP into a multidisciplinary chronic pain management group (PMG) treatment program would result in better treatment outcomes than usual PMG treatment.One hundred forty-three chronic pain patients who were assessed as suitable for an outpatient multidisciplinary chronic PMG program were randomly allocated to 3 experimental conditions; usual PMG, PMG incorporating systematic graded exposure, and wait-list control.The clinical outcomes of the 2 treatment conditions were not significantly different, suggesting that the systematic incorporation of GEXP into a multidisciplinary PMG program did not result in better treatment outcomes than usual PMG treatment. Both group treatment programs were associated with significant treatment effects when compared with the wait-list control on measures of pain intensity, fear of movement/(re)injury, pain self-efficacy, activity level, and depression. No treatment effects were found on self-report measures of pain disability or anxiety.The addition of systematic graded exposure into a multidisciplinary chronic pain management program did not result in better clinical outcomes than the usual group treatment program. The validity of GEXP to the broader population of chronic pain patients warrants further investigation.

Objective: To explore the relationships between weight-bearing, pain and walking velocity in the first four weeks of prosthetic training. Subjects: Consecutively referred transtibial amputees (n = 27). Design: Longitudinal study. Setting: Inpatient rehabilitation centre. Interventions: Measurements of static weight-bearing (SWB), perceived pain during the SWB test and self-selected walking velocity (VEL) were taken at entry, and at four weeks into the prosthetic training programme. Path analysis was conducted using a series of linear regression analyses to determine predictors of walking velocity at week 4. Results: Significant improvements from week 1 to week 4 were found in SWB, reported pain and velocity. SWB at week 4, when coupled with age, predicted 66% of the variance in walking velocity at week 4. Pain did not directly predict velocity. However, SWB at entry and perceived pain at week 4 predicted 56% of the variance in SWB at week 4. Conclusions: These analyses suggested a model in which SWB and age were both significantly related to velocity, and further, that pain played a role in velocity through a relationship mediated by its direct effect on SWB. Unlike age, SWB is a predictor of velocity that might be altered through pain reduction, wound-healing and rehabilitative interventions.

Supervisors' ratings of psychology trainees' competence in field settings are a critical component of training assessment. There has been little systematic research regarding the validity of these assessments, but the available evidence suggests we have a problem! Supervisors' judgments may be affected by systemic biases that pose a serious threat to assessment credibility. The current study is part of a research collaboration among six universities that endeavors to develop and evaluate a new method-the use of vignettes-against outcomes derived from a conventional rating scale. Individual vignettes were designed and subjected to a rigorous process of peer-review and revisions, before final vignettes were assigned calibration scores by a group of experts. A catalogue of vignettes (n = 41) that represent various domains of competence across several developmental stages was compiled. University and field super-visors used the conventional rating scale and the vignette-matching procedure (VMP) to evaluate competencies at end-placement. Data from a pilot (n = 20) and a follow-up study (n = 57) suggest that compared with a conventional rating scale, the VMP reduced leniency and halo biases. The VMP has the potential to improve outcomes of competency assessments in field placements and merits further research and development. © eat to assessment credibility. The current study is part of a research collaboration among six universities that endeavors to develop and evaluate a new method-the use of vignettes-against outcomes derived from a conventional rating scale. Individual vignettes were designed and subjected to a rigorous process of peer2013 American Psychological Association.