comparative study of nurses as case manager and telephone follow-up on clinical outcomes of patients with severe mental illness

Background: Providing community-based mental health services is crucial and is an agreed plan between the Iranian Mental Health Office and the Regional Committee for the Eastern Mediterranean [affiliated with WHO]. The aim of this study was to determine the effectiveness of home-visit clinical case-management services on the hospitalization rate and other clinical outcomes in patients with severe mental illness

Methods: A total of 182 patients were randomly allocated into three groups, namely, home-visit [n=60], telephone follow-up [n=61] and as-usual care [n=61] groups. Trained nurses as clinical case-managers provided home-visit services and the telephone follow-up tasks. Hospitalization rate as a measure of recurrence, as well as burden, knowledge, general health condition of caregivers with positive/negative symptoms, satisfaction, quality of life, and social skills of the consumers were assessed as the main and secondary outcomes, respectively

Results: Most clinical variables were improved in both intervention groups compared with the control group. During the one year follow-up, the rate of rehospitalization for the telephone follow-up and as-usual groups were respectively 1.5 and 2.5 times higher than the home-visit group

Conclusion: Trained clinical case-managers are capable of providing continuous care services to patients with severe mental illness. The telephone follow-up services could also have beneficiary outcome for the consumers, their caregivers, and the health system network

[Evaluating critical thinking skills in medical students, Isfahan University of Medical Sciences, Iran]

Background and Objective: Medical students should learn some skills for better clinical reasoning, decision making and using evidence based medicine. One of the most important attributes of a successful clinician is the ability of critical thinking in patient care situations. The purpose of this study was to evaluate critical thinking skills [analysis, evaluation, inference, and deductive and inductive reasoning] in medical students of Isfahan University of Medical Sciences, Isfahan, Iran

Methods: This non-experimental study was conducted on 92 men in first, third and fifth years of medical education in 2008-2009. Data were collected using California Critical Thinking Skills Test [form B] and analyzed by SPSS software. Statistical tests used for data analysis were ANOVA, Duncan Posthoc and Pearson tests

Results: The mean scores of 5 sub-skills were low in all three groups. Significant differences were found among three groups in regard to evaluation [P = 0.48], inductive reasoning [P < 0.001] and deductive reasoning [P = 0.01]

Conclusion: It seems that students' critical thinking skill is not so desirable in Iran and educational planning should be considered for its development

[Validity and the cultural adaptation of the Carers' Needs Assessment for Schizophrenia and assessing the needs of family members of bipolar mood disorder and schizophrenia spectrum patients]

One of the main issues in mental health system is the assessment of patients and their carers' needs. The objective of this study was to determine the validity and the cultural adaptation of the Carers' Needs Assessment for Schizophrenia [CNA-S] and assessing the needs of families of bipolar and schizophrenia spectrum patients. CAN-S is included 18 items of carers' needs. After translation, all items of test were discussed between two different focus groups [psychiatrists and families of patients]. Then a semi-structured interview according to the final questionnaire was performed in 50 family members of patients [diagnosed bipolar disorder and schizophrenia spectrum] selected by available sampling. Data was analyzed using SPSS-17 and descriptive statistical methods, alpha Cronbach's Alpha and Kruskal Wallis tests. No item was omitted or added by each focus group. Based on CAN-S-Farsi version, 79.88% of families of patients considered all of the 18 items as "serious and severe" and 92.84% of them considered at least one of the suggested interventions as helpful for each problem. There was no significant difference among needs of three groups of the family members of patients with diagnosis of bipolar disorder, schizophrenia or schizoaffective except in one item. Cultural adaptation of this instrument could assess the needs and possible interventions for families of patients with severe mental disorder. The questionnaire may be useful for the researcher in future studies as well as professionals working in mental health field

Training health professionals to conduct family education for families of patients with first-episode psychosis: adherence to protocol

The implementation of family psychoeducation at the service delivery level is not without difficulty. Few mental health professionals receive special training to work with families especially in Iran. The aim of the present study was to evaluate the effectiveness of training health professionals in terms of their adherence to protocol. Eight professionals [general practitioners, nurses and social workers] participated in a training program for health professionals as part of the Roozbeh First-Episode Psychosis Program [RooF] to conduct family psychoeducation. Training included a 3-day- workshop and 12 supervision sessions during the course of the implementation of the psychoeducation program. The family psychoeducation sessions [multiple-family group or single-family home-based] were tape-recorded. Transcripts of the audiotaped sessions were analyzed based on the content of the manual and were scored accordingly. Twenty-four recorded sessions were analyzed in terms of the adherence to protocol, the number of questions and the time for each session. The overall rating showed a 72% adherence to the protocol. Multiple-family group sessions had a higher rate compared to the singlefamily home-based family psychoeducation sessions [79% to 69%] as well as the time spent and questions asked. The rate of adherence to the protocol of conducting the family psychoeducation sessions had not changed over time. Considering the amount of time taken for training and supervision, the level of adherence to the protocol was satisfactory. Tape recording sessions and regular supervision would be beneficial following specialized training. Further research is needed to tailor the amount of training and supervision required for professionals to conduct family psychoeducation programs in different settings