Parenting and Serious Mental Illness (SMI): A Systematic Review and Metasynthesis.

The consequences of Serious Mental Illness (SMI) on parent and child outcomes can be profound. Supporting parents to manage their caregiving roles alongside parental SMI successfully has been recognised as a public health priority. To meet this priority and develop effective and acceptable interventions, it is imperative that parents' experiences and support needs are understood. This systematic review aimed to synthesise qualitative research that explored parents' experiences and perceptions of the impact of SMI on their parenting and their corresponding support needs. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. Five databases were searched for terms associated with SMI, parenting, and qualitative research. Twenty-nine studies involving 562 parents who experienced SMI met inclusion criteria, and the methodological quality of included studies was appraised using the Critical Appraisal Skills Programme. After findings were synthesised using thematic synthesis, six themes were identified: (1) The constrained parent, (2) parenting difficulties, (3) the strained child, (4) inescapable threat, (5) combatting threat, and (6) wrap-around support needs. Novel insights into the centrality of SMI-related parenting difficulties and threat perceptions across parent, family, healthcare, and wider social systems on strained parent-child and distanced parent-support relationships were highlighted. Systemic practice change initiatives via compassionate and inclusive system-wide support were recommended.

Self-reported benefits from successive bilateral cochlear implantation in post-lingually deafened adults: randomised controlled trial.

Adult users of unilateral Nucleus CI24 cochlear implants with the SPEAK processing strategy were randomised either to receive a second identical implant in the contralateral ear immediately, or to wait 12 months while they acted as controls for late-emerging benefits of the first implant. Twenty four subjects, twelve from each group, completed the study. Receipt of a second implant led to improvements in self-reported abilities in spatial hearing, quality of hearing, and hearing for speech, but to generally non-significant changes in measures of quality of life. Multivariate analyses showed that positive changes in quality of life were associated with improvements in hearing, but were offset by negative changes associated with worsening tinnitus. Even in a best-case scenario, in which no worsening of tinnitus was assumed to occur, the gain in quality of life was too small to achieve an acceptable cost-effectiveness ratio. The most promising strategies for improving the cost-effectiveness of bilateral implantation are to increase effectiveness through enhanced signal processing in binaural processors, and to reduce the cost of implant hardware.

Taking advice, using information and knowing what you are doing.

Subjective descriptions of judgment policies have been found to be imperfect. This could be because subjective weights are obtained on just a single occasion after all judgments have been completed. It could also be because people have tended to state their perception of an ideal way of responding rather than their perception of how they actually responded. Finally, it could be because they experience difficulty in relating variation in stimulus dimensions to variation in quite different response dimensions. In our task, people made sales forecasts on the basis of four pieces of information. They also stated the weight they placed on each one and the weight they should have placed on it. The means of weights stated on each trial were more appropriate than those stated at the end of all trials. Stated actual weights were very similar to stated ideal weights. Weights were more appropriate when forecasts and cues varied along the same dimension than when they did not. Thus, our results are consistent with the view that all three factors affect people's ability to provide subjective descriptions of their judgment policies.

Using Advice and Assessing Its Quality.

People received advice from four sources and used it to produce a judgment. They also assessed the quality of advice by estimating the probability that it would be correct. They were better at assessing than at using advice: combinations of advice based on their assessments were superior to their judgments. Order of assessing and using advice, superficial differences between advisors, and using other methods of advice assessment had no significant effects on this superiority of advice assessment over advice use. However, use but not assessment was improved when some advisors exhibited biases opposite to those that people typically show. It appears that using advice imposes a heavier processing load than assessing its quality and that this load can be lightened by including advisors who exhibit unusual behavior. Their salience may help people working under a heavy processing load make appropriate pairings between advisor weights and advice. Copyright 2000 Academic Press.

Disruption of short-term recognition memory for tones: streaming or interference?

A sequence of auditory stimuli interpolated between the initial presentation of a tone and a comparison tone impairs recognition performance. Notably, the impairment is much less with interpolated speech than with tones. Six experiments converge on the conclusion that this pattern of impairment is due more to the organization of the interpolated sequence than to its similarity to the to-be-remembered standard. Factors that contribute to the coherence of the interpolated sequence into a stream distinct from the initial tone are primary determinants of the level of impairment. This is demonstrated by manipulating factors that contribute to the coherence of the interpolated sequence by the action of temporal, spatial, timbral, and tonal attributes. However, the relative immunity of recognition performance to the interpolation of unprocessed digit sequences is not explained wholly by such coherence.

General practitioners' tacit and stated policies in the prescription of lipid lowering agents.

BACKGROUND: Research into general practitioners' prescribing behaviour with regard to lipid lowering agents has relied on survey methods which presume that doctors have insight into their prescribing behaviour and can describe it accurately. AIM: This study set out to measure the tacit policies used by general practitioners in prescribing lipid lowering agents and to compare these with their stated policies. METHOD: Effects of 13 separate cues on decisions to prescribe were examined. The cues included cholesterol levels and a number of associated risk factors for coronary heart disease. Doctors rated 130 imaginary cases presented by a computer. Thirty five general practitioners in the Plymouth area participated in the study. Their ages ranged from 31 to 55 years and all but four were men. The raw data in each case was a rating of the likelihood that the doctor would prescribe for the patient described. These were converted into statistical weightings by use of multiple linear regression. The pattern of (standardized) weights constituted the tacit policy for each doctor. Stated policies were measured in a subsequent interview by asking doctors to rate the influence of each cue. RESULTS: Both tacit and stated policies diverged widely between different doctors. Most doctors overestimated the number of cues that had actually influenced their decisions, and many believed that they had taken into account associated factors for coronary heart disease when they had not. On lifestyle related risks doctors were generally less likely to treat overweight people and most stated this as their policy. Most were also less likely to treat smokers but some had the opposite policy. Those less likely to treat smokers were also less likely to treat obese patients. There was also considerable variation in the extent to which the doctors took account of the attitude of the patient to receiving treatment. CONCLUSION: Doctors' policies are highly variable and particularly inconsistent in the treatment of smokers. Relevant risk factors may be ignored--even though they are understood--because the risk assessment involved is too psychologically complex a task to be performed intuitively. Decision aids and clear protocols are needed in this area.

Measuring pressure under burns pressure garments using the Oxford Pressure Monitor.

Pressure garments are used extensively in the treatment of hypertrophic scarring following burn injuries. The Oxford Pressure Monitor was used to measure garment-scar interface pressure (mmHg) using a number of fabric types over various body parts. The results indicate a wide range of pressure values between different garments and body parts with the greatest pressures found over the dorsum of hands and feet. The problems of achieving 'optimal pressure' over hypertrophic scarring are discussed with emphasis on the need for more accurate measuring equipment.

Foam ear protectors for burnt ears.

Foam ear protectors were developed at the Royal Brisbane Hospital for use with selected patients with burns to the ears. The protectors assist in preventing pressure necrosis of the ear and damage to skin grafts. They permit visualization of the ears after grafting and allow the patient to sleep in a side-lying position if desired.

'The hidden society': the practical use of multi-dimensional scaling to illuminate the pattern of relationships between long-stay psychiatric residents.

This paper briefly reports testing the use of multi-dimensional scaling as a method to illuminate the complex pattern of relationships existing between patients in a long-stay psychiatric setting. The results did not support the hypothesis that recently formed rehabilitation groups in the hostel would serve to explain the pattern of relationships between patients. The results did, however, promote a more informed discussion regarding the origin and implications of patient relationships in long-stay psychiatric care, which served to revise staff ideas and options regarding the organization of care. Relationships between long-stay disabled psychiatric patients are notoriously opaque to observers. The use of multi-dimensional scaling helped make them more transparent.

Some pharmacological aspects of desmethylclomipramine.

The N-desmethyl metabolites of imipramine and amitriptyline possess antidepressant activity in their own right. To test whether this is also true of desmethylclomipramine, studies have been carried out on appropriate models. Desmethylclomipramine was shown to be present in plasma in higher concentrations than the parent compound, to be strongly active in reversing or suppressing reserpine-induced hypothermia, to possess anticholinergic activity on gastrointestinal smooth muscle, inhibiting motility and antagonizing muscarinic receptors, though to a lesser extent than clomipramine. It is also a more potent inhibitor of noradrenaline and dopamine uptake than clomipramine is, though less potent in inhibiting 5-hydroxytryptamine uptake. The metabolite has antidepressant activity of its own, probably associated with its monoamine uptake inhibitory properties, and doubtless makes an important contribution to the efficacy of treatment of depression with clomipramine; for this reason plasma levels of the metabolite as well as those of the parent compound should be taken into account.