The potential for person-centred planning to support the community participation of adults with an intellectual disability.

Person-centred planning (PCP) puts individuals with an intellectual disability at the centre of service and support planning, identifying how individuals wish to live their lives and what is needed to make that possible. PCP has been identified as having the potential to facilitate improved social inclusion and community participation. A mixed-methods approach combined quantitative analyses with qualitative case studies of individuals with severe-profound intellectual disability to assess the impact of PCP on community participation for adults with an intellectual disability at a disability service in Dublin. We conclude that PCP may provide a good basis to plan community participation and, with the right supports in place, may provide opportunities for people with complex needs to improve their community participation. Supports including familiar staff and family are critical to the success of PCP for people with complex needs, and their absence may undermine the best intentions of PCP for this population.

Mental health service users experiences of medication discontinuation: a systematic review of qualitative studies.

BACKGROUND: The use of psychotropic medication is often the first line of treatment for people with mental distress. However, many service users discontinue their prescribed medication, and little is known about their experiences or the reasons why they choose to stop taking medication. AIM: The aim of this review is to synthesize research literature focused on the experiences of people who decided to discontinue taking medication for their mental health problem. METHODS: A systematic review of qualitative studies was conducted. Data bases were searched for qualitative research which explored participants' motivations for discontinuing medication and their experiences of the process. RESULTS: Six themes were identified: (1) Taking medications: a loss of autonomy, (2) Discontinuing medication: a thought-out process, (3) Factors influencing the decision to discontinue medication, (4) Discontinuing medication: experiences of the process, (5) Outcomes of discontinuing medication, (6) Managing mental distress in the absence of medication. CONCLUSION: Service providers need to be aware that for some service user's psychotropic medication is not deemed a suitable treatment approach. Those who wish to discontinue medication need to be supported in the context of positive, therapeutic risk where their mental and physical health can be monitored and the likelihood of success increased.

Deciding to discontinue prescribed psychotropic medication: A qualitative study of service users' experiences.

Many mental health service users decide to discontinue their psychotropic medication at some stage in the treatment process; however, few studies have captured these experiences. This study aimed to explore people's experiences of coming off medication. A qualitative descriptive design and individual interviews with 23 people who experienced coming off medication were employed. COREQ checklist was used. Data were analysed using inductive and deductive approaches and six major themes were developed. Findings suggest that while medication was useful for many in the short-term, the adverse effects had significant impact and contributed to the decision to come off medication. Participants also reported being driven by a questioning of the biomedical model of treatment and the belief that there were other strategies to manage their distress. Mixed experiences of support from healthcare professionals for the medication cessation process were reported. The discontinuation process was often difficult resulting in changes in mood and behaviour which for many culminated in relapse of distress, rehospitalization and return to medication. To support the process of coming off and staying off medication, participants identified a range of useful strategies but particularly highlighted the importance of peer support. Findings from this study demonstrate the importance of mental health nurses having a collaborative discussion with service users which may support safer decision-making and lessen the risk of people discontinuing medication abruptly. Finding also indicates a need for robust studies that develop and test interventions to support people who wish to discontinue psychotropic medications.

Interdisciplinary Mobile Health Model to Improve Clinical Care After Heart Transplantation: Implementation Strategy Study.

BACKGROUND: Solid organ transplantation could be the only life-saving treatment for end-stage heart failure. Nevertheless, multimorbidity and polypharmacy remain major problems after heart transplant. A technology-based behavioral intervention model was established to improve clinical practice in a heart transplant outpatient setting. To support the new strategy, the mHeart app, a mobile health (mHealth) tool, was developed for use by patients and providers. OBJECTIVE: The primary objective of this study was to describe the implementation of the mHeart model and to outline the main facilitators identified when conceiving an mHealth approach. The secondary objectives were to evaluate the barriers, benefits, and willingness to use mHealth services reported by heart transplant recipients and cardiology providers. METHODS: This was an implementation strategy study directed by a multidisciplinary cardiology team conducted in four stages: design of the model and the software, development of the mHeart tool, interoperability among systems, and quality and security requirements. A mixed methods study design was applied combining a literature review, several surveys, interviews, and focus groups. The approach involved merging engineering and behavioral theory science. Participants were chronic-stage heart transplant recipients, patient associations, health providers, stakeholders, and diverse experts from the legal, data protection, and interoperability fields. RESULTS: An interdisciplinary and patient-centered process was applied to obtain a comprehensive care model. The heart transplant recipients (N=135) included in the study confirmed they had access to smartphones (132/135, 97.7%) and were willing to use the mHeart system (132/135, 97.7%). Based on stakeholder agreement (>75%, N=26), the major priorities identified of the mHealth approach were to improve therapy management, patient empowerment, and patient-provider interactions. Stakeholder agreement on the barriers to implementing the system was weak (<75%). Establishing the new model posed several challenges to the multidisciplinary team in charge. The main factors that needed to be overcome were ensuring data confidentiality, reducing workload, minimizing the digital divide, and increasing interoperability. Experts from various fields, scientific societies, and patient associations were essential to meet the quality requirements and the model scalability. CONCLUSIONS: The mHeart model will be applicable in distinct clinical and research contexts, and may inspire other cardiology health providers to create innovative ways to deal with therapeutic complexity and multimorbidity through health care systems. Professionals and patients are willing to use such innovative mHealth programs. The facilitators and key strategies described were needed for success in the implementation of the new holistic theory-based mHealth strategy.

Exploring Mental Health Issues through the Use of Blogs: A Scoping Review of the Research Evidence.

The aim of this scoping review of the available research evidence was to explore the experiences and perceptions of people with mental health difficulties through the use of blogs. A search of relevant electronic databases was undertaken from January 2009 to February 2019. Selected studies included people who blog about their mental health difficulties online. The PRISMA system was used to present the results of the searches. Following the application of specific inclusion and exclusion criteria, the final number of included studies was eleven. Following data analysis, the subordinate categories in the public category were moderation, confidentiality and boundaries. The subordinate categories in the private sphere included catharsis, enhanced coping strategies and social connectedness. The implications for mental health practice developments and research, are presented and discussed.

Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review.

OBJECTIVE: To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities. DESIGN: Systematic review. POPULATION: Adults (aged 18 years and over) with intellectual disabilities. INTERVENTION: Deinstitutionalisation, that is, the move from institutional to community settings. PRIMARY AND SECONDARY OUTCOME MEASURES: Studies were eligible if evaluating within any cost-consequence framework (eg, cost-effectiveness analysis, cost-utility analysis) or resource use typically considered to fall within the societal viewpoint (eg, cost to payers, service-users, families and informal care costs). SEARCH: We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches and handsearching of the references of the eligible studies. We assessed study quality using the Critical Appraisals Skills Programme suite of tools, excluding those judged to be of poor methodological quality. RESULTS: Two studies were included; both were cohort studies from the payer perspective of people leaving long-stay National Health Service hospitals in the UK between 1984 and 1992. One study found that deinstitutionalisation reduced costs, one study found an increase in costs. CONCLUSION: A wide-ranging literature review found limited evidence on costs associated with deinstitutionalisation for people with intellectual disabilities. From two studies included in the review, the results were conflicting. Significant gaps in the evidence base were observable, particularly with respect to priority populations in contemporary policy: older people with intellectual disabilities and serious medical illness, and younger people with very complex needs and challenging behaviours. PROSPERO REGISTRATION NUMBER: CRD42018077406.

Effect of deinstitutionalisation on quality of life for adults with intellectual disabilities: a systematic review.

OBJECTIVE: To review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities. DESIGN: Systematic review. POPULATION: Adults (aged 18 years and over) with intellectual disabilities. INTERVENTIONS: A move from residential to community setting. PRIMARY AND SECONDARY OUTCOME MEASURES: Studies were eligible if evaluating effect on QoL or life quality, as defined by study authors. SEARCH: We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches. We assessed study quality using the Critical Appraisal Skills Programme suite of tools, excluding those judged to be of poor methodological quality. RESULTS: Thirteen studies were included; eight quantitative studies, two qualitative, two mixed methods studies and one case study. There was substantial agreement across quantitative and qualitative studies that a move to community living was associated with improved QoL. QoL for people with any level of intellectual disabilities who move from any type of institutional setting to any type of community setting was increased at up to 1 year postmove (standardised mean difference [SMD] 2.03; 95% CI [1.21 to 2.85], five studies, 246 participants) and beyond 1 year postmove (SMD 2.34. 95% CI [0.49 to 4.20], three studies, 160 participants), with total QoL change scores higher at 24 months comparative to 12 months, regardless of QoL measure used. CONCLUSION: Our systematic review demonstrated a consistent pattern that moving to the community was associated with improved QoL compared with the institution. It is recommended that gaps in the evidence base, for example, with regard to growing populations of older people with intellectual disability and complex needs are addressed. PROSPERO REGISTRATION NUMBER: CRD42018077406.

Efficacy and safety of direct-acting antiviral agents when combined with secukinumab.

BACKGROUND: The interference in the immune response induced by biological disease-modifying antirheumatic drugs (bDMARDs) increases the risk of reactivation of infections. Treatment of patients with chronic hepatitis C virus (HCV) infection and psoriasis is complex. The efficacy and safety of the new direct-acting antiviral agents (DAA) when combined with bDMARDs remain unknown. CASE REPORT: We present a case of a 44-year-old Caucasian man affected with psoriasis and HCV infection. Throughout the course of the psoriatic disease, this patient received several lines of treatment, including secukinumab, a new type of bDMARD. At the time of commencing secukinumab, new DAA agents (ledipasvir/sofosbuvir) were also initiated. At week 12 post-treatment, hepatitis C viral load was undetectable and the patient remained in remission of psoriasis. CONCLUSION: This case report suggests that secukinumab is a therapeutic option in patients with psoriasis, particularly in those cases with HCV infection where treatment with DAA agents is warranted.

DigiPlace4all: an online peer support community for digital skills.

The DigiPlace4all online peer support community supports people with disabilities in developing digital literacy skills needed to transition from Vocational and Educational Training (VET) to mainstream education & employment. It facilitates the development of informal one-to-one peer support relationships between members who can post and respond to requests and offers of peer support and share information on a range of associated topics. It is active in Ireland, Belgium, Poland and Bulgaria and is being spread internationally.