Comparing the effects and potencies of perchlorate and nitrate on amphibian metamorphosis using a modified amphibian metamorphosis assay (AMA).

A modified amphibian metamorphosis assay was performed in which Nieuwkoop and Faber (NF) stage 47 Xenopus laevis larvae were exposed to different concentrations of either perchlorate (ClO4 -) or nitrate (NO3 -) for 32 days. Larvae were exposed to 0.0 (control), 5, 25, 125, 625, and 3125 µg/L ClO4 -, or 0 (control), 23, 71, 217, 660, and 2000 mg/L NO3 -. The primary endpoints were survival, hind limb length (HLL), forelimb emergence and development, developmental stage (including time to NF stage 62 [MT62]), thyroid histopathology, wet weight, and snout-vent length (SVL). Developmental delay as evidenced by altered stage distribution and increased MT62, a higher degree of thyroid follicular cell hypertrophy, and an increase in the prevalence of follicular cell hyperplasia was observed at concentrations ≥125 µg/L ClO4 -. The no observed effect concentration (NOEC) for developmental endpoints was 25.0 µg/L ClO4 - and the NOEC for growth endpoints was 3125 µg/L ClO4 -. Exposure to nitrate did not adversely affect MT62, but a decreasing trend in stage distribution and median developmental stage at ≥217 mg/L NO3 - was observed. No histopathologic effects associated with nitrate exposure were observed. An increasing trend in SVL-normalized HLL was observed at 2000 mg/L NO3 -. Nitrate did not alter larval growth. The NOEC for developmental endpoints was 71 mg/L NO3 -, and 2000 mg/L NO3 - for growth endpoints. The present study provided additional evidence that the effects and potency of nitrate and perchlorate on metamorphosis and growth in X. laevis are considerably different.

Dataset of 3D computer models of Late Miocene Mount Messenger Formation outcrops in New Zealand, built with UAV drones.

The aim of constructing 3D computer models of outcrops of the Mount Messenger Formation using unmanned aerial vehicle (UAV) drone technology was to enable better visualization and potential for analysis of deep-water sedimentary systems in Taranaki Basin, New Zealand. The Late Miocene-aged strata crop out along the north Taranaki coast of western North Island, New Zealand. The Mount Messenger Formation sandstone and siltstone beds are outstanding examples of deep-water sedimentary strata. These strata can be observed in outcrop sections, as well as in offshore drillholes (wireline logs) and in seismic reflection data acquired immediately offshore of the north Taranaki coastal section. In previous research undertaken on the Mount Messenger Formation in North Taranaki Basin, geologists used photographs and coupled these with observations and descriptions of strata in the field. Modern UAV drone technology now enables 3D perspectives to be obtained of outcrop sections, which greatly improves geometrical analysis of the rocks. This type of analysis, coupled with mapping of seismic reflection data in the immediate offshore area has enabled us to better understand the nature of Mount Messenger Formation deep-water sedimentary strata and to interpret the associated paleogeography with implications for energy resource exploration and evaluation. Using UAV drone photogrammetry, we acquired ∼3000 images of the Mount Messenger Formation outcrop at four locations along the north Taranaki coast. Drone surveys were conducted using a real-time kinetic (RTK) global positioning system (GPS) for accurate geolocation. The surveys were conducted on a DJI Phantom 4 drone, with a focal length of 24 mm with a 20-megapixel resolution. Survey images overlapped by 80-90%. The drone work adhered to the rules and regulations of the Aviation Security Service and the University of Waikato, New Zealand. Images were captured using programmed flight paths where the drone faced the outcrops at distances ranging from ∼3-7 m. 3D computer models were constructed using Pix4Dmapper version 4.4.12 to generate dense 3D point clouds, digital surface models (DSMs), triangle meshes, and orthomosaic images of the outcrops (i.e., 3D models). Once the 3D computer models of the outcrops were constructed, they were exported out of Pix4Dmapper as ArcGIS Scene Layer Package format (.slpk) and loaded into ArcGIS Pro version 3.0.3 for further analysis. The 3D computer models comprise a rich and valuable scientific dataset that can enhance geological analysis of sedimentary strata beyond the capabilities of photographs and manual fieldwork. These models allow desktop analysis of the geology and "virtual fieldwork" by imaging areas that are commonly inaccessible on foot due to their high elevation above ground level, location in rugged and steep terrane, as well as periodic intertidal flooding. This electronic geological dataset is stored in commonly used spatial format and plain-text ASCII files, allowing the preservation of geological data in digital records, especially when the outcrops are prone to erosion and cover by vegetation. The drone model dataset can be reused by the scientific community for virtual geological fieldwork, as petroleum and water reservoir analogues, as well as for research on coastal, environmental and geotechnical topics.

Associated factors of nurse-sensitive patient outcomes: A multicentred cross-sectional study in psychiatric inpatient hospitals.

WHAT IS ALREADY KNOWN?: The nurse-patient relationship in mental health care is an important focus of mental health nursing theories and research. There is limited evidence about which factors influence nurse-sensitive patient outcomes of the nurse-patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse-patient relationship in nursing practice and nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our best knowledge, this is the first study to examine associations between nurse-sensitive patient outcomes of the nurse-patient relationship and a range of patient characteristics and relationship-contextual factors. In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse-sensitive patient outcome scale. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Having insight into the factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse-patient relationship, trying to influence outcomes of nursing care. ABSTRACT: Introduction The lack of evidence on patient characteristics and relational-contextual factors influencing nurse-sensitive patient outcomes of a nurse-patient relationship is a possible threat to the quality and education of the nurse-patient relationship. Aim To measure nurse-sensitive patient outcomes of the nurse-patient relationship and to explore the associations between nurse-sensitive patient outcomes and a range of patient characteristics and relational-contextual factors. Method In a multicenter cross-sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse-Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results Overall, patient-reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion The results may help nurses to become more sensitive and responsive to factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship. Implications The nurse-sensitive results can support nurses in designing future nurse-patient relationships.

Patient-reported outcomes of the nurse-patient relationship in psychiatric inpatient hospitals: A multicentred descriptive cross-sectional study.

WHAT IS KNOWN ON THE SUBJECT?: Psychiatric and/or mental health nurses are struggling to measure the outcomes of the nurse-patient relationship. Collecting nurse-sensitive patient outcomes is a strategy to provide outcomes of a nurse-patient relationship from patients' perspectives. Because there was no validated scale, the Mental Health Nurse-Sensitive Patient Outcome-Scale (six-point Likert-scale) was recently developed and psychometrically evaluated. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study using the Mental Health Nurse-Sensitive Patient Outcome-scale to measure nurse-sensitive patient outcomes of the nurse-patient relationship in psychiatric hospitals. Moderate to good average scores for the MH-NURSE-POS total (4.42) and domains scores (≥4.09). are observed. Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). Our results are consistent with the patient-reported effect(s) of relation-based nursing in qualitative research. The scores generate evidence to support the outcomes of the nurse-patient relationship and implicates that further investment in (re)defining and elaborating nurse-patient relationships in mental healthcare is meaningful and justified. More comparative patient-reported data can determine how nurse-sensitive patient outcomes are affected by the patient, nurse, and context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Demonstrating patient-reported outcomes of the nurse-patient relationship can be important to enhance the therapeutic alliance between nurses and patients, organize responsive nursing care, and create nursing visibility in mental healthcare. Further nursing staff training on interpersonal competencies, such as self-awareness and cultural sensitivity, can be pivotal to achieving the patient-reported outcomes for inpatients with mental health problems. ABSTRACT: INTRODUCTION: Identifying patient-reported outcomes of the nurse-patient relationship is a priority in inpatient mental healthcare to guide clinical decision-making and quality improvement initiatives. Moreover, demonstrating nurse-sensitive patient outcomes can be a strategy to avoid further erosion of the specialism of psychiatric and/or mental health nursing. AIM/QUESTION: To measure nurse-sensitive patient outcomes of the nurse-patient relationship. METHOD: In a multicentred cross-sectional study, 296 inpatients admitted to five psychiatric hospitals completed the recently developed and validated Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS). The MH-NURSE-POS consists of 21 items (six-point Likert-scale) in four domains: 'growth', 'expression', 'control', and 'motivation'. RESULTS: Participants displayed moderate to good average scores for the MH-NURSE-POS total (4.42) and domain scores (≥4.09). Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). DISCUSSION: The results demonstrate that patients perceive the nurse-patient relationship and the care given by psychiatric and/or mental health nurses as contributing to their treatment. IMPLICATIONS FOR PRACTICES: Patient-reported outcomes can guide nurses and managers to provide and organize nursing care and to build a nurse-patient relationship that has a positive impact on these outcomes. Additionally, outcomes can create nursing visibility as a profession in- and outside mental healthcare.

Importance of diet in amphibian metamorphosis-based studies designed to assess the risk of thyroid active substances.

The present study evaluated the hypothesis that dietary quality used in historical studies may impact the effects of chemical stressors on premetamorphic development and metamorphosis due to suboptimal nutritional quality. A modified Amphibian Metamorphosis Assay (AMA) was performed in which Nieuwkoop and Faber (NF) Stage 47 tadpoles of Xenopus laevis were exposed for 32 days to iodide (I- )-deficient FETAX solution supplemented with <0.025, 0.17, 0.52, 1.58, and 4.80 µg I- /L (measured concentrations 0.061, 0.220, 0.614, 1.65, and 4.73 µg I- /L) and fed a pureed Frog Brittle (FB) diet. An AMA guideline benchmark group (four replicates) exposed to dechlorinated tap water and fed standard Sera Micron Nature® (SMN) diet was evaluated concurrently. Developmental delay, observed as changes in stage distribution or median developmental stage, occurred in FB treatments with 0.061, 0.220, and 0.614 µg/L I- , respectively. Developmental rates and hind limb length of the 1.65 and 4.73 µg/L I- groups were similar to each other, but both treatments fell short of the developmental rate achieved by the SMN benchmark. Iodide supplementation also had no impact on nonthyroidal growth endpoints, which were markedly reduced in FB-fed frogs compared with their SMN-fed counterparts. All larvae that received the FB diet had mildly to severely hypoplastic/atrophic thyroids, a condition for which iodine supplementation had little if any ameliorative effect. Collectively, these results suggested that nutritional deficiencies in the FB diet negatively affected both growth and metamorphic development, the latter of which was only compensated to a limited extent by iodine supplementation.

Nursing Care for Patients With Acute Mania: Exploring Experiential Knowledge and Developing a Standard of Good Care-Results of the Delphi Study.

BACKGROUND: When patients diagnosed with bipolar disorder are suffering from acute mania (involuntary), hospitalization is often necessary. Patients are often quite disruptive, which makes it difficult to regulate their behavior and manage them in their current condition. The nursing team must also ensure the safety of the other patients on the ward. Nursing practice in this domain appears to draw primarily on tradition and experience. AIMS: To achieve consensus on a standard for nursing practice for patients suffering from mania who are admitted to a closed psychiatric ward. METHODS: Previously, professionals, patients, and informal caregivers in the Netherlands were interviewed about the nursing care and their lived experiences. Based on these findings and on the results of a literature review, 89 statements were formulated. A three-round Delphi study among professionals, patients, and informal caregivers was carried out. The accepted statements were summarized. RESULTS: In the first round, 71 statements were accepted, none were rejected, and for 18 statements, no consensus could be reached. These were reformulated and presented in a second round. Thirteen of these statements were accepted, none were rejected, and five statements needed to be reformulated and were presented in the third and final round of this Delphi study. In this final round, all statements were accepted. CONCLUSIONS: Consensus was reached among professionals, patients, and informal caregivers in the Netherlands about essential and valuable components of nursing care for patients suffering from acute mania who are admitted to a closed psychiatric ward.

The course of bipolar disorder in pregnant versus non-pregnant women.

BACKGROUND AND RATIONALE: Although it has been suggested that pregnancy may influence the course of bipolar disorder (BD), studies show contradictory results. Until now, no studies included a finegrained validated method to report mood symptoms on a daily basis, such as the lifechart method (LCM). The aim of the present study is to investigate the course of BD during pregnancy by comparing LCM scores of pregnant and non-pregnant women. METHODS: Study design: Comparison of LCM scores of two prospective observational BD cohort studies, a cohort of pregnant women (n = 34) and a cohort of non-pregnant women of childbearing age (n = 52). Main study parameters are: (1) proportions of symptomatic and non-symptomatic days; (2) symptom severity, frequency, and duration of episodes; (3) state sequences, longitudinal variation of symptom severity scores. RESULTS: No differences in clinical course variables (symptomatic days, average severity scores, frequency, and duration of episodes in BD were found between pregnant and non-pregnant women. With a combination of State Sequence Analysis (SSA) and cluster analysis on the sequences of daily mood scores three comparable clusters were found in both samples: euthymic, moderately ill and severely ill. The distribution differences between pregnant and non-pregnant women were significant, with a majority of the pregnant women (68%) belonging to the moderately ill cluster and a majority of the non-pregnant women (46%) to the euthymic cluster. In pregnant women the average daily variation in mood symptoms as assessed with Shannon's entropy was less than in non-pregnant women (respectively 0.43 versus 0.56). CONCLUSIONS: Although the use of daily mood scores revealed no difference in overall course of BD in pregnant versus non-pregnant women, more pregnant than non-pregnant women belonged to the moderately ill cluster, and during pregnancy the variation in mood state was less than in non-pregnant women. Further research is necessary to clarify these findings.

Needs and Experiences of Adolescents with Congenital Heart Disease and Parents in the Transitional Process: A Qualitative Study.

PURPOSE: Most patients with congenital heart disease (CHD) need lifelong cardiac follow-up. Transitioning to adulthood and transferring to adult-focused care are often challenging. We explored the experiences and needs of adolescents with CHD and parents during the entire transitional process, including the post-transfer period. DESIGN AND METHODS: We performed a qualitative study according to the phenomenological approach, focusing on adolescents with CHD and parents. Semi-structured interviews were carried out with patients (n = 9) and parents (n = 12) after being transferred to adult care facilities. Data were analyzed with inductive thematic analysis. Data collection and -analysis of both samples were done separately in a first step, after which results were merged to discover common themes. RESULTS: Five common themes were identified: 1) Having mixed feelings about leaving pediatric care; 2) Being prepared and informed; 3) Shifting responsibilities and roles; 4) Being accompanied during consultations; and 5) Gaining trust in new healthcare providers. CONCLUSION: Adolescents with CHD and parents express a need for adequate preparation and personalized guidance to reduce anxiety and uncertainty during transition. The process may benefit from focusing on improving the adolescents´ transitional skills and disease-related knowledge, which may, in turn, facilitate handing over responsibilities and adapting to new roles by the parents. Adolescents appreciate the presence of parents during the consultation, albeit with reduced input. Finally, a transition coordinator and a joint transfer consultation involving the pediatric cardiologist seem paramount for a fluent transitional process, especially in establishing new treatment relationships.

The development and psychometric evaluation of the Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS) for inpatient psychiatric hospital settings.

Mental health nurses are struggling to describe their nursing identity as professional discipline in a changing mental health care. Measuring nurse-sensitive patient outcomes and demonstrating nursing's effect(s) experienced by patients contribute to (re)discover the specific nursing identity. However, a valid and reliable scale is currently lacking. The aim of this study was the development and psychometric evaluation of the Mental Health Nurse-Sensitive Patient Outcome Scale (MH-NURSE-POS) for inpatient psychiatric hospital settings. This three-staged study resulted in a scale capturing how inpatients experience the contribution of nurses in their treatment in psychiatric hospitals. First, a draft questionnaire was developed based on a literature review, an independent expert's advice, and an experts panel. Second, the content validity was tested in a two-round Delphi-procedure and focus groups with patients. A pilot test, based on cognitive interviews, confirmed the feasibility of the questionnaire. Third, the psychometric properties of the mental health nurse-sensitive patient outcomes were determined in a sample of 353 patients. The cross-sectional study included a convenience sample of five psychiatric hospitals (Belgium). The factor structure (Kaiser-Meyer-Olkin measure of sampling adequacy 0.924; Bartlett's test of sphericity χ2  = 4162.537; df = 231; P < 0.001), convergent validity by the Individualized Care Scale (Pearson correlation 0.660; P < 0.001), and reliability (Cronbach's Alpha 0.854) were evaluated. The factor analysis resulted in a four-factor solution representing growth, expression, control, and motivation. The Mental Health Nurse-Sensitive Patient Outcome Scale is a valid and reliable tool to measure the effectiveness of mental health nurses from the patient perspective.

Identifying the minimal important difference in patient-reported outcome measures in the field of people with severe mental illness: a pre-post-analysis of the Illness Management and Recovery Programme.

PURPOSE: Complementary interventions for persons with severe mental illness (SMI) focus on both personal recovery and illness self-management. This paper aimed to identify the patient-reported outcome measures (PROMs) associated with the most relevant and meaningful change in persons with SMI who attended the Illness Management and Recovery Programme (IMR). METHODS: The effect of the IMR was measured with PROMs concerning recovery, illness self-management, burden of symptoms and quality of life (QoL). From the QoL measures, an anchor was chosen based on the most statistically significant correlations with the PROMs. Then, we estimated the minimal important difference (MID) for all PROMs using an anchor-based method supported by distribution-based methods. The PROM with the highest outcome for effect score divided by MID (the effect/MID index) was considered to be a measure of the most relevant and meaningful change. RESULTS: All PROMs showed significant pre-post-effects. The QoL measure 'General Health Perception (Rand-GHP)' was identified as the anchor. Based on the anchor method, the Mental Health Recovery Measure (MHRM) showed the highest effect/MID index, which was supported by the distribution-based methods. Because of the modifying gender covariate, we stratified the MID calculations. In most MIDs, the MHRM showed the highest effect/MID indexes. CONCLUSION: Taking into account the low sample size and the gender covariate, we conclude that the MHRM was capable of showing the most relevant and meaningful change as a result of the IMR in persons with SMI.

A Blended Electronic Illness Management and Recovery Program for People With Severe Mental Illness: Qualitative Process Evaluation Alongside a Randomized Controlled Trial.

BACKGROUND: We conducted a trial to test the electronic Illness Management and Recovery (e-IMR) intervention to provide conclusions on the potential efficacy of eHealth for people with severe mental illness (SMI). In the e-IMR intervention, we used the standard IMR program content and methodology and combined face-to-face sessions with internet-based strategies on the constructed e-IMR internet platform. During the trial, the e-IMR platform was sparsely used. OBJECTIVE: This study aimed to evaluate the added value of the e-IMR intervention and the barriers and facilitators that can explain the low use of the e-IMR platform. METHODS: This process evaluation was designed alongside a multicenter, cluster randomized controlled trial. In this study, we included all available participants and trainers from the intervention arm of the trial. Baseline characteristics were used to compare users with nonusers. Qualitative data were gathered at the end of the semistructured interviews. Using theoretical thematic analyses, the data were analyzed deductively using a pre-existing coding frame. RESULTS: Out of 41 eligible participants and 14 trainers, 27 participants and 11 trainers were interviewed. Of the 27 participants, 10 were identified as users. eHealth components that had added value were the persuasive nature of the goal-tracking sheets, monitoring, and the peer testimonials, which had the potential to enhance group discussions and disclosure by participants. The low use of the e-IMR platform was influenced by the inflexibility of the platform, the lack of information technology (IT) resources, the group context, participants' low computer skills and disabilities, and the hesitant eHealth attitude of the trainers. CONCLUSIONS: The extent of eHealth readiness and correlations with vulnerabilities in persons with SMI need further investigation. This study shows that flexible options were needed for the use of e-IMR components and that options should be provided only in response to a participant's need. Use of the e-IMR intervention in the future is preconditioned by checking the available IT resources (such as tablets for participants) providing computer or internet guidance to participants outside the group sessions, evaluating the eHealth attitude and skills of trainers, and tailoring eHealth training to increase the skills of future e-IMR trainers. TRIAL REGISTRATION: Netherlands Trial Register NTR4772; https://www.trialregister.nl/trial/4621. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12913-016-1267-z.

Experiences of Dutch ambulance nurses in emergency care for patients with acute manic and/or psychotic symptoms: A qualitative study.

PURPOSE: To explore the experiences of ambulance nurses in emergency care of patients with acute manic and/or psychotic symptoms. METHODS: In this qualitative study, 14 interviews were conducted and analyzed using thematic analysis according to Braun and Clarke (2006). FINDINGS: Psychiatric emergency care causes stress and uncomfortable feelings for ambulance nurses due to a lack of information on the patients, being alone with the patient in a small place and the unpredictability of the situation. PRACTICE IMPLICATIONS: More information about the specific patient, education, and good collaboration with other professionals could improve care.

Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder.

BACKGROUND: Interpersonal trauma and post-traumatic stress disorder (PTSD) in patients with severe mental illness (SMI) negatively affect illness course. Narrative exposure therapy (NET) is effective in vulnerable patient groups, but its efficacy and applicability has not been studied in out-patients with SMI. AIMS: We aimed to evaluate the efficacy and applicability of NET in SMI on changes in PTSD, dissociation, SMI symptoms, care needs, quality of life, global functioning and care consumption. METHOD: The study had a single-group, pre-test-post-test, repeated-measures design and was registered in The Netherlands National Trial Register (identifier TR571). Primary outcomes were assessed at pre-treatment (T0), 1 month post-treatment (T1) and 7 months' follow-up (T2), with a structured interview for PTSD and dissociation screening. Secondary outcomes followed routinely SMI measurements and medical data. Mixed models were used for data analysis. RESULTS: The majority of the 23 participants was female (82%). Mean age was 49.9 years (s.d. 9.8) and mean PTSD duration was 24.1 years (s.d. 14.5). Mean PTSD severity decreased from 37.9 at T0 to 31.9 at T1 (-6.0 difference, 95%CI -10.0 to -2.0), and decreased further to 24.5 at T2 (-13.4 difference, 95%CI -17.4 to -9.4). Dissociation, SMI symptoms, duration of contacts, and medication decreased; global functioning increased; and quality of life and perceived needs did not change. Eleven participants were in remission for PTSD at T2, of which five were also in remission for major depression. CONCLUSIONS: NET appeared efficacious and applicable to out-patients with SMI and PTSD, and was well tolerated.

[1,2,4]Triazolo[1,5-a]pyrimidine Phosphodiesterase 2A Inhibitors: Structure and Free-Energy Perturbation-Guided Exploration.

We describe the hit-to-lead exploration of a [1,2,4]triazolo[1,5-a]pyrimidine phosphodiesterase 2A (PDE2A) inhibitor arising from high-throughput screening. X-ray crystallography enabled structure-guided design, leading to the identification of preferred substructural components. Further rounds of optimization used relative binding free-energy calculations to prioritize different substituents from the large accessible chemical space. The free-energy perturbation (FEP) calculations were performed for 265 putative PDE2A inhibitors, and 100 compounds were synthesized representing a relatively large prospective application providing unexpectedly active molecules with IC50's from 2340 to 0.89 nM. Lead compound 46 originating from the FEP calculations showed PDE2A inhibition IC50 of 1.3 ± 0.39 nM, ∼100-fold selectivity versus other PDE enzymes, clean cytochrome P450 profile, in vivo target occupancy, and promise for further lead optimization.

A multi-center naturalistic study of a newly designed 12-sessions group psychoeducation program for patients with bipolar disorder and their caregivers.

BACKGROUND: Psychoeducation (PE) for bipolar disorder (BD) has a first-line recommendation for the maintenance treatment phase of BD. Formats vary greatly in the number of sessions, whether offered individually or in a group, and with or without caregivers attending. Due to a large variation in formats in the Netherlands, a new program was developed and implemented in 17 outpatient clinics throughout the country. The current study investigated the feasibility of a newly developed 12-sessions PE group program for patients with BD and their caregivers in routine outpatient practice and additionally explored its effectiveness. METHODS: Participants in the study were 108 patients diagnosed with BD, 88 caregivers and 35 course leaders. Feasibility and acceptance of the program were investigated by measures of attendance, and evaluative questionnaires after session 12. Preliminary treatment effects were investigated by pre- and post-measures on mood symptoms, attitudes towards BD and its treatment, levels of self-management, and levels of expressed emotion. RESULTS: There was a high degree of satisfaction with the current program as reported by patients, caregivers, and course leaders. The average attendance was high and 83% of the patients and 75% of the caregivers completed the program. Analyses of treatment effects suggest positive effects on depressive symptoms and self-management in patients, and lower EE as experienced by caregivers. CONCLUSIONS: This compact 12-sessions psychoeducation group program showed good feasibility and was well accepted by patients, caregivers, and course leaders. Preliminary effects on measures of self-management, expressed emotions, and depressive symptoms were promising. After its introduction it has been widely implemented in mental health institutions throughout the Netherlands.

A nonsurgical approach with repeated orthoptic evaluation is justified for most blow-out fractures.

OBJECTIVE: This study presents the results of an updated clinical protocol for orbital blow-out fractures, with a special emphasis on nonsurgical treatment and orthoptic evaluation of functional improvement. METHODS: A two-centre multidisciplinary prospective cohort study was designed to monitor the results of a clinical protocol by assessing ductions, diplopia, globe position, and fracture size. Patients underwent clinical assessment and orthoptic evaluation at first presentation and then at 2 weeks and 3/6/12 months after nonsurgical or surgical treatment. Outcome parameters were field of binocular single vision (BSV), ductions, degree of enophthalmos, a diplopia quality-of-life (QoL) questionnaire, and other sequelae or surgical complications. RESULTS: 46 of the 58 patients who completed the 3, 6 and/or 12-month follow-up received nonsurgical treatment. There was full recovery without diplopia or enophthalmos (>2 mm) in 45 of the 58 patients. The other 13 patients had limited diplopia, mainly in extreme upward gaze (average BSV 90). Five of those 13 patients did not experience impairment of diplopia in daily life. The average QoL score at the end of follow-up was 97. No patients developed late enophthalmos. CONCLUSION: This study showed that a high percentage of patients with orbital floor and/or medial wall fracture recovered spontaneously without lasting diplopia or cosmetically disfiguring enophthalmos. The conservative treatment protocol assessed here underlines the importance of orthoptic evaluation of functional parameters.

Patient experiences with nursing care during hospitalization on a closed ward due to a manic episode: A qualitative study.

PURPOSE: To describe the experiences of patients with nursing care they had received when hospitalized for mania. DESIGN AND METHODS: Multicenter qualitative study using open interviews. Data were analyzed using the Stevick-Colaizzi-Keen method. FINDINGS: Sense of security is vital for the recovery of these patients, nurses can support and hinder this. Feelings of security are related to clear and calm communication, respect, recognizability of nurses, and daily structure. PRACTICE IMPLICATIONS: Nurses should make sure that the patient recognizes them as nurses. Nurses should spend as much time as possible in the living room. Clear communication about treatment goals is important.

Show yourself, experiences of patients with bipolar disorder recording a film to show their "euthymic being": A qualitative study.

PURPOSE: To examine the experiences of outpatients with bipolar disorder recording a 10-minute film to show their "being" in a euthymic mood state. DESIGN AND METHODS: A multicenter qualitative study, in the context of a feasibility study for a newly developed intervention. Data were analyzed using the Stevick-Colaizzi-Keen method. FINDINGS: Participants experienced the recording as positive and valuable. Although camera anxiety was mentioned frequently, the overall conclusion is that recording a film in the context of a newly developed film intervention is valid. PRACTICE IMPLICATIONS: Clear information and support for the patient should be provided during the preparatory conversation and recording.