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2.
Int J Oral Maxillofac Surg ; 50(11): 1464-1470, 2021 Nov.
Article in English | MEDLINE | ID: mdl-33712316

ABSTRACT

Post-traumatic stress disorder (PTSD) is a distressing consequence of a traumatic event associated with an increased suicide risk and reduced quality of life. Surgeons often have low confidence in identifying psychological problems. The prevalence of PTSD following facial trauma ranges from 23% to 41%. This highlights the importance of identifying and managing at-risk patients to optimize both mental and physical recovery. IMPARTS (Integrating Mental and Physical healthcare: Research, Training and Services) provides electronic screening tools to guide the non-mental health clinician in the 'real-time' identification, documentation, and management of potential mental health problems. The bespoke IMPARTS facial trauma screening tool was piloted in a UK oral and maxillofacial surgery trauma clinic from July 2015 to November 2017. A total of 199 patients completed screening, with 48 (24%) screening positive for possible PTSD. Further analysis of these 48 patients revealed that four (8%) had PTSD symptoms alone; three (6%) also screened positive for depression, 17 (35%) for co-existing symptoms of anxiety, and 24 (50%) for PTSD, anxiety, and depression. IMPARTS was found to be a highly effective tool aiding the non-mental health clinician to screen for PTSD and initiate prompt management. The data captured informs planning of the psychological support service.


Subject(s)
Maxillofacial Injuries , Stress Disorders, Post-Traumatic , Anxiety Disorders , Humans , Maxillofacial Injuries/diagnosis , Maxillofacial Injuries/epidemiology , Quality of Life , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , United Kingdom/epidemiology
3.
Skin Health Dis ; 1(2): e33, 2021 Jun.
Article in English | MEDLINE | ID: mdl-35664982

ABSTRACT

Background: Excess weight is a common (30%-40%) multifactorial concern that remains understudied in adults with psoriasis. Objectives: This systematic review aimed to synthesise the evidence on the psychosocial factors associated with body weight in psoriasis and to use these findings to inform clinical practice. The review was registered with PROSPERO (registration number: CRD42020201138). Methods: Electronic databases, related reviews and associated reference lists were searched. Observational and experimental studies reporting on the relationship of psychosocial factors to weight-related outcomes in adults with body mass index (BMI) of ≥30 kg/m2 and psoriasis were eligible. The methodological quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP). Results: Eighteen studies were included in the review, the majority of which (n = 16) examined cross-sectional associations between psychosocial factors and weight outcomes. Although the strengths of the associations were heterogeneous, most studies confirmed the positive association between high BMI and increased reports of depression and anxiety, impaired quality of life, deteriorated sleep quality, sexual dysfunction, and daily functioning issues. Only four studies were rated as high quality. Conclusions: The current evidence of the association between psychosocial factors and weight-related outcomes is largely cross-sectional with unclear directionality of causality. Longitudinal studies are needed to examine the replicability and generalisability of the examined obesity-related psychosocial factors in psoriasis. Theoretical exploration of subgroup differences and similarities may pave the way towards intervention personalisation, and ultimately, improved patient outcomes.

5.
Respir Med ; 132: 217-225, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29229101

ABSTRACT

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in England, however estimates of its prevalence vary considerably. Routinely collected and coded primary care data can be used to monitor disease prevalence, however reliance upon diagnostic codes alone is likely to miss cases. METHODS: We devised an ontological approach to COPD case detection and implemented it in a large primary care database to identify definite and probable cases of COPD. We used this to estimate the prevalence of COPD in England. RESULTS: Use of this approach to detect definite COPD cases yielded a prevalence of 2.57% (95% CI 2.55-2.60) in the total population, 4.56% (95%CI 4.52-4.61) in those aged ≥ 35 and 5.41% (95% CI 5.36-5.47) in ex or current smokers. The ontological approach identified an additional 10,543 definite cases compared with using diagnostic codes alone. Prevalence estimates were higher than the 1.9% prevalence currently reported by the UK primary care pay for performance (P4P) disease register. COPD prevalence when definite and probable cases were combined was 3.02% (95% CI 3.0-3.05) in the total population, 5.38% (95% CI 5.33-5.42) in those aged ≥ 35 and 6.46% (95% CI 6.46-6.40-6.56) in ex or current smokers. CONCLUSIONS: We demonstrate a robust reproducible method for COPD case detection in routinely collected primary care data. Our calculated prevalence differed significantly from current estimates based upon P4P data, suggesting that the burden of COPD in England is greater than currently predicted.


Subject(s)
Primary Health Care , Pulmonary Disease, Chronic Obstructive/epidemiology , Smoking/epidemiology , Administration, Inhalation , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-2 Receptor Agonists/therapeutic use , Adult , Aged , England/epidemiology , Female , Forced Expiratory Volume , Humans , Male , Middle Aged , Muscarinic Antagonists/therapeutic use , Prevalence , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/therapy , Reimbursement, Incentive , Respiratory Therapy , Spirometry , Vital Capacity
6.
Br J Dermatol ; 176(4): 1028-1034, 2017 Apr.
Article in English | MEDLINE | ID: mdl-27363600

ABSTRACT

BACKGROUND: National Institute for Health and Care Excellence guidance recommends assessment of psychological and social well-being in people with psoriasis. OBJECTIVES: To screen systematically for depression and anxiety in patients with psoriasis in routine clinical practice and to identify at-risk groups for psychiatric morbidity. METHODS: Consecutive patients attending a single, tertiary centre over a 10-month period were invited to complete the Patient Health Questionnaire Depression Scale (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Dermatology Life Quality Index (DLQI) as part of IMPARTS: Integrating Mental and Physical Healthcare: Research, Training and Services. Information on demographics, treatment and clinical disease severity was collated from electronic patient records. Regression models were used to identify at-risk groups for psychiatric morbidity. RESULTS: Of 607 patients included (56·2% on biologics), 9·9% (95% confidence interval 7·5-12·3%) screened positive for major depressive disorder (MDD) and 13·1% (79/604) (95% confidence interval 10·4-15·8%) for generalized anxiety disorder (GAD; GAD-7 score > 9). Suicidal ideation was reported in 35% of those with MDD; DLQI was < 10 in 38·3% and 45·6% cases of MDD and GAD, respectively. After adjusting for covariates, the risk of MDD or GAD was significantly higher in women and those with severe clinical disease, psoriatic arthritis and previous depression/anxiety. The risk of GAD was significantly increased with Asian ethnicity and use of topical treatments only. CONCLUSIONS: Systematic screening for anxiety and depression identifies clinically important levels of depression and anxiety that may be missed using DLQI data alone. Women and those with severe disease, psoriatic arthritis and/or a prior history of psychiatric morbidity may be at particular risk.


Subject(s)
Anxiety Disorders/diagnosis , Depressive Disorder/diagnosis , Psoriasis/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety Disorders/etiology , Child , Cross-Sectional Studies , Depressive Disorder/etiology , Early Diagnosis , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Young Adult
7.
J Psychosom Res ; 89: 53-60, 2016 10.
Article in English | MEDLINE | ID: mdl-27663111

ABSTRACT

OBJECTIVE: This cross-sectional survey aimed to assess the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), and drug and alcohol dependence in a limb reconstruction population and examine associations with demographic and functional variables. METHODS: As part of routine clinical care, data were collected from 566 patients attending a tertiary referral centre for limb reconstruction between April 2012 and February 2016. Depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol and drug dependence were measured using standardised self-report screening tools. RESULTS: 173 patients (30.6% CI 26.7-34.4) screened positive for at least one of the mental disorders assessed. 110 (19.4% CI 16.2-22.7) met criteria for probable major depression; 112 (19.9% CI 16.6-23.2) patients met criteria for probable generalised anxiety disorder; and 41 (7.6% CI 5.3-9.8) patients met criteria for probable PTSD. The prevalence of probable alcohol dependence and probable drug dependence was 1.6% (CI 0.6-2.7) and 4.5% (CI 2.7-6.3), respectively. Patients who screened positive for depression, anxiety and PTSD reported significantly higher levels of pain, fatigue, and functional impairment. Depression and anxiety were independently associated with work disability after adjustment for covariates (OR 1.98 (CI 1.08-3.62) and OR 1.83 (CI 1.04-3.23), respectively). CONCLUSION: The high prevalence and adverse associations of probable mental disorder in limb reconstruction attest to the need for routine psychological assessment and support. Integrated screening and management of mental disorder in this population may have a positive impact on patients' emotional, physical and occupational rehabilitation. A randomised controlled trial is needed to test this hypothesis.


Subject(s)
Disabled Persons/psychology , Employment/psychology , Limb Salvage/psychology , Mental Disorders/epidemiology , Mental Disorders/psychology , Plastic Surgery Procedures/psychology , Adult , Alcoholism/diagnosis , Alcoholism/epidemiology , Alcoholism/psychology , Anxiety/diagnosis , Anxiety/epidemiology , Anxiety/psychology , Cross-Sectional Studies , Depression/diagnosis , Depression/epidemiology , Depression/psychology , Female , Humans , Limb Salvage/adverse effects , Male , Mental Disorders/diagnosis , Middle Aged , Prevalence , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Plastic Surgery Procedures/adverse effects , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology
8.
Oncogenesis ; 5: e208, 2016 Mar 21.
Article in English | MEDLINE | ID: mdl-26999717

ABSTRACT

Triple-negative breast cancers (TNBCs) represent a subset of breast tumors that are highly aggressive and metastatic, and are responsible for a disproportionate number of breast cancer-related deaths. Several studies have postulated a role for the epithelial-to-mesenchymal transition (EMT) program in the increased aggressiveness and metastatic propensity of TNBCs. Although EMT is essential for early vertebrate development and wound healing, it is frequently co-opted by cancer cells during tumorigenesis. One prominent signaling pathway involved in EMT is the transforming growth factor-ß (TGFß) pathway. In this study, we report that the novel POZ-ZF transcription factor Kaiso is highly expressed in TNBCs and correlates with a shorter metastasis-free survival. Notably, Kaiso expression is induced by the TGFß pathway and silencing Kaiso expression in the highly invasive breast cancer cell lines, MDA-MB-231 (hereafter MDA-231) and Hs578T, attenuated the expression of several EMT-associated proteins (Vimentin, Slug and ZEB1), abrogated TGFß signaling and TGFß-dependent EMT. Moreover, Kaiso depletion attenuated the metastasis of TNBC cells (MDA-231 and Hs578T) in a mouse model. Although high Kaiso and high TGFßR1 expression is associated with poor overall survival in breast cancer patients, overexpression of a kinase-active TGFßR1 in the Kaiso-depleted cells was insufficient to restore the metastatic potential of these cells, suggesting that Kaiso is a key downstream component of TGFß-mediated pro-metastatic responses. Collectively, these findings suggest a critical role for Kaiso in TGFß signaling and the metastasis of TNBCs.

9.
Gen Hosp Psychiatry ; 36(3): 318-24, 2014.
Article in English | MEDLINE | ID: mdl-24630892

ABSTRACT

OBJECTIVE: To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder. METHOD: A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7. RESULTS: The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD. CONCLUSION: Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.


Subject(s)
Delivery of Health Care, Integrated/standards , Hospitals, General/standards , Mental Disorders/diagnosis , Program Evaluation/standards , Delivery of Health Care, Integrated/statistics & numerical data , Feasibility Studies , Hospitals, General/statistics & numerical data , Humans , London/epidemiology , Mental Disorders/epidemiology , Mental Disorders/therapy , Patient Acceptance of Health Care/statistics & numerical data , Prevalence , Program Evaluation/statistics & numerical data
10.
Clin Psychol Rev ; 34(2): 141-57, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24508685

ABSTRACT

Psychological distress, depression and anxiety are common in most physical diseases, and self-help interventions, if effective, might be an important approach to improve outcomes as they are inexpensive to provide to large numbers of patients. The primary aim of this review was to assess randomised controlled trials examining the impact of self-help interventions on symptoms of depression, anxiety and psychological distress in patients with physical illness. Systematic searches of electronic databases resulted in twenty-five eligible studies for meta-analysis (n=4211). The results of the primary meta-analyses revealed a significant improvement in depression symptoms, in favour of the intervention group (SMD=-0.13, 95% CI: -0.25, -0.02, p=0.02, I(2)=50%). There were no significant differences in symptoms of anxiety (SMD=-0.10, 95% CI: -0.24, 0.05, p=0.20, I(2)=63%) or psychological distress (SMD=-0.14, 95% CI: -0.40, 0.12, p=0.30, I(2)=72%) between intervention and control conditions. Several subgroup and sensitivity analyses improved effect sizes, suggesting that optimal mental health outcomes may be obtained in patients without neurological conditions, and with interventions based on a therapeutic model (such as cognitive behavioural therapy), and with stress management components. This review demonstrates that with appropriate design and implementation, self-help interventions may potentially improve symptoms of depression in patients with physical conditions.


Subject(s)
Anxiety/therapy , Depression/therapy , Psychotherapy/methods , Self Care/methods , Stress, Psychological/therapy , Anxiety/psychology , Depression/psychology , Humans , Stress, Psychological/psychology
12.
J Psychiatr Ment Health Nurs ; 12(4): 481-7, 2005 Aug.
Article in English | MEDLINE | ID: mdl-16011504

ABSTRACT

Care pathways are used extensively in inpatient medical and surgical services to facilitate the delivery of evidence-based health care. There is a growing interest in their use in the mental health arena. However, questions remain about their acceptability to service users and staff. Most current literature is aimed at communicating the value of care pathways. Consequently, issues that are particularly pertinent to mental health, like language, therapeutic relationships and individualized care have not been fully addressed. This paper reports on the development of a care pathway in residential services in Nottingham. It will illustrate how by working in multidisciplinary groups with service users and carers these issues were incorporated into a comprehensive pathway that follows the service user's journey from admission to discharge. The paper concludes by highlighting some of the challenges of care pathway implementation and suggests ways they can be overcome.


Subject(s)
Critical Pathways/organization & administration , Interprofessional Relations , Mental Disorders/therapy , Patient Care Planning/organization & administration , Patient Care Team/organization & administration , Psychiatric Nursing/organization & administration , Semantics , Communication , Continuity of Patient Care , Documentation , England , Evidence-Based Medicine , Humans , Mental Disorders/psychology , Models, Nursing , Needs Assessment , Nursing Assessment , Nursing Process , Nursing Records , Patient Participation/methods , Patient Participation/psychology , Philosophy, Nursing , Program Development , Residential Treatment
13.
J Psychiatr Ment Health Nurs ; 11(5): 602-7, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15450029

ABSTRACT

The Thorn Initiative is a prominent education and training programme for psychosocial interventions. The course originated in two centres in the UK in 1992, 10 years on the programme had expanded to 13 centres across England and Wales. A survey of course content and structure was sent out to all 13 sites by email of which eight responded by post. The survey results showed that since 1999 there has been a rapid growth in the number of Thorn sites. There remains a high degree of fidelity to the original courses in mode of delivery, service user and carer participation, and core content. All of the sites were progressing towards providing degree courses, usually in a modular format and with an expanded curriculum. In conclusion, the Thorn Steering Group has been successful in Thorn site expansion and curriculum development. Such success has taken activity away from audit and research in psychosocial interventions, education, training, implementation and fidelity to taught skills. Implementation remains a cause for concern and it is recommended that a focus for Thorn sites should be on creating and evaluating novel solutions to this pervasive problem.


Subject(s)
Leadership , Psychiatric Nursing/education , Psychotic Disorders/nursing , Cooperative Behavior , Education, Nursing , Education, Nursing, Diploma Programs , Humans , Interprofessional Relations , Nursing Audit , Nursing Education Research , Outcome and Process Assessment, Health Care , State Medicine , United Kingdom
14.
Med Pediatr Oncol ; 23(2): 136-9, 1994.
Article in English | MEDLINE | ID: mdl-8202037

ABSTRACT

Acute tumour lysis syndrome (ATLS) is a common complication of the treatment of haematopoietic malignancies. It is also well recognized in many nonhaematopoeitic malignancies of adults. There are very few reports of the syndrome occurring during therapy for the nonhaematopoeitic malignancies of childhood, and none has previously been reported in the treatment of neuroblastoma. We report the cases of four patients presenting to The Hospital for Sick Children (HSC) between 1985 and 1992 who developed ATLS during treatment for stage IVS neuroblastoma. ATLS is a significant risk in patients undergoing therapy for stage IVS neuroblastoma, particularly where this has been delayed.


Subject(s)
Neuroblastoma/complications , Tumor Lysis Syndrome/etiology , Acute Disease , Adrenal Cortex Neoplasms/complications , Adrenal Cortex Neoplasms/secondary , Antineoplastic Agents/adverse effects , Female , Humans , Infant , Infant, Newborn , Liver Neoplasms/complications , Liver Neoplasms/secondary , Male , Neoplasm Staging , Neuroblastoma/drug therapy , Neuroblastoma/pathology
18.
FEBS Lett ; 8(5): 286-288, 1970 Jun 27.
Article in English | MEDLINE | ID: mdl-11947595
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