Improving psychological adjustment following a first episode of psychosis: a randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms.

There are few evaluated psychological interventions or theoretical approaches which are specifically aimed at reducing problems related to adjustment and adaptation following a first episode of psychosis. The present study tests the efficacy of a form of CBT (Cognitive Recovery Intervention; CRI) in reducing trauma, depression and low self esteem following a first episode of psychosis, in a single-blind randomised controlled trial. A total of 66 patients who had recently experienced a first episode of psychosis were randomly assigned to CRI or treatment as usual (TAU) and followed up at 6 and 12 months. People receiving CRI tended to have lower levels of post-intervention trauma symptoms and demonstrated greater improvement than those receiving TAU alone. This was especially the case at 6 months for those with high pre-treatment levels of trauma. There was, however, no advantage for the CRI group with regards to reduced depression or improved self esteem. In conclusion, CRI appears to be an effective intervention to help young people adapt to the traumatic aspects of a first episode of psychosis although further evaluation in a larger study is warranted.

Femoral neck stress fractures in military personnel--a case series.

Femoral neck stress fractures (FNSF) are uncommon, representing 5% of all stress fractures. In military personnel, FNSF represents one of the more severe complications of training, which can result in medical discharge. Clinical examination findings are often non-specific and plain radiography may be inconclusive--leading to missed or late diagnosis of FNSF This paper highlights the significance of FNSFs in military personnel and alerts physicians to the potential diagnosis. We identified all military recruits, aged 17 to 26, who attended the Infantry Training Centre (Catterick, U.K.), over a four-year period from the 1st July 2002 to 30th June 2006, who had suffered a FNSF. The medical records, plain radiographs, bone scans and MRIs of the recruits were retrospectively reviewed. Of 250 stress fractures 20 were of the femoral neck; representing 8% of all stress fractures and an overall FNSF rate of 12 in 10,000 military recruits. FNSFs were most prevalent amongst Parachute Regiment recruits (1 in 250, p < 0.05). Onset of symptoms was most commonly between weeks 13-16 of training. The majority (17/20, 85%) of FNSFs were undisplaced, these were all treated conservatively. Three FNSFs were displaced on presentation and were treated surgically. Overall, the medical discharge rate was 40% (8/20). FNSFs are uncommon and the diagnosis remains a challenge to clinicians and requires a high index of suspicion in these young athletic individuals. In such individuals early referral for MRI is recommended, to aid prompt diagnosis and treatment and to prevent more serious sequelae.

Clinical supervision in cognitive behavioural psychotherapy: development of a model for mental health nursing through grounded theory.

This study focuses on the development of a cognitive behavioural model of supervision for mental health nurses. The study utilized a grounded theory approach with cognitive behavioural psychotherapy training course directors. The aim was to more fully understand cognitive behavioural supervision from the perspective of expert supervisors, and develop a model of supervision for mental health nurses who are also cognitive behavioural psychotherapists. For this purpose, 16 course directors were interviewed in-depth, with data analysis taking place after each interview. Through a process of inductive reasoning, core categories were identified from the participants themselves. The relationships between the categories are described. The findings are discussed in terms of a new model that can be used to underpin cognitive behavioural psychotherapy supervision in mental health nursing.

Integrating science, practice and reflexivity--cognitive therapy with driving phobia.

The scientist-practitioner model has long been espoused within cognitive behavioural psychotherapy. The study includes an evaluation of the efficacy of cognitive therapy for driving phobia. Assessment, formulation and practical treatment of this common problem are also reported. Self-report measures evaluated results. Eight of the 10 consecutive cases improved significantly and reported that the intervention was acceptable. A reflexive analysis of the research findings and the influences on the first author's practice as a researcher and practitioner are also explored. Recommendations for future research are also made.

Interprofessional supervision from the perspectives of both mental health nurses and other professionals in the field of cognitive behavioural psychotherapy.

This study reports on an open-ended qualitative survey to describe interprofessional supervision within a sample of 170 randomly recruited accredited cognitive behavioural psychotherapists, the majority of whom are mental health nurses. Interdisciplinary supervision was found to be very common and creating some rich opportunities for learning and practice development. A number of interprofessional difficulties were also found to be occurring for a variety of reasons, which are described. Recommendations are made as to how these problems can be overcome.

Metalwork removal in potential army recruits. Evidence-based changes to entry criteria.

Civilian practice and the literature do not support the routine removal of metalwork from the asymptomatic patient. A significant risk of complication exists. The MoD and Army Medical Services are expected to conduct themselves in line with current National Health Service guidelines and standards of care. The literature is clear that removal is not indicated unless sound clinical reasons exist. There is no comparable group to that of the recruit with retained metal, but evidence suggests that the rigors of basic training can be accepted without risk to the individual. If a problem arose then removal could be indicated at that time. No studies or papers in support of this policy were found. No evidence was found to support the current British Army policy, which is now being altered.

Simultaneous presentation of both true and false aneurysm in the infrarenal aorta.

Interventional radiology has resulted in a reduced need for bypass procedures for aorto-occlusive disease. However, there are still indications for surgery of this type, which carries with it a small but significant morbidity and mortality. False aneurysms are well described following such procedures but with the development of inert, strong and non-absorbable materials they are becoming less common. This paper describes the acute presentation of a false aneurysm of the aorta following an aorto-iliac bypass where true aneurysmal change had taken place in the area of the anastomosis.

Sources and appropriateness of medical advice for trekkers.

BACKGROUND: Little has previously been published on the sources of health advice used by trekkers. This paper investigates the sources of advice used by a group of British trekkers and the appropriateness of the advice which they were given. METHODS: A questionnaire was issued to 107 clients of a U.K. trekking operator. Clients were asked which advice sources they had used and how useful they found them. They were also asked about advice which they had received on vaccination, antimalarial drugs, and other health precautions. The appropriateness of such advice was assessed by reference to standard advice sources used in the United Kingdom. RESULTS: One hundred replies were received, a response rate of 93.5%. Responders had traveled to India (10%), Nepal (45%) and Morocco (45%). The most frequently used advice sources were general medical practitioners or health centers (69%) and the tour operator (68%), many trekkers using more than one source. Specialist travel advice centers and general practitioners were rated most highly by 67% and 59% of users for usefulness and 60% and 52% of users for being informative. Other travelers were also rated highly as a source. Some appropriate vaccinations were under-recommended while others which were not appropriate were recommended. Antimalarial drugs were recommended when needed but they were sometimes recommended when not appropriate. Advice on other health risks was generally inadequate. CONCLUSIONS: Trekkers need access to more relevant health advice. Tour operators need to have better medical information to pass on to their clients, and health professionals need more education about health risks for and the avoidance of health risks by trekkers.

Macrocellular silicone foam for mechanically retaining orbital prostheses.

The prosthesis processed with the technique described has a fitting surface that is smooth and glossy, a soft and uniformly compressible foam-filled mass to engage severe undercuts, and a lightweight mass for the completed prosthesis. The technique described increases laboratory time. However, the lightweight prosthesis provides intrinsic mechanical retention that justifies the extra time. Moreover, the controllable uniform compressibility of the foam-filled extension and the improved surface characteristics of the silicone fitting surface minimize the possibility of producing trauma while the prosthesis is inserted, worn, or removed by the patient.