Are diabetes self-management programmes for the general diabetes population effective for people with severe mental illness?: a systematic review.

BACKGROUND: Diabetes self-management education programmes are effective in improving health outcomes in the general population with diabetes. However, it is not known if these programmes include people who also have a severe mental illness (SMI) and, if so, what their outcomes are. The aim of this review was to examine if evaluations of diabetes self-management education programmes included people with SMI, and if so, whether the interventions were beneficial for this population. METHODS: The inclusion criteria for this systematic review, defined by PICOS criteria, were: Population - Adults with type 2 diabetes; Intervention - self-management education programme; Comparator - another active intervention or usual care; Outcomes of interest - inclusion of people with SMI and the clinical, behavioural and psychosocial outcomes in this population; Study design - randomised controlled trials. The following bibliographic databases were searched from January 2004 to April 2018: Cochrane Library, Medline, Embase, PsychINFO, Allied and Complimentary Medicine Database, Health Technology Assessment, NHS Economic Evaluations Database and CINAHL. Data were extracted on study characteristics, inclusion and exclusion criteria, participant and intervention characteristics, number of participants with SMI, and outcomes for people with SMI, if reported. Authors were contacted by email for missing data. RESULTS: A total of 410 trials were included. At least 42% of trials did not recruit any participants with SMI. Only nine confirmed inclusion of participants with SMI, of which six provided data on the number recruited. These six trials recruited a total of 1009 participants, of whom 31 (3.1%) had SMI. It was not possible to assess intervention effectiveness for people with SMI as none of the trials reported outcomes for these participants. CONCLUSIONS: This systematic review confirms that people with SMI are often excluded from trials of diabetes self-management education, resulting in a lack of an evidence base on which to base treatment paths for this vulnerable population. It cannot be assumed that programmes developed for the general diabetes population meet the needs of people with SMI. Future research needs to examine if and how these programmes could be adapted for people with SMI or if new programmes are required.

A risk-based approach to cognitive bias in forensic science.

Over the past decade, the potential impact of cognitive bias in forensic science has instigated much discussion and debate between academics, scientists and those in the justice sector. Evidence of bias influencing subjective decision-making across a range of forensic disciplines has been described in the literature. Forensic service organisations are being urged to address cognitive bias in subjective decision-making by designing processes or procedures to limit access to (irrelevant) contextual information or reduce dependence on cognitive functions. Although some laboratories have implemented bias mitigating strategies, with varying impact on operational efficiency, there has been no systematic assessment of the risk posed by cognitive bias. Forensic Science SA assessed the potential impact of bias on forensic interpretations across multiple disciplines, using a risk management framework. This process proved useful in assessing the effectiveness of existing bias mitigating strategies and identified the latent level of risk posed. While all forensic organisations should seek to implement bias limiting measures that are simple, cost-effective and do not adversely impact efficiency, using a risk-based approach has contextualised the limited benefit of introducing resource hungry measures, as postulated in the literature. That is not to suggest that forensic organisations should dismiss the potential influence of cognitive bias but they need to strike an appropriate balance between risk and return, as they do with any business risk.

Isotope fractionation during precipitation of methamphetamine HCl and discrimination of seized forensic samples.

Methamphetamine is a widely abused illicit drug. Increasingly, studies have focused on stable isotope analysis by isotope ratio mass spectrometry (IRMS) to link samples of methamphetamine synthesized together or from the same source of precursor. For this reason, it is important to understand potential sources of isotope fractionation that could cause variability in forensic data sets. In this study, methamphetamine free base samples were synthesized from (-)-ephedrine HCl using the HI/red phosphorus synthetic route and then precipitated as HCl salts by bubbling with HCl gas. The entire sample did not precipitate when first bubbled with gas, and multiple precipitation steps were required. Fractions of precipitate were individually analyzed for delta(13)C, delta(15)N and delta(2)H by IRMS. Both delta(15)N and delta(2)H were found to become more negative, with the heavy isotopes depleted, in successive fractions of precipitate. Homogenizing the precipitate fractions together could eliminate this fractionation. However, in a clandestine situation this fractionation could lead to greater than expected delta(15)N and delta(2)H variability between illicit samples of methamphetamine HCl that have been synthesized from the same sample of ephedrine. This needs to be taken into account when interpreting forensic IRMS data. We also present an analysis of four separate seized case lots of methamphetamine HCl, taking into account the possible sources of fractionation and available intelligence information.