The evaluation of an e-learning prescribing course for general practice.

Prescribed medication may lead to significant morbidity or mortality as a result of these medications causing adverse events, or because of a prescribing error. E-learning is a common tool used in supporting training in prescribing. This paper describes the development of an e-learning course and the subsequent evaluation undertaken by the users with the aim of obtaining an effective e-learning course for prescribing. The e-learning course was developed by general practitioners and pharmacists and focussed on the principles of good prescribing, examined the common reasons for prescribing errors, and was evaluated using self-reported quantitative and qualitative measures. Scores significantly increased on an assessment given before and after the course. The majority of respondents reported that the e-learning course had a positive impact on prescribing knowledge, skills and attitudes, with medication reviews the top area where a change in prescribing practice was reported. Over 90% of the respondents agreed that the e-learning course was easy to use and a useful part of their continuing professional education. This study shows that clinicians recognise the on-going need for training in prescribing, but the lack of training is one of the factors contributing to errors, which suggests that more education is needed, not just for GPs in training, but for qualified GPs as well.

Meaning differentiates depression and grief among suicide survivors.

The present study examined the utility of meaning to differentiate between depression and grief in a sample of suicide survivors (N = 555). Three regression models were tested, each with a different measure of meaning predicting depression and grief. Across three models, meaning was negatively associated with depression but positively associated with grief. Additionally, grief and depression were negatively correlated across all models. Results support a conceptual distinction between grief and depression, with the presence or absence of meaning in life as a key distinguishing factor between the two in a population with a relatively high risk for pathological grieving.

Functional correlates of military sexual assault in male veterans.

Despite research findings that similar numbers of male and female veterans are affected by military sexual trauma (MST), there has been considerably less research on the effects of MST specific to male veterans. The aim of the present study was to provide preliminary data describing functional correlates of military sexual assault (MSA) among male Iraq/Afghanistan-era veterans to identify potential health care needs for this population. We evaluated the following functional correlates: posttraumatic stress disorder (PTSD) symptoms, depression symptoms, alcohol use, drug use, suicidality, social support, violent behavior in the past 30 days, incarceration, disability eligibility status, and use of outpatient mental health treatment. We compared 3 groups: (a) male veterans who endorsed a history of MSA (n = 39), (b) a general non-MSA sample (n = 2,003), and (c) a matched non-MSA sample (n = 39) identified by matching algorithms on the basis of factors (e.g., age, education, adult premilitary sexual trauma history, childhood sexual and physical trauma history, and race) that could increase veterans' vulnerability to the functional correlates examined. MSA in men was associated with greater PTSD symptom severity, greater depression symptom severity, higher suicidality, and higher outpatient mental health treatment, above and beyond the effects of vulnerability factors. These findings suggest that, for male veterans, MSA may result in a severe and enduring overall symptom profile requiring ongoing clinical management.

Development and validation of the Perceived Life Significance Scale.

A recent literature review of meaning and bereavement suggests a conceptual distinction between sense-making, or the integration of a loss with beliefs and narratives, and life significance, or perception of value associated with an aspect of one's life experience. The present study aims to develop and validate a new measure: the Perceived Life Significance Scale (PLSS). Exploratory (n = 353) and confirmatory (n = 483) factor analyses support three factors: active pursuit of goals and activities; emptiness/insignificance (reverse-scored); and receptivity to beauty in everyday life. The PLSS demonstrates convergent and discriminant validity with respect to general measures of meaning, negative affect, depression, and sense-making.

Meaning reconstruction in bereavement: sense and significance.

Recently there has been growing empirical and theoretical attention to the role of meaning in grief along with increased recognition of the need for more sophisticated definitions of meaning. The present article highlights philosophical issues inherent in the study of meaning and grief reviews the place of meaning in current theories of grief and provides a brief overview of the ways that meaning has been operationalized by grief researchers, including sense-making, benefit finding, identity change, and purpose in life. It is argued that, in our focus on the ways mourners make sense of loss, we have neglected an important aspect of meaning: life significance. Life significance is the felt perception that some aspect of one's life experience "matters." The construct is explored as a potentially important outcome of bereavement; mourners may lose life significance along with their lost loved one, or they may develop new avenues to life significance as they confront mortality and rebuild shattered worldviews. Related literature, such as appreciation of life as a facet of posttraumatic growth, is surveyed for clues as to the role of life significance in grief. Suggestions for future study are offered.

Broad clinical phenotypes associated with TAR-DNA binding protein (TARDBP) mutations in amyotrophic lateral sclerosis.

The finding of TDP-43 as a major component of ubiquitinated protein inclusions in amyotrophic lateral sclerosis (ALS) has led to the identification of 30 mutations in the transactive response-DNA binding protein (TARDBP) gene, encoding TDP-43. All but one are in exon 6, which encodes the glycine-rich domain. The aim of this study was to determine the frequency of TARDBP mutations in a large cohort of motor neurone disease patients from Northern England (42 non-superoxide dismutase 1 (SOD1) familial ALS (FALS), nine ALS-frontotemporal dementia, 474 sporadic ALS (SALS), 45 progressive muscular atrophy cases). We identified four mutations, two of which were novel, in two familial (FALS) and two sporadic (SALS) cases, giving a frequency of TARDBP mutations in non-SOD1 FALS of 5% and SALS of 0.4%. Analysis of clinical data identified that patients had typical ALS, with limb or bulbar onset, and showed considerable variation in age of onset and rapidity of disease course. However, all cases had an absence of clinically overt cognitive dysfunction.