Can non-pharmacological interventions prevent relapse in adults who have recovered from depression? A systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: To identify studies of non-pharmacological interventions provided following recovery from depression, and to evaluate their efficacy in preventing further episodes. METHOD: We identified relevant randomised controlled trials from searching MEDLINE, Embase, PsycINFO, CENTRAL, and ProQuest, searching reference and citation lists, and contacting study authors. We conducted a meta-analysis of relapse outcomes. RESULTS: There were 29 eligible trials. 27 two-way comparisons including 2742 participants were included in the primary analysis. At 12months cognitive-behavioural therapy (CBT), mindfulness-based cognitive therapy (MBCT), and interpersonal psychotherapy (IPT) were associated with a 22% reduction in relapse compared with controls (95% CI 15% to 29%). The effect was maintained at 24months for CBT, but not for IPT despite ongoing sessions. There were no 24-month MBCT data. A key area of heterogeneity differentiating these groups was prior acute treatment. Other psychological therapies and service-level programmes varied in efficacy. CONCLUSION AND IMPLICATIONS: Psychological interventions may prolong the recovery a person has achieved through use of medication or acute psychological therapy. Although there was evidence that MBCT is effective, it was largely tested following medication, so its efficacy following psychological interventions is less clear. IPT was only tested following acute IPT. Further exploration of sequencing of interventions is needed. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO 2011:CRD42011001646.

Mission possible: twenty-five years of university and college collaboration in baccalaureate nursing education.

In Canada, nurse educators from five postsecondary institutions in the province of British Columbia established a collaborative nursing education initiative in 1989, with a vision to transform RN college diploma programs to baccalaureate degree programs. The principles, processes, and structures that served to develop and sustain this nursing education initiative are briefly reviewed. Curriculum, scholarship, and education legislation serve as platforms to critically explore a 25-year history (1989-2014) of successes, challenges, and transitions within this unique nursing education collaboration. The importance of curriculum development as faculty development, program evaluation as an adjunct to pedagogical scholarship, diversity of cross-institutional mandates, political interplay in nursing education, collegiality, and courageous leadership are highlighted. Nurse educators seeking to create successful collaborations must draw upon well-defined principles and organizational structures and processes to guide pedagogical practices and inquiry while remaining mindful of and engaged in professional and societal developments.

Policy analysis and advocacy in nursing education: the Nursing Education Council of British Columbia framework.

Academic nursing leaders play a crucial role in the policy context for nursing education. Effectiveness in this role requires that they work together in presenting nursing education issues from a position of strength, informed by a critical analysis of policy pertaining to the delivery of quality nursing education and scholarship. We describe a collective process of dialog and critical analysis whereby nurse leaders in one Canadian province addressed pressing policy issues facing governments, nursing programs, faculty, and students. Consensus among academic nurse leaders, formalized through the development of a policy action framework, has enabled us to take a stand, at times highly contested, in the politicized arena of the nursing shortage. We present the components of a policy action framework for nursing education and share examples of how we have used a critical approach to analyze and frame policy issues in nursing education for inclusion on policy agendas. We believe our work has influenced provincial and national thinking about policy in nursing education is the foundation of our conclusion that political presence and shared strategy among academic nursing leaders is undeniably critical in the global context of nursing today.

Conditions underpinning success in joint service-education workforce planning.

Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area of Greater Vancouver (estimated population 2.17 million) by the Georgia Strait, this geographical location poses unique challenges in delivering health care to a mixed urban, rural and remote population of approximately 730,000 people living on the main island and the surrounding Gulf Islands. These challenges are offset by opportunities for the Vancouver Island Health Authority (VIHA) to collaborate with four publicly funded post-secondary institutions in planning and implementing responses to existing and emerging health care workforce needs. In this commentary, we outline strategies we have found successful in aligning health education and training with local health needs in ways that demonstrate socially accountable outcomes. Challenges encountered through this process (i.e. regulatory reform, post-secondary policy reform, impacts of an ageing population, impact of private, for-profit educational institutions) have placed demands on us to establish and build on open and collaborative working relationships. Some of our successes can be attributed to evidence-informed decision-making. Other successes result from less tangible but no less important factors. We argue that both rational and "accidental" factors are significant--and that strategic use of "accidental" features may prove most significant in our efforts to ensure the delivery of high-quality health care to our communities.