Frontline Health Professionals Research Articles

The re-emergence of psychiatric neurosurgery: insights from a cross-national study of newspaper and magazine coverage.

Surgical approaches to treat psychiatric disorders have made a comeback. News media plays an essential role in exposing the public to trends in health care such as the re-emergence of therapeutic interventions in psychiatric neurosurgery that were set aside for decades, and in shaping attitudes and acceptance to them. We conducted an analysis of media articles covering all types of psychiatric neurosurgery published in Canada, USA, Germany, and Spain between the years 1960 and 2015. We applied both quantitative and qualitative methods to elucidate patterns of reporting for conditions, themes and tone, across geographic regions, time, and for type of intervention. Coverage of psychiatric neurosurgery has surged since 2001 and is largely consistent across the countries examined. It focuses on depression and deep brain stimulation, and is explicit about historical context. The tone of coverage becomes more positive for Canada, USA and Spain over time; the tone of coverage from Germany remains cautious. Identity and privacy are among the few ethical and philosophical issues raised, notably in the German press. The focused and optimistic attention to contemporary psychiatric neurosurgery in the media, but inattention to ethical issues, places an extra burden on functional neurosurgeons, psychiatrists, and other frontline health professionals to attend to queries from patients and policy makers about the full range of relevant emergent and emerging interventions and the mental health issues to which they may beneficially apply.

Acute stress and frontline healthcare providers

Background: Repeated exposure to stress increases the risk of acute stress response (ASR) and post-traumatic stress disorder (PTSD). Aims: The authors aimed to investigate ASR/PTSD symptoms among a multidisciplinary population of frontline health professionals who care for injured and critically unwell patients. Methods: A voluntary, anonymous questionnaire included an Impact of Events Scale-revised (IES-R) assessment, addressed stressors, teamwork, and mentorship. An IES-R score of >33 indicated symptoms in keeping with ASR (lasting <1 month) and PTSD (lasting >1 month). Findings: 15% (27/181) of returned questionnaires had an IES-R score >33; 19 had symptoms >1 month. Seven participants with IES-R >33 group had sought professional help. Less than half knew of a mentorship programme at their place of work. Conclusion: There is a hidden, untreated burden of stress symptoms among frontline emergency healthcare providers, and a variable environment of mentorship and teamwork. Attention is warranted if patient safety is to be optimised.

Building psychosocial capacity through training of front-line health professionals to provide brief therapy: lessons learned from the PROMPT study.

This report describes the views of front-line health professionals who participated in a randomised controlled trial examining a model of care in which depressed cancer patients received a brief psychosocial intervention. Health professionals from four cancer centres received focused training, skill development and clinical supervision in order to deliver the intervention. We interviewed 20 health professionals asking them about their perceptions of participation in the study and their views about more widespread implementation of this model of care. Participants strongly advocated for widespread implementation of this model of care; however, their ability to deliver the intervention varied depending on clinical roles and responsibilities. Many oncology nurses expressed conflict about delivering a psychosocial intervention when their clinical unit was busy. Finding a private area in which to talk was a frequent barrier in busy clinical units. Participants reported that they applied the skills and insights acquired in the study in their routine clinical work. Supervision was highly valued and was feasible to provide in clinical settings. Psychosocial care can be provided by a range of health professionals if they receive focused training and have access to supervision, but competing clinical demands are likely to limit their ability to routinely provide psychosocial care. This suggests that training should target professionals who have greater autonomy and flexibility in their work roles. ANZCTR1260000448044.

Correlations Between Environmental Factors and Increasing Lyme Disease Incidence in Canada

BackgroundLyme disease (LD) is an emerging infectious disease in Canada due to northward expansion of the geographic range of Ixodes scapularis, the principal tick vector for the LD agent Borrelia burgdorferi, into central and eastern Canada. This study aims to i) summarize the surveillance data for LD cases reported in Canada between 2009 and 2015, ii) identify potential environmental risk factors and iii) develop an acarological risk indicator from passive surveillance for occurrence of human cases.MethodsWe described the distribution, trends, demographic and clinical characteristics of cases of the disease. Logistic regression models were used to identify risk factors for the occurrence of LD: 1) demographic (age and sex), and 2) environmental (type of forest cover, temperature and abundance of ticks). Passive surveillance data were used to develop an acarological indicator of at-risk areas for LD.ResultsThe number of reported LD cases increased more than six-fold overall, from 144 cases in 2009 to 917 cases in 2015, mainly due to locally acquired infections. LD incidence in Nova Scotia has risen sharply since 2013 and was the highest in Canada over the study period. Children below 15 years and adults of the 55–74 age groups reported highest incidence. Significantly more men than women were infected and men had significantly more symptoms of late disseminated LD than women. Variability in clinical manifestations is observed between provinces, years, for children below 15 years and between age groups. The majority of cases were reported between April and November and there was an increase in risk areas. The abundance of Ixodes scapularis ticks collected on humans and deciduous forest cover were significantly associated with the occurrence of LD cases at the municipality scale. Passive surveillance provides a cost-effective alert tool for public health authorities to timely identify risk areas and target vulnerable populations and front-line health professionals by means of awareness campaigns.ConclusionThese findings showed that LD continues to increase in Canada, both over time and geographically, underlining the need to implement better preventive strategies, early disease recognition and treatment and efficient surveillance systems.Disclosures All authors: No reported disclosures.

Primary care workforce and continuous medical education in China: lessons to learn from a nationwide cross-sectional survey

ObjectivesThis study aimed to examine the education and training background of Chinese community health centres (CHCs) staff, continuous medical education (CME) and factors affecting participation in CME.DesignCross-sectional survey.SettingCommunity health centres...

Managing acute respiratory tract infections in children.

Respiratory tract infections (RTIs), including community-acquired pneumonia (CAP), bronchiolitis, viral-induced wheeze and croup, account for more primary care consultations than any other illness group and are the most likely reason for a parent or carer to contact a health professional. The majority of RTIs in fully immunised children are usually self-limiting. However, in a small percentage of children RTIs may become life threatening and it is crucial that all front-line health professionals are able to recognise and identify these children who are at risk of deterioration. To ensure this, fast recognition of symptoms is important, with care taken to exclude any 'red flag' features that may prompt a referral to secondary care. Nurses are well placed to reassure and support families, and to provide education regarding the facts about fever, the appropriate use of a single antipyretic medication, how to avoid dehydration in children with RTIs, and the beneficial role of immunisation in preventing infection. It is also important to explain in cases of CAP where antibiotics are necessary about how soon to expect a response, any side effects from antibiotics, and to provide 'safety net advice' on when to consider reassessment for the child. An illustrative case study is included to highlight some of the challenges that are likely to be encountered in clinical practice.

Delayed discharges within community hospitals

Purpose The purpose of this paper is to understand the perspectives of frontline health and social care professionals in relation to delays in discharge from community hospitals. Design/methodology/approach A qualitative approach was taken, using semi-structured interviews and non-participant observation, within three community hospitals in NHS Scotland. In total, 12 frontline health and social care professionals were interviewed and observation of the multi-disciplinary team meeting was completed. Thematic content analysis was used to analyse the data produced. Findings The key findings were delayed discharge as an issue, lack of resources and capacity, difficulties in the relationship between acute and community health staff, silo working between health and social care, conflicting pressures on staff, and influence over services and external factors. There were perceived different ways of working within acute health, community health and social work, which were suggested to reduce efficiency, cause tension and ultimately result in delays. All professionals perceived an inability to influence any of the factors causing delays in discharge. Practical implications The internal issues regarding inter-professional working could potentially damage integration, indicating a need to teach collaborative team skills as well as quality improvement training to support staff to challenge and change current ways of working. Originality/value The paper contributes to the evidence base of community hospitals. There are implications for both health and social care policy.

Bridging Science and Religion: How Health‐Care Workers as Storytellers Construct Spiritual Meanings

Contrary to the notion that medical science has supplanted religious understandings of human suffering, recent research suggests that health‐care workers like nurses can still portray their confrontations with illness and death in spiritual terms through storytelling. However, scholars have yet to systematically analyze the rhetorical devices used to construct spiritual meanings. Drawing on a symbolic interactionist perspective, we theorize that front‐line health professionals can deploy various rhetorical devices to infuse their workplace interactions with a spiritual significance. We also propose novel fuzzy set analysis techniques for determining which configurations of devices are most important in developing spiritual meanings. This approach was illustrated by examining 173 stories elicited from nurses at a nonsectarian, teaching hospital about encounters at work that significantly impacted their understanding of spirituality. Consistent with our expectations, the way in which nurses tell stories about their experiences not only shapes whether they attach spiritual significance to them, but whether they perceive spirituality and medicine to be compatible. We discuss the implications of our findings for future research on lived religion, conflicting identities, and institutional boundaries.

A tiered multidisciplinary approach to the psychosocial care of adult cancer patients integrated into routine care: the PROMPT study (a cluster-randomised controlled trial).

A stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care. Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater. Of eligible patients, 222 were recruited in control epoch and 247 in intervention epoch. Twenty-seven health professionals (HPs) were trained to deliver the psychosocial intervention consisting of up to four sessions, tailored to patient symptoms and distress. HPs participated in group supervision with a psychiatrist. The primary outcome, analysed by intention to treat, was depression measured with the HADS at 10weeks after receiving the intervention. At 10-week follow-up, there were no significant differences in HADS score for the 181 patients in control epoch and 177 in intervention epoch (adjusted difference -1.23, 95% CI -3.81--1.35, p=0.35). Patients with disease progression who received the intervention experienced significant benefits in unmet practical support needs including care and support, information, and physical and daily living. A brief psychosocial intervention delivered by front-line oncology health professionals is feasible to deliver but is insufficient as a stand-alone treatment for depression in cancer patients. Psychosocial interventions should be targeted to populations most likely to experience benefit.

Perfectionism as a warning sign for postnatal mental health difficulties

There is a growing evidence base indicating that maladaptive perfectionism is a risk factor for later mental health difficulties, such as postnatal depression. Perfection is defined as a state where an individual determinedly pursues self-imposed, personally demanding standards, despite adverse consequences. The article gives an overview of the links between clinical perfectionism and perinatal mental health difficulties, drawing on current research and models of best practice. Front-line health professionals such as health visitors are well placed to identify perfectionism early by assessing personality traits and other risk factors for depression and anxiety, and work with women and their families to prevent the onset of later, more severe, presentations.

Emotional demands, emotional labour and occupational outcomes in school principals

Most research into emotional labour is focussed on front-line service staff and health professionals, in short-term interactions. Little exists exploring the emotional labour involved in repeated on-going interactions by educational leaders with key stakeholders. This study explored the relationships between emotional demands, three emotional labour facets, burnout, wellbeing and job satisfaction in 1320 full-time school principals. Principals displayed significantly higher scores on emotional demands at work, burnout and job satisfaction, and significantly lower wellbeing scores than the general population. Structural equation modelling revealed that emotional demands predicted the elevated use of all emotional labour strategies. Surface Acting-Hiding emotions had an inverse relationship with burnout, wellbeing and job satisfaction. Surface Acting-Faking emotions had an inverse relationship with job satisfaction. Deep Acting demonstrated no significant associations with outcome variables. The findings of this study extend the current literature on the effects of emotional labour. The study also extends understanding about the separate effects of the facets of emotional labour, which will aid in the development of interventions to reduce high levels of burnout reported by educational leaders.

Parents Plus Systemic, Solution-Focused Parent Training Programs: Description, Review of the Evidence Base, and Meta-Analysis.

Parents Plus (PP) programs are systemic, solution-focused, group-based interventions. They are designed for delivery in clinical and community settings as treatment programs for families with child-focused problems, such as behavioral difficulties, disruptive behavior disorders, and emotional disorders in young people with and without developmental disabilities. PP programs have been developed for families of preschoolers, preadolescent children, and teenagers, as well as for separated or divorced families. Seventeen evaluation studies involving over 1,000 families have shown that PP programs have a significant impact on child behavior problems, goal attainment, and parental satisfaction and stress. The effect size of 0.57 (p<.001) from a meta-analysis of 10 controlled studies for child behavior problems compares favorably with those of meta-analyses of other well-established parent training programs with large evidence bases. In controlled studies, PP programs yielded significant (p<.001) effect sizes for goal attainment (d=1.51), parental satisfaction (d=0.78), and parental stress reduction (d=0.54). PP programs may be facilitated by trained front-line mental health and educational professionals.

Demographic and psychosocial correlates of sexual activity in older Chinese people.

This study examines sexual activity and associated psychosocial factors in older Chinese people. Sexuality continues to play a pivotal role in our lives even as we grow old. There is, however, very limited research on the topic in older populations. Cross-sectional survey. A representative sample of 688 older Chinese people (>60 years old) were individually interviewed on their demographic characteristics; their interest in, knowledge of and perceived control over sexual activities; and their engagement in sexual activity. The results show that 51·32% of men and 41·26% of women reported engaging in some form of sexual activity. Sexual intercourse and caressing were commonly reported. A multiple regression analysis also showed that a higher level of sexual activity was associated with being younger, living with a spouse, having a strong interest in sex, having sufficient knowledge of elder sexuality and a high perceived control over sex. Distinct predictive factors in each gender were observed. A high level of perceived control was associated with a higher level of sexual activity in males but not females. A series of binary logistic regression analyses were conducted to determine the demographic and psychosocial correlates of sexual activity. With the exception of the use of objects (sex toys), sexual activities were consistently associated with being younger; living with a spouse; and having high levels of interest, knowledge and perceived control. A sizable amount of older Chinese people engage in varying degrees of sexual activity, and most are still interested in sex. Frontline health professionals need to be aware of the growing needs for sex education in older persons, particular attention should be paid to discuss the limitations brought about by various chronic conditions associated with ageing and their relevance to elder sexuality.

Bringing the relationship to life: The power of video-feedback approaches

This article gives an overview of video-feedback approaches in parenting support, drawing on current research and models of best practice. Video-feedback approaches use a strength-based model to combine positive feedback from parent–infant film clips to promote sensitive parenting. There is a growing evidence-base for the use of video-feedback across a wide range of populations, and support for its use by front-line health professionals such as health visitors with families in the perinatal period and early years.

Do Health Professionals Need Additional Competencies for Stratified Cancer Prevention Based on Genetic Risk Profiling?

There is growing evidence that inclusion of genetic information about known common susceptibility variants may enable population risk-stratification and personalized prevention for common diseases including cancer. This would require the inclusion of genetic testing as an integral part of individual risk assessment of an asymptomatic individual. Front line health professionals would be expected to interact with and assist asymptomatic individuals through the risk stratification process. In that case, additional knowledge and skills may be needed. Current guidelines and frameworks for genetic competencies of non-specialist health professionals place an emphasis on rare inherited genetic diseases. For common diseases, health professionals do use risk assessment tools but such tools currently do not assess genetic susceptibility of individuals. In this article, we compare the skills and knowledge needed by non-genetic health professionals, if risk-stratified prevention is implemented, with existing competence recommendations from the UK, USA and Europe, in order to assess the gaps in current competences. We found that health professionals would benefit from understanding the contribution of common genetic variations in disease risk, the rationale for a risk-stratified prevention pathway, and the implications of using genomic information in risk-assessment and risk management of asymptomatic individuals for common disease prevention.

Should the influenza vaccine be mandatory for frontline staff?

Professor Alan Glasper from the University of Southampton discusses the latest flu plan initiative by the Department of Health, NHS England and Public Health England for the winter of 2014-15 designed to increase flu vaccine uptake among frontline health professionals.

Risk Assessment: A Reflection on the Principles of Tools to Help Manage Risk of Violence in Mental Health

The proposition that the vast majority of persons experiencing mental illness will never be violent is complicated by the large body of literature demonstrating a heightened risk of violent behaviour in persons suffering from mental disorder. In an era in which resources and individual judgement appear to dictate treatment, the question arises as to why structured clinical judgement is not utilized more in front-line assessment of risk for violence in those with mental and personality disorders? Our review of the literature on mental disorder and violence, risk assessment and risk management led to the contention that front-line mental health professionals can employ structured clinical judgement underpinned by the principles of risk assessment tools, such as the HCR-20. Ongoing resource development, education and availability of expertise should aid the development of more uniform approaches to violence risk management and therapeutic amelioration of the likelihood for violence in persons affected by mental illness.

Experiences of front-line health professionals in the delivery of telehealth: a qualitative study

Telehealth is an emerging field of clinical practice but current UK health policy has not taken account of the perceptions of front-line healthcare professionals expected to implement it. To investigate telehealth care for people with long-term conditions from the perspective of the front-line health professional. A qualitative study in three sites within the UK (Kent, Cornwall, and the London Borough of Newham) and embedded in the Whole Systems Demonstrator evaluation, a large cluster randomised controlled trial of telehealth and telecare for patients with long-term and complex conditions. Semi-structured qualitative interviews with 32 front-line health professionals (13 community matrons, 10 telehealth monitoring nurses and 9 GPs) involved in the delivery of telehealth. Data were analysed using a modified grounded theory approach. Mixed views were expressed by front-line professionals, which seem to reflect their levels of engagement. It was broadly welcomed by nursing staff as long as it supplemented rather than substituted their role in traditional patient care. GPs held mixed views; some gave a cautious welcome but most saw telehealth as increasing their work burden and potentially undermining their professional autonomy. Health care professionals will need to develop a shared understanding of patient self-management through telehealth. This may require a renegotiation of their roles and responsibilities.

Comparative study of children and adolescents referred for eating disorder treatment at a specialist tertiary setting

To examine child and adolescent differences in the clinical presentation of eating disorders (EDs) at referral to a specialist pediatric program. This study compared cognitive, behavioral, and physical and medical features of children (≤ 12 years) and adolescents (13-18 years) with EDs presenting to a state-wide specialist pediatric ED service over two decades (N = 656; 8-18 years; 94% female). Significant differences were found between the groups. Children were more commonly male (p < .001), had lower eating pathology scores (p < .001), were less likely to binge eat (p = .02), purge (p < .001) or exercise for shape and weight control (p < .001), and lost weight at a faster rate than adolescents (p = .009), whereas adolescents were more likely to present with bulimia nervosa spectrum disorders (p = .004). Children and adolescents did not differ significantly on mean body mass index z-score, percentage of body weight lost, or indicators of medical compromise (p > .05). The clinical presentation of EDs differs among children and adolescents, with eating pathology and behavioral symptoms less prominent among children. Frontline health professionals require knowledge of these differences to assist with early detection, diagnosis, and prognosis.

Exploring the boundary of a specialist service for adults with intellectual disabilities using a Delphi study: a quantification of stakeholder participation

BackgroundThere are arguments that a specialist service for adults with intellectual disabilities is needed to address the health inequalities that this group experiences. The boundary of such a specialist service however is unclear, and definition is difficult, given the varying experiences of the multiple stakeholder groups.ObjectivesThe study reported here quantitatively investigates divergence in stakeholders’ views of what constitutes a good specialist service for people with intellectual disabilities. It is the first step of a larger project that aims to investigate the purpose, function and design of such a specialist service. The results are intended to support policy and service development.Study designA Delphi study was carried out to elicit the requirements of this new specialist service from stakeholder groups. It consisted of three panels (carers, frontline health professionals, researchers and policymakers) and had three rounds. The quantification of stakeholder participation covers the number of unique ideas per panel, the value of these ideas as determined by the other panels and the level of agreement within and between panels.FindingsThere is some overlap of ideas about of what should constitute this specialist service, but both carers and frontline health professionals contributed unique ideas. Many of these were valued by the researchers and policymakers. Interestingly, carers generated more ideas regarding how to deliver services than what services to deliver. Regarding whether ideas are considered appropriate, the variation both within and between groups is small. On the other hand, the feasibility of solutions is much more contested, with large variations among carers.ConclusionsThis study provides a quantified representation of the diversity of ideas among stakeholder groups regarding where the boundary of a specialist service for adults with learning disabilities should sit. The results can be used as a starting point for the design process. The study also offers one way to measure the impact of participation for those interested in participation as a mechanism for service improvement.