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Improving usability of Electronic Health Records in a UK Mental Health setting: a feasibility study.
BACKGROUND: Electronic Health Records (EHRs) can help clinicians to plan, document and deliver care for patients in healthcare services. When used consistently, EHRs can advance patient safety and quality, and reduce clinician's workload. However, usability problems can make it difficult for clinicians to use EHRs effectively, which can negatively impact both healthcare professionals and patients. OBJECTIVE: To improve usability of EHRs within a mental health service in the UK. METHODS: This was a feasibility study conducted with two mental health teams. A mixed-methods approach was employed. Focus group discussions with clinicians identified existing usability problems in EHRs and changes were made to address these problems. Updated EHR assessment forms were evaluated by comparing the following measures pre and post changes: (1) usability testing to monitor time spent completing and duplicating patient information in EHRs, (2) clinician's experience of using EHRs, and (3) proportion of completed EHR assessment forms. RESULTS: Usability testing with clinicians (n = 3) showed that the time taken to complete EHR assessment forms and time spent duplicating patient information decreased. Clinician's experience of completing EHR assessment forms also significantly improved post changes compared to baseline (n = 71; p
Patient-reported harm from NHS treatment or care, or the lack of access to care: a cross-sectional survey of general population prevalence, impact and responses.
OBJECTIVES: The aim of this article is to provide an estimate of the proportion of the general public reporting healthcare-related harm in Great Britain, its location, impact, responses post-harm and desired reactions from healthcare providers. DESIGN: We used a cross-sectional survey, using quota sampling. SETTING: This research was conducted in Great Britain. PARTICIPANTS: The survey had 10 064 participants (weighted analysis). RESULTS: In our survey 9.7% participants reported harm caused by the National Health Service (NHS) in the last 3 years through treatment or care (6.2%) or the lack of access to care (3.5%). The main location where the harm first occurred was hospitals. A total of 37.6% of participants reported a moderate impact and 44.8% a severe impact of harm. The most common response to harm was to share their experience with others (67.1%). Almost 60% sought professional advice and support, with 11.6% contacting the Patient Advice and Liaison Service (PALS). Only 17% submitted a formal complaint, and 2.1% made a claim for financial compensation. People wanted treatment or care to redress the harm (44.4%) and an explanation (34.8%). Two-thirds of those making a complaint felt it was not handled well and approximately half were satisfied with PALS. Experiences and responses differed according to sex and age (eg, women reported more harm). People with long-term illness or disability, those in lower social grades, and people in other disadvantaged groups reported higher rates and more severe impact of harm. CONCLUSIONS: We found that 9.7% of the British general population reported harm by the NHS, a higher rate than reported in two previous surveys. Our study used a broader and more inclusive definition of harm and was conducted during the COVID-19 pandemic, making comparison to previous surveys challenging. People responded to harm in different ways, such as sharing experiences with others and seeking professional advice and support. Mostly, people who were harmed wanted help to redress the harm or to gain access to the care needed. Low satisfaction with PALS and complaints services may reflect that these services do not always deliver the required support. There is a need to better understand the patient perspective following harm and for further consideration of what a person-centred approach to resolution and recovery might look like.
Stuttering: Our Current Knowledge, Research Opportunities, and Ways to Address Critical Gaps.
Our understanding of the neurobiological bases of stuttering remains limited, hampering development of effective treatments that are informed by basic science. Stuttering affects more than 5% of all preschool-age children and remains chronic in approximately 1% of adults worldwide. As a condition that affects a most fundamental human ability to engage in fluid and spontaneous verbal communication, stuttering can have substantial psychosocial, occupational, and educational impacts on those who are affected. This article summarizes invited talks and breakout sessions that were held in June 2023 as part of a 2-day workshop sponsored by the US National Institute on Deafness and Other Communication Disorders. The workshop encompassed topics including neurobiology, genetics, speech motor control, cognitive, social, and emotional impacts, and intervention. Updates on current research in these areas were summarized by each speaker, and critical gaps and priorities for future research were raised, and then discussed by participants. Research talks were followed by smaller, moderated breakout sessions intended to elicit diverse perspectives, including on the matter of defining therapeutic targets for stuttering. A major concern that emerged following participant discussion was whether priorities for treatment in older children and adults should focus on targeting core speech symptoms of stuttering, or on embracing effective communication regardless of whether the speaker exhibits overt stuttering. This article concludes with accumulated convergent points endorsed by most attendees on research and clinical priorities that may lead to breakthroughs with substantial potential to contribute to bettering the lives of those living with this complex speech disorder.
A feasibility study of a preventative, transdiagnostic intervention for mental health problems in adolescence: building resilience through socioemotional training (ReSET).
BACKGROUND: Adolescence is a developmental period during which an estimated 75% of mental health problems emerge (Solmi et al. in Mol Psychiat 27:281-295, 2022). This paper reports a feasibility study of a novel indicated, preventative, transdiagnostic, school-based intervention: Building Resilience Through Socioemotional Training (ReSET). The intervention addresses two domains thought to be causally related to mental health problems during adolescence: social relationships and emotion processing. Social relationships were targeted using principles from interpersonal psychotherapy, while emotion processing was targeted using cognitive-emotional training focused on three areas of emotion processing: Emotion perception, emotion regulation and interoception. The aims of this feasibility study were to (i) assess the acceptability of integrating group-based psychotherapy with individual cognitive-emotional training, (ii) evaluate the feasibility of our recruitment measures, and (iii) assess the feasibility of delivering our research measures. METHODS: The feasibility study involved 41 adolescents, aged 12-14, who were randomly assigned to receive the ReSET intervention or their school's usual mental health and wellbeing provision. RESULTS: Qualitative data from intervention participants suggested the programme was experienced as a cohesive intervention, with participants able to draw on a combination of skills. Further, the cognitive-training tasks were received positively (with the exception of the interoception training task). The recruitment and research measures were successfully delivered in the school-based setting, with 97.5% retention of participants from baseline to post-intervention assessment. Qualitative data was overwhelmingly positive regarding the benefits to participants who had completed the intervention. Moreover, there was only limited data missingness. CONCLUSIONS: We conclude that a trial of the ReSET intervention in a school setting is feasible. We discuss the implications of the feasibility study with regard to optimising school-based interventions and adaptations made in preparation for a full-scale randomised controlled trial, now underway.
Disentangling the Component Processes in Complex Planning Impairments Following Ventromedial Prefrontal Lesions.
Damage to the ventromedial prefrontal cortex (vmPFC) in humans disrupts planning abilities in naturalistic settings. However, it is unknown which components of planning are affected in these patients, including selecting the relevant information, simulating future states, or evaluating between these states. To address this question, we leveraged computational paradigms to investigate the role of vmPFC in planning, using the board game task "Four-in-a-Row" (18 lesion patients, 9 female; 30 healthy control participants, 16 female) and the simpler "Two-Step" task measuring model-based reasoning (49 lesion patients, 27 female; 20 healthy control participants, 13 female). Damage to vmPFC disrupted performance in Four-in-a-Row compared with both control lesion patients and healthy age-matched controls. We leveraged a computational framework to assess different component processes of planning in Four-in-a-Row and found that impairments following vmPFC damage included shallower planning depth and a tendency to overlook game-relevant features. In the "Two-Step" task, which involves binary choices across a short future horizon, we found little evidence of planning in all groups and no behavioral differences between groups. Complex yet computationally tractable tasks such as "Four-in-a-Row" offer novel opportunities for characterizing neuropsychological planning impairments, which in vmPFC patients we find are associated with oversights and reduced planning depth.
Craving what you imagine: How sensory mental imagery relates to trait food craving and BMI.
Mental imagery (MI), particularly visual imagery, is thought to play a key role in inducing food cravings, yet its relationship with trait food craving and adiposity remains underexplored. This study investigated how MI for multiple senses is related to the individual food craving trait and BMI. Experiment 1, conducted with a cohort of 291 individuals, used a partial Plymouth Sensory Imagery Questionnaire (PSI-Q) and the Food Craving Inventory. Experiment 2 expanded on this with a large sample (n = 1371) collected across NZ, the United Kingdom, and the United States, incorporating a full PSI-Q with an additional food dimension, the Spontaneous Use of Imagery Scale, as well as the Food Craving Questionnaire-Trait. Across both studies, weak positive correlations emerged between the vividness of olfactory MI scores and trait food craving. In Experiment 2, the vividness scores associated with Smell, Taste, Food, Sensation, and Feel were weakly correlated with the trait food craving measure. Interestingly, an individual's spontaneous use of visual MI, measured with the Spontaneous Use of Imagery Scale, was indirectly linked to BMI, mediated by an individual's food craving trait. These findings provide novel insights into the role of sensory MI in habitual food cravings and adiposity, while at the same time highlighting methodological gaps in current approaches to measuring individual sensory MI.
Understanding disrupted motivation in Parkinson's disease through a value-based decision-making lens
Neurobehavioural disturbances such as loss of motivation have profound effects on the lives of many people living with Parkinson's disease (PD), as well as other brain disorders. The field of decision-making neuroscience, underpinned by a plethora of work across species, provides an important framework within which to investigate apathy in clinical populations. Here we review how changes in a number of different processes underlying value-based decision making may lead to the common phenotype of apathy in PD. The application of computational models to probe both behaviour and neurophysiology show promise in elucidating these cognitive processes crucial for motivated behaviour. However, observations from the clinical management of PD demand an expanded view of this relationship, which we aim to delineate. Ultimately, effective treatment of apathy may depend on identifying the pattern in which decision making and related mechanisms have been disrupted in individuals living with PD.