Aims
Within a multidisciplinary team of medical and non medical prescribers the aim of this project was to improve SSRI prescribing safety by 30% by June 2022. This was with view to enhance ...prescribing provision across the trust.
Methods
Multiple methods were done to improve staffs perception of safety. Criteria were set out in keeping with NICE guidance, RCPSYCH and BAP guidance on prescribing. Psychoeducation and focus groups were held to gauge colleagues thoughts on SSRI prescribing. This was along with pulse surveys.
An SSRI clinic was set up, with referral pathway, protocol for referral and staff clinics for reviews and new prescribing. This was to improve prescribing safety.
Health promotion leaflets were also made for the clinic in terms of non pharmacological methods to improve mental health.
Results
Improved staff safety from a Good (3) to Excellent (5).
Established SSRI clinic which will be spread trust wide to the other clinics.
Better monitoring and education of SSRIs.
Health promotion benefits.
Conclusion
Improved staff safety from a Good (3) to Excellent (5).
Established SSRI clinic which will be spread trust wide to the other clinics.
Better monitoring and education of SSRIs.
Health promotion benefits.
Epidemiological studies of the impact of environmental chemicals on reproductive health demonstrate consequences of exposure but establishing causative links requires animal models using ‘real life’ ...in utero exposures. We aimed to determine whether prolonged, low-dose, exposure of pregnant sheep to a mixture of environmental chemicals affects fetal ovarian development. Exposure of treated ewes (n = 7) to pollutants was maximized by surface application of processed sewage sludge to pasture. Control ewes (n = 10) were reared on pasture treated with inorganic fertilizer. Ovaries and blood were collected from fetuses (n = 15 control and n = 8 treated) on Day 110 of gestation for investigation of fetal endocrinology, ovarian follicle/oocyte numbers and ovarian proteome. Treated fetuses were 14% lighter than controls but fetal ovary weights were unchanged. Prolactin (48% lower) was the only measured hormone significantly affected by treatment. Treatment reduced numbers of growth differentiation factor (GDF9) and induced myeloid leukaemia cell differentiation protein (MCL1) positive oocytes by 25–26% and increased pro-apoptotic BAX by 65% and 42% of protein spots in the treated ovarian proteome were differently expressed compared with controls. Nineteen spots were identified and included proteins involved in gene expression/transcription, protein synthesis, phosphorylation and receptor activity. Fetal exposure to environmental chemicals, via the mother, significantly perturbs fetal ovarian development. If such effects are replicated in humans, premature menopause could be an outcome.
Abstract
Many music therapists have alluded to challenges in their work with groups of young people. However, chaos, incorporating experiences of disintegration and destruction, is a construct often ...overlooked in music therapy literature. Some music therapy authors have related experiences of chaos to the struggles faced by young people referred for therapy. These experiences require management, modification, or resolution. The authors of this article synthesized broader understandings and approaches towards chaos described in literature from fields including music therapy group work, drama therapy, the arts, psychoanalysis, organizational studies, and philosophy. Chaos is positioned as an inherent and necessary aspect of music therapy groups with young people, situated within a mutually potentiating relationship with more ordered features of a group process. From this paradoxical perspective, therapeutic transformation is enabled through creativity that holds the tension between order and the destructiveness of chaos. When chaos is welcomed in music therapy groups and framed within appropriate boundaries, the authors argue that experiences of chaos can be harnessed to support engagement with the paradoxes of creativity and destructiveness. The provision of a space to play with chaos supports young people who are required to flourish within adverse, chaotic life circumstances. The significance of this position for a group of young people who have committed offences in the South African context is highlighted.
A number of popular theories about trauma have suggested rhythm has potential as a mechanism for regulating arousal levels. However, there is very little literature examining this proposal from the ...perspective of the young people who might benefit. This action research project addresses this gap by collaborating with four groups of children in the out-of-home-care system to discover what they wanted from music therapists who brought a strong focus on rhythm-based activities. The four music therapy groups took place over a 12 month period and each cycle of action and reflection led to adjustments in what activities were offered, as well as exploring different levels of structure and ways of building relationships in the groups. The initial group incorporated a strong emphasis on highly structured rhythm-based activities, but young people found the format difficult to engage with. The second cycle included more opportunities for creativity and self-direction within semi-structured activities which children reported enjoying, but too much freedom also became overwhelming at times. The two groups in the third cycle seemed to balance structure and responsiveness successfully but were also influenced by the introduction of individual sessions prior to group commencement, which was designed to contribute to safety and trust building. Final reflections on the role of rhythm in supporting young people who have had adverse experiences were centred around the ideas of co-regulation. This was qualitatively different to our expectations that practicing rhythm-based activities would lead to an expanded window of tolerance that resulted in less time being spent in either hypo-arousal or hyper-arousal. Instead of entraining to an external rhythm, young people felt safe when their rhythms were matched, even if they were irregular, out of time and unpredictable. The small moments of co-regulation resulted in pleasure, comfort, satisfaction and peace and these moments were highly valued by the young people, who described just wanting to be relaxed and happy. Although not as rhythm-specific as the literature might suggest, music making with trusted adults helped the young people in this study feel more content.
Recent theorizing about the connection between the brain and trauma (Perry, 2009; Porges, 2011; van der Kolk, 2015) has led to a burgeoning of interest in the provision of music-based programs with ...people who have had adverse experiences. Although there has been critique of the lack of scientific basis of these theories and their implications for practice (McLean, 2016), they remain popular with practitioners who are keen to introduce innovative and potentially beneficial approaches to the people with whom they work. Music therapists have a long tradition of working with traumatized clients, however, the brain-based rationales did not seem congruent with the less predictable and more idiosyncratic benefits reported, which seem to occur through more psychodynamic mechanisms of action. In order to unravel what seemed to be a body of literature plagued by the conflation of theories, we undertook a critical interpretive synthesis of literature in the past 10 years to cross-examine the ways that music and trauma have been connected. To do this we extracted data from 36 identified articles to distinguish what music methods were used, what claims were made about benefits, what theoretical justifications were provided and how much research basis there was for the claims being made. Having systematically disentangled the various dimensions, we then constructed a spectrum of approaches that offers a logical categorization of four different ways of using music with people who have had adverse life experiences. These included using music for stabilizing, entrainment, expressive and performative purposes. Specific music-based methods were proposed for those associated with brain-based rationales, and more responsive, multi-method approaches were congruent with recovery and social change models. Future research would benefit from a more clearly articulated connection between theoretical rationale, music-based methods, benefits and research approaches. The resultant spectrum may provide useful guidance for both practice and research design.
An increasing number of people with dementia receive informal care from family members to help them remain living in the community. Music therapy is particularly beneficial for supporting the ...wellbeing of people living with dementia. However, little is known about how music therapy might support people with dementia and their family care partners as dyads. This study explored the experiences of six dyads participating in a 12-week home-based skill-sharing music intervention facilitated by a music therapist. We examined their experiences during the intervention period and in the 3-6 months following. This study was conducted within a larger randomised control trial, HOMESIDE. Data was collected through video-recorded music-based interviews, participant diaries, and a semi-structured interview. Data was analysed using an abductive and relational-centred research approach in consideration of the
. The study found fifteen themes that describe dyads' supported experiences of sharing music in their homes. These were organised into three global themes: (1) experiences were shaped by complex influences; (2) a connected musical ecosystem; and (3) music was a resource for wellbeing. This study highlighted the important role of personalised facilitation and the therapeutic relationship as dyads learned to use music as a resource through a process of trial and error. The implications for skill-sharing, indirect music therapy and direct music therapy practice are discussed.
Cancer is a leading cause of disease burden globally, with more than 19·3 million cases and 10 million deaths recorded in 2020. Research is crucial to understanding the determinants of cancer and the ...effects of interventions, and to improving outcomes. We aimed to analyse global patterns of public and philanthropic investment in cancer research.
In this content analysis, we searched the UberResearch Dimensions database and Cancer Research UK data for human cancer research funding awards from public and philanthropic funders between Jan 1, 2016, and Dec 31, 2020. Included award types were project and programme grants, fellowships, pump priming, and pilot projects. Awards focused on operational delivery of cancer care were excluded. Awards were categorised by cancer type, cross-cutting research theme, and research phase. Funding amount was compared with global burden of specific cancers, measured by disability-adjusted life-years, years lived with disability, and mortality using data from the Global Burden of Disease study.
We identified 66 388 awards with total investment of about US$24·5 billion in 2016–20. Investment decreased year-on-year, with the largest drop observed between 2019 and 2020. Pre-clinical research received 73·5% of the funding across the 5 years ($18 billion), phase 1–4 clinical trials received 7·4% ($1·8 billion), public health research received 9·4% ($2·3 billion), and cross-disciplinary research received 5·0% ($1·2 billion). General cancer research received the largest investment ($7·1 billion, 29·2% of the total funding). The most highly funded cancer types were breast cancer ($2·7 billion 11·2%), haematological cancer ($2·3 billion 9·4%), and brain cancer ($1·3 billion 5·5%). Analysis by cross-cutting theme revealed that 41·2% of investment ($9·6 billion) went to cancer biology research, 19·6% ($4·6 billion) to drug treatment research, and 12·1% ($2·8 billion) to immuno-oncology. 1·4% of the total funding ($0·3 billion) was spent on surgery research, 2·8% ($0·7 billion) was spent on radiotherapy research, and 0·5% ($0·1 billion) was spent on global health studies.
Cancer research funding must be aligned with the global burden of cancer with more equitable funding for cancer research in low-income and middle-income countries (which account for 80% of cancer burden), both to support research relevant to these settings, and build research capacity within these countries. There is an urgent need to prioritise investment in surgery and radiotherapy research given their primacy in the treatment of many solid tumours.
None.
Students with profound intellectual disabilities disorders (IDDs) have the right to participate in educational opportunities that recognize their unique resources and needs, as do all children. ...Because of their specific communication challenges, positive relationships with attentive communication partners are critical for success. In fact, the power of positive relationships in schools is recognized to be connected to student well-being more broadly. This article examines the case of one young man with profound IDD and his relationship with his music therapist using a duo-ethnographic informed paradigmatic case study. Video analysis based on multi-voice perspectives is used to generate hermeneutic phenomenological findings to closely examine the relationship between a young man with profound IDD and a music therapist. The voices of four allied health researchers were also gathered to inform the authors' construction of an informed commentary on the phenomenon. The results suggest that the essence lay in a combination of attentive, responsive and creative being with the other person over time. Four principles of musical engagement were identified in the video footage as critical to the meaningful relationships through music: the music therapist listens; the music therapist takes responsibility for structure; spontaneous initiation is sought from the young person; and the relationship is built over time. These concepts are contextualized within a discussion of student well-being that is underpinned by positive relationships and leads to students achieving their full potential within diverse school contexts.
Correspondence to Dr Ethna McFerran, Queen’s University Belfast Centre for Public Health, Queens University Belfast, Belfast BT7 1NN, UK; e.mcferran@qub.ac.uk A dwindling minority of countries now ...offer guaiac-based colorectal cancer (CRC) screening tests (including Croatia, Finland, Greece and Hungary) since, for over a decade, faecal immunochemical testing (FIT) has been shown to be more effective.1 FIT detects more positive results compared with guaiac-based tests with fewer false negatives and for participants is a more acceptable test. The Northern Ireland population is being left behind with an inferior screening test. ...since CRC screening is offered to 60-to-74-year-olds in Northern Ireland, those in their 50s will not have the option to undergo screening, unlike their GB counterparts, and this will widen regional health inequalities. Gastroenterology 2017; 152: 1217–37. doi:10.1053/j.gastro.2016.08.053 2 Murphy J. The cost-effectiveness of immunochemical faecal occult blood testing vs. guaiac faecal occult blood testing for colorectal cancer screening in the NHS Bowel Cancer Screening Programme Report to the UK National Screening Committee. 2015. http://legacy.screening.nhs.uk/bowelcancer 3 UK National Screening Committee.
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