This article discusses the findings of a recent study which demonstrates that generic attributes are highly context-dependent, and are shaped by the disciplinary epistemology in which they are ...conceptualised and taught. Generic attributes have, for a long time, been viewed as super-disciplinary, and hence as separated from and overlayed onto disciplinary content. There has been considerable interest in generic skills or attributes over more than a decade, and there has also been interest in disciplinary culture, and yet there has been little research which has examined the importance of disciplinary epistemology in shaping generic skills and attributes. This study brings together these two strands of research. The study examined the teaching of generic attributes in five disciplines - physics, history, economics, medicine and law - in two Australian universities. The study is based on in-depth, semi-structured interviews with academic staff. The findings demonstrate that skills such as critical thinking, analysis, problem solving and communication are conceptualised and taught in quite different ways in each of the disciplines. This article suggests that a de-disciplined approach to generic skills has led to problems in the areas of educational policy and practice. Instead it proposes a re-disciplined theorising of generic skills and attributes, which frames them as part of the social practice of the disciplines, and so understood as in and of the disciplinary culture. This new conceptualisation of generic skills and attributes acknowledges the integration of attributes with disciplinary epistemology.
Achieving hepatitic C virus (HCV) elimination requires linking people who use drugs (PWUD) into care. We report final direct‐acting antivirals (DAAs)‐based outcomes from the Integrated‐Test‐stage ...‐Treat (ITTREAT) study. Project ITTREAT (2013–2021), based at an addiction centre, was a ‘one‐stop’ service with innovative linkage to care strategies. Primary outcome was sustained virological response (SVR12) (intention to treat ITT) including whether individuals were recruited in first (period 1) versus last four (period 2 included the COVID‐19 pandemic) years of the study. Number recruited were n = 765, mean age 40.9 ± 10.1 years, 78% males, history of current/past injecting drug use (IDU) and alcohol use being 77% and 90%, respectively. Prevalence of a positive HCV PCR was 84% with 19% having cirrhosis. Comparing those recruited in period 2 versus period 1, there was increasing prevalence of IDU, 90% versus 72% (p < .001); homelessness, 67% versus 50% (p < .001); psychiatric diagnosis, 84% versus 50% (p < .001); overdose history 71% versus 31% (p < .001), receiving opioid agonist treatment (OAT) 75% versus 52% (p < .001) and comorbidity 44% versus 25% (p < .001). Of those treated with DAAs (n = 272), ITT SVR rates were 86% (95% CI: 81%–90%), being similar in period 2 versus period 1. Predictors of non‐SVR were receiving OAT (OR 0.33, 95% CI: 0.12–0.87, p = .025) and ≥80% adherence (OR 0.01, 95% CI: 0.003–0.041, p < .001). Reinfection rates period 2 versus period 1 (per 100 person‐years) were 1.84 versus 1.70, respectively. In the treated cohort, mortality was 15%, being mostly drug‐related. Despite increasing complexity of PWUD, high SVR12 rates are achievable with use of OAT and good adherence.
Background/aims
Direct‐acting antivirals (DAAs) provide an unprecedented opportunity for a “find‐and‐treat strategy.” We aimed to report real‐world clinical, patient reported and health economic ...outcomes of community‐based hepatitis C virus (HCV) screening/treatment in people who use drugs (PWUDs).
Methods
Project ITTREAT (2013‐2021), established at a drug and alcohol treatment centre, offered a comprehensive service. Generic (SF‐12v2 and EQ‐5D‐5L) and liver‐specific (SFLDQoL) health‐related quality of life (HRQoL) were assessed before and after HCV treatment. Costs/case detected and cured were calculated. Primary outcome measure was sustained virological response (SVR) (intention to treat).
Results
Till March 2018, 573 individuals recruited, 462 (81%) males, mean age 40.5 ± 10.0 years. Of the 125 treated, 115 (92%) had past/current history of injecting drug use, 88 (70%) were receiving opioid agonist treatment and 50 (40%) were homeless. Twenty‐six per cent received interferon‐based and 74% DAA‐only regimens. SVR (ITT) was 87% (90% with DAAs). Service uptake/HCV treatment completion rates were >95%, HCV reinfection being 2.63/100 person years (95% CI 0.67‐10.33). HRQoL improved significantly at end of treatment (EOT) in those with SVR: SFLDQoL (symptoms, memory, distress, loneliness, hopelessness, sleep and stigma) (P</ = .011); SF‐12 v2 physical and mental health domains (P < .001); and EQ‐5D‐5L composite profile score (P = .009) and visual analogue scale, P < .001. Cost (British pounds 2018) per case detected was £171; mean cost per cure (excluding medication) was £702 ± 188.
Conclusions
Excellent real‐world SVRs in PWUDs with significant improvement in HRQoL can be achieved at modest costs. Project ITTREAT endorses community‐based integrated services to help achieve HCV elimination.
Abstract Auditory hallucinations (AH) are a common and distressing experience and patients report distress reduction to be a priority. Relating Therapy adopts a symptom-specific and mechanism focused ...approach to the reduction of AH distress. We conducted this single-blind, pragmatic, parallel groups, superiority pilot RCT within a single mental health centre in the UK. Patients (18 + years) with persistent and distressing AH, irrespective of diagnosis were randomly allocated to receive either Relating Therapy and Treatment-as-usual (RT) or Treatment as-usual alone (TAU). Assessment of outcome was completed pre-randomisation (T0), 16 weeks post-randomisation (T1) and 36 weeks post-randomisation (T2). The primary outcome was the 5-item Distress scale of the Psychotic Symptoms Rating Scale - Auditory Hallucinations (PSYRATS-AHRS) at T1. We randomly assigned 29 patients to receive RT ( n = 14) or TAU ( n = 15). Twenty-five patients (86%) provided complete datasets. Compared with TAU, RT led to reductions in AH distress in the large effect size range across T1 and T2. Our findings suggest that Relating Therapy might be effective for reducing AH distress. A larger, suitably powered phase 3 study is needed to provide a precise estimate of the effects of Relating Therapy for AH distress.
Background
Voice hearing in the context of Borderline Personality Disorder (BPD) has traditionally been regarded as transient and an experience that lacks legitimacy. Consequently, there are no ...evidence‐based treatments for the voices reported by BPD patients. Contrary to the traditional view, there is a growing literature suggesting that voice hearing in the context of BPD can be an enduring and distressing experience which shares similarities with voice hearing in the context of psychosis. Given these similarities, the aim of this study was to explore whether brief Coping Strategy Enhancement developed in the context of psychosis can be used to treat distressing voice hearing in the context of BPD.
Method
This was a service evaluation carried out in a specialist NHS service delivering psychological therapies for distressing voices. Patients with either a BPD (n = 46) or a psychosis diagnosis (n = 125) received four sessions of Coping Strategy Enhancement (CSE). The primary outcome was voice‐related distress. The pre‐post outcomes for BPD patients were explored and compared with those achieved by the psychosis patients.
Results
Both the BPD and psychosis groups experienced a significant reduction in voice‐related distress after CSE compared with baseline. The interaction between diagnosis group and time was small and statistically non‐significant.
Conclusion
These findings suggest a brief CSE intervention developed in the context of psychosis can be an effective starting point in the treatment of distressing voice hearing in the context of BPD. Such interventions have the potential to be integrated into broader BPD treatment programmes for those who hear voices.
Substance use has been consistently reported to be more prevalent amongst Men who have Sex with Men (MSM) compared to the general population. Substance use, in particular polydrug use, has been found ...to be influenced by social and contextual factors and to increase the risk of unprotected intercourse among MSM. The objective of this analysis was to investigate the prevalence and predictors of drug use during a sexual encounter and to identify specific prevention needs.
A multi-site bio-behavioural cross-sectional survey was implemented in 13 European cities, targeting MSM and using Time-Location Sampling and Respondent-Driven Sampling methods Multivariable multi-level logistic random-intercept model (random effect of study site) was estimated to identify factors associated with the use of alcohol, cannabis, party drugs, sexual performance enhancement drugs and chemsex drugs.
Overall, 1261 (30.0%) participants reported drug use, and 436 of 3706 (11.8%) reported the use of two or more drugs during their last sexual encounter. By drug class, 966 (23.0%) reported using sexual performance enhancement drugs, 353 (8.4%) – party drugs, and 142 (3.4%) the use of chemsex drugs. Respondents who reported drug use were more frequently diagnosed with HIV (10.5% vs. 3.9%) before and with other STIs during the 12 months prior to the study (16.7% vs. 9.2%). The use of all the analysed substances was significantly associated with sexual encounter with more than one partner.
Substance and polydrug use during sexual encounters occurred amongst sampled MSM across Europe although varying greatly between study sites. Different local social norms within MSM communities may be important contextual drivers of drug use, highlighting the need for innovative and multi-faceted prevention measures to reduce HIV/STI risk in the context of drug use.
Cognitive behaviour therapy is recommended internationally as a treatment for psychosis (targeting symptoms such as auditory hallucinations, or “voices”). Yet mental health services are commonly ...unable to offer such resource‐intensive psychological interventions. Brief, symptom‐specific and less resource‐intensive therapies are being developed as one initiative to increase access. However, as access increases, so might the risk of offering therapy to clients who are not optimally disposed to engage with and benefit from therapy. Thus, it is important to identify who is most/least likely to engage with and benefit from therapy, and when. In the current study, 225 clients were assessed for suitability for a brief, 4‐session, manualized, cognitive behaviour therapy‐based intervention for voices (named coping strategy enhancement therapy) and 144 commenced therapy, at a transdiagnostic voices clinic based in Sussex, UK. This article reports on the value of depression, anxiety, stress, insight into the origin of voices, length of voice hearing, and demographics in the prediction of engagement and outcomes. The study found that higher levels of baseline depression, anxiety, and stress were significantly associated with poorer outcomes, especially if clients also had high levels of voice‐related distress. The engagement analyses showed that levels of voice‐related distress at baseline predicted dropout. These findings highlight the importance of assessing negative affect and voice‐related distress prior to commencing therapy for distressing voices, to help determine if the client is suitable or ready for brief‐coping strategy enhancement.
Abstract Group Person-Based Cognitive Therapy (PBCT) integrates cognitive therapy and mindfulness to target distinct sources of distress in psychosis. The present study presents data from the first ...randomised controlled trial investigating group PBCT in people distressed by hearing voices. One-hundred and eight participants were randomised to receive either group PBCT and Treatment As Usual (TAU) or TAU only. While there was no significant effect on the primary outcome, a measure of general psychological distress, results showed significant between-group post-intervention benefits in voice-related distress, perceived controllability of voices and recovery. Participants in the PBCT group reported significantly lower post-treatment levels of depression, with this effect maintained at six-month follow-up. Findings suggest PBCT delivered over 12 weeks effectively impacts key dimensions of the voice hearing experience, supports meaningful behaviour change, and has lasting effects on mood.
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