Usefulness of working with a person-centred intervention in a group: Perspectives from facilitators and persons with mental illness.

BACKGROUND: When implementing new interventions into clinical practice, it is of great importance to investigate the implementation process to better understand factors promoting and impeding the implementation to stimulate engagement and sustainability of the intervention. It is essential to consider perspectives both from the health professionals delivering the intervention and those receiving the intervention to be open to their suggestions for enhancing the dissemination and implementation of the intervention. The aim of the study was to evaluate adoption, acceptability and appropriateness of a person-centred group intervention (PCGI) from the perspectives of facilitators and participants with mental illness in mental health outpatient services right after delivery. METHODS: A qualitative interview study design was used. Interview data from three individual interviews, one group interview with facilitators and 16 individual interviews with participants were analyzed through content analysis. RESULTS: As described in the following three categories, the facilitators and participants found the PCGI overall useful and meaningful to deliver and receive: (1) application of a PCGI in clinical practice, (2) balancing the facilitator role and (3) establishing and maintaining a safe relationship. CONCLUSION: Facilitators and participants found the form and structure of the PCGI useful and meaningful. Some participants dropped out as they did not feel comfortable in a group setting. The components in the sessions, questions on cards and reflection sheets together with peer-to-peer interactions provided a safe environment. However, facilitation from facilitators requires appropriate skills and qualifications, which must be provided by the hospital together with supervision and the possibility for peer feedback and exchange of experiences.

The deadlock of saying "That is what we already do!" A thematic analysis of mental healthcare professionals' reactions to using an evidence-based intervention.

WHAT IS KNOWN ON THIS SUBJECT?: There is a need to shed light on healthcare professionals' reactions to the use of the Guided Self-Determination method in a mental health hospital to better understand and adjust the implementation process of evidence-based practice. Healthcare professionals´ values and beliefs play an important role when implementing evidence-based practice in real-world healthcare settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The study identifies opposite positions in mental healthcare professionals: being ready or resistant to change when implementing an evidence-based intervention. The positions are elaborated in four thematic dynamic continuums describing reactions to using the intervention. In addition, this is the first study to explore mental healthcare professionals´ reactions to using the Guided Self-Determination method in a mental health context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When preparing implementation of an evidence-based intervention, it is important to consider adaptation of the intervention, the mental healthcare professionals' acceptability, support from management and participation in supervision. In future research, it is important to consider collecting data from mental healthcare professionals trained in using an evidence-based intervention, however not using it in clinical practice, to understand barriers towards evidence-based practice. ABSTRACT: Introduction Evidence-based interventions are required in mental health nursing to improve quality and outcome for patients. However, there is a need to shed light on professionals' reactions to the use of evidence-based interventions to better understand and adjust the implementation process. Aim To explore mental healthcare professionals´ reactions to using the evidence-based intervention Guided Self-Determination method in the care of inpatients with severe mental illness. Method A qualitative study conducted in relation to an 8 months implementation program. Data collection: 9 qualitative interviews and field notes generated from supervision of the intervention. Results Four themes emerged from a thematic analysis: "The expert becomes novice," "Theory used as a looking glass," "Guided Self-Determination perceived as an interruption" and "Becoming an informer of the impact of GSD." Discussion Using the themes may help leaders or researchers predict or discover the support needed by individual professionals. Implications for practice When preparing implementation of an evidence-based intervention, it is important to consider adaptation and acceptability, as well as support from management and participation in supervision. Finally, it is worth to consider collecting data from trained professionals, who did not use the intervention in practice to understand barriers towards evidence-based practise.

Caries Epidemiology and Community Dentistry: Chances for Future Improvements in Caries Risk Groups. Outcomes of the ORCA Saturday Afternoon Symposium, Greifswald, 2014. Part 1.

This paper reviews the first part of the outcomes of the ORCA Saturday Afternoon Symposium 2014 dealing with 'caries epidemiology and community dentistry: chances for future improvements in caries risk groups'. After the caries decline in many countries, there are remaining pockets of higher caries levels, mostly in the primary dentition and/or linked to a low socio-economic status (SES). The review into the evidence of caries-preventive measures clearly points to the use of fluorides, especially toothbrushing with fluoridated toothpaste and collective measures such as water fluoridation. In contrast to several unsuccessful high-risk approaches, community and public health programmes seem to be able to ensure a population-wide access and compliance in risk groups. Their simple and evidence-based measures mostly combine regular plaque removal and fluoride applications via toothbrushing, at least for children and adolescents. For the future, the common risk factor approach which addresses associations between oral health, social deprivation, diet, hygiene, smoking, alcohol use and stress should lead to combined efforts with other community health and education specialists. Further engagement with public policy, community leaders and administration is needed in order to strengthen healthy choices and behaviour, e.g. in 'healthy' schools and kindergartens. It seems advisable that these population programmes also aim at improving upstream factors.

Time and duration of eruption of first and second permanent molars: a longitudinal investigation.

OBJECTIVE: The aim of this study was to investigate the variation in (i) the time (age) of eruption and (ii) the duration of the eruption of first (M1) and second (M2) permanent molar teeth. Finally, the study also provides data about the association between time of eruption of the first of the M1s and the first of the M2s. METHODS: The study was carried out in Nexö Public Dental Health Service, Denmark. All children who, in a period of 12 months, had the first of their M1s or M2s recorded as erupted and the occlusal surface still partly covered by gingiva formed the study groups (N = 69 and 112 children, respectively). The continued eruption of all four molar teeth was recorded at recall intervals not exceeding 4 months until functional occlusion was obtained. RESULTS: First permanent molars: eruption time--girls: from the age of 5 years and 3 months to 7 years and 8 months (mean 6.1 years); boys: from 5 years and 2 months to 7 years and 10 months (mean 6.3 years). The duration of eruption--girls: from 5 to 32 months (mean 15.4 months); boys: from 7 to 28 months (mean 15.0). Second permanent molars: eruption time--girls: from the age of 8 years and 11 months to 14 years and 4 months (mean 11.3 years); boys: from 9 years and 11 months to 13 years and 11 months (mean 12.0 years). The duration of eruption--girls: from 12 to 44 months (mean 27.1 months); boys: from 9 to 45 months (mean 27.9 months). No correlation was found between the time of eruption and the duration of eruption of M1 or M2. There was a strong positive association between the time of eruption of the M1s and the M2s (r(s) = 0.81). CONCLUSIONS: A tremendous variation was found in time of eruption and in duration of eruption of permanent molars. This variation highlights the importance of individualizing caries preventive strategies for children.

Flow cytometric bivariate analysis of DNA and cytokeratin in colorectal cancer.

Different opinions about flow cytometric estimates of DNA aneuploidy and/or S-phase fraction (SPF) as supplementary prognostic markers in colorectal cancer are to some degree associated with methodology. Using univariate DNA analysis, we have previously investigated the DNA ploidy in colorectal cancer, its heterogeneity within and between tumors and its relation to survival. To improve detection of DNA aneuploid subpopulations and particularly estimation of their SPF's we investigated a method for bivariate DNA/cytokeratin analysis on fine-needle aspirates of 728 frozen biopsies from 157 colorectal tumors. Unfixed aspirates were stained with propidium iodide and FITC-conjugated anti-cytokeratin antibody in a saponin-buffer. A significant association between SPF and debris was observed. There were no substantial difference in DNA ploidy patterns between univariate and bivariate measurements (concordance was 92-95%). No new DNA aneuploid subpopulations were detected in cytokeratin-gated compared to ungated or univariate histograms. Debris-adjusted SPF's of cytokeratin-gated histograms were significantly higher than of ungated histograms, also for subpopulations with DI>1.4 (p<0.0001). There was no significant association between SPF and survival.