The active problem solving of patients dependent on home parenteral nutrition: A qualitative analysis.

BACKGROUND & AIMS: People with chronic, type 3, intestinal failure often require long-term home parenteral nutrition (HPN). People receiving HPN have frequent interactions with their healthcare, due to the need for close monitoring and due to recurrent hospital admissions. Individuals' responses to, and interactions with, their health care service provides are poorly described. We conducted a service evaluation to explore people's experiences of HPN-related healthcare interactions in order to identify how service providers can best meet the individualised needs of patients. METHODS: We interviewed ten people receiving HPN. The participants were asked about their healthcare interactions related to HPN. The data were analysed using a qualitative research method known as interpretive phenomenological analysis. This analytical approach is concerned with the meaning that people ascribe to particular events, in this case their HPN-related healthcare interactions. RESULTS: The participants in this study described a range of psychosocial problems related to their HPN healthcare interactions, including reliance, risk and restrictions. Participants' solutions to these problems included adaptation of their routine, self-guardianship and passivity. Sometimes, these solutions generated secondary problems of their own, including concerns with resource use, negative healthcare interactions and conflicts of responsibility. A range of contextual factors influenced how participants interpreted their healthcare interactions and the solutions available to them. These contextual factors included continuity of healthcare professionals, the attitude of staff, and information and knowledge about HPN. CONCLUSIONS: By attending to the individual meaning ascribed to healthcare events, and the contextual factors that surround these events, we have been able to better understand the decisions made by patients dependent on HPN. This suggests that healthcare professionals may also better understand their patients' decision making by attending to the individual meaning that patients ascribe to healthcare events and to contextual factors. We propose a model to describe the process of problem -> resolution -> problem in which participants are actively engaged.

Identifying Criminogenic Needs Using the Personality Assessment Inventory With Males Who Have Sexually Offended.

The present study investigated the relationships between the scales of the Personality Assessment Inventory (PAI) and variables relevant to recidivism risk and criminogenic need to inform clinicians' use of the PAI for purposes of treatment planning and risk management. PAI profiles, risk measure and domain scores, and recidivism data were collected for 158 males who have been convicted of sexually offending. Data were analyzed to investigate whether select clinical scales of the PAI correlated with conceptually relevant domains of risk and/or recidivism. Our findings demonstrated that the antisocial scales were consistently associated with risk constructs and recidivism, while very few clinical and personality scales showed relationships with risk constructs. The PAI seems to include select scales that represent risk-related needs, but also, other scales that may be more related to responsivity issues, and therefore may have utility to address two of the risk, need, and responsivity principles.

An Evaluation of the Reliability, Construct Validity, and Factor Structure of the Static-2002R.

The fundamental psychometric properties of the subscales found in the Static-2002R, an actuarial measure of sexual recidivism risk, were evaluated in the current study. Namely, the reliability, concurrent and construct validity, and factor structure of the Static-2002R subscales were examined with a sample of 372 adult male sex offenders. In addition to using validated measures of sexual violence risk to examine concurrent validity, construct-related measures taken from extant risk measures and psychometric tests were correlated with three of the subscales to assess overall construct validity. Moderate support was found for the reliability of the Static-2002R. The concurrent and construct validity of the General Criminality, Persistence of Sexual Offending, and Deviant Sexual Interest subscales were supported. Generally, these findings further support the Static-2002R as a valid sex offender risk appraisal instrument that encompasses multiple distinct, clinically relevant, risk domains.

Sense and readability: participant information sheets for research studies.

BACKGROUND: Informed consent in research is partly achieved through the use of information sheets. There is a perception however that these information sheets are long and complex. The recommended reading level for patient information is grade 6, or 11-12 years old. AIMS: To investigate whether the readability of participant information sheets has changed over time, whether particular study characteristics are related to poorer readability and whether readability and other study characteristics are related to successful study recruitment. Method: We obtained 522 information sheets from the UK National Institute for Health Research Clinical Research Network: Mental Health portfolio database and study principal investigators. Readability was assessed with the Flesch reading index and the Grade level test. RESULTS: Information sheets increased in length over the study period. The mean grade level across all information sheets was 9.8, or 15-16 years old. A high level of patient involvement was associated with more recruitment success and studies involving pharmaceutical or device interventions were the least successful. The complexity of information sheets had little bearing on successful recruitment. CONCLUSIONS: Information sheets are far more complex than the recommended reading level of grade 6 for patient information. The disparity may be exacerbated by an increasing focus on legal content. Researchers would benefit from clear guidance from ethics committees on writing succinctly and accessibly and how to balance the competing legal issues with the ability of participants to understand what a study entails.

Identifying Male Sexual Offender Subtypes Using Cluster Analysis and the Static-2002R.

This study examines whether clinically meaningful subgroups could be identified within a large, undifferentiated group of convicted adult male sex offenders. Of eight cluster analyses, a reliable three-cluster solution emerged based on the subscores of the Static-2002R with 345 sex offenders. To establish the validity of the emergent clusters, the three groups of offenders were compared on four domains: criminal history, psychosexual development, sexual attitudes and interests, and recidivism. The findings revealed meaningful differences among the group, and the implications of subgroup membership is discussed in terms of risk, treatment, and supervision.

Collaborative development of an electronic Personal Health Record for people with severe and enduring mental health problems.

BACKGROUND: Previous attempts to implement electronic Personal Health Records (ePHRs) underline the importance of stakeholder involvement. We describe the development of an ePHR for people with severe and enduring mental health problems, and provide a model of involving stakeholders throughout. METHODS: There were three stages to the development of the ePHR. These were 1) identifying and responding to user and clinical needs; 2) preliminary testing; and 3) preliminary implementation. Stakeholder involvement was pervasive in all stages. We collaborated with 133 stakeholders in the first stage, 13 in the second, and 26 in the third. On the micro-level, a service user researcher conducted much of the data collection and analysis. On the macro-level, a service user advisory group guided decisions throughout the project, and a service user was an active member of the project executive board and the implementation team. RESULTS: Service users and clinicians preferred an interactive ePHR with features such as access to care plans and care notes, a mood tracker, patient reported outcomes feeding into the clinical record, and social networking features. Many of the above were constructed following consultation with the relevant professionals, however further consultation is required before building a social networking function or providing access to full care notes. Service users positively rated the usability of the ePHR. Drop-in sessions helped service users access technology and learn how to use the ePHR. CONCLUSIONS: We outline four considerations for future developers of ePHRs: appeal, construction, ease of use, and implementation. Success rests on implementation in routine practice, so ePHRs must be intuitive and useful for both service users and staff. Continued involvement of end users throughout the design and testing process can help to achieve this goal.

Impact of patient involvement in mental health research: longitudinal study.

BACKGROUND: It is deemed good practice to involve patients routinely in research but no study has investigated the practical benefits, particularly to successful recruitment. AIMS: To identify whether patient involvement is associated with study success. METHOD: All studies listed on the Mental Health Research Network (MHRN) portfolio database (n = 374) were interrogated using logistic regression, ANOVA and Pearson's correlation to identify associations with study characteristics, funding bodies and recruitment success. RESULTS: Patient involvement increased over time although in some areas of research it was limited. Some funders, especially the National Institute for Health Research (NIHR), had more associated patient involvement than others. Studies that involved patients to a greater extent were more likely to have achieved recruitment targets (χ(2) = 4.58, P<0.05), defined as reaching at least 90% of the target. CONCLUSIONS: This is the first time associations with study success have been identified for patient involvement. Researchers might now consider ways to involve patients more comprehensively as this is associated with study success. Further research is needed to explore this finding.

Can't surf, won't surf: the digital divide in mental health.

BACKGROUND: New health information technology (HIT) increasingly plays a role in health care as technology becomes cheaper and more widespread. However, there is a danger that those who do not use or have access to technology will not benefit from HIT innovations, thus creating a "digital divide". AIMS: To assess the extent to which mental health service users have access to, skills in using and appetite for various technologies. METHODS: A cross-sectional survey was used to assess technology use and access patterns of 121 people from community mental health services. Data were analysed using logistic regression. RESULTS: Technology use and access were very similar to that of the general population with older individuals reporting less familiarity, access and confidence across a range of technologies. Black, minority and ethnic (BME) groups were more likely to access computers outside of their own homes than white individuals. Older participants experiencing psychosis indicated a desire to increase their computer use. CONCLUSIONS: The findings reported here contrast with recent evidence suggesting that those who do not engage with technology are "self-excluders". Furthermore, BME groups may need extra support regarding provision of technology in order to engage with HIT.

Rapid progress or lengthy process? Electronic personal health records in mental health.

A major objective of many healthcare providers is to increase patients' participation in their own care. The introduction of electronic personal health records (ePHRs) may help to achieve this. An ePHR is an electronic database of an individual's health information, accessible to and maintained by the patient. ePHRs are very much in vogue, with an increasing number of studies reporting their potential utility as well as cost. However, the vast majority of these studies focus on general healthcare. Little attempt has been made to document the specific problems which might occur throughout the implementation of ePHRs in mental health. This review identifies such concerns through an electronic search of the literature. Several potential difficulties are highlighted and addressed, including access to information technology, identifying relevant populations and the handling of sensitive information. Special attention is paid to the concept of 'empowerment' and what this means in relation to ePHRs.

Detecting anomalous sexual interests in juvenile sex offenders.

Phallometric studies suggest that some adolescent sex offenders exhibit anomalous sexual interests. However, there have been ethical and practical objections to the phallometric testing of adolescents. Alternative measures may be needed if we are to understand the role of anomalous sexual interests in adolescent sexual offending. The Screening Scale for Pedophilic Interests (SSPI) was designed as a brief measure of pedophilic interests based on sexual offense history variables: any male victims, more than one victim, any victims under age 12, and any unrelated victims. Score on the SSPI is significantly and positively correlated with phallometrically measured pedophilic interests among adult offenders against children. In this study, the SSPI was scored in three samples of adolescent sex offenders who underwent phallometric testing for pedophilic interests. Scores on the SSPI were positively correlated with a phallometric index of relative sexual arousal to children in all three samples. This relationship was strongest using visual stimuli. The positive relationship between SSPI scores and pedophilic responding held up despite the use of different penile measures, stimulus sets, procedures, and scoring methods. The usefulness of the SSPI as a proxy measure among adolescents is discussed.

Predicting psychological distress in sex offender therapists.

The provision of psychological services to sexual offenders presents therapists with many challenges, including exposure to vivid descriptions of sexual violence and trauma. Although there is an increasingly robust body of literature investigating the effects of such traumatic exposure on therapists who work with the victims of sexual abuse, there have been few studies of its impact on those who treat the perpetrators. This study provides an exploratory investigation of the experience of psychological distress among therapists who work with sex offenders, as well as the social support mechanisms that may serve to mitigate therapist risk. Fifty-nine sex offender therapists completed a self-report measure of posttraumatic stress symptomatology, and rated their perceptions of family and peer support. therapists also reported the number of hours that they devote to sex offender treatment and the amount of clinical supervision they participate in on a weekly basis. As a group, participants reported experiencing low levels of general and trauma-related distress. Although statistical analyses failed to indicate the existence of a significant positive correlation between number of hours devoted to sex offender treatment and the experience of therapist distress, greater perceptions of peer support were significantly predictive of lower levels of psychological distress and PTSD symptoms. These results are discussed relative to their implications for sex offender therapist self-care and future research.