A community-based tobacco cessation program for individuals experiencing homelessness.

BACKGROUND: Tobacco use is common among persons experiencing homelessness (PEH), and interventions are needed. We conducted a community-based, single-arm uncontrolled trial of a pharmacy-linked intervention for smoking cessation for PEH. METHODS: The intervention took place between September 2019 and June 2021 in homeless shelters in San Francisco, CA. We trained shelter staff on how to provide brief cessation counseling, then tested a program among PEH in two shelters that included one-time pharmacist-delivered cessation counseling and nicotine replacement therapy (NRT) for 3 months. We examined factors associated with cigarette consumption and quit attempts. RESULTS: We trained 69 staff from 8 shelters and selected 2 of those shelters as pilot sites for the program. Of the 52 participants, 71% were male and 49% were Black. The majority of participants reported making a quit attempt (70%) and using NRT (84%). Having an encounter with staff in the past week was associated with a 40% reduction in weekly consumption (Incidence rate ratio (IRR) 0.61, 95% CI 0.57-0.67) and using medications in the past week was associated with a 23% reduction in weekly consumption (IRR 0.78, 95% CI 0.75-0.81). Using medications in the past week increased the odds of a quit attempt 2.89 times compared to not using medications (Adjusted odds ratio (AOR), 2.89, 95% CI 1.45-5.77). CONCLUSIONS: Our findings highlight a role for leveraging community-based pharmacists to expand smoking cessation services in homeless shelters to reduce tobacco use among PEH.

Substance use and borderline personality disorder: fostering hope in the face of complexity.

OBJECTIVE: Impulsivity and emotional dysregulation are common characteristics of patients presenting with co-occurring borderline personality disorder (BPD) and substance use disorder (SUD). This article aims to provide an overview of the clinical approaches psychiatrists should consider when treating patients with these conditions. CONCLUSIONS: Co-occurring BPD and SUD can be effectively treated within a staged, transdiagnostic approach with an emphasis on the therapeutic alliance.

An exploration of self-compassion and self-criticism in the context of personal recovery from borderline personality disorder.

OBJECTIVES:: A lack of compassion for oneself, or harsh self-criticism, is associated with a range of psychiatric disorders including borderline personality disorder (BPD). Personal recovery in the context of a mental illness such as BPD involves building a life that is subjectively meaningful and satisfying. Limited self-compassion or harsh self-criticism may be an impediment to recovery from BPD. The association between self-compassion and recovery and self- criticism and recovery were examined. METHOD:: Nineteen individuals diagnosed with BPD completed the Neff Self-Compassion Scale, the Forms of Self-Criticising/Attacking and Self-Reassuring Scale and the Recovery Assessment Scale at a single time point. RESULTS:: There was a strong positive correlation between self-compassion and recovery ( r = 0.75) and a strong negative correlation ( rho = -0.67) between self- criticism and recovery. CONCLUSIONS:: Although preliminary in nature, these results suggest the importance of fostering self-compassion and working to address self-criticism within clinical interventions supporting recovery from BPD.

Psychometric Properties of the Persian Version of the Sibling Cancer Needs Instrument (SCNI)

The sibling cancer needs instrument (SCNI) is the first developed specifically for assessing psychosocial unmet needs of adolescents having a sibling with cancer. The aim of this study is to evaluate the psychometric properties of its Persian version. Methods: For this methodological study, the SCNI was translated into Persian using back-translation and revised according to the comments of the developer of the instrument. Then face validity, content validity, construct validity, internal consistency and the stability of the Persian version of the instrument were measure, by examining a population of 180 adolescents having a sibling with cancer in six hospitals in Tehran, Iran. The data were analyzed using SPSS version 16 and EQS version 6.1. Results: Confirmatory factor analysis approved the construct validity of the instrument and its seven domains. Cronbach's alpha was measured as 0.97 for the total instrument and 0.80- 0.92 for its seven domains. In order to evaluate ttest-retest reliability, the intra-class correlation coefficient (ICC) was also calculated (0.94). Conclusions: The Persian version of SCNI has acceptable psychometric properties. It can be used for measuring the unmet psychosocial needs in adolescents who have a sibling with cancer in the Persian-speaking population.

Identifying Deteriorating Patients Through Multidisciplinary Team Training.

Multidisciplinary training has improved maternity outcomes when the training has been well attended, regular, in house, used high-fidelity simulators, and integrated teamwork training. If these principles were used in other settings, better clinical care may result. This before-after study sought to establish whether a short multidisciplinary training intervention can improve recognition of the deteriorating patient using an aggregated physiological parameter scoring system (Early Warning Score [EWS]). Nursing, medical, and allied nursing staff participated in an hour-long training session, using real-life scenarios with simple tools and structured debriefing. After training, staff were more likely to calculate EWS scores correctly (68.02% vs 55.12%; risk ratio [RR] = 1.24, 95% confidence interval [CI] = 1.07-1.44), and observations were more likely to be performed at the correct frequency (78.57% vs 68.09%; RR = 1.20, 95% CI = 1.09-1.32). Multidisciplinary training, according to core principles, can lead to more accurate identification of deteriorating patients, with implications for subsequent care and outcome.

Myths and realities of training in obstetric emergencies.

Training for intrapartum emergencies is a promising strategy to reduce preventable harm during birth; however, not all training is clinically effective. Many myths have developed around such training. These principally derive from misinformed beliefs that all training must be effective, cheap, independent of context and sustainable. The current evidence base for effective training supports local, unit-based and multi-professional training, with appropriate mannequins, and practice-based tools to support the best care. Training programmes based on these principles are associated with improved clinical outcomes, but we need to understand how and why that is, and also why some training is associated with no improvements, or even deterioration in outcomes. Effective training is not cheap, but it can be cost-effective. Insurers have the fiscal power to incentivise training, but they should demand the evidence of clinical effect; aspiration and proxies alone should no longer be sufficient for funding, in any resource setting.

Consumer perspectives on the therapeutic value of a psychiatric environment.

BACKGROUND: Existing reports of the environmental aspects of recovery from mental illness have been confined to consideration of community spaces and the natural environment. AIMS: This paper aims to extend this literature by assessing the role of psychiatric settings in recovery. METHODS: Nineteen inpatients from the psychiatric unit of a large inner city hospital in Melbourne, Australia, took part in the study, which involved semi-structured interviews and focus groups. RESULTS: Analysis identified three major themes concerning consumers' experience within the unit: the importance of staff; lack of clear architectural identity resulting in confused or confusing space; and limited amenity due to poor architectural design. CONCLUSIONS: These findings have important implications for the delivery of care in psychiatric environments in ways that promote well being within these settings, and align with relevant mental health policy recommendations.

Work exposure and vigilance decrements in closed circuit television surveillance.

The aim of this study was to examine operator effectiveness in terms of detection rates and potential vigilance decrements in a proactive or real time CCTV surveillance task. The study was conducted in two stages. During stage one, 42 operators who were employed full-time in CCTV surveillance observed a 90-min video and were required to detect four types of target behaviours. No vigilance decrement was found for this sample as a whole. Stage two involved collecting additional data from 31 novices and dividing the existing operators into two sub-samples, consisting of generalists and specialists depending on the type of surveillance they performed at work (total N = 73). Fifty percent of target behaviours were detected and false alarms were high. Vigilance decrements were found for novices and generalists, but specialists maintained their performance for the first hour and then increased it. Results are discussed in terms of surveillance background, work exposure, transfer of learning, selection, training and motivation and the impact of these on vigilance and CCTV performance.

Multiprofessional team simulation training, based on an obstetric model, can improve teamwork in other areas of health care.

This interrupted time-series study evaluated the impact of multiprofessional scenario-based training on the safety culture and teamwork climate of 3 surgical wards during a time of reduced financial resources. The authors ran 22 team training sessions for teams of 4 to 5 medical and nursing staff over a 4-month period on 3 surgical wards, using 2 scenarios based on a previously successful obstetric training program. Safety culture was measured before and after training using a validated psychometric questionnaire. After training there was a statistically significant improvement in safety culture (P = .036) on the wards. Teamwork climate improved, but the evidence was not as strong (P = .052). Perceptions of hospital management and adequacy of staffing levels showed significant deterioration. Simple, low-resource interventions can have a significant positive impact on safety culture and possibly teamwork climate on surgical wards. This could be of great value in maintaining patient safety at times of financial constraint.

The classification of vigilance tasks in the real world.

The ability to generalise vigilance research to operational environments has been questioned, largely due to differences between laboratory research and real-world settings. The taxonomy of vigilance tasks proposed by Parasuraman and Davies (1977) represents an attempt to classify vigilance tasks so that tasks with similar information-processing demands can be compared and the ability to generalise results enhanced. Although the taxonomy originally included complexity, the term specifically referred to multiple sources of information. Complexity has been overlooked in much of the traditional vigilance literature, although it is included in more recent studies of jobs such as air traffic control. In this paper, the taxonomy is evaluated in relation to two vigilance intensive jobs - closed circuit television surveillance operators and air traffic controllers. In its present form, the existing taxonomy of experimental settings has limited applicability to these operational settings. Therefore, recommendations for expanding the taxonomy to include more aspects of complexity are made. It is argued that the revised taxonomy be used in conjunction with situation awareness, which makes provision for the cognitive processes involved in these jobs.