The impact of early intervention psychosis services on hospitalisation experiences: a qualitative study with young people and their carers.

BACKGROUND: While a core aim of early intervention psychosis services (EIPS) is to prevent hospitalisation, many with a first episode of psychosis (FEP) will require inpatient care. We explored young people's (YP) and their carers' hospitalisation experiences prior to and during EIPS engagement and how factors across these services influenced these experiences. METHODS: Using purposive sampling, we recruited twenty-seven YP, all of whom had been involved with the hospital system at some stage, and twelve support persons (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration with secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician, and academic researchers) used an inductive thematic analysis process. RESULTS: Four key themes were identified as influential in shaping participant's hospital experiences and provide ideas for an approach to care that is improved by the effective coordination of that care, and includes this care being delivered in a trauma informed manner: (1) A two-way street: EIPS affected how participants experienced hospitalisation, and vice versa; (2) It's about people: the quality and continuity of relationships participants had with staff, in hospital and at their EIPS, was central to their experience; (3) A gradual feeling of agency: participants viewed EIPS as both reducing involuntary care and supporting their self-management; and (4) Care coordination as navigation for the healthcare system: great when it works; frustrating when it breaks down. CONCLUSIONS: Hospitalisation was viewed as a stressful and frequently traumatic event, but a approach to care founded on trust, transparency, and collaboration that is trauma-informed ameliorated this negative experience. Consistent EIPS care coordination was reported as essential in assisting YP and carers navigate the hospital system; conversely, discontinuity in EIPS staff and lack of integration of EIPS with hospital care undermined the positive impact of the EIPS care coordinator during hospitalisation. Care coordinator involvement as a facilitator, information provider, and collaborator in inpatient treatment decisions may improve the usefulness and meaningfulness of hospital interventions.

Economic evaluations of fall prevention exercise programs: a systematic review.

OBJECTIVE: To investigate cost-effectiveness and costs of fall prevention exercise programmes for older adults. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, Web of Science, Scopus, National Institute for Health Research Economic Evaluation Database, Health Technology Assessment database, Tufts Cost-Effectiveness Analysis Registry, Research Papers in Economics and EconLit (inception to May 2022). ELIGIBILITY CRITERIA FOR STUDY SELECTION: Economic evaluations (trial-based or model-based) and costing studies investigating fall prevention exercise programmes versus no intervention or usual care for older adults living in the community or care facilities, and reporting incremental cost-effectiveness ratio (ICER) for fall-related outcomes or quality-adjusted life years (QALY, expressed as cost/QALY) and/or intervention costs. RESULTS: 31 studies were included. For community-dwelling older adults (21 economic evaluations, 6 costing studies), results ranged from more effective and less costly (dominant) interventions up to an ICER of US$279 802/QALY gained and US$11 986/fall prevented (US$ in 2020). Assuming an arbitrary willingness-to-pay threshold (US$100 000/QALY), most results (17/24) were considered cost-effective (moderate certainty). The greatest value for money (lower ICER/QALY gained and fall prevented) appeared to accrue for older adults and those with high fall risk, but unsupervised exercise appeared to offer poor value for money (higher ICER/QALY). For care facilities (two economic evaluations, two costing studies), ICERs ranged from dominant (low certainty) to US$35/fall prevented (moderate certainty). Overall, intervention costs varied and were poorly reported. CONCLUSIONS: Most economic evaluations investigated fall prevention exercise programmes for older adults living in the community. There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective. The evidence for older adults living in care facilities is more limited but promising. PROSPERO REGISTRATION NUMBER: PROSPERO 2020 CRD42020178023.

Dental implant placement with bone augmentation in a patient who received intravenous bisphosphonate treatment for osteoporosis.

Intravenous (IV) administration of bisphosphonates has been considered an absolute contraindication for placement of dental implants, because of the increased risk of bisphosphonate-related osteonecrosis of the jaw (BRONJ). However, the evidence regarding this association originates from patients being treated for various forms of metastatic cancer. In the case reported here, a patient received a dental implant while undergoing IV treatment with zoledronic acid for osteoporosis. The authors discuss the current evidence regarding the risks of dental procedures in patients receiving IV bisphosphonates for this indication. They also evaluate important risk factors and the decision-making pathway in such cases. On the basis of existing evidence, receipt of a single IV infusion of zoledronic acid for the treatment of osteoporosis does not appear to be an absolute contraindication to implant placement.

Detection of unusual reaction intermediates during the conversion of W(N2)2(dppe)2 to W(H)4(dppe)2 and of H2O into H2.

W(N(2))(2)(dppe-κ(2)P)(2) reacts with H(2) to form WH(3){Ph(C(6)H(4))PCH(2)CH(2)PPh(2)-κ(2)P}(dppe-κ(2)P) and then W(H)(4)(dppe-κ(2)P)(2). When para-hydrogen is used in this study, polarized hydride signals are seen for these two species. The reaction is complicated by the fact that trace amounts of water lead to the formation of H(2), PPh(2)CH(2)CH(2)Ph(2)P(O) and W(H)(3)(OH)(dppe-κ(2)P)(2), the latter of which reacts further via H(2)O elimination to form W(H)(4)(dppe-κ(2)P)(2) and [WH(3){Ph(C(6)H(4))PCH(2)CH(2)PPh(2)-κ(2)P}(dppe-κ(2)P)]. These studies demonstrate a role for the 14-electron intermediate W(dppe-κ(2)P)(2) in the CH activation reaction pathway leading to [WH(3){Ph(C(6)H(4))PCH(2)CH(2)PPh(2)-k(2)P}(dppe-k(2)P)]. UV irradiation of W(H)(4)(dppe-κ(2)P)(2) under H(2) led to phosphine dechelation and the formation of W(H)(6)(dppe-k(2)P)(dppe-k(1)P) rather than H(2) loss and W(H)(2)(dppe-κ(2)P)(2) as expected. Parallel DFT studies using the simplified model system W(N(2))(2)((Ph)HPCH(2)CH(2)PH(2)-κ(2)P)(H(2)PCH(2)CH(2)PH(2)-κ(2)P) confirm that ortho-metalation is viable via both W(dppe-κ(2)P)(2) and W(H)(2)(dppe-κ(2)P)(2) with explicit THF solvation being necessary to produce the electronic singlet-based reaction pathway that matches with the observation of para-hydrogen induced polarization in the hydride signals of [WH(3){Ph(C(6)H(4))PCH(2)CH(2)PPh(2)-κ(2)P}(dppe-κ(2)P)], W(H)(3)(OH)(dppe-κ(2)P)(2) and W(H)(4)(dppe-κ(2)P)(2) during this study. These studies therefore reveal the existence of differentiated and previously unsuspected thermal and photochemical reaction pathways in the chemistry of both W(N(2))(2)(dppe-κ(2)P)(2) and W(H)(4)(dppe-κ(2)P)(2) which have implications for their reported role in N(2) fixation.

A new approach to aid the characterisation and identification of metabolites of a model drug; partial isotope enrichment combined with novel formula elucidation software.

This work describes the identification of 'isotopically enriched' metabolites of 4-cyanoaniline using the unique features of the software package 'Spectral Simplicity'. The software is capable of creating the theoretical mass spectra for partially isotope-enriched compounds, and subsequently performing an elemental composition analysis to give the elemental formula for the 'isotopically enriched' metabolite. A novel mass spectral correlation method, called 'FuzzyFit', was employed. 'FuzzyFit' utilises the expected experimental distribution of errors in both mass accuracy and isotope pattern and enables discrimination between statistically probable and improbable candidate formulae. The software correctly determined the molecular formulae of ten previously described metabolites of 4-cyanoaniline confirming the technique of partial isotope enrichment can produce results analogous to standard methodologies. Six previously unknown species were also identified, based on the presence of the unique 'designer' isotope ratio. Three of the unknowns were tentatively identified as N-acetylglutamine, O-methyl-N acetylglucuronide and a putative fatty acid conjugate. The discovery of a significant number of unknown species of a model drug with a comprehensive history of investigation highlights the potential for enhancement to the analytical process by the use of 'designer' isotope ratio compounds. The 'FuzzyFit' methodology significantly aided the elucidation of candidate formulae, by provision of a vastly simplified candidate formula data set.