Primary care for people with severe mental illness and comorbid obstructive airways disease: a qualitative study of patient perspectives with integrated stakeholder feedback.

OBJECTIVES: To explore patient and stakeholder perspectives on primary respiratory care for people with severe mental illness (SMI) and comorbid obstructive airways disease (OAD). DESIGN: Qualitative, semistructured qualitative interviews were undertaken with a purposive sample of people with a diagnosis of SMI (bipolar illness, schizophrenia, affective disorder with psychosis) and comorbid asthma or chronic obstructive pulmonary disease. Transcribed data were analysed using an interpretive phenomenological approach. Study results were discussed with stakeholders. SETTING: Eight UK general practices. PARTICIPANTS: 16 people aged 45-75 years, with SMI and comorbid asthma or chronic obstructive pulmonary disease, were interviewed. Twenty-one people, four with lived experience of SMI and seventeen health/social care/third sector practitioners, participated in discussion groups at a stakeholder event. RESULTS: Participants described disability and isolation arising from the interplay of SMI and OAD symptoms. Social support determined ease of access to primary care. Self-management of respiratory health was not person-centred as practitioners failed to consider individual needs and health literacy. Participants perceived smoking cessation impossible without tailored support. Less than half of the practices facilitated personalised access to timely primary care and continuity. Overall, there was a reliance on urgent care if service adaptations and social support were lacking. The stakeholder group expressed concern about gaps in care, the short-term funding of community organisations and fear of loss of benefits. Potential solutions focused on supported navigation of care pathways, relational continuity, individual and community asset building and the evolving social prescriber role. CONCLUSION: This study suggests that despite UK guidelines and incentives to optimise physical healthcare, primary care fails to consistently deliver integrated biopsychosocial care for patients with SMI and OAD. Collaborative, personalised care that builds social capital and tailors support for self-management is needed, alongside service-level interventions to enhance access to healthcare for patients with comorbid SMI and OAD.

Effectiveness of stress control large group psychoeducation for anxiety and depression: Systematic review and meta-analysis.

OBJECTIVES: This review sought to evaluate the effectiveness of the 'Stress Control' (SC) large psychoeducational 6-session group programme developed to increase access to treatment for patients with anxiety and depression. DESIGN: Systematic review and meta-analysis (Prospero registration: CRD42020173676). METHODS: Pre-post and post-treatment follow-up effect sizes were extracted and synthesized in a random effects meta-analysis, and variations in effect sizes were investigated via moderator analyses. Secondary analyses synthesized between-group effect sizes from controlled studies containing comparator treatments and calculated the average dropout rate. The quality of the meta-analysis was assessed using the GRADE approach. RESULTS: Nineteen studies with pre-post treatment outcomes were included. The average group size was N = 39, and the average dropout rate was 34%. Pooled effect sizes indicated moderate pre-post treatment reductions in anxiety (ES = 0.58; CI 0.41 to 0.75; N = 5597; Z = 7.13; p < .001), moderate reductions in depression (ES = 0.62; CI 0.44 to 0.80; N = 5538, Z = 7.30; p < .001), and large reductions in global distress (ES = 0.86; CI 0.61 to 1.11; N = 591; Z = 7.41; p < .001). At follow-up, improvements in anxiety, depression, and global distress were maintained. When SC was compared to active and passive controls, outcomes were equivalent for anxiety (ES = 0.12, 95% CI -0.25 to 0.49, Z = -0.70; p = .482) and depression (ES = 0.15, 95% CI -0.24 to 0.54, Z = 0.84; p = .401). CONCLUSIONS: SC appears to be a clinically effective and durable low-intensity group intervention that facilitates access to treatment for large patient numbers. However, conclusions are limited by the low methodological quality of the evidence. PRACTITIONER POINTS: The stress control version of large group psychoeducation is appropriate and effective for mild-to-moderate anxiety and depression The evidence base for stress control is predominantly made up of practice-based studies Stress control needs to form one component of the overall offer made to patients presenting with mild-to-moderate anxiety and depression The competencies required to deliver such groups need better specification.

A family of cationic oxime-based hexametallic manganese(III) single-molecule magnets.

Three novel cationic hexametallic Mn(III) compounds of formulae [Mn6(µ3-O)2(H2N-sao)6(py)6(EtOH)2](ClO4)2·4EtOH (1), [Mn6(µ3-O)2(H2N-sao)6(tpy)6(H2O)2](ClO4)2·2tpy·4H2O·2EtOH (2) and [Mn6(µ3-O)2(H2N-sao)6(Him)6(EtOH)2](ClO4)2·6EtOH (3) [H2N-saoH2 = salicylamidoxime, py = pyridine, tpy = 4-tert-butylpyridine and Him = imidazole] have been synthesised and magnetostructurally characterised. These [Mn6](2+) complexes are new members of the oxime-based family of neutral [Mn6] single-molecule magnets (SMMs) in which the previously terminally bonded carboxylates, phosphinates, halides or ROH molecules on the outwardly facing triangular faces have been replaced with pyridine (1), 4-tert-butylpyridine (2) and imidazole (3) molecules generating a new series of salts based on Mn6 complexes. These results suggest that the cationic [Mn6](2+) species could be used as suitable building blocks for preparing new materials with different functionalities.

A cationic and ferromagnetic hexametallic Mn(III) single-molecule magnet based on the salicylamidoxime ligand.

The salicylamidoxime-based complex [Mn6(µ3-O)2(H2N-sao)6(py)6(EtOH)2](ClO4)2·4EtOH (1·4EtOH) constitutes the first example of a cationic and ferromagnetic member of the oxime-based family of [Mn(III)6] single-molecule magnets.