Complex patient cases solved by near-peer integrated teams provides leadership, professionalism, and peer-teaching opportunities.

BACKGROUND AND PURPOSE: Near-peer teaching is commonly used in experiential learning, residency training, and teaching certificate programs, but data on near-peer teaching in didactic course work are lacking. An innovative, near-peer learning opportunity that encouraged leadership and professionalism is described. EDUCATIONAL ACTIVITY AND SETTING: Thirty-six teams comprised of first-, second-, and third-year pharmacy students presented a 15-min oncology patient case to faculty reviewers. Presentations were focused on calculations, medicinal chemistry, pharmacology, and therapeutic application. Students were evaluated on communication skills, presentation skills, and presentation content. Additionally, students provided feedback about their perceptions of the laboratory experience. A chi-square test was used to determine significance or parity in student responses. FINDINGS: The majority of the students (82%) felt the teams worked well together and 85% indicated that they played an important role on their team, with second- and third-year students rating this item significantly higher than first year students. Additionally, 85% of participating students expressed that this experience provided an opportunity to demonstrate professionalism. SUMMARY: Integration of first-, second-, and third-year pharmacy students into teams was an innovative and effective method to provide opportunity for leadership, professionalism, and near-peer teaching through evaluation and presentation of an oncology patient case.

Carer's education groups for relatives with a first episode of psychosis: an evaluation of an eight-week education group.

AIM: This study aimed to evaluate an eight-week carers group for people with first episode of psychosis receiving services from the Gloucestershire Recovery in Psychosis Early Intervention Team. Potential benefits for carers were assessed including changes in feelings of stress, isolation, recognition, and of being appreciated and valued. METHODS: Following completion of the group, all 12 carers participated in an independently facilitated focus group to evaluate the course. Transcripts were imported into the QSR NVivo 8 (QSR International, Doncaster, Victoria, Australia) software package for thematic analysis. An independent coding and correlational analysis of data was used to identify any common themes. RESULTS: Results identified five key themes reported by carers: the emotional impacts of being a carer (loss, grief, guilt, shock, acceptance), the wider impacts of mental illness within a family (isolation, stigma), the caring role and how this affected relationships (improved relationships), the design of the group (barriers, course content, timing of invitations, moving forward) and the wider impacts of participation (carer education, importance of sharing real-life experiences, navigating the National Health Service). CONCLUSIONS: Carers reported less isolation, improved confidence, greater understanding of psychosis, reduction in guilt and increased coping in their caring role after the group. Carers reported that they gained new knowledge, obtained support from staff and graduate carers, increased the recognition of their caring role and had improved relationships with their relative with mental illness.

Effects of controlled fire and livestock grazing on bird communities in East African savannas.

In East Africa fire and grazing by wild and domestic ungulates maintain savannas, and pastoralists historically set fires and herded livestock through the use of temporary corrals called bomas. In recent decades traditional pastoral practices have declined, and this may be affecting biodiversity. We investigated the effects of prescribed fires and bomas on savanna bird communities in East Africa during the first and second dry seasons of the year (respectively before and after the rains that mark the onset of breeding for most birds). We compared abundance, richness, and community composition on 9-ha burned plots, recently abandoned bomas, and control plots in the undisturbed matrix habitat over a 3-year period. Generally, recently burned areas and abandoned bomas attracted greater densities of birds and had different community assemblages than the surrounding matrix. The effects of disturbances were influenced by interactions between primary productivity, represented by the normalized difference vegetation index, and time. Bird densities were highest and a greater proportion of species was observed on burned plots in the months following the fires. Drought conditions equalized bird densities across treatments within 1 year, and individuals from a greater proportion of species were more commonly observed on abandoned bomas. Yearly fluctuations in abundance were less pronounced on bomas than on burns, which indicate that although fire may benefit birds in the short term, bomas may have a more-lasting positive effect and provide resources during droughts. Several Palearctic migrants were attracted to burned plots regardless of rainfall, which indicates continued fire suppression may threaten their already-declining populations. Most notably, the paucity of birds observed on the controls suggests that the current structure of the matrix developed as a result of fire suppression. Traditional pastoralism appears critical to the maintenance of avian diversity in these savannas.

Assertive outreach handbook will aid mental health staff in maintaining client engagement.

The model of assertive outreach is one of the most internationally researched areas of community mental healthcare. An assertive outreach team at a mental health trust developed a handbook on the model, involving contributions from service users, carers, local clinicians and the voluntary sector. This article outlines the process of developing the handbook, summarises its content and user feedback.

Factors associated with changing patient needs in an assertive outreach team.

BACKGROUND, AIMS: Although clinical use of needs assessment tools is widespread, there is little evidence about their value in longitudinal use. This study aimed to identify the factors associated with changing needs in an assertive outreach (AO) team's caseload, over a 6-month rating period. METHODS: The Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS) and the Engagement Measure (EM) were used to assess need and engagement with services respectively, in an AO team caseload. Care planning was based partly on awareness of current unmet needs. The patients were then reassessed at a 6-month follow-up, to determine to what extent identified unmet need had been successfully addressed, and whether levels of engagement had altered. RESULTS: Data were obtained for 79 of 82 patients on the AO team caseload. At 6-month follow-up patient-rated unmet need, but not staff-rated unmet need, was significantly reduced. Patient-, but not staff-rated met need was significantly increased. Measures of engagement were unchanged. Patients' needs changed across a variety of physical, social and psychological domains, rather than in one specific area. In regression analyses, only accommodation type was independently associated with patient-rated changing met need; only diagnosis was significantly related to changing patient-related unmet need. CONCLUSION: In this study, the CANSAS was used routinely in a standard AO team, and the finding that over a 6-month period patient-rated unmet need reduced significantly suggests that formal rating of needs assessment may have helped to target care planning effectively. The results suggest that accommodation type and diagnosis may play an important role in the ability of services to effectively meet patient needs, but further work in larger samples is needed to address these questions.

Heterospecific alarm call recognition in a non-vocal reptile.

The ability to recognize and respond to the alarm calls of heterospecifics has previously been described only in species with vocal communication. Here we provide evidence that a non-vocal reptile, the Galápagos marine iguana (Amblyrhynchus cristatus), can eavesdrop on the alarm call of the Galápagos mockingbird (Nesomimus parvulus) and respond with anti-predator behaviour. Eavesdropping on complex heterospecific communications demonstrates a remarkable degree of auditory discrimination in a non-vocal species.

Barriers to employment in severe mental illness.

This article explores two issues related to the barriers to employment for people with severe mental illness: the mental health service user's perspective; and the efficacy of mental health nurses and community mental health teams. It suggests that clinical practice needs to be modified and further research carried out if these barriers are to be removed. This is a summary: the full paper and reference list can be accessed at nursingtimes.net.

Identifying the needs of carers in mental health services.

AIM: To assess all carers in the Gloucester Assertive Community Treatment Team and identify their needs. METHOD: Carers were identified using the definition employed in the Notional Service Framework for Mental Health (DH, 1999): they were family or close friends who spent a minimum of 12 hours per week helping/supporting the service user. Paid carers were excluded. A standardised carer's assessment that had been developed as part of the care programme approach (CPA) was used to evaluate the needs of carers. RESULTS: The study highlights the type of support that carers give those who use the mental health services and reveals the impact that this caring has on them. The carers' needs are identified as: someone to talk to; help with cleaning/ironing; help with finances; support to enable them to take a break; plus respite care and accommodation for the service user. CONCLUSION: Carers play an important role in supporting people who are diagnosed with severe mental illness although further research is necessary to consider the benefits of a closer relationship between the carer, service user and mental health professionals.

The Gloucester assertive community treatment team: A description and comparison with other services.

Assertive Community Treatment (ACT) has developed globally as a model of community care for the severely mentally ill. However, in the United Kingdom there is mixed evidence regarding improvements in outcome and concerns about ACT teams having poor fidelity to the original ACT model. OBJECTIVE: This study presents the fidelity characteristics of an established ACT team serving Gloucester City. It describes service user demographic and illness data and compares these findings to other important studies in the United Kingdom. METHOD: The Dartmouth Assertive Community Treatment Scale was applied to rate the Gloucester ACT team's fidelity characteristics. The Gloucester Caseload Project Demographic Pro-Forma was collected from all of the team's 79 service users. RESULTS: The population of severely mentally ill ACT service users in Gloucester City were an older and more "disabled" group compared to the classic ACT studies. Furthermore, although findings indicate a high level of fidelity to the original ACT model, the team it is still associated with high levels of inpatient treatment. CONCLUSION: High fidelity ACT services appear to be associated with high admission rates. Therefore teams should not be viewed as alternatives to hospital admission but have goals of improving engagement and social functioning. Furthermore, findings have allowed the team to benchmark its service and target areas for further service development. More consistent reporting of fidelity data on ACT research would facilitate comparison across different services.

The link between mental health problems and violent behaviour.

Fear of violence in relation to people with mental illness is common and affects the way society views and treats such individuals. This article reviews literature on mental illness and violence with the aim of clarifying whether there is a link between the two. While higher rates of violence have been found among people with mental illness, most studies have flaws and their results should be viewed with caution. Further research is required particularly in connection with people with serious mental illness. We also need to develop preventative strategies by providing appropriate support for people with mental health problems.