Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry.

OBJECTIVES: This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. DESIGN: In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. SETTING: Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. PARTICIPANTS: An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218). MEASUREMENTS: Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. FINDINGS: Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.

The impact of COVID-19 on acute psychiatric admissions for first and repeated episode psychosis.

BACKGROUND: There is limited evidence of the longer-term impact of the COVID-19 pandemic on acute admissions for psychosis in the UK. AIMS: We examined the impact of COVID-19 on rates of admissions for first and repeated episode psychosis, and changes in patient profile and seasonal patterns, over a period of 12 months. METHOD: We conducted a retrospective case note review of all patients admitted with a primary psychosis (F20-29 ICD 10 diagnosis) to an NHS psychiatric inpatient unit. We compared the 12 months pre-COVID-19 period between 1 March 2019 and 28 February 2020, and the 12 months post-COVID-19 period between 1 March 2020 and 28 February 2021. RESULTS: The results showed increase rates of admissions post-COVID-19 in both first and repeated episode psychosis, the patient profile had more females and older age in the repeated episode group, with increased employment rates. Combined group data for both pre- and post-COVID-19 periods showed an increased trend in spring and summer admissions, and even though not statistically significant, more pronounced post-COVID-19. CONCLUSIONS: Our findings highlight the effect of the COVID-19 pandemic on acute psychosis admissions over a 12-month period. The results provide evidence for the 'stress-pathogenesis' in the context of genetic vulnerability in psychosis. Preventative strategies in the context of the 'stress-pathogenesis model', improved access to and responsiveness within NHS transformation efforts needs to be adjusted to fit local need and environmental changes.

Investigation of physical activity, sleep, and mental health recovery in treatment resistant depression (TRD) patients receiving repetitive transcranial magnetic stimulation (rTMS) treatment.

Background: Repetitive transcranial magnetic stimulation (rTMS) is effective in treating depression; however, the effect on physical activity, sleep and recovery is unclear. This study investigated rTMS effect on physical activity and sleep through providing patients with a Fitbit and software apps; and reports the impact of rTMS on depression, anxiety and mental health recovery. Methods: Study design was a pre and post data collection without a control, with twenty-four participants with treatment-resistant depression (TRD). Measures used were Fitbit activity and sleep data, and patient-rated Recovering Quality of Life (ReQoL-20), Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder (GAD-7). Results: Response and remission rates were, respectively: 34.8% and 39% for PHQ-9; 34.8% and 47.8% for GAD-7. ReQoL-20 response and reliable improvement were 29.4% and 53%. PHQ-9, GAD-7 and ReQol-20 scores significantly improved, with large effect sizes. Analysis of Fitbit activity and sleep data yielded non-significant results. The Fitbit data machine learning model classified two levels of depression to 82% accuracy. Limitations: rTMS treatment was open-label and adjunct to existing antidepressant medication. No control group. Female patients were overrepresented. Conclusions: Improvements on the ReQoL-20 and aspects of sleep and activity indicate the positive impact of rTMS on the individual's real world functioning and quality of life. A wearable activity tracker can provide feedback to patients and clinicians on sleep, physical activity and depression levels. Further research could be undertaken through a sufficiently powered RCT comparing rTMS versus rTMS with use of a Fitbit, its software applications, and sleep and physical activity advice.

Impact of repetitive transcranial magnetic stimulation on generalized anxiety disorder in treatment-resistant depression.

BACKGROUND: Published evidence indicates the value of repetitive transcranial magnetic stimulation (rTMS) for generalized anxiety disorder in patients with treatment-resistant depression (TRD). As a part of routine clinical service, patients with TRD received right dorsolateral prefrontal cortex (DLPFC) inhibitory rTMS immediately prior to left DLPFC depression treatment delivered according to a US Food and Drug Administration protocol. METHODS: A retrospective investigation of routinely collected data between 2016 and 2018 was undertaken. Measures used were the clinicianrated Clinical Global Impressions-Severity (CGI-S) scale and Hamilton Depression Rating scale (HAM-D), and the patient-rated Generalized Anxiety Disorder scale-7 (GAD-7) and Patient Health Questionnaire (PHQ-9). The outcome data of 61 patients with TRD were analyzed. The sample included patients with comorbid psychiatric diagnoses. RESULTS: Response and remission rates, respectively, were 17.1% and 27.3% on the GAD-7; 20.7% and 12.5% on the HAM-D; 19% and 24% on the PHQ-9; and 20% and 23.5% on the CGI-S. Post-treatment scores significantly improved on the GAD-7, HAM-D, and CGI-S scales, with medium to large effect sizes (.61, .62, and .86 respectively). CONCLUSIONS: Results indicate the potential value of rTMS in treating anxiety in patients who are referred for rTMS for TRD. Well-designed and adequately powered randomized controlled trials are required to determine clinical recommendations.

Repetitive transcranial magnetic stimulation (rTMS) for depression: outcomes in a United Kingdom (UK) clinical practice.

Objective: The aim of this paper is to present the outcomes data from the largest United Kingdom's (UK) National Health Service (NHS) clinical rTMS service treating treatment resistant depression (TRD). Methods: The study was a retrospective investigation of routinely collected data on patients receiving rTMS between 2015 and 2017. Measures used were the clinician-rated Clinical Global Impression (CGI) and Hamilton Depression Rating Scale (HAM-D), and patient rated Beck Depression Inventory (BDI). The outcome data of 73 patients with TRD were analysed. The sample included patients with co-morbid psychiatric diagnosis. Results: Response and remission rates, respectively, were 40.4% and 25.5% for the HAM-D; 35.6% and 20.8% for the BDI; and 51.1% and 52.1% for the CGI. Effect sizes were medium (0.54, 0.52 and 0.56, respectively). Conclusions: The results show that a UK-based clinical service achieves similar results to those published internationally and that clinical rTMS can have significant impact on symptoms of depression in many patients with TRD. Health services are under pressure to make financial savings, investment in rTMS could reduce the long-term treatment costs associated with TRD.

Developing European guidelines for training care professionals in mental health promotion.

BACKGROUND: Although mental health promotion is a priority mental health action area for all European countries, high level training resources and high quality skills acquisition in mental health promotion are still relatively rare. The aim of the current paper is to present the results of the DG SANCO-funded PROMISE project concerning the development of European guidelines for training social and health care professionals in mental health promotion. METHODS: The PROMISE project brought together a multidisciplinary scientific committee from eight European sites representing a variety of institutions including universities, mental health service providers and public health organisations. The committee used thematic content analysis to filter and analyse European and international policy documents, scientific literature reviews on mental health promotion and existing mental health promotion programmes with regard to identifying quality criteria for training care professionals on this subject. The resulting PROMISE Guidelines quality criteria were then subjected to an iterative feedback procedure with local steering groups and training professionals at all sites with the aim of developing resource kits and evaluation tools for using the PROMISE Guidelines. Scientific committees also collected information from European, national and local stakeholder groups and professional organisations on existing training programmes, policies and projects. RESULTS: The process identified ten quality criteria for training care professionals in mental health promotion: embracing the principle of positive mental health; empowering community stakeholders; adopting an interdisciplinary and intersectoral approach; including people with mental health problems; advocating; consulting the knowledge base; adapting interventions to local contexts; identifying and evaluating risks; using the media; evaluating training, implementation processes and outcomes. The iterative feedback process produced resource kits and evaluation checklists linked with each of these quality criteria in all PROMISE languages. CONCLUSIONS: The development of generic guidelines based on key quality criteria for training health and social care professionals in mental health promotion should contribute in a significant way to implementing policy in this important area.