Post-secondary students with symptoms of psychosis: A mixed-methods systematic review.

Post-secondary students are at a heightened risk of psychosis, yet little is known about this population. The aim of this study was to conduct a mixed-methods systematic review of psychosis among post-secondary students, including student characteristics, overall prevalence, risk factors, interventions, and their reported experiences. Procedures were modelled on the Joanna Briggs Institute approach, while PRISMA guided conduct and reporting. A librarian created a systematic search of nine databases, and quality was assessed using JBI Critical Appraisal Tools. We pooled and analysed data according to objectives and recorded data using synthesis tables and narrative summaries. 26 articles published between 2006 and 2018 are included. The average age of participants was 21 years, and most identified as female and Caucasian. The prevalence of psychosis was often measured in a way that limited comparison across studies. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. Other risk factors trending towards a relationship included racial discrimination and anxiety. Protective factors included self-esteem and self-concept clarity. Five interventions were studied, with mixed results, and only three studies reported on the experience of students. While five promising interventions are identified, inadequate testing and replication limit confidence in their effectiveness and there is a notable deficit in qualitative evidence exploring the experiences of these students. Integrating knowledge on risk factors, interventions, and experiences of students with psychosis will help tailor and facilitate their health care while protecting their right to education.

Interventions to improve emergency department use for mental health reasons: protocol for a mixed-methods systematic review.

BACKGROUND: Healthcare resources are limited and unnecessary, and inappropriate emergency department use is now a highly visible healthcare priority. Individuals visiting the emergency department for mental health-related reasons are often amongst the most frequent presenters. In response, researchers and clinicians have created interventions to streamline emergency department use and several primary studies describe the effects of these interventions. Yet, no consensus exists on the optimal approach, and information on the quality of development, effectiveness, acceptability, and economic considerations is hard to find. The purpose of this study is to systematically review interventions designed to improve appropriate use of the emergency department for mental health reasons. METHOD: A mixed-method systematic review using Joanna Briggs Methodology. Search combining electronic databases (EMBASE, MEDLINE, PsycINFO, CINAHL, HealthSTAR, PROQUEST, Cumulative Index to Nursing and Allied Health) and secondary searches (grey literature and hand search with consultation). Two independent reviewers will screen titles and abstracts using predetermined eligibility criteria and a third reviewer will resolve conflicts. Full texts will also be screened by two independent reviews and conflicts resolved in a consensus meeting with a third reviewer. A pilot-tested data extraction form will be used to retrieve data relevant to the study objectives. We will assess the quality and of all included studies. Data describing interventions will be summarized using logic models and reported narratively. Quality of development will be assessed using the Oxford Implementation Index. For data on intervention effectiveness, we will assess statistical heterogeneity and conduct a meta-analysis using a random effects method, if appropriate. For interventions that cannot be pooled, we will report outcomes narratively and descriptively. Qualitative data on acceptability will be synthesized using meta-aggregation and an economic evaluation of interventions will be done. The reporting of this protocol follows the PRISMA-P statement. DISCUSSION: Using a combined systematic review methodology and integrated knowledge translation plan, the project will provide decision makers with concrete evidence to support the implementation and evaluation of interventions to improve emergency department use for mental health reasons. These interventions reflect widespread priorities in the area of mental health care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018087430.

Exploring the Experiences of Parent Caregivers of Adult Children With Schizophrenia: A Systematic Review.

This is a qualitative evidence synthesis on the experiences of parents caring for their adult child with schizophrenia. The Joanna Briggs Methodology for systematic reviews guided the study and standard systematic review procedures were followed. Content analysis was used to synthesize findings from the five studies included into the following categories: 'Resources,' 'Loss,' 'Psychological Distress,' 'Effects on Family,' and 'Framing the Experience.' Findings suggest that parent caregivers struggle to navigate services and need greater support to protect their mental and physical health. From a research perspective, factors influencing parents' abilities to stay engaged in caregiving warrant further exploration.

Using the Alberta Continuity of Services Observer-Rated Scale to Measure Continuity of Care in a Psychiatric Population.

BACKGROUND AND PURPOSE: Continuity of care (CoC) is an important component in the delivery of quality mental health care. Yet, its measurement is inconsistent. We explored the use of the Alberta Continuity of Services Scale for Mental Health (ACSS-MH) observer-rated scale and compared CoC scores in 2 groups (N = 140) of individuals with mental health complaints (5+ and 1 emergency department [ED] visits/year). METHODS: Secondary analysis of health record data. RESULTS: The application of the ACSS-MH observer-rated scale in our population is discussed, as well as differences in CoC scores by group. CONCLUSIONS: The ACSS-MH observer-rated scale may be useful for obtaining CoC scores in several mental health populations. Minor modifications (e.g., to response options) are suggested that may improve scoring accuracy. Research is needed to further explore the relationship between CoC and ED use.

Exploring the Facilitators and Barriers to Home Dialysis: A Scoping Review.

A meta-synthesis of qualitative literature from 2004-2014 was conducted to identify the facilitators and barriers related to patients' uptake and continued use of home dialysis. These factors were addressed from the patient perspective using a systematic scoping review. A total of 848 citations were retrieved, and 12 studies were ultimately included. Data were analyzed descriptively by content analysis. The most commonly reported barriers were Burden of Care, Invasion of Body, and Disruption of Lifestyle, while the most common facilitators were Support, Physical and Mental Well-Being, Ability to Maintain a Normal Life, and Autonomy. Nursing implications are discussed for supporting facilitators and addressing barriers.

Profiling frequent presenters to the emergency department for mental health complaints: socio-demographic, clinical, and service use characteristics.

BACKGROUND: A small subset of individuals makes a disproportionate number of ED visits for mental health complaints. STUDY OBJECTIVES: To explore the population profile and associated socio-demographic, clinical, and service use factors of individuals who make frequent visits (5+ annually) to hospital EDs for mental health complaints. METHODS: Case-control study using electronic health record data. RESULTS: Frequent presenters represented 3% of mental health ED patients and accounted for 18% of visits. Several factors were significantly associated with frequent ED use, including limited social support, documented personality disorder/traits, regular antipsychotic use, self-reported alcohol use, and having multiple referral sources.

Frequent emergency department use by individuals seeking mental healthcare: a systematic search and review.

OBJECTIVE: The aim of this study was to compare research on individuals who frequently use the ED for mental health complaints including parameters used to identify the population, as well as socio-demographic, clinical, and service use factors. METHODS: Systematic search and review of Medline, Cinahl, PsycInfo, and HealthStar (1980 to 2011). Double-data extraction ensured accuracy. Descriptive statistics were reported. RESULTS: Thirteen studies were included. Median sample size was 100. Parameters varied across studies. Profile: young, unemployed males living in transient accommodations, diagnosis of a psychotic disorder, self-referral to the ED for symptoms/unmet needs, and discharge to community resources. CONCLUSIONS: Consistently used, meaningful definitions/parameters are needed.

Turning knowledge into action at the point-of-care: the collective experience of nurses facilitating the implementation of evidence-based practice.

BACKGROUND: Facilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well-established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America. AIM: To describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice. METHODS: Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses' facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison. RESULTS: A number of factors emerged at various levels associated with the successes and failures of participants' efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability. CONCLUSIONS: Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence-based practice in real situations at the point-of-care. With a greater understanding of factors contributing to successful or unsuccessful facilitation, future research should focus on analyzing facilitation interventions tailored to address barriers and enhance facilitators of evidence uptake.

Emergency department visits for symptoms experienced by oncology patients: a systematic review.

PURPOSE: The aim of this review was to explore the range and prevalence of cancer treatment or disease-related symptoms in the emergency department and their associated outcomes. METHODS: A systematic review examined studies cited in Medline, Embase, PsycINFO, and CINAHL published from 1980 to July 2011. Eligible studies measured emergency department visits for symptom assessment in adult oncology patients. Two reviewers independently screened citations and double data extraction was used. Descriptive analysis was conducted. RESULTS: Of 1,298 citations, six prospective and 12 retrospective descriptive studies were included. Of these, eight focused on multiple symptoms and 10 targeted specific symptoms. The studies were published between 1995 and 2011, conducted in seven countries, and had a median sample size of 143 (range 9-27,644). Of the 28 symptoms reported, the most common were febrile neutropenia, infection, pain, fever, and dyspnea. Definitions provided for individual symptoms were inconsistent. Of 16 studies reporting admission rates, emergency visits resulted in hospital admissions 58 % (median) of the time in multi-symptom studies (range 31 % to 100 %) and 100 % (median) of the time in targeted symptoms studies (range 39 % to 100 %). Of 11 studies reporting mortality rates, 13 % (median) of emergency visits captured in multi-symptom studies (range 1 % to 56 %) and 20 % (median) of visits in targeted symptoms studies (range 4 % to 67 %) resulted in death. CONCLUSIONS: Individuals with cancer present to emergency departments with a myriad of symptoms. Over half of emergency department visits resulted in hospital admissions. Few symptoms were defined adequately to compare data across studies, thereby revealing an important gap in cancer symptom reporting.

Qualitative descriptive study exploring schizophrenia and the everyday effect of medication-induced weight gain.

Weight gain and obesity are serious side effects of the medications used to manage psychotic disorders and successful, long-term weight loss interventions are not yet available. One reason for this may be that current interventions are designed without consideration of the patient's perspective. The purpose of this study was to explore the subjective experience of weight and lifestyle from the perspective of people with schizophrenia. A qualitative, constructivist research design was used and conversational interviews were conducted with 18 purposefully recruited participants from an outpatient clinic at a psychiatric hospital in Eastern Ontario. Data were analysed according to the method of constant comparison and three central themes emerged: a life altering diagnosis, weight management as complex, and today's experiences shape tomorrow's outcomes. Weight management was seen as difficult yet important to the participants. The findings of this study provide insight into the views and opinions of the participants regarding weight and lifestyle and may be used to support the design of tailored heath initiatives for persons with mental illness.

Depressive symptoms before and after elective hysterectomy.

OBJECTIVE: To examine the factors associated with depressive symptoms before and after surgery in women who undergo elective hysterectomy. DESIGN: A secondary analysis of longitudinal data from a prospective cohort study designed to understand chronic postsurgical pain in women. SETTING: One acute care hospital in southeastern, Ontario, over a 4-year period (2006-2010). PARTICIPANTS: Three hundred eighty-four (384) English-speaking women, age 18 years or older, who presented for elective hysterectomies. METHODS: Data were gathered preoperatively in the same-day admission center and six months postoperatively using validated web-based or mailed questionnaires. RESULTS: Thirty six percent (36%) of participants reported depressive symptoms before surgery, 22% reported symptoms afterwards, 15% reported symptoms at both time points, and 6% developed new onset depressive symptoms postoperatively. Younger (odds ratio [OR] = 2.5, 95% confidence interval [CI], [1.7, 5.0]) women, those with higher levels of anxiety (state: OR = 8.6, 95% CI [5.2, 14.0]), or who experienced pain that interfered with their daily functioning (OR = 2.8, 95% CI [1.7, 4.7]) were more likely to report depressive symptoms prior to hysterectomy. Preoperative pain (OR = 2.0, 95% CI [1.1, 3.6]), trait anxiety (OR = 2.4, 95% CI [1.2, 4.6]), and depressive symptoms (OR = 3.9, 95% CI [2.1, 7.5]) increased the risk of depressive symptoms 6 months postoperatively. CONCLUSION: Young women who exhibit high levels of anxiety and pain and who require a hysterectomy are at risk of experiencing psychological distress prior to and following their surgery.