The effectiveness of cognitive behavioural therapy for depression in women with breast cancer: a systematic review and meta-analysis.

BACKGROUND: Depression is a common co-morbidity in women with breast cancer. Previous systematic reviews investigating cognitive behavioural therapy (CBT) for depression in this population based their conclusions on findings from studies with varying and often limited specificity, quality and/or quantity of CBT within their interventions. AIM: To determine the effectiveness of a specific, well-evidenced CBT protocol for depression in women with breast cancer. METHOD: Online databases were systematically searched to identify randomised controlled trials (RCTs) testing CBT (aligned to Beck's protocol) as a treatment for depression in women with breast cancer. Screening, data extraction and risk of bias assessment were independently undertaken by two study authors. Both narrative synthesis and meta-analysis were used to analyse the data. The meta-analysis used a random effects model to compare CBT with non-active/active controls of depression using validated, self-report measures. RESULTS: Six RCTs were included in the narrative synthesis, and five in the meta-analysis (n = 531 participants). Overall, CBT demonstrated an improvement in depression scores in the CBT condition versus active and non-active controls at post-intervention (SMD = -0.93 [95% CI -1.47, -0.40]). Narratively, five out of six RCTs reported statistically significant improvements in depression symptoms for CBT over control conditions for women with breast cancer. CONCLUSION: CBT aligned to Beck's protocol for depression appears effective for treating depression in women with breast cancer. However, further research is needed for women with stage IV breast cancer. The clinical recommendation is that therapists utilise Beck's CBT protocol for depression, whilst considering the complex presentation and adapt their practice accordingly.

The use of digital touch screen technology to deliver reminiscence therapy among people with dementia in Jordanian care homes: a mixed-method feasibility study.

BACKGROUND: Using technology to deliver psychosocial interventions such as reminiscence therapy (RT) to people with dementia may improve their mental health. Yet, establishing the feasibility of digital interventions in low- to middle-income countries is still in the early stages. This study aimed to: (i) determine the feasibility of using digital touch screen technology to deliver RT among people with dementia living in Jordanian care homes; and (ii) compare study outcomes pre- and post-reminiscence sessions to investigate whether specific outcomes are sensitive to change and explore the acceptability and experiences of the intervention. METHODS: A pragmatic mixed-method study design was implemented. Sixty residents with dementia were recruited from two Jordanian care homes (Site 1: n = 35; Site 2: n = 10). A process evaluation was conducted alongside a single-group pre-post-intervention study. The intervention involved 10 supported RT sessions of up to 1 h each, delivered over 5 weeks. Feasibility was determined by assessing the rate of recruitment, adherence, retention, data completion, implementation fidelity, and adverse events. Qualitative semi-structured interview questions were used to explore experience and acceptability, and data were thematically analysed. RESULTS: Response rate was 100%; loss to follow up at post-intervention was 25%. Median session attendance for those who received the intervention was 80%. No serious adverse events were reported. A positive, statistically significant and clinically relevant difference was found in all outcome measures before and after reminiscence sessions. Qualitative findings suggest that digital RT intervention is generally well accepted by people with dementia who reported positive changes, including enhanced communication and cognitive abilities. CONCLUSION: Using digital touch screen technology to deliver RT is feasible and acceptable among people with dementia in Jordanian care homes. Digital RT intervention is a promising approach to improving mental health and communication for people living with dementia.

The effectiveness of exercise-based interventions for preventing or treating postpartum depression: a systematic review and meta-analysis.

Postpartum depression can have detrimental effects on both a mother's physical and mental health and on her child's growth and emotional development. The aim of this study is to assess the effectiveness of exercise/physical activity-based interventions in preventing and treating postpartum depressive symptoms in primiparous and multiparous women to the end of the postnatal period at 52 weeks postpartum. Electronic databases were searched for published and unpublished randomised controlled trials of exercise/physical activity-based interventions in preventing and treating depressive symptoms and increasing health-related quality of life in women from 4 to 52 weeks postpartum. The results of the studies were meta-analysed and effect sizes with confidence intervals were calculated. The Grading of Recommendations Assessment and Development and Evaluation (GRADE) system was used to determine the confidence in the effect estimates. Eighteen trials conducted across a range of countries met the inclusion criteria. Most of the exercise interventions were aerobic and coaching compared to usual care, non-intervention and active controls. Small effect sizes of exercise-based interventions in reducing depressive symptoms were observed collectively and the quality of evidence was low across the individual studies. Although exercise-based interventions could create an alternative therapeutic approach for preventing major depression in postpartum women who experience subthreshold elevated depressive symptoms, the clinical effectiveness and the cost-effectiveness of exercise-based and physical activity interventions need to be better established. There is a need for further more rigorous testing of such interventions in high-quality randomised controlled trials against active control conditions before large-scale roll-out of these interventions in clinical practice is proposed.

A pragmatic randomised controlled trial of preferred intensity exercise in depressed adult women in the United Kingdom: secondary analysis of individual variability of depression.

BACKGROUND: This study is a secondary analysis of the trial by Callaghan et al. (2011), which reported higher antidepressant effects for preferred intensity (n = 19) vs. prescribed intensity (n = 19) exercise of three sessions/week over four weeks in depressed women. In particular, the present study sought to examine whether greater clinically significant individual change/recovery was observed in the preferred compared to the prescribed exercise group. METHODS: The reliable change index and the Ccutoff score criteria described by Jacobson and Truax (1991) were employed to determine clinical significance. These criteria examined if individual change in depression scores from pre- to post-intervention in the preferred intensity group were statistically significant beyond the standard error of difference derived from the active comparator prescribed group, and subsequently within a normal population range. Patients fulfilling the first or both criteria were classified as improved or recovered, respectively. RESULTS: Post-intervention depression scores of six patients in the preferred intensity exercise group (32%) demonstrated statistically reliable improvement (p < 0.05) and recovery. Half of this subgroup started as moderately depressed. No patient demonstrated a reliable deterioration in depression. Due to a small sample size, it was impossible to determine whether patients on psychiatric medication or medication-free patients were equally benefited from preferred intensity exercise. Thirteen patients in the preferred intensity group (68%) displayed non-statistically significant change in post-intervention depression scores (p > 0.05), although eight of them showed a non-significant improvement in post-intervention depression scores and three could not technically show an improvement in depression due to floor effects (baseline depression within normal range). CONCLUSIONS: Preferred intensity exercise of three sessions/week over four weeks led almost a third of the patients to record scores consistent with recovery from depression. Health professionals may consider that short-term preferred intensity exercise provides clinically significant antidepressant effects comparing favourably to exercise on prescription.

An exploration of predictors of children's nurses' attitudes, knowledge, confidence and clinical behavioural intentions towards children and young people who self-harm.

AIMS AND OBJECTIVES: To explore the potential predictors of children's nurses' attitudes, knowledge and confidence towards caring for children and young people admitted to hospital with self-harm. BACKGROUND: Admissions to paediatric inpatient settings for individuals who have self-harmed are growing. Limited previous research suggests that nurses have mixed attitudes towards people who have self-harmed and potentially lack the confidence to provide effective care. There is a specific paucity of research in this area for children's nurses. DESIGN: A cross-sectional descriptive survey was used to gather data for exploration of variables associated with attitudes, confidence, knowledge and clinical behavioural intentions of 98 registered children's nurses in a single tertiary children's hospital, colocated in a large acute NHS Trust in the UK. METHODS: Data were collected over a 4 weeks in 2015, using an online survey tool. The predictive effect of several demographic variables was tested on the outcomes of attitudes, knowledge, confidence and behavioural intentions, which were collected using relevant, previously used outcome measures. RESULTS: Increased experience was found to be associated with improved attitudes relating to negativity. Previous training in caring for children who had self-harmed was found to be associated with improved attitudes around perceived effectiveness of their care. Higher academic qualifications and having undertaken previous training on self-harm were each found to be associated with increased knowledge of self-harm, and increased age was associated with reduced knowledge of self-harm. CONCLUSIONS: This study provides an initial exploration of variables associated with attitudes, knowledge, confidence and behaviour intentions of registered children's nurses in relation to caring for CYP who have self-harmed. RELEVANCE TO CLINICAL PRACTICE: Targeted training on caring for CYP who have self-harmed should be considered as a component of continuing education for registered children's nurses in the UK to improve the experience and outcomes for this patient group.

Preferred intensity exercise for adolescents receiving treatment for depression: a pragmatic randomised controlled trial.

BACKGROUND: Exercise has been shown to be effective in treating depression, but trials testing the effect of exercise for depressed adolescents utilising mental health services are rare. The aim of this study was to determine the effectiveness of a preferred intensity exercise intervention on the depressive symptoms of adolescents with depression. METHODS: We randomly assigned 87 adolescents who were receiving treatment for depression to either 12 sessions of aerobic exercise at preferred intensity alongside treatment as usual or treatment as usual only. The primary outcome was depressive symptom change using the Children's Depression Inventory 2(nd) Version (CDI-2) at post intervention. Secondary outcomes were health-related quality of life and physical activity rates. Outcomes were taken at baseline, post intervention and at six month follow up. RESULTS: CDI-2 score reduction did not differ significantly between groups at post-intervention (est. 95% CI -6.82, 1.68, p = 0.23). However, there was a difference in CDI-2 score reduction at six month follow-up in favour of the intervention of -4.81 (est. 95% CI -9.49, -0.12, p = 0.03). Health-related quality of life and physical activity rates did not differ significantly between groups at post-intervention and follow-up. CONCLUSIONS: There was no additional effect of preferred intensity exercise alongside treatment as usual on depressive reduction immediately post intervention. However, effects were observed at six months post-intervention, suggesting a delayed response. However, further trials, with larger samples are required to determine the validity of this finding. TRIAL REGISTRATION: ClinicalTrials.gov NCT01474837, March 16 2011.

Understanding the presentation and treatment of anxiety disorders.

Anxiety disorders are the most prevalent mental health issues worldwide and can have significant detrimental effects on people's quality of life and daily functioning. Nurses in a range of healthcare settings are likely to encounter people with various anxiety disorders, so it is essential that they have adequate knowledge and understanding of these conditions. This article explores the development of anxiety, before outlining the aetiologies and symptoms of common anxiety disorders. The author also provides an overview of some of the treatments available for anxiety disorders and explains the nurse's role in supporting those affected by these conditions.

Nature-Based Interventions in the UK: A Mixed Methods Study Exploring Green Prescribing for Promoting the Mental Wellbeing of Young Pregnant Women.

Green prescribing is gaining in popularity internationally for the promotion of mental wellbeing. However, the evidence base is limited, particularly in young pregnant women, a population with known risk factors for anxiety and depression. The aim of this mixed-methods study was to provide insights into the availability, processes, and suitability of nature-based interventions for young pregnant women. First, an online mapping survey of nature-based activities in the East Midlands region of the United Kingdom (UK) was undertaken. Second, focus groups (n = 6) were conducted with nature activity providers and young mothers (n = 11). This study found there were many diverse nature-based activities available to promote mental wellbeing. The organisational challenges highlighted include a lack of sufficient funding for service provision and disappointing experiences with some green prescribing programmes. The young women felt that nature-based activities helped to promote their mental wellbeing, and also offered an opportunity for social support. The facilitators, such as having detailed information and being accompanied to initial sessions to ease anxieties, were found to maximise the women's engagement with nature-based interventions. This study provides new perspectives on nature-based interventions from service providers and young women. Findings on the organisational barriers and facilitators to delivering interventions will inform the design of much needed future experimental research.

Nature-based interventions to support mental health and well-being of young women in pregnancy: exploratory work for future feasibility RCT.

Background: The prevalence of mental health and well-being issues among young women is increasing. Pregnancy is a time when new mental health challenges may arise, or existing conditions can be exacerbated. This project presents preparatory work on how nature-based interventions may help to support the mental health and well-being of young pregnant women (aged 16-24 years) in a future study. Methods: This project was formed of three main phases conducted from March to August 2022: (1) mapping nature activities available across the East Midlands region and two focus groups with providers of nature activities (n = 6); (2) public participation and involvement work to inform future research. This included four focus groups with young women (n = 11), leading to the formation of a new young women's panel (Research Influencers Group). Networking and stakeholder engagement to support future research. Results: The mapping survey identified 68 nature-based organisations/projects operating in the region, many of whom expressed interest in being involved in future research. The young women's focus groups confirmed the importance of the topic and generated a wealth of information to support the intervention design. A Research Influencer Group of five young women was established from the focus group participants. The Research Influencer Group chose the nature-based intervention and had input into all aspects of the study design. This group will continue into future projects. Focus groups with providers of nature activities have further advanced the study design. The project team have developed relationships with relevant stakeholders and networks that will inform the future trial. Conclusion: This preparatory co-design work suggested that a nature-based intervention may be acceptable to young women, and providers of such interventions felt it was feasible to offer these activities to young pregnant women. This preparatory work has led to an outline research plan which has been co-produced with public contributors and stakeholders throughout. Limitations: This preparatory work is limited by small focus group samples, and the possibility that not all providers were reached through the snowballing approach to the mapping survey. Future work: Future research is needed to test the nature-based intervention; this would be in the form of a feasibility randomised controlled trial of nature-based interventions to promote the mental health and well-being of young pregnant women. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR135167.

The mental health and well-being of young women has been getting worse since the 1990s. In particular, young women are more likely to experience depression or anxiety when pregnant or after giving birth. This can have long-term effects for them and their children. This also results in high costs for the National Health Service and social services. We know that social support can help to protect people against poor mental health and well-being. Research has also shown that access to nature may be linked to better mental health and well-being. This project aimed to find out what types of group nature activities were offered in the community and whether young women (aged 16­24) felt doing these activities might help their mental health during and after pregnancy. Our first step was to map the nature-based activities that are available in the East Midlands region of the United Kingdom by sending a short survey to organisations to find out more. These may include activities such as walking, music or dance, or arts and crafts sessions held in natural settings such as forests or community gardens. We also held focus groups with young women to discuss the idea of nature activities to promote mental health and well-being. We invited some women to work with us as part of our 'Research Influencer Group'. They were involved in co-designing the future research, including choosing the nature activity to be tested. We have also linked up with the right people to support this and future projects. In this small preparatory study, young women we spoke to were very enthusiastic about spending time in nature and they felt it could benefit young pregnant women and their babies in many ways. There are currently a wide range of nature activities available in the East Midlands. Providers of these activities have recommended ways to make sure a future study works well. An outline research plan has been co-developed with the Research Influencer Group to move forward with the next stages of this research.

Exploring the mental health experiences of young trans and gender diverse people during the Covid-19 pandemic.

Background: Both anxiety and depression have been identified as negative health outcomes associated with the distressing nature of the Covid-19 pandemic, especially among young people. Within this age demographic, trans and gender diverse people may be particularly vulnerable to pandemic-related mental health outcomes, such as anxiety and depression, due to the social challenges, gender dissonance, and poor mental health they experience. Furthermore, the social distancing measures impose several unique social and help-seeking challenges which may further contribute to the worsening of mental health. While there has been acknowledgment that vulnerable populations may be disproportionally affected by the pandemic, the experiences of trans and gender diverse youth have received very little empirical attention. Aims: To explore the mental health impact of Covid-19 on the lives of young trans and gender diverse people in the UK. Method: In total, 243 people took part in an online survey between May and July in 2020. Eighty-two people were removed due to providing insufficient data. The analyzed dataset therefore comprised of 161 respondents ranging from 16 to 25 years (M = 20; SD = 2.68). Participants were asked how social distancing measures had impact on their social lives, mental health and access to health services. They were also asked to complete validated measures of anxiety and depression. Results: This study found that those who experienced a greater impact of the Covid-19 outbreak and its associated social distancing measures, reported poorer mental health. Lack of social support, negative interpersonal interactions, unsupportive and non-affirming living environments and the inability to access mental health support and gender-affirming interventions were all factors that were associated with poor mental health. Conclusion: The findings provide specific direction for the tailoring of mental health service delivery to this population, noting the need for private, safe spaces in which young people can feel supported and have their gender identity affirmed.

Developing a prototype digital risk mitigation pathway for children and young people admitted to acute paediatric NHS care in mental health crisis: Protocol of the Safety Assessment in Paediatric healthcare Environments (SAPhE) pathway study.

Background: Globally, there are increasing numbers of Children and young people (CYPs) experiencing a mental health crisis requiring admission to acute paediatric inpatient care. These CYPs can often experience fluctuating emotional states accompanied by urges to self-harm or attempt to end their life, leading to reduced safety and poorer experiences. Currently, in the UK National Health Service (NHS) there are no standardised, evidence-based interventions in acute paediatric care to mitigate or minimise immediate risk of self-harm and suicide in CYP admitted with mental health crisis. Objective: To outline the protocol for the SAPhE Pathway study which aims to: 1) identify and prioritise risk mitigation strategies to include in the digital prototype, 2) understand the feasibility of implementing a novel digital risk mitigation pathway in differing NHS contexts, and 3) co-create a prototype digital risk mitigation pathway. Methods: This is a multi-centre study uses a mixed-methods design. A systematic review and exploratory methods (interviews, surveys, and focus groups) will be used to identify the content and feasibility of implementing a digital risk mitigation pathway. Participants will include healthcare professionals, digital experts and CYP with experience of mental health conditions. Data will be collected between January 2022 and March 2023 and analysed using content and thematic analysis, case study, cross-case analysis for qualitative data and descriptive statistics for quantitative data. Findings will inform the experience-based co-design workshops. Ethics and Dissemination: The study received full ethical approval from NHS REC [Ref: 22/SC/0237 and 22/WM/0167]. Findings will be made available to all stakeholders using multiple approaches.

A biopsy simulation study to assess the accuracy of several transrectal ultrasonography (TRUS)-biopsy strategies compared with template prostate mapping biopsies in patients who have undergone radical prostatectomy.

UNLABELLED: What's known on the subject? and What does the study add? Transrectal ultrasonography (TRUS)-guided biopsies can miss prostate cancer and misclassify risk in a diagnostic setting; the exact extent to which it does so in a repeat biopsy strategy in men with low-intermediate risk prostate cancer is unknown. A simulation study of different biopsy strategies showed that repeat 12-core TRUS biopsy performs poorly. Adding anterior sampling improves on this but the highest accuracy is achieved using transperineal template prostate mapping using a 5 mm sampling frame. OBJECTIVE: To determine the effectiveness of two sampling strategies; repeat transrectal ultrasonography (TRUS)-biopsy and transperineal template prostate mapping (TPM) to detect and exclude lesions of ≥0.2 mL or ≥0.5 mL using computer simulation on reconstructed three-dimensional (3-D) computer models of radical whole-mount specimens. PATIENTS AND METHODS: Computer simulation on reconstructed 3-D computer models of radical whole-mount specimens was used to evaluate the performance characteristics of repeat TRUS-biopsy and TPM to detect and exclude lesions of ≥0.2 mL or ≥0.5 mL. In all, 107 consecutive cases were analysed (1999-2001) with simulations repeated 500 times for each biopsy strategy. TPM and five different TRUS-biopsy strategies were simulated; the latter involved a standard 12-core sampling and incorporated variable amounts of error, as well as the addition of anterior cores. Sensitivity, specificity, negative and positive predictive values for detection of lesions with a volume of ≥0.2 mL or ≥0.5 mL were calculated. RESULTS: The mean (SD) age and PSA concentration were 61 (6.4) years and 8.5 (5.9) ng/mL, respectively.In all, 53% (57/107) had low-intermediate risk disease. In all, 665 foci were reconstructed; there were 149 foci ≥0.2 mL and 97 ≥ 0.5 mL in the full cohort and 68 ≥ 0.2 mL and 43 ≥ 0.5 mL in the low-intermediate risk group. Overall, TPM accuracy (area under the receiver operating curve, AUC) was ≈0.90 compared with AUC 0.70-0.80 for TRUS-biopsy. In addition, at best, TRUS-biopsy missed 30-40% of lesions of ≥0.2 mL and ≥0.5 mL whilst TPM missed 5% of such lesions. CONCLUSION: TPM under simulation conditions appears the most effective re-classification strategy, although augmented TRUS-biopsy techniques are better than standard TRUS-biopsy.

The effectiveness of a preferred intensity exercise programme on the mental health outcomes of young people with depression: a sequential mixed methods evaluation.

BACKGROUND: People with mental illness are more likely to suffer physical health problems than comparable populations who do not have mental illness. There is evidence to suggest that exercise, as well has having obvious physical benefits, also has positive effects on mental health. There is a distinct paucity of research testing its effects on young people seeking help for mental health issues. Additionally, it is generally found that compliance with prescribed exercise programmes is low. As such, encouraging young people to exercise at levels recommended by national guidelines may be unrealistic considering their struggle with mental health difficulties. It is proposed that an exercise intervention tailored to young people's preferred intensity may improve mental health outcomes, overall quality of life, and reduce exercise attrition rates. METHODS/DESIGN: A sequential mixed methods design will be utilised to assess the effectiveness of an individually tailored exercise programme on the mental health outcomes of young people with depression. The mixed methods design incorporates a Randomised Controlled Trial (RCT), focus groups and interviews and an economic evaluation. PARTICIPANTS: 158 young people (14-17 years) recruited from primary care and voluntary services randomly allocated to either the intervention group or control group. Intervention group: PARTICIPANTS will undertake a 12 week exercise programme of 12 × 60 minutes of preferred intensity aerobic exercise receiving motivational coaching and support throughout. PARTICIPANTS will also be invited to attend focus groups and 1-1 interviews following completion of the exercise programme to illicit potential barriers facilitators to participation. CONTROL GROUP: PARTICIPANTS will receive treatment as usual. PRIMARY OUTCOME MEASURE: Depression using the Children's Depression Inventory 2 (CDI-2). SECONDARY OUTCOME MEASURES: Quality of Life (EQ-5D), physical fitness (Borg RPE scale, heart rate), incidents of self-harm, treatment received and compliance with treatment, and the cost effectiveness of the intervention. Outcome measures will be taken at baseline, post intervention and 6 month follow up. DISCUSSION: The results of this study will inform policy makers of the effectiveness of preferred intensity exercise on the mental health outcomes of young people with depression, the acceptability of such an intervention to this population and its cost effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01474837.

Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland: a mixed methods pre-postevaluation.

AIM: To report a study evaluating the effectiveness of a Wellness Recovery Action Planning education programme. BACKGROUND: Internationally, mental health policy is advocating using recovery approaches to care. Underpinning these approaches is investment in education in recovery principles and methods and a need to provide evidence of the impact of this education. DESIGN: The study design employed a mixed methods approach. METHODS: Using questionnaires and focus groups, we evaluated 2- and 5-day Wellness Recovery Action Planning Education Programmes and assessed participants' attitudes towards recovery, knowledge of recovery and Wellness Recovery Action Planning beliefs. Data were collected between 2009 and 2010. Participants were people with personal experience of mental health problems, practitioners in mental health services and family members/carers of those with mental health problems. RESULTS: Comparing the pre and postmeasures showed that the programme increased participants' knowledge of and attitudes towards recovery and Wellness Recovery Action Planning. Although this increase was statistically significant for the 2-day programme, it was not so for the 5-day programme. Participants reported being very positive and enthusiastic about the programme and the benefits they had achieved personally and professionally as a result of participating. CONCLUSIONS: This exploratory study shows that providing mental health practitioners and people with personal experience of mental health problems with a systematic education and training in recovery principles using the Wellness Recovery Action Planning approach leads to positive changes in people's knowledge, skills and attitudes towards recovery. This education appeared to inspire, invigorate and empower people, and for many, it was a life changing experience.

Acute paediatric inpatient care of children and young people admitted with self-harm or eating disorders: A single centre evaluation.

In the United Kingdom, the prevalence of children and young people (CYP) accessing acute paediatric inpatient care with mental health problems is increasing, with self-harm and eating disorders particularly prevalent. This study evaluated CYP experiences of being in receipt of acute paediatric inpatient care following either self-harm or crisis stemming from an eating disorder to inform domains for a person-centred outcome measure (PCOM). A series of stakeholder engagement events were conducted between April and July 2015 where creative approaches were used to explore stakeholder experiences of care and to identify outcome domains that were subsequently prioritised using a Nominal Group Technique. Data were analysed using inductive thematic approach, with significance scores calculated for domain statements. Ninety-six stakeholders (15 CYP, eight parents and carers, and 73 professionals) participated. Findings showed five priority PCOM domains: privacy and surveillance; holistic care; making choices, appropriate communication; working together to achieve care goals; and respect and empowerment. This single centre evaluation highlights the need for a PCOM to be developed for this patient group that comprehensively reflects stakeholders' expectations in order to inform improvements to quality of acute paediatric care.

Characterizing clinically significant prostate cancer using template prostate mapping biopsy.

PURPOSE: Definitions of prostate cancer risk are limited since accurate attribution of the cancer grade and burden is not possible due to the random and systematic errors associated with transrectal ultrasound guided biopsy. Transperineal prostate mapping biopsy may have a role in accurate risk stratification. We defined the transperineal prostate mapping biopsy characteristics of clinically significant disease. MATERIALS AND METHODS: A 3-dimensional model of each gland and individual cancer was reconstructed using 107 radical whole mount specimens. We performed 500 transperineal prostate mapping simulations per case by varying needle targeting errors to calculate sensitivity, specificity, and negative and positive predictive value to detect lesions 0.2 ml or greater, or 0.5 ml or greater. Definitions of clinically significant cancer based on a combination of Gleason grade and cancer burden (cancer core length) were derived. RESULTS: Mean±SD patient age was 61±6.4 years (range 44 to 74) and mean prostate specific antigen was 9.7±5.9 ng/ml (range 0.8 to 36.2). We reconstructed 665 foci. The total cancer core length from all positive biopsies for a particular lesion that detected more than 95% of lesions 0.5 ml or greater and 0.2 ml or greater was 10 mm or greater and 6 mm or greater, respectively. The maximum cancer core length that detected more than 95% of lesions 0.5 ml or greater and 0.2 ml or greater was 6 mm or greater and 4 mm or greater, respectively. We combined these cancer burden thresholds with dominant and nondominant Gleason pattern 4 to derive 2 definitions of clinically significant disease. CONCLUSIONS: Transperineal prostate mapping may provide an effective method to risk stratify men with localized prostate cancer. The definitions that we present require prospective validation.

Pragmatic randomised controlled trial of preferred intensity exercise in women living with depression.

BACKGROUND: Exercise may be effective in treating depression, but trials testing its effect in depressed women are rare. AIM: To compare the effect of exercise of preferred intensity with exercise of prescribed intensity in thirty-eight women living with depression. METHODS: A Pragmatic RCT of 12 sessions of exercise at preferred intensity compared with 12 sessions at prescribed intensity. Beck Depression Inventory (BDI), Rosenberg Self Esteem Scale (RSES), General Health Questionnaire 12 (GHQ-12), heart rate (HR), Rating of Perceived Exertion Scale (RPE), Quality of Life in Depression Scale (QLDS), Multi-Dimensional Scale of Perceived Social Support (MDSPSS), SF12 Health Survey and exercise participation rates were compared between groups. RESULTS: Intervention participants had statistically better BDI (t = 2.638, df = 36, p = 0.006, 95% mean (SD) 26.5 (10.7), CI-20.4 to -2.7, d = 0.86), GHQ-12 (t = 3.284, df = 36, p = 0.001, mean (SD) 8.3 (3.7) 95% CI -6.5 to -1.5, d = 1.08), RSES (t = 2.045, df = 36, p = 0.024, mean (SD) 11.3 (5.8), 95% CI 0.3 -6.4, d = 0.25), QLDS (t = 1.902, df = 36, p = 0.0325, mean (SD) 15.5 (7.9), 95% CI -12.2 -0.4, d = 0.27) RPE scores (t = 1.755, df = 36, p = 0.0475, mean (SD) 9.2 (3.2), 95% CI -.5 - 5.2, d = 0.77) and attended more exercise sessions (t = 1.781, df = 36, p = 0.0415, number of sessions 8 (65%), 95% CI-0.3 -4.8, d = 0.58). SF-12, MSPSS and HR did not differ significantly between groups. CONCLUSIONS: Exercise of preferred intensity improves psychological, physiological and social outcomes, and exercise participation rates in women living with depression. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00546221.

A review of the literature on peer support in mental health services.

BACKGROUND: Although mutual support and self-help groups based on shared experience play a large part in recovery, the employment of peer support workers (PSWs) in mental health services is a recent development. However, peer support has been implemented outside the UK and is showing great promise in facilitating recovery. AIMS: This article aims to review the literature on PSWs employed in mental health services to provide a description of the development, impact and challenges presented by the employment of PSWs and to inform implementation in the UK. METHOD: An inclusive search of published and grey literature was undertaken to identify all studies of intentional peer support in mental health services. Articles were summarised and findings analysed. RESULTS: The literature demonstrates that PSWs can lead to a reduction in admissions among those with whom they work. Additionally, associated improvements have been reported on numerous issues that can impact on the lives of people with mental health problems. CONCLUSION: PSWs have the potential to drive through recovery-focused changes in services. However, many challenges are involved in the development of peer support. Careful training, supervision and management of all involved are required.

Assessing risk of self-harm in acute paediatric settings: a multicentre exploratory evaluation of the CYP-MH SAPhE instrument.

OBJECTIVE: To psychometrically assess the Children and Young People-Mental Health Self-harm Assessment in Paediatric healthcare Environments (CYP-MH SAPhE) instrument for the identification of immediate risk of self-harm in CYP, aged 10-19 years, in acute paediatric wards or emergency departments. DESIGN: The CYP-MH SAPhE Instrument was developed through a robust scoping review and Delphi consensus with 30 clinicians/topic experts. To evaluate the psychometric properties, a multicentre exploratory study was conducted. SETTING: Three acute hospitals in the UK. PARTICIPANTS: 163 CYP presenting at acute hospital settings with primary mental health (cases) or physical health (non-cases) conditions. PRIMARY AND SECONDARY OUTCOME MEASURES: Psychometric properties of the CYP-MH SAPhE instrument were evaluated through Principle Axis Factoring (PAF) with Oblimin (Kaiser normalisation) alongside measures of internal consistency (Cronbach's α), convergent, discriminant and face validity. RESULTS: PAF of the dichotomous items (n=9) loaded onto three factors (1) behaviours and intentions; (2) suicidality and (3) self-harm. Factors 1 (Cronbach's α=0.960) and 3 (Cronbach's α=1) had high internal consistency. There was: good level of agreement between raters (kappa=0.65); a moderately positive correlation between the CYP-MH SAPhE instrument and the Columbia-Suicide Severity Rating Scale; and discrimination between cases and non-cases across the three factors (factor 1: m=88 vs 70; factor 2: m=102 vs 70; factor 3: m=104 vs 68). Assessment of face validity resulted in six items being removed, culminating in an eight question, rapid assessment instrument. CONCLUSIONS: The results support the CYP-MH SAPhE Tool as a potentially reliable and valid instrument to identify immediate risk of self-harm in CYP presenting to acute paediatric healthcare environments, which is a burgeoning and significant global health issue.

The effect of physical activity on anxiety in children and young people: a systematic review and meta-analysis.

BACKGROUND: There is emerging evidence that physical activity can have beneficial effects on anxiety. A comprehensive synthesis of the evidence of the anxiolytic effects of physical activity from randomised controlled trials (RCTs) in children and young people (CYP) is warranted. METHODS: A search of 13 databases was conducted to identify RCTs testing the effects of physical activity on anxiety symptoms in children and young people (up to 25 years). Screening, data extraction and risk of bias assessment (using the Cochrane Collaboration tool for assessing risk of bias) were independently undertaken by two study authors. The primary analysis used a random effects model to compare the effect of physical activity interventions to no intervention or minimal intervention control conditions on state anxiety, assessed using validated, self-report measures. RESULTS: Of the 3590 articles retrieved, 22 RCTs were included, with nine included in the primary meta-analysis. The overall standardised mean difference was 0.54 (95% CI -0.796, -0.28), representing a moderate improvement in state anxiety, compared to no intervention or minimal intervention control conditions. Physical activity was also found to produce significantly superior effects on state anxiety when compared to a time and attention-controlled group. LIMITATIONS: The studies are of low quality overall, and there are a limited number of studies included in the meta-analyses therefore limiting the precision of results. CONCLUSIONS: Physical activity may be a useful approach to addressing anxiety symptoms in children and young people, however, further trials of clinical populations are required to determine the effectiveness of physical activity as a treatment of anxiety disorders.