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20 vastly increases the likelihood of incapacity. 2 A variety of validated tools exist to aid the assessment of decision-making capacity such as the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Clinicians often overestimate their patient's decision-making capacity. 2,3 Raymont et al 4 investigated the prevalence of mental incapacity in a cross-sectional study in London and found that incapacity was rarely detected by clinicians or relatives. While the authors noted there was little conflict between patients and treating physicians with regard to treatment decisions, it still leaves the possibility of patients making decisions they do not have the capacity to make. There is a potential for clinical harm, as well as the violation of autonomous choices, if protective measures are not in place because a patient is wrongly assumed to have decision-making capacity. No review so far has compared prevalence of incapacity in two or more different settings. The aim of our review is to estimate the prevalence of incapacity to consent to treatment or admission in different settings. We have included medical and psychiatric patients covering inpatient, outpatient and other settings as well as subspecialities within psychiatry. The results provide guidance to the level of incapacity that clinicians should expect in a variety of different settings. We also compared medical and psychiatric settings to see whether there is a significant difference. Methods We followed PRISMA principles for systematic reviews. We searched all articles published until November 2013 in Embase, Medline or Psychinfo. We used the following search terms: mental competency/or capacity assessments or decision making/informed consent/or consent to treatment in medical wards or hospital units/inpatients or inpatients hospitals, psychiatric/or schizophrenia/or depressive disorder/or mental disorders/or psychiatric patients substance-related disorders/or mood disorders. Inclusion criteria: > participants: any medical or psychiatric patients > assessment: conducted with a validated tool > data about the prevalence of incapacity were either stated directly or were possible to calculate from the available data > data were presented in a binary way (either patients had capacity or not) > any setting including mixed settings > reporting: published in peer review journals and available as electronic or paper full text in any language. Recent court cases in England and Wales have refocused attention on patients' decision-making capacity to consent. Little is known about the prevalence of incapacity across specialities but decision-making capacity is likely to be overestimated by clinicians. The aim of this systematic review is to estimate the prevalence of incapacity to consent to treatment or admission in different medical and psychiatric settings, and compare the two. We conducted an electronic search following PRISMA principles and included 35 studies in psychiatric and 23 studies in medical settings. The 58 included studies revealed 70 data set...

Although quality of many studies was not optimal, the results of this meta analysis support the results of earlier meta analyses. Group cognitive behavioural therapy is effective in older adults with depression.

BackgroundThe duration between first symptom and a cancer diagnosis is important because, if shortened, may lead to earlier stage diagnosis and improved cancer outcomes. We have previously developed a tool to measure this duration in newly-diagnosed patients. In this two-phase study, we aimed further improve our tool and to conduct a trial comparing levels of anxiety between two modes of delivery: self-completed versus researcher-administered.MethodsIn phase 1, ten patients completed the modified tool and participated in cognitive debrief interviews. In phase 2, we undertook a Randomised Controlled Trial (RCT) of the revised tool (Cancer Symptom Interval Measure (C-SIM)) in three hospitals for 11 different cancers. Respondents were invited to provide either exact or estimated dates of first noticing symptoms and presenting them to primary care. The primary outcome was anxiety related to delivery mode, with completeness of recording as a secondary outcome. Dates from a subset of patients were compared with GP records.ResultsAfter analysis of phase 1 interviews, the wording and format were improved. In phase 2, 201 patients were randomised (93 self-complete and 108 researcher-complete). Anxiety scores were significantly lower in the researcher-completed group, with a mean rank of 83.5; compared with the self-completed group, with a mean rank of 104.0 (Mann-Whitney U = 3152, p = 0.007). Completeness of data was significantly better in the researcher-completed group, with no statistically significant difference in time taken to complete the tool between the two groups. When comparing the dates in the patient questionnaires with those in the GP records, there was evidence in the records of a consultation on the same date or within a proscribed time window for 32/37 (86%) consultations; for estimated dates there was evidence for 23/37 consultations (62%).ConclusionsWe have developed and tested a tool for collecting patient-reported data relating to appraisal intervals, help-seeking intervals, and diagnostic intervals in the cancer diagnostic pathway for 11 separate cancers, and provided evidence of its acceptability, feasibility and validity. This is a useful tool to use in descriptive and epidemiological studies of cancer diagnostic journeys, and causes less anxiety if administered by a researcher.Trial registrationISRCTN04475865

This study identified levels of distress, and predictors of levels of distress, in women undergoing assessment for genetic risk of breast/ovarian cancer based on their family history. It comprised a cohort study following 154 women who completed questionnaires at entry into a cancer genetic assessment programme and following risk provision. Independent significant associates of anxiety following risk provision were age, neuroticism, feeling hopeless about developing cancer, a perceived lack of control over developing cancer, lack of a social confidant, and a coping response involving acceptance/resignation. Depression was associated with age, neuroticism, feeling hopeless about developing cancer, lack of social confidant, and a coping response involving acceptance/resignation. To avoid high levels of psychological morbidity in future cohorts undergoing cancer genetic risk assessment, information should be given that emphasises that some degree of control over health outcomes through behaviour change or increased surveillance is possible.

-Patient and visitor violence adversely affects staff and organisations; however, there are few UK data about patient and visitor violence on medical wards. Therefore, we conducted a cross-sectional study using a validated tool (Survey of Violence Experienced by Staff ) in six medical wards in three North Wales district general hospitals to assess the prevalence of violence against healthcare staff. A total of 158 staff responded (12 men, 144 women, two not stated). We found that, within the previous 4 weeks, 83% of staff had experienced verbal aggression, 50% had been threatened and 63% had been physically assaulted. Of those assaulted, 56% sustained an injury, with three requiring medical assessment or treatment. Length of experience in the workplace correlated negatively with verbal abuse, but not with threats or assaults. IntroductionHealthcare workers are one of the most likely groups to experience workplace aggression. 1 Although violence and aggression can occur in all health settings, the most extensive evidence comes from psychiatric wards. 2 The biggest single data set is the Annual National Audit of Violence conducted by the Royal College of Psychiatrists and funded by the British Healthcare Commission, whose final report was published in 2007 and contained information from 131 psychiatric wards across England and Wales. 3 In this report, 58% of nurses reported career incidents that were upsetting or distressing (n=1,809) and 72% had felt threatened or feel unsafe. In addition, 46% had been physically assaulted over the previous year. Fewer doctors and nonclinical staff reported such experiences. 3 Despite these results, a comparative international study showed that British psychiatric ward managers perceived violence and aggression to be a smaller problem on their wards compared with their Swiss and German counterparts. This was associated with the availability of control and restraint teams, regular training, clear protocols and, to a lesser degree, risk assessments, but not staffing levels. 4 Outside the psychiatric setting, the picture is less clear. Hahn et al, in a systematic review of patient and visitor violence (PVV), concluded that 'patient and visitor violence is a serious problem for healthcare staff in general hospitals, especially those working in medical and surgical units' . 5 Owing to the heterogeneity of the included studies, it was difficult to gauge a comprehensive picture of the true situation. However, the data showed patient or visitor violence was most often separated into three specific types of incident: verbal aggression, threats and physical assaults. With regards to patient violence, the percentage figures for verbal aggression ranged from 9% in a Swedish study to 97% in a Turkish study. The percentages for threats were equally variable, ranging from 5% in a Jamaican study to 70% in a US study. For physical assaults, the range was from 3% in an Israeli study to 58% in a US study. The prevalence figures for visitor aggression were generally smaller. However, one...

The study has three aims; firstly to establish if, having been informed of their risk status and that gene testing is inappropriate for them, low and moderate risk patients have misunderstood or failed to grasp this and want a test that is inappropriate for them. Secondly, to elicit patients' willingness to pay for cancer genetic services. Thirdly, to ascertain the aspects of cancer genetics services that are important to high risk patients and present service configurations prioritised in terms of preferences accompanied by their costs (cost-consequences analysis). Patient preferences were gathered from 120 patients returning a self-administered discrete choice questionnaire issued post genetic risk assessment. Patients at low and moderate risk of developing breast cancer desired inappropriate testing. Patients at high, moderate and low risk of developing genetic cancer were willing to pay up to 3,000 pounds for genetic serviced, which exceeds the current estimated cost of providing testing and counselling. Counselling by a genetics associate accompanied by favourable levels of other attributes provided high utility and substantial cost savings.

Recent work in muscle sensing has demonstrated the potential of human-computer interfaces based on finger gestures sensed from electrodes on the upper forearm. While this approach holds much potential, previous work has given little attention to sensing finger gestures in the context of three important real-world requirements: sensing hardware suitable for mobile and off-desktop environments, electrodes that can be put on quickly without adhesives or gel, and gesture recognition techniques that require no new training or calibration after re-donning a muscle-sensing armband. In this note, we describe our approach to overcoming these challenges, and we demonstrate average classification accuracies as high as 86% for pinching with one of three fingers in a two-session, eight-person experiment.