If effective, less intensive treatments for people with personality disorder have the potential to serve more people.To compare the clinical effectiveness and cost-effectiveness of psychoeducation with problem-solving (PEPS) therapy plus usual treatment against usual treatment alone in improving social problem-solving with adults with personality disorder.Multisite two-arm, parallel-group, pragmatic randomised controlled superiority trial.Community mental health services in three NHS trusts in England and Wales.Community-dwelling adults with any personality disorder recruited from community mental health services.Up to four individual sessions of psychoeducation, a collaborative dialogue about personality disorder, followed by 12 group sessions of problem-solving therapy to help participants learn a process for solving interpersonal problems.The primary outcome was measured by the Social Functioning Questionnaire (SFQ). Secondary outcomes were service use (general practitioner records), mood (measured via the Hospital Anxiety and Depression Scale) and client-specified three main problems rated by severity. We studied the mechanism of change using the Social Problem-Solving Inventory. Costs were identified using the Client Service Receipt Inventory and quality of life was identified by the European Quality of Life-5 Dimensions questionnaire. Research assistants blinded to treatment allocation collected follow-up information.There were 739 people referred for the trial and 444 were eligible. More adverse events in the PEPS arm led to a halt to recruitment after 306 people were randomised (90% of planned sample size); 154 participants received PEPS and 152 received usual treatment. The mean age was 38 years and 67% were women. Follow-up at 72 weeks after randomisation was completed for 62% of participants in the usual-treatment arm and 73% in the PEPS arm. Intention-to-treat analyses compared individuals as randomised, regardless of treatment received or availability of 72-week follow-up SFQ data. Median attendance at psychoeducation sessions was approximately 90% and for problem-solving sessions was approximately 50%. PEPS therapy plus usual treatment was no more effective than usual treatment alone for the primary outcome [adjusted difference in means for SFQ -0.73 points, 95% confidence interval (CI) -1.83 to 0.38 points; p = 0.19], any of the secondary outcomes or social problem-solving. Over the follow-up, PEPS costs were, on average, £182 less than for usual treatment. It also resulted in 0.0148 more quality-adjusted life-years. Neither difference was statistically significant. At the National Institute for Health and Care Excellence thresholds, the intervention had a 64% likelihood of being the more cost-effective option. More adverse events, mainly incidents of self-harm, occurred in the PEPS arm, but the difference was not significant (adjusted incidence rate ratio 1.24, 95% CI 0.93 to 1.64).There was possible bias in adverse event recording because of dependence on self-disclosure or reporting by the clini...

At a time of competing demands on the National Health Service (NHS), systematic consultant job planning is necessary to ensure that limited resources are being used productively, especially with the prospect of expanded 7-day services. Based on a presentation to the Royal College of Physicians Annual Conference in March 2016, a broad overview of job planning is presented, together with more specifi c examples relating to acute medicine and gastroenterology/general medicine.

Background: Evidence indicates that the more traditional and behavioural parenting strategies are ineffective when parenting a child who has experienced developmental trauma. Recognising the need to parent with an attachment focus, the current paper evaluates the effectiveness of running the [Enfys] Nurturing Attachments Group, virtually, within the context of the COVID-19 pandemic. Method: A pilot feasibility study evaluated eight bespoke groups. Consenting professionals and co-professionals completed the Brief Parental Self-Efficacy Scale (BFSS), Care Questionnaire (CQ) and the Parental Reflective Functioning Questionnaire (PRFQ). Results: One hundred forty individuals attended the groups, with 51 (36%) completing both pre-and post-measures. The results provide evidence that professionals and co-professionals reported statistically significant positive increases on both the BPSS ( d = .55) and CQ ( d = .62). For the PRFQ, the results showed a statistically significant decrease on the Pre-mentalising sub scale, a non-significant mid-range score for Certainty about Mental States and a non-significant increase for Parental Interest and Curiosity in Mental States. Conclusion: The study has demonstrated initial viability of effectively facilitating the [Enfys] Nurturing Attachments Group, virtually. Importantly, it has also shown that the group can be run with professionals alongside co-professionals.

The Doctor of Nursing Practice (DNP) degree is gaining interest within the nursing profession but not without debate. A review of the literature regarding the DNP demonstrates that the debate focuses on academic, clinical, and professional practice issues of nursing. The multiple points of debate as well as the positive and negative perspectives leads one to question whether an author's degree credentials correlate with their expression of positive or negative sentiment towards the DNP. The points of debate surrounding the DNP were identified from the literature and adapted into a sentiment analysis tool. The tool was used for the extraction of positive or negative sentiment from 90 pieces of DNP and practice doctorate related literature. The positive or negative sentiment expressed by each author was correlated with their credentials. No particular sentiment was found that correlated with non-DNP credentialed authors. However, a correlation was identified between DNP credentialed authors and the expression of positive sentiment toward the DNP.

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BackgroundCo-morbid osteoarthritis (OA), anxiety and depression are undermanaged in primary care yet have significant impact on pain, disability and outcomes of other long-term conditions (LTCs).ObjectivesTo test the feasibility and acceptability of integrating case-finding and initial management for OA, anxiety and depression within extended primary care practice nurse (PN)-led LTC review consultations.MethodsA stepped wedge pilot trial with process evaluation. PNs gave a study pack to patients age ≥45 years attending routine LTC reviews (asthma, COPD, hypertension, ischaemic heart disease, diabetes). The intervention included case finding questions (Generalized Anxiety Disorder (GAD2), Whooley 2-item depression, diagnosing OA clinically (hands, hips, knees or feet)) followed by further assessments (anxiety (GAD7), depression (PHQ9), joint examination). PNs completed an electronic patient record and initiated management. Pre-determined success criteria were to recruit 4 practices; deliver training to 2 PNs per practice, recruit 50% of those invited, ensure 75% follow up (6 week, 6 month), and the satisfaction (GPAQ) of intervention patients to be at least as acceptable as that of control patients. 24 audio recorded consultations provided insight into fidelity of intervention delivery.ResultsFour practices were recruited. PNs were sequentially trained in practice prior to switching to intervention. Of the 474 people invited, 319 responded (207 control, 112 intervention) (67%). 83% and 79% of participants returned 6 week and 6 month questionnaires respectively. Demographic characteristics, general health, pain intensity, anxiety and depression scores were similar across arms. Overall, self-reported health (EQ5D5L) was high (median 0.84; IQR 0.72, 0.94). 14% of participants reported moderate to severe depression (PHQ9). Median GPAQ scores were similar (control 1.00 (IQR: 1.00, 1.29), intervention 1.00 (IQR: 1.00, 1.14)). 96% of those in the intervention arm reported being asked about joint pain, 93% reported being asked about mood. Audio recordings revealed that case finding questions were used as intended in most consultations (joint pain 20/24 consultations, anxiety 15/24, depression 6/24). One referral to physiotherapy and none to primary care mental health services were recorded by the PNs.ConclusionsRecruitment and follow up were good. However, to target those who may benefit from the intervention, changes to the target population and eligibility criteria are required. There was reasonable delivery of the case finding questions, but limited referral and signposting, highlighting areas to optimise ahead of a main trial.AcknowledgementsELH, CJ, CCG, ALE and CDM are part funded by NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands. CDM is funded by NIHR School for Primary Care Research, NIHR Research Professorship in General Practice (NIHR-RP-2014–04–026). KSD is part-funded by an NIHR Knowledge Mobilisation Research Fellowship (KMRF-2014–03–002). Views expressed in this paper are...