Browsing by Author "Clifton, Andrew"

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    Co-production: facilitating evidence based practice
    (John Wiley & Sons Ltd., 2018) Clifton, Andrew; Nobel, Jane
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    Concealment, communication and stigma: The perspectives of HIV-positive immigrant Black African men and their partners living in the United Kingdom
    (Sage, 2015-07-06) Owuor, John O. A.; Locke, Abigail; Heyman, Bob; Clifton, Andrew
    This study explored the perspectives of Black men, originally from East Africa, living in the United Kingdom and their partners on what it means to live with diagnosed HIV. This article reports on concealment of HIV-positive status as a strategy adopted by the affected participants to manage the flow of information about their HIV-positive status. Analysis of the data, collected using in-depth interviews involving 23 participants, found widespread selective concealment of HIV-positive status. However, a few respondents had 'come out' publicly about their condition. HIV prevention initiatives should recognise concealment as a vital strategy in managing communication about one's HIV-positive status.
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    Evaluating a train-the-trainer educational intervention to raise standards of care, within the nursing home sector in the United Kingdom
    (OAT, 2018-12-17) Clifton, Andrew; de Vries, Kay; Juttla, Karan; Welyczko, Nikki; Carroll, Rachael; O’Keeffe, Gabriella
    Objective: As a response to service needs and project development by the East Midlands Health Innovation Education Cluster, now the Health Education East Midlands, an education programme intervention was developed to raise the standards of clinical and non-clinical care, particularly within the nursing home sector. This paper discusses the development of the intervention based on the “train-the-trainer” model presenting data which highlights improved service quality and a reduction in NHS costs as a result of the training. Methods: The programme measured pre and post impact of the programme on the knowledge and confidence of the staff who took part and captured the impact of the overall training in terms of reported measures such as falls, urinary tract infections, referrals from nursing homes to an emergency department, and number of GP call outs to nursing homes. Results: Analysis revealed; an increase in knowledge and confidence of staff following training, an improvement in outcomes for all key measures including; falls, urinary tract infections, referrals to emergency departments, and number of GP callouts. The data also highlights cost reduction in all these areas based on cost estimates. Conclusions: There is evidence that the delivery of an education intervention in nursing homes, based on local/regional needs and adopting a 'train-the-trainer' approach can improve outcomes for residents and reduce costs for providers, including the NHS, in regard to reduced GP callouts and hospital admissions. It is important to have pre and post data collection measures in place to capture its impact on service quality and evaluate the cost effectiveness of programmes.
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    Examining the UK Covid-19 mortality paradox: Pandemic preparedness, healthcare expenditure and the nursing workforce
    (Wiley, 2020-09-10) Stribling, Julian; Clifton, Andrew; McGill, George; de Vries, Kay
    Aim To examine the UK pandemic preparedness in light of health expenditure, nursing workforce, and mortality rates in and relation to nursing leadership. Background The Global Health Security Index categorised the preparedness of 195 countries to face a biological threat on a variety of measures, producing an overall score. The United States of America and the United Kingdom were ranked 1st and 2nd most prepared in 2019. Method A cross-nation comparison of the top-36 countries ranked by Global Health Security score using a variety of online sources, including key data about each nation’s expenditure on health and the nursing workforce, and compared these with mortality data for COVID-19. Results The extent of a countries pandemic preparedness, expenditure on healthcare and magnitude of the nursing workforce does not appear to impact mortality rates at this stage of the pandemic which is something of a paradox. Conclusion It is important that arrangements for dealing with future global pandemics involve a range of agencies and experts in the field, including nurse leaders. Implications for Nursing To achieve the best outcomes for patients, nurse leaders should be involved in policy forums at all levels of government to ensure nurses can influence health policy.
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    An exploration of clinician attitudes towards older adults experiencing mental and physical health problems in the UK
    (Common Ground Publishing, 2016) Clifton, Andrew; Marples, Gwen; Clarke, Amanda; Wilcockson, Jane; Harrington, Barbara; Brady, Danielle
    It has been suggested that agism, stigma and other forms of discrimination lead to older adults with serious mental illness (SMI) being invisible in policy, practice and research. This paper explores and critically examines stakeholders’ attitudes and perceptions concerning older adults with serious mental illness also experiencing physical health needs based on research conducted in the UK. A qualitative case study approach was utilised and a purposive sample of 24 staff involved in the commissioning, managing, planning and provision of services for older adults with SMI were recruited. Data collected from ten semi-structured interviews and two focus groups was analysed using a framework analysis and four themes emerged: Defining the patient group and their journey in care; seeing the whole person; Devolving care (falling through the gap); and Making it happen and moving forward. Although participants held positive attitudes towards older adults with SMI with an emphasis on the provision of holistic care, gaps in service provision and organisational structures were apparent. Service users appeared to be moved through services dependent on presentation rather than need, without a coordinated approach. Practitioners felt it was becoming increasingly challenging to manage physical healthcare needs in addition to managing more pressing mental health issues and many older adults with SMI and physical health needs were falling through the gap. However, the hospital trust was seen to be making steady progress with the implementation of early warning systems, recognition of the importance of education for all healthcare professionals and early signs of linkage between services. It is suggested that more collaborative working between relevant services is required, and it is proposed that the establishment of a community psychiatric liaison service to coordinate care could prevent crisis situations arising for patients with co-morbidities.
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    An exploration of why qualified mental health nurse prescribers do not prescribe
    (MAG Open, 2019-02-05) Gillibrand, Warren; Clifton, Andrew; Oldknow, Helen
    This article is an exploratory study of perceptions in mental health nurses who are qualified to prescribe yet choose not to do so. In-depth semi-structured face-to-face interviews, field notes and analysis of documents were used to investigate the perceptions of the non–prescribing nurse prescriber. A mapping exercise was conducted to identify potential participants. Interview data analysis was based on the principles of descriptive phenomenology and the research was theoretically framed within concepts of power, structure/agency and culture. This study has contributed to understanding the views of non‑prescribing mental health nurse prescribers on why they do not use their prescribing qualification. The findings from this study suggest that there are complex, interlocking factors: power and knowledge; culture; and structure and agency, which may enable or prevent mental health nurse prescribers from independently prescribing.
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    Facilitating knowledge of mental health nurses to undertake physical health interventions: a pre-test/post-test evaluation
    (John Wiley & Sons Ltd, 2014-03-07) Hemingway, Steven; Clifton, Andrew; Stephenson, J.; Edward, Karen-Leigh
    AIM: The aim of this project was to develop and deliver an evidence-based educational package with a physical and mental health focus to clinicians and other health care workers in mental health settings. BACKGROUND: For individuals who experience mental disorders, pharmacotherapy is often considered as a first line of treatment. However, owing to adverse drug reactions and pre-existing physical conditions, outcomes for clients/service users may be compromised. Mortality and morbidity rates of people diagnosed with a serious mental illness caused by physical health conditions do not compare favourably with the general population. This paper reports on a physical skills project that was developed in collaboration between the University of Huddersfield and South West Yorkshire Partnership Foundation Trust. METHOD: Pre-post study design: five workshops were conducted in the fields of intramuscular injections, diabetes, health improvement, oral health and wound care. A total of 180 pairs of questionnaires to assess practitioner and student skills and knowledge were administered to participants before and after workshops. All workshops resulted in a statistically significant improvement in subject skills and knowledge scores (P < 0.001 in all cases). Questionnaires also elicited participant satisfaction with the workshops: over 99% of participants reported being 'satisfied' or 'very satisfied' with the workshops. IMPLICATIONS FOR NURSING MANAGEMENT: Mental health nurses are the largest group of registered practitioners working in the mental health setting and thus need to be harnessed to make a positive contribution to the improvement of the physical health status of service users with a serious mental illness
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    The future of mental health nursing education in the United Kingdom: reflections on the Australian and New Zealand experience
    (Wiley, 2016-06-16) Hemingway, Steven; Clifton, Andrew; Edward, Karen-Leigh
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    General physical health advice for people with serious mental illness.
    (Wiley, 2014-06) Tosh, Graeme E.; Clifton, Andrew; Xia, J.; White, M. M.
    BACKGROUND: There is currently much focus on provision of general physical health advice to people with serious mental illness and there has been increasing pressure for services to take responsibility for providing this. OBJECTIVES: To review the effects of general physical healthcare advice for people with serious mental illness. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Trials Register (last update search October 2012) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO and registries of Clinical Trials. There is no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA: All randomised clinical trials focusing on general physical health advice for people with serious mental illness.. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS: Seven studies are now included in this review. For the comparison of physical healthcare advice versus standard care we identified six studies (total n = 964) of limited quality. For measures of quality of life one trial found no difference (n = 54, 1 RCT, MD Lehman scale 0.20, CI -0.47 to 0.87, very low quality of evidence) but another two did for the Quality of Life Medical Outcomes Scale - mental component (n = 487, 2 RCTs, MD 3.70, CI 1.76 to 5.64). There was no difference between groups for the outcome of death (n = 487, 2 RCTs, RR 0.98, CI 0.27 to 3.56, low quality of evidence). For service use two studies presented favourable results for health advice, uptake of ill-health prevention services was significantly greater in the advice group (n = 363, 1 RCT, MD 36.90, CI 33.07 to 40.73) and service use: one or more primary care visit was significantly higher in the advice group (n = 80, 1 RCT, RR 1.77, CI 1.09 to 2.85). Economic data were equivocal. Attrition was large (> 30%) but similar for both groups (n = 964, 6 RCTs, RR 1.11, CI 0.92 to 1.35). Comparisons of one type of physical healthcare advice with another were grossly underpowered and equivocal. AUTHORS' CONCLUSIONS: General physical health could lead to people with serious mental illness accessing more health services which, in turn, could mean they see longer-term benefits such as reduced mortality or morbidity. On the other hand, it is possible clinicians are expending much effort, time and financial resources on giving ineffective advice. The main results in this review are based on low or very low quality data. There is some limited and poor quality evidence that the provision of general physical healthcare advice can improve health-related quality of life in the mental component but not the physical component, but this evidence is based on data from one study only. This is an important area for good research reporting outcome of interest to carers and people with serious illnesses as well as researchers and fundholders.
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    HIV prevention advice for people with serious mental illness.
    (Wiley: Cochrane Library, 2016-09-09) Wright, Nicola; Akhtar, Athfah; Tosh, Graeme E.; Clifton, Andrew
    Background People with serious mental illness have rates of Human Immuno-deficiency Virus (HIV) infection higher than expected in the general population for the same demographic area. Despite this elevated prevalence, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. However, a significant proportion in this group are sexually active and engage in HIV-risk behaviours including having multiple sexual partners, infrequent use of condoms and trading sex for money or drugs. Therefore we propose the provision of HIV prevention advice could enhance the physical and social well being of this population. Objectives To assess the effects of HIV prevention advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness. Search methods We searched the Cochrane Schizophrenia Group’s Trials Register (24 January 2012; 4 July 2016). Selection criteria We planned to include all randomised controlled trials focusing on HIV prevention advice versus standard care or comparing HIV prevention advice with other more focused methods of delivering care or information for people with serious mental illness. Data collection and analysis Review authors (NW, AC, AA, GT) independently screened search results and did not identify any studies that fulfilled the review’s criteria. Main results We did not identify any randomised studies that evaluated advice regarding HIV for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to both people with serious mental illness and HIV risk are possible. Authors’ conclusions Policy makers, clinicians, researchers and service users need to collaborate to produce guidance on how best to provide advice for people with serious mental illness in preventing the spread
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    “Like an unbridled horse that runs away with you”: A study of older and disabled people during the COVID-19 pandemic and their use of digital technologies.
    (Taylor and Francis, 2023-05-31) Clayton, David; de Vries, Kay; Clifton, Andrew; Cousins, Emily; Norton, Wendy; Seims, Melissa
    This study explored the uses of digital technologies by older and disabled people who were social distancing and shielding during the early Covid-19 pandemic lockdowns. The study considers the benefits, difficulties, and technical support needs of these groups of people during this time. Using a case study methodology, in-depth interviews were undertaken with 11 older and disabled people recruited from a local digital support service, and their support workers. Five main themes were identified by the research team. These were: technology was a mixed blessing and caused frustration; technology use increased during lockdown; technology supported resilience and contributed to identity through “stimulation, knowledge and friendship”; technology needs to be accessible, and support was required to facilitate technology use. Understanding these experiences will enable policymakers, commissioners, and providers to develop better and more responsive digital support for older and disabled people in the future.
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    Monitoring oral health of people in Early Intervention for Psychosis teams: The extended Three Shires randomised trial
    (Elsevier, 2017-10-16) Clifton, Andrew; Adams, C.; Clark Wells, N.; Jones, Hannah; Simpson, J.; Tosh, G.; Callaghan, P.; Liddle, P.; Bollang, G.; Furtadoe, V.; Khokhar, M. A.; Aggarwalg, V.
    Background The British Society for Disability and Oral Health guidelines made recommendations for oral health care for people with mental health problems, including providing oral health advice, support, promotion and education. The effectiveness of interventions based on these guidelines on oral health-related outcomes in mental health service users is untested. Objective To acquire basic data on the oral health of people with or at risk of serious mental illness. To determine the effects of an oral health checklist in routine clinical practice. Design: Clinician and service user-designed cluster randomised trial. Settings and Participants The trial compared a simple form for monitoring oral health care with standard care (no form) for outcomes relevant to service use and dental health behaviour for people with suspected psychosis in Mid and North England. Thirty-five teams were divided into two groups and recruited across 2012-3 with one year follow up. Results 18 intervention teams returned 882 baseline intervention forms and 274 outcome sheets one year later (31%). Control teams (n=17) returned 366 baseline forms. For the proportion for which data were available at one year we found no significant differences for any outcomes between those allocated to the initial monitoring checklist and people in the control group (Registered with dentist (p=0.44), routine check-up within last year (p= 0.18), owning a toothbrush (p= 0.99), cleaning teeth twice a day (p=0.68), requiring urgent dental treatment (p=0.11). Conclusion This trial provides no clear evidence that Care Co-ordinators (largely nursing staff) using an oral health checklist improves oral health behaviour or oral health state in those thought to be at risk of psychosis or with early psychosis.
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    My Story: Using a life story approach to build friendships between younger and older people to alleviate loneliness and social isolation
    (Emerald, 2022-11-10) Clayton, David; Clifton, Andrew; de Vries, Kay; Kuuya, Henson; Ochieng, B.
    Loneliness and social isolation for older people remain a problem. Intergenerational befriending may be one solution that could help with loneliness and social isolation. ‘My Story’ is based on a life story approach aimed at facilitating friendship by providing a format for older and younger people to interact. An original pilot was undertaken to test the approach by bringing together older people identified as lonely by a voluntary sector provider and pairing these with a student volunteer. The students visited the older person over six weeks to discuss their life story and create an artefact based on the story of the older person. Three pairings were studied to explore the experiences of the older and younger person using ‘My Story’. The focus of the case studies was if a therapeutic alliance emerged which could lead to friendship. The research found that in the two of the pairings, ‘My Story’ helped to create mutual benefit and a therapeutic bond that could lead to friendship. As this was an exploratory and small pilot, more cases and further research is required to fully assess if ‘My Story’ is an effective approach to intergenerational befriending.
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    Oral health education (advice and training) for people with seriousmental illness (Review)
    (Wiley: Cochrane Library, 2016-01-07) Khokhar, M. A.; Khokhar, W. A.; Clifton, Andrew; Tosh, Graeme E.
    Background People with serious mental illness not only experience an erosion of functioning in day-to-day life over a protracted period of time, but evidence also suggests that they have a greater risk of experiencing oral disease and greater oral treatment needs than the general population. Poor oral hygiene has been linked to coronary heart disease, diabetes, and respiratory disease and impacts on quality of life, affecting everyday functioning such as eating, comfort, appearance, social acceptance, and self esteem. Oral health, however, is often not seen as a priority in people suffering with serious mental illness. Objectives To review the effects of oral health education (advice and training) with or without monitoring for people with serious mental illness. Search methods We searched the Cochrane Schizophrenia Group’s Trials Register (5November 2015), which is based on regular searches ofMEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the register. Selection criteria All randomised clinical trials focusing on oral health education (advice and training) with or without monitoring for people with serious mental illness. Data collection and analysis We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created ’Summary of findings’ tables using GRADE. Main results We included three randomised controlled trials (RCTs) involving 1358 participants. None of the studies provided useable data for the key outcomes of not having seen a dentist in the past year, not brushing teeth twice a day, chronic pain, clinically important adverse events, and service use. Data for leaving the study early and change in plaque index scores were provided. Oral health education compared with standard care When ’oral health education’ was compared with ’standard care’, there was no clear difference between the groups for numbers leaving the study early (1 RCT, n = 50, RR 1.67, 95%CI 0.45 to 6.24, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect was found. Although this was statistically significant and favoured the intervention group, it is unclear if it was clinically important (1 RCT, n = 40, MD - 0.50 95% CI - 0.62 to - 0.38, very low quality evidence).These limited data may have implications regarding improvement in oral hygiene. Motivational interview + oral health education compared with oral health education Similarly, when ’motivational interview + oral health education’ was compared with ’oral health education’, there was no clear difference for the outcome of leaving the study early (1 RCT, n = 60 RR 3.00, 95% CI 0.33 to 27.23, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect favouring the intervention group was found (1 RCT, n = 56, MD - 0.60 95% CI - 1.02 to - 0.18 very low-quality evidence). These limited, clinically opaque data may or may not have implications regarding improvement in oral hygiene. Monitoring compared with no monitoring For this comparison, only data for leaving the study early were available. We found a difference in numbers leaving early, favouring the ’no monitoring’ group (1 RCT, n = 1682, RR 1.07, 95% CI 1.00 to 1.14, moderate-quality evidence). However, these data are problematic. The control denominator is implied and not clear, and follow-up did not depend only on individual participants, but also on professional caregivers and organisations - the latter changing frequently resulting in poor follow-up, but not a good reflection of the acceptability of the monitoring to patients. For this comparison, no data were available for ’no clinically important change in plaque index’. Authors’ conclusions We found no evidence from trials that oral health advice helps people with serious mental illness in terms of clinically meaningful outcomes. It makes sense to follow guidelines and recommendations such as those put forward by the British Society for Disability and Oral Health working group until better evidence is generated. Pioneering
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    Peer support for people with schizophrenia or other serious mental illness.
    (John Wiley & Sons, Ltd., 2019-03-30) Lui, S; Clifton, Andrew; Chien, W. T.; Zhao, S.
    Background Peer support provides the opportunity for peers with experiential knowledge of a mental illness to give emotional, appraisal and informational assistance to current service users, and is becoming an important recovery-oriented approach in healthcare for people with mental illness. Objectives To assess the effects of peer-support interventions for people with schizophrenia or other serious mental disorders, compared to standard care or other supportive or psychosocial interventions not from peers. Search methods We searched the Cochrane Schizophrenia Group’s Study-Based Register of Trials on 27 July 2016 and 4 July 2017. There were no limitations regarding language, date, document type or publication status. Selection criteria We selected all randomised controlled clinical studies involving people diagnosed with schizophrenia or other related serious mental illness that compared peer support to standard care or other psychosocial interventions and that did not involve ’peer’ individual/ group(s). We included studies that met our inclusion criteria and reported useable data. Our primary outcomes were service use and global state (relapse). Data collection and analysis The authors of this review complied with the Cochrane recommended standard of conduct for data screening and collection. Two review authors independently screened the studies, extracted data and assessed the risk of bias of the included studies. Any disagreement was resolved by discussion until the authors reached a consensus. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary data, and the mean difference and its 95% CI for continuous data.We used a random-effects model for analyses.We assessed the quality of evidence and created a ’Summary of findings’ table using the GRADE approach. Main results This review included 13 studies with 2479 participants. All included studies compared peer support in addition to standard care with standard care alone. We had significant concern regarding risk of bias of included studies as over half had an unclear risk of bias for the majority of the risk domains (i.e. random sequence generation, allocation concealment, blinding, attrition and selective reporting). Additional concerns regarding blinding of participants and outcome assessment, attrition and selective reporting were especially serious, as about a quarter of the included studies were at high risk of bias for these domains. All included studies provided useable data for analyses but only two trials provided useable data for two of our main outcomes of interest, and there were no data for one of our primary outcomes, relapse. Peer support appeared to have little or no effect on hospital admission at medium term (RR 0.44, 95% CI 0.11 to 1.75; participants = 19; studies = 1, very low-quality evidence) or all-cause death in the long term(RR 1.52, 95%CI 0.43 to 5.31; participants = 555; studies = 1, very low-quality evidence). There were no useable data for our other prespecified important outcomes: days in hospital, clinically important change in global state (improvement), clinically important change in quality of life for peer supporter and service user, or increased cost to society. One trial compared peer support with clinician-led support but did not report any useable data for the above main outcomes. Authors’ conclusions Currently, very limited data are available for the effects of peer support for people with schizophrenia. The risk of bias within trials is of concern and we were unable to use the majority of data reported in the included trials. In addition, the few that were available, were of very low quality. The current body of evidence is insufficient to either refute or support the use of peer-support interventions for people with schizophrenia and other mental illness.
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    The role of universities in attracting male students on to pre-registration nursing programmes: An electronic survey of UK higher education institutions
    (Elsevier, 2018-09-19) Clifton, Andrew; Higman, Jo; Stephenson, John; Navarro, Alfonso R.; Welyczko, Nikki
    The UK nursing workforce is facing a crisis. More nurses are leaving than entering the profession, and there are tens of thousands of unfilled vacancies. Political factors are having a significant impact on numbers, in particular the decision to withdraw bursaries for nursing undergraduates, and a steep decline in EU nurses registering to work in the UK post-Brexit. Against this backdrop, there is a stark gender imbalance in the workforce, with only around 11% of registered nurses being male. We surveyed UK higher education institutions to try to identify whether the gendered nature of nursing was considered a concern and whether steps were being taken to address it. We sent an electronic survey to every UK university offering undergraduate nurse training validated by the Nursing and Midwifery Council (NMC). With a response rate of 42%, the majority of respondents felt that nursing departments should take much more responsibility to increase the proportion of male nurses entering the nursing profession. More needs to be done to diversify the workforce and make nursing an appealing career choice for men and women.
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    Smoking cessation advice for people with serious mental
    (Wiley, 2016-01-28) Khanna, Priya; Clifton, Andrew; Banks, David; Tosh, Graeme E.
    Background People with a serious mental illness are more likely to smoke more and to be more dependent smokers than the general population. This may be due to a wide range of factors that could include a common aetiology to both smoking and the illness, self medication, smoking to alleviate adverse effects of medications, boredom in the existing environment, or a combination of these factors. It is important to undertake this review to facilitate improvements in both the health and safety of people with serious mental illness who smoke, and to reduce the overall burden of costs (both financial and health) to the smoker and, eventually, to the taxpayer. Objectives To review the effects of smoking cessation advice for people with serious mental illness. Search methods We searched the Cochrane Schizophrenia Group Specialized Trials Register up to 2 April 2015, which is based on regular searches of CENTRAL, BIOSIS, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and trial registries. We also undertook unsystematic searches of a sample of the component databases (BNI, CINHAL, EMBASE, MEDLINE, and PsycINFO), up to 2 April 2015, and searched references of all identified studies Selection criteria We planned to include all randomised controlled trials (RCTs) that focussed on smoking cessation advice versus standard care or comparing smoking cessation advice with other more focussed methods of delivering care or information. Data collection and analysis The review authors (PK, AC, and DB) independently screened search results but did not identify any trials that fulfilled the inclusion criteria of this review. Main results We did not identify any RCTs that evaluated advice regarding smoking cessation for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to smokers with serious mental illness is possible. Authors’ conclusions People with serious mental illness are more likely to smoke than the general population. Yet we could not find any high quality evidence to guide the smoking cessation advice healthcare professionals pass onto service users. This is an area where trials are possible and needed.
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    Valproate preparations for agitation in dementia (Review)
    (Wiley, 2018-10-05) Clifton, Andrew; Narayanan, U.; Baillon, S.F.; Luxenburg, J.S.
    Background Agitation has been reported in up to 90% of people with dementia. Agitation in people with dementia worsens carer burden, increases the risk of injury, and adds to the need for institutionalisation. Valproate preparations have been used in an attempt to control agitation in dementia, but their safety and efficacy have been questioned. Objectives To determine the efficacy and adverse effects of valproate preparations used to treat agitation in people with dementia, including the impact on carers. Search methods We searched ALOIS - the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register on 7 December 2017 using the terms: valproic OR valproate OR divalproex. ALOIS contains records from all major health care databases (the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources. Selection criteria Randomised, placebo-controlled trials that assessed valproate preparations for agitation in people with dementia. Data collection and analysis Two review authors independently screened the retrieved studies against the inclusion criteria and extracted data and assessed methodological quality of the included studies. If necessary, we contacted trial authors to ask for additional data, including relevant subscales, or for other missing information. We pooled data in meta-analyses where possible. This is an update of a Cochrane Review last published in 2009. We found no new studies for inclusion. Main results The review included five studies with 430 participants. Studies varied in the preparations of valproate,mean doses (480 mg/day to 1000 mg/day), duration of treatment (three weeks to six weeks), and outcome measures used. The studies were generally well conducted although some methodological information was missing and one study was at high risk of attrition bias. The quality of evidence related to our primary efficacy outcome of agitation varied from moderate to very low. We found moderatequality evidence from two studies that measured behaviour with the total Brief Psychiatric Rating Scale (BPRS) score (range 0 to 108) Valproate preparations for agitation in dementia (Review) Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. and with the BPRS agitation factor (range 0 to 18). They found that there was probably little or no effect of valproate treatment over six weeks (total BPRS: mean difference (MD) 0.23, 95% confidence interval (CI) -2.14 to 2.59; 202 participants, 2 studies; BPRS agitation factor: MD -0.67, 95% CI -1.49 to 0.15; 202 participants, 2 studies). Very low-quality evidence from three studies which measured agitation with the Cohen-Mansfield Agitation Index (CMAI) were consistent with a lack of effect of valproate treatment on agitation. There was variable quality evidence on other behaviour outcomes reported in single studies of no difference between groups or a benefit for the placebo group. Three studies, which measured cognitive function using the Mini-Mental State Examination (MMSE), found little or no effect of valproate over six weeks, but we were uncertain about this result because the quality of the evidence was very low. Two studies that assessed functional ability using the Physical Self-Maintenance Scale (PSMS) (range 6 to 30) found that there was probably slightly worse function in the valproate-treated group, which was of uncertain clinical importance (MD 1.19, 95% CI 0.40 to 1.98; 203 participants, 2 studies; moderate-quality evidence). Analysis of adverse effects and serious adverse events (SAE) indicated a higher incidence in valproate-treated participants. A metaanalysis of three studies showed that there may have been a higher rate of adverse effects among valproate-treated participants than among controls (odds ratio (OR) 2.02, 95% CI 1.30 to 3.14; 381 participants, 3 studies, low-quality evidence). Pooled analysis of the number of SAE for the two studies that reported such data indicated that participants treated with valproate preparations were more likely to experience SAEs (OR 4.77, 95% CI 1.00 to 22.74; 228 participants, 2 studies), but the very low quality of the data made it difficult to draw any firm conclusions regarding SAEs. Individual adverse events that were more frequent in the valproate-treated group included sedation, gastrointestinal symptoms (nausea, vomiting, and diarrhoea), and urinary tract infections. Authors’ conclusions This updated review corroborates earlier findings that valproate preparations are probably ineffective in treating agitation in people with dementia, but are associated with a higher rate of adverse effects, and possibly of SAEs. On the basis of this evidence, valproate therapy cannot be recommended for management of agitation in dementia. Further research may not be justified, particularly in light of the increased risk of adverse effects in this often frail group of people. Research would be better focused on effective non-pharmacological interventions for this patient group, or, for those situations where medication may be needed, further investigation of how to use other medications as effectively and safely as possible.
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    What is mental health?
    (John Wiley & Sons, Ltd., 2018) Felton, Anne; Stacey, Gemma; Hemingway, Steven; Clifton, Andrew