scholarly journals Mindfulness-based interventions in secure settings: challenges and opportunities

2013 ◽  
Vol 19 (3) ◽  
pp. 191-200 ◽  
Author(s):  
Dumindu Witharana ◽  
Gwen Adshead
Keyword(s):  
Mental Healthcare ◽  
Evidence Base ◽  
Mechanisms Of Action ◽  
Current Evidence ◽  
Psychological Treatments ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Current Evidence Base ◽  
Challenges And Opportunities ◽  
Recent Developments

SummaryPsychological treatments in secure settings have traditionally been based on psychodynamic and cognitive–behavioural approaches. Recent developments, supported by an emerging evidence base, have generated a significant amount of interest in mindfulness-based psychological therapies and their utility in diverse areas of mental healthcare. In this article we analyse the current evidence base and describe possible mechanisms of action of mindfulness-based psychological approaches. On the basis of the evidence, we advocate a cautious but positive approach to using mindfulness-based interventions in secure services.

scholarly journals Group cognitive–behavioural therapy for anxiety and depression

2010 ◽  
Vol 16 (3) ◽  
pp. 219-227 ◽  
Author(s):  
Graeme Whitfield
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Psychological Treatment ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Current Evidence ◽  
Anxiety And Depression ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Current Evidence Base ◽  
Group Cbt

SummaryCognitive–behavioural therapy (CBT) is a psychological treatment approach that can be delivered not only on a one-to-one basis but also to groups and in self-help formats. However, the evidence base supporting individual CBT is more extensive than the research regarding group CBT. This is likely to influence the choice of services that develop in the Improving Access to Psychological Therapies (IAPT) programme for the treatment of depression and anxiety disorders in primary care in England. This article outlines the different forms that group CBT takes, the way in which it may benefit people and the current evidence base supporting its use for anxiety and depression. It also outlines the advantages of group or individual CBT and describes those patients who appear to be best suited to a specific delivery.

Acupuncture for Gastrointestinal Disorders

2019 ◽  
pp. 229-254
Author(s):  
Malcolm B. Taw ◽  
Andrew Shubov
Keyword(s):  
Gastric Emptying ◽  
Chinese Medicine ◽  
Vagal Tone ◽  
Evidence Base ◽  
Mechanisms Of Action ◽  
Current Evidence ◽  
Gastrointestinal Disorders ◽  
Current Evidence Base ◽  
The Brain ◽  
East West

This chapter provides an introduction to acupuncture, elucidates known neurobiological mechanisms of action, and summarizes the current evidence base for the use of acupuncture in the treatment of various gastrointestinal (GI) disorders. It reviews how acupuncture can increase esophageal and GI motility, reduce transient lower esophageal sphincter relaxations, stimulate gastric emptying, accelerate antral contractions, regulate neurohormonal mediators, promote autonomic and vagal tone, and modulate different regions of the brain-gut-microbiota axis. The therapeutic rationale for acupuncture as well as basic theories and concepts from a traditional Chinese medicine (TCM) perspective are also described. This chapter concludes with a discussion about the potential therapeutic combination of integrative East-West medicine to treat GI disorders.

scholarly journals Intravenous fluids: balancing solutions

2016 ◽  
Vol 30 (4) ◽  
pp. 485-492 ◽  
Author(s):  
Ewout J. Hoorn
Keyword(s):  
Fluid Therapy ◽  
Evidence Base ◽  
Potential Effect ◽  
Current Evidence ◽  
Acid Base Balance ◽  
Current Evidence Base ◽  
Recent Developments ◽  
Base Balance ◽  
Indications And Complications ◽  
Balanced Crystalloids

Abstract The topic of intravenous (IV) fluids may be regarded as “reverse nephrology”, because nephrologists usually treat to remove fluids rather than to infuse them. However, because nephrology is deeply rooted in fluid, electrolyte, and acid-base balance, IV fluids belong in the realm of our specialty. The field of IV fluid therapy is in motion due to the increasing use of balanced crystalloids, partly fueled by the advent of new solutions. This review aims to capture these recent developments by critically evaluating the current evidence base. It will review both indications and complications of IV fluid therapy, including the characteristics of the currently available solutions. It will also cover the use of IV fluids in specific settings such as kidney transplantation and pediatrics. Finally, this review will address the pathogenesis of saline-induced hyperchloremic acidosis, its potential effect on outcomes, and the question if this should lead to a definitive switch to balanced solutions.

scholarly journals Squaring the circle: developing clinical risk management strategies in mental healthcare organisations

2013 ◽  
Vol 19 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Billy Boland ◽  
Sandy Bremner
Keyword(s):  
Risk Management ◽  
Management Practice ◽  
Local Level ◽  
Management Strategies ◽  
Mental Healthcare ◽  
Evidence Base ◽  
Current Evidence ◽  
Clinical Risk Management ◽  
Clinical Risk ◽  
Current Evidence Base

SummaryThis article explores the challenges of developing clinical risk management practice and policy within large mental healthcare organisations. The national context is outlined and requirements of organisations explained. Consideration is given to how clinical risk relates to clinical quality and the benefits of standardisation are explored. We highlight the complexities and conflicts of implementing standardised procedures, given the current evidence base, and the difficulties of applying this in clinical practice. Using concepts from strategic planning and psychology, we suggest an approach to respond to these factors at a local level to achieve better outcomes for service users and clinicians.

scholarly journals IAPT and the internet: the current and future role of therapist-guided internet interventions within routine care settings

2020 ◽  
Vol 13 ◽  
Author(s):  
Graham R. Thew
Keyword(s):  
Evidence Base ◽  
Routine Care ◽  
Current Evidence ◽  
List Type ◽  
Face To Face ◽  
Internet Interventions ◽  
Psychological Therapies ◽  
Current Evidence Base ◽  
Online Format ◽  
The Right

Abstract Compared with the traditional face-to-face format, therapist-guided internet interventions offer a different approach to supporting clients in learning skills to manage and overcome mental health difficulties. Such interventions are already in use within IAPT (Improving Access to Psychological Therapies) and other routine care settings, but given their potential to deliver treatment more efficiently and therefore increase availability and access to evidence-based interventions, their use is likely to increase significantly over the coming years. This article outlines what is meant by therapist-guided internet interventions and why an online format is thought to be advantageous for clients, therapists, services, and communities more broadly. It reviews the current evidence in the context of common therapist beliefs about internet-based treatment. It aims to identify gaps where further research is required, particularly in relation to the broader implementation of these treatments in IAPT and other routine clinical services. Specifically, it emphasises the importance of choosing the right programmes, providing adequate therapist training in their use, and considering practical and organisational issues, all of which are likely to determine the success of implementation efforts. Key learning aims (1) To understand what therapist-guided internet interventions are and their potential advantages. (2) To understand the current evidence base for these interventions. (3) To learn where further research is needed with regard to both the interventions themselves, and to their broader implementation in IAPT.

scholarly journals Psychological treatments in intellectual disability: the challenges of building a good evidence base

2011 ◽  
Vol 198 (6) ◽  
pp. 428-430 ◽  
Author(s):  
Sabyasachi Bhaumik ◽  
Satheesh Gangadharan ◽  
Avinash Hiremath ◽  
Paul Swamidhas Sudhakar Russell
Keyword(s):  
Randomised Controlled Trials ◽  
Evidence Base ◽  
Good Evidence ◽  
Current Evidence ◽  
Controlled Trials ◽  
Psychological Treatments ◽  
Current Evidence Base ◽  
People With Intellectual Disabilities ◽  
Randomised Controlled ◽  
The Cost

SummaryPsychological treatments are widely used for the management of mental health and behavioural problems in people with intellectual disabilities. The evidence base, including the cost-effectiveness of such interventions, is limited. This editorial explores the current evidence base and analyses its strengths and limitations. The editorial also highlights current problems in conducting randomised controlled trials in this area and suggests a way forward.

scholarly journals A systematic scoping review of psychological therapies for psychosis within acute psychiatric in-patient settings

2018 ◽  
Vol 213 (2) ◽  
pp. 490-497 ◽  
Author(s):  
Pamela Jacobsen ◽  
Kathleen Hodkinson ◽  
Emmanuelle Peters ◽  
Paul Chadwick
Keyword(s):  
Outcome Measures ◽  
Scoping Review ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Allocation Concealment ◽  
Current Evidence ◽  
Psychological Therapies ◽  
Affective Symptoms ◽  
Wide Range ◽  
Current Evidence Base

BackgroundPeople with psychotic disorders account for most acute admissions to psychiatric wards. Psychological therapies are a treatment adjunct to standard medication and nursing care, but the evidence base for such therapies within in-patient settings is unclear.AimsTo conduct a systematic scoping review of the current evidence base for psychological therapies for psychosis delivered within acute in-patient settings (PROSPERO: CRD42015025623).MethodAll study designs, and therapy models, were eligible for inclusion in the review. We searched PubMed, PsycINFO, EThOS, ProQuest, conference abstracts and trial registries.ResultsWe found 65 studies that met criteria for inclusion in the review, 21 of which were randomised controlled trials (RCTs). The majority of studies evaluated cognitive–behavioural interventions. Quality was variable across all study types. The RCTs were mostly small (n<25 in the treatment arm), and many had methodological limitations including poorly described randomisation methods, inadequate allocation concealment and non-masked outcome assessments. We found studies used a wide range of different outcome measures, and relatively few studies reported affective symptoms or recovery-based outcomes. Many studies described adaptations to treatment delivery within in-patient settings, including increased frequency of sessions, briefer interventions and use of single-session formats.ConclusionsBased on these findings, there is a clear need to improve methodological rigour within in-patient research. Interpretation of the current evidence base is challenging given the wide range of different therapies, outcome measures and models of delivery described in the literature.Declaration of interestNone.

Cognitive Behaviour Therapy for Psychosis: Current Evidence and Future Directions

2008 ◽  
Vol 36 (6) ◽  
pp. 705-712 ◽  
Author(s):  
Craig Steel
Keyword(s):  
Evidence Base ◽  
Behavioural Therapy ◽  
Current Evidence ◽  
Behaviour Therapy ◽  
Theoretical Understanding ◽  
Future Directions ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour ◽  
Current Evidence Base ◽  
Cognitive Behavioural Interventions

AbstractThe past decade has seen considerable growth in the evidence base of cognitive behavioural therapy for psychosis. Consistent reports of moderate effect sizes have led to such interventions being recommended as part of routine clinical practice. Most of this evidence is based on a generic form of CBT for psychosis applied to a heterogeneous group. An increase in the effectiveness of cognitive behavioural interventions may require new protocols. Such therapeutic developments should be based on the theoretical understanding of the psychological processes associated with specific forms of psychotic presentation. The current evidence base of CBT for psychosis is reviewed, and barriers that have held back the development of this research are discussed.

scholarly journals Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

2020 ◽  
pp. 1-15
Author(s):  
Daniel Joseph Lamport ◽  
Claire Michelle Williams
Keyword(s):  
Systematic Reviews ◽  
Evidence Base ◽  
Epidemiological Studies ◽  
Cognitive Outcome ◽  
Current Evidence ◽  
Duration Of Treatment ◽  
Current Evidence Base ◽  
Cognitive Benefits ◽  
Meta Analyses ◽  
The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

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