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Flynn S. Understanding homicide-suicide, next steps in research. Crim Behav Ment Health 2024; 34:7-9. [PMID: 38233965 DOI: 10.1002/cbm.2325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Sandra Flynn
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
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Hayden NK, Flynn S, Blumenfeld F, Hastings RP, Gray KM, Cullen S, Cullen MA, Langdon PE. Reducing the risk of criminal exploitation using multi-systemic therapy (the RESET Study): study protocol for a feasibility study and process evaluation. Pilot Feasibility Stud 2023; 9:193. [PMID: 38012747 PMCID: PMC10680250 DOI: 10.1186/s40814-023-01409-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/16/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Child criminal exploitation is a form of child abuse that poses a serious risk to the welfare, safety, and wellbeing of young people. Multisystemic therapy (MST) is an intensive family and community-based intervention for young people with anti-social behavioral problems, many of whom will be at risk of criminal exploitation. This protocol describes a pilot feasibility study and process evaluation, designed to examine MST for children at risk of criminal exploitation. METHODS This pilot feasibility study and process evaluation involves two phases with associated subphases: phase 1.1 involved the collaborative refinement of the logic model adapting MST for children at risk of criminal exploitation; phase 1.2 involved pre-pilot interviews with MST therapists, families, and young people; phase 2.1 is a pilot modeling study of MST for children at risk of criminal exploitation, and; Phase 2.2 is a process evaluation that will involve interviewing stakeholders, MST therapists and employees, families, and young people. The dataset for the process evaluation will include questionnaires completed by parents and young people at baseline, mid-treatment, end of treatment, and 6 months after treatment. We will supplement these data with participant-level data linkage from MST sites and services. RESULTS Accrual to the pilot stage of this project opened on 6th August 2021 and is due to close on 31st May 2022. We aim to publish the results of this feasibility study and process evaluation in 2023. CONCLUSIONS The results of this feasibility study and process evaluation will inform the decision as to whether it is advisable to progress to a pilot clinical trial of MST for children at risk of criminal exploitation. TRIAL REGISTRATION Trial registration: ISRCTN registry, ISRCTN16164816 on 25th January 2021- https://doi.org/10.1186/ISRCTN16164816 .
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Affiliation(s)
- N K Hayden
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - S Flynn
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - F Blumenfeld
- School of Health and Social Care, University of Essex, Colchester, UK
| | - R P Hastings
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - K M Gray
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - S Cullen
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - M A Cullen
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - P E Langdon
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK.
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK.
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Sutherland D, Flynn S, Kurzeja O, Griffin J, Hastings R. Family-systems interventions for families of people with an intellectual disability or who are autistic: a systematic review. J Intellect Disabil Res 2023; 67:1003-1028. [PMID: 37532456 DOI: 10.1111/jir.13068] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Family-systems interventions have been proposed as one way of supporting families of people with an intellectual disability (ID) or who are autistic. This systematic review aimed to summarise what family-systems interventions have been studied with this population, what evidence there is for their effectiveness and families' experiences of the interventions. METHODS The review was preregistered on PROSPERO (CRD42022297516). We searched five electronic databases, identified 6908 records and screened 72 full texts. Study quality was evaluated using the Mixed Methods Appraisal Tool, and a narrative synthesis was used. RESULTS We identified 13 eligible articles with 292 participating families. Most studies reported positive effects of the interventions on wellbeing and family relationships, and families reported positive experiences. However, research quality was poor and there are no any sufficiently powered randomised controlled trials demonstrating family-systems interventions' effectiveness for this population. CONCLUSIONS There is a need for higher-quality research to establish whether family-systems interventions are beneficial for families of people who have an ID or who are autistic.
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Affiliation(s)
- D Sutherland
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - O Kurzeja
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - J Griffin
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - R Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry and Psychology, Monash University, Clayton, Australia
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McFadzean IJ, Davies K, Purchase T, Edwards A, Hellard S, Ashcroft DM, Avery AJ, Flynn S, Hewson T, Jordan M, Keers R, Panagioti M, Wainwright V, Walter F, Shaw J, Carson-Stevens A. Patient safety in prisons: a multi-method analysis of reported incidents in England. J R Soc Med 2023:1410768231166138. [PMID: 37196674 PMCID: PMC10387805 DOI: 10.1177/01410768231166138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Prisoners use healthcare services three times more frequently than the general population with poorer health outcomes. Their distinct healthcare needs often pose challenges to safe healthcare provision. This study aimed to characterise patient safety incidents reported in prisons to guide practice improvement and identify health policy priorities.Design: We carried out an exploratory multi-method analysis of anonymised safety incidents from prisons. SETTING Safety incidents had been reported to the National Reporting and Learning System by prisons in England between April 2018 and March 2019. PARTICIPANTS Reports were reviewed to identify any unintended or unexpected incident(s) which could have, or did, lead to harm for prisoners receiving healthcare. MAIN OUTCOME MEASURES Free-text descriptions were examined to identify the type and nature of safety incidents, their outcomes and harm severity. Analysis was contextualised with subject experts through structured workshops to explain relationships between the most common incidents and contributory factors. RESULTS Of 4112 reports, the most frequently observed incidents were medication-related (n = 1167, 33%), specifically whilst administering medications (n = 626, 54%). Next, were access-related (n = 559,15%), inclusive of delays in patients accessing healthcare professionals (n = 236, 42%) and managing medical appointments (n = 171, 31%). The workshops contextualised incidents involving contributing factors (n = 1529, 28%) into three key themes, namely healthcare access, continuity of care and the balance between prison and healthcare priorities. CONCLUSIONS This study highlights the importance of improving medication safety and access to healthcare services for prisoners. We recommend staffing level reviews to ensure healthcare appointments are attended, and to review procedures for handling missed appointments, communication during patient transfers and medication prescribing.
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Affiliation(s)
- Isobel J McFadzean
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Kate Davies
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Thomas Purchase
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Stuart Hellard
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Sandra Flynn
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Tom Hewson
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Melanie Jordan
- School of Sociology & Social Policy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Richard Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, M25 3BL, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9NT, UK
| | - Verity Wainwright
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Florian Walter
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Jenny Shaw
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, M25 3BL, UK
- Independent Advisory Panel on Deaths in Custody, London, SW1H 9AJ, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
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McDonnell S, Flynn S, Shaw J, Smith S, McGale B, Hunt I. Suicide bereavement in the UK: Descriptive findings from a national survey. Suicide Life Threat Behav 2022; 52:887-897. [PMID: 35611626 PMCID: PMC9790485 DOI: 10.1111/sltb.12874] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Those bereaved by suicide are a high-risk group of adverse health outcomes and suicidal behavior, yet little is known about the experiences and support needs of these individuals in the UK. METHODS We conducted a national cross-sectional study using an online survey and analyzed the experiences of 7158 participants who had been bereaved or affected by suicide. RESULTS Suicide had a major impact on 77% of participants, including those who had lost a friend and those exposed to suicide at a professional level. Mental and physical health problems linked to the suicide were reported in half. Adverse social outcomes and engaging in high-risk behaviors following the suicide were common. Over a third reported suicidal ideation and 8% had attempted suicide as a direct result of the suicide loss. Most had not accessed support services, with the majority viewing provision of local suicide bereavement support as inadequate. CONCLUSIONS Our results highlight the need for a multi-disciplinary approach in postvention and the provision of proactive outreach to support those bereaved by suicide. Postvention efforts need to acknowledge the death of a friend by suicide as a significant loss.
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Affiliation(s)
- Sharon McDonnell
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK,Suicide BereavementRamsbottomUK
| | - Sandra Flynn
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK
| | - Jenny Shaw
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchesterUK,Independent Advisory Panel on Deaths in CustodyLondonUK
| | - Shirley Smith
- If U Care Share FoundationChesterUK,Support After Suicide PartnershipLondonUK
| | - Barry McGale
- Suicide BereavementRamsbottomUK,Support After Suicide PartnershipLondonUK
| | - Isabelle M. Hunt
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK
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Flynn S. Bridging the Age-based Digital Divide: An Intergenerational Exchange during the First COVID-19 Pandemic Lockdown Period in Ireland. Journal of Intergenerational Relationships 2022. [DOI: 10.1080/15350770.2022.2050334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sandra Flynn
- Department of Educational Research, Lancaster University, Lancaster, UK
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Douralis A, Bass G, Dumbill A, Flynn S, Lee N, Manning J, Subiel A. ESTABLISHMENT OF A FLASH RADIOTHERAPY FACILITY AT NPL AND DOSIMETRY STUDY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Edge L, Cunningham C, Murphy N, Dillon A, Flynn S, O'Shaughnessy Í, Davis A, O'Rourke B, Brossier L, Doran C, Hennessy A, Kennedy U, McMahon G, McNamara R, Shields D, Staunton P, Horgan F. 142 FRAILTY IDENTIFICATION AND INTERDISCIPLINARY ASSESSMENT OF OLDER PEOPLE IN THE EMERGENCY DEPARTMENT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Older People are attending Emergency Departments (EDs) in increasing numbers but the optimal assessment measures to use have yet to be established. This study examined the clinical utility of different assessments of strength, functional mobility, sarcopenia, cognition and frailty used by the physiotherapist in an interdisciplinary team (IDT) in the ED and determined any associations with clinical outcomes.
Methods
This observational cross-sectional study recruited adults ≥70 years who were assessed by an IDT on weekdays during working hours. Demographic variables such as age, gender, social situation, baseline mobility, falls and clinical measures such as Clinical Frailty Scale (CFS), 4AT, hand-held dynamometry, calf circumference and functional mobility in ED were recorded. Clinical outcomes were admission to hospital, discharge from ED with onward referral (ambulatory care or community) and discharge from ED with no referral. Ethical approval was obtained and SPSS was used for statistical analysis.
Results
Two hundred and fifty four participants were recruited, 58.3% female, mean age 80.23 (SD 6.56). Median CFS was 4 (IRQ 2.0), range 1–7 with 32.7% (n = 83) considered frail. Sarcopenia prevalence was 89.3% using grip strength and 7.1% using calf circumference. Grip strength predicted frailty even after adjusting for age (p < 0.0001), gender (p < 0.0001) and falls (p = 0.043). Admission to hospital was predicted by major diagnostic category (p = 0.016) and inability to sit to stand independently in ED (p < 0.0001). Seventy percent (n = 179) of participants were discharged from ED, with 27.6% referred to ambulatory care or community services. Onward referral was predicted by frailty (p = 0.016) and falls in the last six months (p = 0.028).
Conclusion
Grip strength in addition to a validated tool such as CFS may assist an experienced IDT in identifying frailty, which can in turn inform decision-making regarding ED disposition and pathways of care for older people. Functional assessment in the ED is also important to determine the need for hospital admission.
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Affiliation(s)
- L Edge
- St James's Hospital , Dublin, Ireland
| | | | - N Murphy
- St James's Hospital , Dublin, Ireland
| | - A Dillon
- St James's Hospital , Dublin, Ireland
| | - S Flynn
- St James's Hospital , Dublin, Ireland
| | | | - A Davis
- St James's Hospital , Dublin, Ireland
| | - B O'Rourke
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - L Brossier
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - C Doran
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | | | - U Kennedy
- St James's Hospital , Dublin, Ireland
| | - G McMahon
- St James's Hospital , Dublin, Ireland
| | | | - D Shields
- St James's Hospital , Dublin, Ireland
| | | | - F Horgan
- Royal College of Surgeons in Ireland , Dublin, Ireland
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Rivart P, Wainwright V, Flynn S, Hunt IM, Shaw J, Smith S, McGale B, McDonnell S. Ethnic Minority Groups' Experiences of Suicide Bereavement: A Qualitative Exploratory Study. Int J Environ Res Public Health 2021; 18:ijerph182211860. [PMID: 34831616 PMCID: PMC8621836 DOI: 10.3390/ijerph182211860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
It is estimated that between 36,000 and 360,000 people are affected by suicide every year in the UK, and a proportion may develop depression and post-traumatic stress disorder, or engage in high-risk behaviours. Recent systematic analyses have revealed a clear gap in research on suicide bereavement in minority ethnic groups. This study aimed to understand the experiences and support needs of individuals from ethnic minority backgrounds bereaved by suicide and was the first in the UK to investigate this matter. The study was a secondary analysis of data. Participants were 7158 people residing in the UK who completed an online survey about their experiences of suicide. Free-text qualitative responses of 227 participants who did not identify as White British were analysed using thematic analysis. Four themes were identified: maladaptive coping strategies, emotional processes following suicide, lack of support from agencies, and the importance of mental health awareness. Ethnic minority groups reported a lack of support despite attempts to engage with services, noted the prevalence of stigma within ethnic minority groups, and expressed a need to tackle this. These preliminary results suggest that ethnic minority individuals require visible and accessible services that can successfully engage with and support them.
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Affiliation(s)
- Pauline Rivart
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
- Correspondence:
| | - Verity Wainwright
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
| | - Sandra Flynn
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
| | - Isabelle M. Hunt
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
| | - Jenny Shaw
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
- Independent Advisory Panel on Deaths in Custody, London SW1H 9AJ, UK
| | - Shirley Smith
- If U Care Share Foundation, Chester-le-Street, Chester DH2 2EY, UK;
- Support After Suicide Partnership, London SE1 7NQ, UK;
| | - Barry McGale
- Support After Suicide Partnership, London SE1 7NQ, UK;
- Suicide Bereavement UK, Ramsbottom BL0 9EX, UK
| | - Sharon McDonnell
- The Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (V.W.); (S.F.); (I.M.H.); (J.S.); (S.M.)
- Suicide Bereavement UK, Ramsbottom BL0 9EX, UK
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Hatton C, Bailey T, Bradshaw J, Caton S, Flynn S, Gillooly A, Jahoda A, Maguire R, Marriott A, Mulhall P, Oloidi E, Taggart L, Todd S, Abbott D, Beyer S, Gore N, Heslop P, Scior K, Hastings RP. The willingness of UK adults with intellectual disabilities to take COVID-19 vaccines. J Intellect Disabil Res 2021; 65:949-961. [PMID: 34529314 PMCID: PMC8657332 DOI: 10.1111/jir.12884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/29/2021] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Given the much greater COVID-19 mortality risk experienced by people with intellectual disabilities (ID), understanding the willingness of people with ID to take a COVID-19 vaccine is a major public health issue. METHOD In December 2020 to February 2021, across the United Kingdom, 621 adults with ID were interviewed remotely and 348 family carers or support workers of adults with ID with greater needs completed an online survey, including a question on willingness to take a COVID-19 vaccine if offered. RESULTS Eighty-seven per cent of interviewees with ID were willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having already had a flu vaccine, gaining information about COVID-19 from television but not from social media, and knowing COVID-19 social restrictions rules. A percentage of 81.7% of surveyed carers of adults with ID with greater needs reported that the person would be willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having a health condition of concern in the context of COVID-19, having had a flu vaccine, being close to someone who had died due to COVID-19, and having shielded at some point during the pandemic. CONCLUSIONS Reported willingness to take the COVID-19 vaccine is high among adults with ID in the United Kingdom, with factors associated with willingness having clear implications for public health policy and practice.
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Affiliation(s)
- C. Hatton
- Department of Social Care and Social WorkManchester Metropolitan UniversityManchesterUK
| | - T. Bailey
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
| | | | - S. Caton
- Department of Social Care and Social WorkManchester Metropolitan UniversityManchesterUK
| | - S. Flynn
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
| | - A. Gillooly
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - A. Jahoda
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - R. Maguire
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - A. Marriott
- National Development Team for InclusionBathUK
| | - P. Mulhall
- Institute of Nursing and Health ResearchUniversity of UlsterJordanstownUK
| | - E. Oloidi
- Unit for Development in Intellectual and Developmental DisabilitiesUniversity of South WalesPontypriddUK
| | - L. Taggart
- Institute of Nursing and Health ResearchUniversity of UlsterJordanstownUK
| | - S. Todd
- Unit for Development in Intellectual and Developmental DisabilitiesUniversity of South WalesPontypriddUK
| | - D. Abbott
- School for Policy StudiesUniversity of BristolBristolUK
| | - S. Beyer
- School of MedicineUniversity of CardiffCardiffUK
| | - N. Gore
- Tizard CentreUniversity of KentCanterburyUK
| | - P. Heslop
- School for Policy StudiesUniversity of BristolBristolUK
| | - K. Scior
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - R. P. Hastings
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and PsychologyMonash UniversityMelbourneVICAustralia
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Flynn S, Ibrahim S, Kapur N, Appleby L, Shaw J. Mental disorder in people convicted of homicide: long-term national trends in rates and court outcome. Br J Psychiatry 2021; 218:210-216. [PMID: 32624025 DOI: 10.1192/bjp.2020.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Homicide rates have fallen markedly in the UK over the past decade. There has been little research on whether homicides by people with mental disorder have contributed to this downward trend. Furthermore, there is limited information on trends in court outcomes for people with mental disorder who commit homicide. AIMS To examine trends in general population homicide and homicide by people with mental disorder, and to explore court outcome. METHOD We conducted a national, consecutive case series of homicide in England and Wales (1997-2015). Data were received from the Home Office Statistics Unit of Home Office Science. Clinical information was obtained from psychiatric reports and mental health services. RESULTS There has been a fall in the homicide rate in England and Wales since 2008. Despite this, the relative contribution of mental disorder as a proportion of all homicide has increased. Our findings also showed the inappropriate management of people with serious mental illness convicted of homicide. Of those who committed homicide and were diagnosed with schizophrenia, a third were imprisoned, and there was a marked fall in hospital order referrals. We found this to be linked to substance misuse comorbidity. CONCLUSIONS The proportional increase in homicide by people with schizophrenia suggests more complex factors may be driving rates, such as substance misuse. Addressing substance misuse comorbidity and maintaining engagement with services may help prevent patient homicide. Despite their complex needs, people with serious mental illness continue to be imprisoned. Improvements in assessment and the timely transfer of prisoners to health services are required.
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Affiliation(s)
- Sandra Flynn
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Saied Ibrahim
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Louis Appleby
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
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12
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Jess M, Flynn S, Bailey T, Hastings RP, Totsika V. Failure to replicate a robust Down syndrome advantage for maternal well-being. J Intellect Disabil Res 2021; 65:262-271. [PMID: 33404135 PMCID: PMC8049030 DOI: 10.1111/jir.12808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/26/2020] [Accepted: 12/08/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Family members caring for children with intellectual disability (ID) routinely report heightened levels of psychological distress. However, families of children with Down syndrome typically report better outcomes (known as the Down syndrome advantage). We examined whether the Down syndrome advantage would be present for maternal psychological distress, impact of caregiving, life satisfaction and perceived positive impact of the child with ID when controlling for external variables. METHODS Mothers of children with Down syndrome (n = 111) and mothers of children with ID of mixed aetiologies (n = 196) completed measures about their own mental health, perceived impact of caregiving, life satisfaction and perceived positive impact of their child on themselves and the family unit. RESULTS A series of group comparisons revealed small to moderate differences supporting the presence of a putative Down syndrome advantage in relation to personal maternal well-being outcomes. However, when child-related characteristics and external variables were controlled, the Down syndrome advantage was no longer present, with reduced, small effect sizes observed for all maternal outcomes. CONCLUSIONS Initial group differences in psychological distress and life satisfaction were largely associated with family poverty, indicating that the Down syndrome advantage may be less robust than previously thought. Future research should seek to move beyond examining the existence of the putative Down syndrome advantage and focus on how families of children with Down syndrome experience family life, including longitudinal research exploring responses to life cycle and transition challenges.
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Affiliation(s)
- M. Jess
- CEDARUniversity of WarwickCoventryUK
| | - S. Flynn
- CEDARUniversity of WarwickCoventryUK
| | - T. Bailey
- CEDARUniversity of WarwickCoventryUK
| | - R. P. Hastings
- CEDARUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
| | - V. Totsika
- CEDARUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
- Division of Psychiatry, Faculty of Brain SciencesUniversity College LondonLondonUK
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Karlsson LC, Antfolk J, Putkonen H, Amon S, da Silva Guerreiro J, de Vogel V, Flynn S, Weizmann-Henelius G. Familicide: A Systematic Literature Review. Trauma Violence Abuse 2021; 22:83-98. [PMID: 30704336 DOI: 10.1177/1524838018821955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Familicides have received relatively little attention and are mostly discussed in studies with broader aims. Here, we reviewed 67 studies from 18 countries on familicides, in which an offender killed or attempted to kill their current or former spouse/intimate partner and one or more of their biological or stepchildren. We conducted a systematic literature search in PubMed, PsycINFO, and Google Scholar. Eight studies investigated familicide specifically, while the remaining reported on familicide cases as a subsample. We retrieved data on offenders' gender, age, and background as well as on victims and their relationship to the offender. We also retrieved data on contextual factors and offense characteristics (i.e., modus operandi, offense location, premeditation, and whether or not the offender had committed suicide). We also coded methodological aspects of the studies. Familicides were almost exclusively committed by men and about half of the familicide cases led to the suicide of the offender. Mental health problems, relationship problems, and financial difficulties were prevalent. Because few studies reported population base rates of the investigated characteristics, it is difficult to draw conclusions about specific risk factors. Future research should further investigate typologies of familicide and examine risk factors for different types of familicides.
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Affiliation(s)
- Linda C Karlsson
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Jan Antfolk
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Hanna Putkonen
- Department of Psychiatry, University of Turku, Turku, Finland
- Department of Addiction Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Sabine Amon
- Department of Psychology, University of Vienna, Vienna, Austria
| | - João da Silva Guerreiro
- Department of Psychology, Centre de recherche de l'Institut Philippe Pinel de Montréal, Université du Québec à Montréal, Montréal, Canada
| | - Vivienne de Vogel
- De Forensische Zorgspecialisten and University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Sandra Flynn
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Ghitta Weizmann-Henelius
- Department of Psychology, Åbo Akademi University, Turku, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
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Bojanić L, Flynn S, Gianatsi M, Kapur N, Appleby L, Shaw J. The typology of parricide and the role of mental illness: Data-driven approach. Aggress Behav 2020; 46:516-522. [PMID: 32725641 DOI: 10.1002/ab.21906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/19/2020] [Accepted: 05/31/2020] [Indexed: 11/06/2022]
Abstract
Parricide is a rare type of homicide in which mental illness is often an important factor. The aims of this study were (a) to describe the characteristics of parricide offenders with a focus on mental illness and clinical care and (b) to examine Heide's widely used typology of parricide through a data-driven approach. We analyzed all homicides in England and Wales between 1997 and 2014. Parricide offenders in our sample were most often male, unmarried, and unemployed, with a third of offenders diagnosed with schizophrenia; 28% had been in contact with mental health services before the offense. The latent class analysis resulted in three types of parricide offenders: middle-aged with affective disorder, previously abused, and seriously mentally Ill, which confirmed, to an extent, Heide's typology. Health and social care services should actively engage with carers of people with mental illness and support to those caring for older relatives and victims of abuse.
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Affiliation(s)
- Lana Bojanić
- National Confidential Inquiry Into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - Sandra Flynn
- National Confidential Inquiry Into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - Myrsini Gianatsi
- National Confidential Inquiry Into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - Navneet Kapur
- National Confidential Inquiry Into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
- Greater Manchester Mental Health NHS Foundation Trust Manchester UK
| | - Louis Appleby
- National Confidential Inquiry Into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
- Greater Manchester Mental Health NHS Foundation Trust Manchester UK
| | - Jenny Shaw
- National Confidential Inquiry Into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
- Greater Manchester Mental Health NHS Foundation Trust Manchester UK
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Abstract
Short sleep duration is a known risk factor for suicidality in the general population, yet it is unclear how short sleep interacts with autism traits in predicting suicidality. In this cross-sectional online study, a general population sample (N = 650) completed measures assessing autism traits, suicidal ideation, and sleep duration. Moderated hierarchical regressions demonstrated that higher autism traits and shorter sleep were independent predictors of increased suicide ideation. However, sleep duration did not significantly moderate the autism trait to suicide ideation relationship. Future work should explore this relationship longitudinally using objective measures before considering intervention work to increase sleep duration in those with elevated autism traits.
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Affiliation(s)
- K D Hochard
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK.
| | - R Pendrous
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK
| | - T Mari
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, CV4 7AL, UK
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16
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Flynn S, Graney J, Nyathi T, Raphael J, Abraham S, Singh-Dernevik S, Williams A, Kapur N, Appleby L, Shaw J. The clinical characteristics and care pathways of patients with personality disorder who died by suicide - CORRIGENDUM. BJPsych Open 2020; 6:e32. [PMID: 32234099 PMCID: PMC7176896 DOI: 10.1192/bjo.2020.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Flynn S, Graney J, Nyathi T, Raphael J, Abraham S, Singh-Dernevik S, Williams A, Kapur N, Appleby L, Shaw J. Clinical characteristics and care pathways of patients with personality disorder who died by suicide. BJPsych Open 2020; 6:e29. [PMID: 32183913 PMCID: PMC7176898 DOI: 10.1192/bjo.2020.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments. AIMS To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance. METHOD National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK. RESULTS The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients. CONCLUSIONS Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.
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Affiliation(s)
- Sandra Flynn
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Jane Graney
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Thabiso Nyathi
- Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Jessica Raphael
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | | | - Sandeep Singh-Dernevik
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Alyson Williams
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Louis Appleby
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
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18
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Friedland N, Negi S, Vinogradova-Shah T, Wu G, Ma L, Flynn S, Kumssa T, Lee CH, Sayre RT. Fine-tuning the photosynthetic light harvesting apparatus for improved photosynthetic efficiency and biomass yield. Sci Rep 2019; 9:13028. [PMID: 31506512 PMCID: PMC6736957 DOI: 10.1038/s41598-019-49545-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/22/2019] [Indexed: 12/21/2022] Open
Abstract
Photosynthetic electron transport rates in higher plants and green algae are light-saturated at approximately one quarter of full sunlight intensity. This is due to the large optical cross section of plant light harvesting antenna complexes which capture photons at a rate nearly 10-fold faster than the rate-limiting step in electron transport. As a result, 75% of the light captured at full sunlight intensities is reradiated as heat or fluorescence. Previously, it has been demonstrated that reductions in the optical cross-section of the light-harvesting antenna can lead to substantial improvements in algal photosynthetic rates and biomass yield. By surveying a range of light harvesting antenna sizes achieved by reduction in chlorophyll b levels, we have determined that there is an optimal light-harvesting antenna size that results in the greatest whole plant photosynthetic performance. We also uncover a sharp transition point where further reductions or increases in antenna size reduce photosynthetic efficiency, tolerance to light stress, and impact thylakoid membrane architecture. Plants with optimized antenna sizes are shown to perform well not only in controlled greenhouse conditions, but also in the field achieving a 40% increase in biomass yield.
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Affiliation(s)
- N Friedland
- New Mexico Consortium, Los Alamos, NM, 87544, USA
| | - S Negi
- New Mexico Consortium, Los Alamos, NM, 87544, USA
| | - T Vinogradova-Shah
- New Mexico Consortium, Los Alamos, NM, 87544, USA.,Pebble Labs, 100 Entrada Drive, Los Alamos, NM, 87544, USA
| | - G Wu
- New Mexico Consortium, Los Alamos, NM, 87544, USA.,Department of Molecular Biology, Pusan National University, Busan, 46241, Republic of Korea
| | - L Ma
- New Mexico Consortium, Los Alamos, NM, 87544, USA.,Department of Molecular Biology, Pusan National University, Busan, 46241, Republic of Korea
| | - S Flynn
- New Mexico Consortium, Los Alamos, NM, 87544, USA
| | - T Kumssa
- University of Nebraska, Lincoln, NE, United States
| | - C-H Lee
- New Mexico Consortium, Los Alamos, NM, 87544, USA.,Department of Molecular Biology, Pusan National University, Busan, 46241, Republic of Korea
| | - R T Sayre
- New Mexico Consortium, Los Alamos, NM, 87544, USA. .,Pebble Labs, 100 Entrada Drive, Los Alamos, NM, 87544, USA.
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19
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Flynn S, Raphael J, Graney J, Nyathi T, Williams A, Kapur N, Appleby L, Shaw J. The personality disorder patient pathway: Service user and clinical perspectives. Personal Ment Health 2019; 13:134-143. [PMID: 31106989 DOI: 10.1002/pmh.1444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 12/30/2022]
Abstract
AIMS There have been recent policy developments and research into care provision for service users with personality disorder. However, few studies have focused on service user and staff perspectives on how services could be improved. METHODS A qualitative study was undertaken in the UK between 2016 and 2017. We conducted six focus groups with clinicians in mental health services with experience of working with people with personality disorder. Using an online survey, we asked current and past service users with personality disorder to describe their experiences of mental health services and make recommendations for improvements. A thematic analysis was conducted. RESULTS Forty-five clinicians participated in the focus group and 131 service users contributed to the online survey. The main areas of concern identified by both staff and patients were the diagnosis of personality disorder, the absence of a coherent care pathway, access to psychological treatment and staff training. CONCLUSIONS The care pathway for individuals with personality disorder is unclear to clinicians and service users, and elements of the pathway are disjointed and not working as effectively as they could. Guidelines recommended by National Institute for Health and Care Excellence are not being followed. Specialist psychological interventions should be available to ensure consistent and stable care provision. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- S Flynn
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - J Raphael
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - J Graney
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - T Nyathi
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - A Williams
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - N Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - L Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - J Shaw
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
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20
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Fehlings M, Nardin A, Jhunjhunwala S, Kowanetz M, O'Gorman B, Hegde P, Li J, Sumatoh H, Lee B, Kim L, Flynn S, Ballinger M, Newell E, Yadav M. Late-differentiated effector neoantigen-specific CD8+ T cells are enriched in non-small cell lung carcinoma patients responding to atezolizumab treatment. Eur J Cancer 2019. [DOI: 10.1016/j.ejca.2019.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Hastings RP, Gillespie D, Flynn S, McNamara R, Taylor Z, Knight R, Randell E, Richards L, Moody G, Mitchell A, Przybylak P, Williams B, Hunt PH. Who's challenging who training for staff empathy towards adults with challenging behaviour: cluster randomised controlled trial. J Intellect Disabil Res 2018; 62:798-813. [PMID: 30033655 DOI: 10.1111/jir.12536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND One in five adults with intellectual disabilities (ID) known to services display challenging behaviours (CBs), and these individuals are at risk for restrictive practices and poor care. Staff attitudes may contribute to the development and/or maintenance of CBs. We investigated the effectiveness of co-produced Who's Challenging Who? training delivered by people with ID to staff. METHOD This study involved a cluster randomised controlled trial (RCT) of Who's Challenging Who? training with follow-up at six and 20 weeks post-randomisation. PARTICIPANTS two staff from each of 118 residential care settings for adults with ID at least one of whom displayed aggressive CB. PRIMARY OUTCOME Self-reported Staff Empathy for people with Challenging Behaviour Questionnaire. ANALYSIS intention to treat of all randomised settings. ISCRTN registration: ISRCTN53763600. RESULTS 118 residential settings (including 236 staff) were randomised to either receive training (59 settings) or to receive training after a delay (59 settings). The primary analysis included data from 121 staff in 76 settings (51% of staff, 64% of settings). The adjusted mean difference on the transformed (cubed) Staff Empathy for people with Challenging Behaviour Questionnaire score at the primary end point was 1073.2 (95% CI: -938.1 to 3084.5, P = 0.296) in favour of the intervention group (effect size Cohen's d = .19). CONCLUSIONS This is the first large-scale RCT of a co-produced training course delivered by people with ID. Findings indicated a small positive (but statistically non-significant) effect on increased staff empathy at 20 weeks, and small to moderate effects for staff reported secondary outcomes in favour of the intervention group.
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Affiliation(s)
- R P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - D Gillespie
- Centre for Trials Research, Cardiff University, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - R McNamara
- Centre for Trials Research, Cardiff University, UK
| | - Z Taylor
- Royal Mencap Society, London, UK
| | - R Knight
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - E Randell
- Centre for Trials Research, Cardiff University, UK
| | - L Richards
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - G Moody
- Centre for Trials Research, Cardiff University, UK
| | - A Mitchell
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - P Przybylak
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - B Williams
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
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Kenyon P, Flynn S, Marlow W. Assessment of the adult patient presenting with shoulder pain. Int J Orthop Trauma Nurs 2017; 28:40-45. [PMID: 29254753 DOI: 10.1016/j.ijotn.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Kenyon
- Countess of Chester NHS Foundation Trust, Liverpool Road, Chester CH2 1UL, UK.
| | - Sandra Flynn
- Countess of Chester NHS Foundation Trust, Liverpool Road, Chester CH2 1UL, UK.
| | - William Marlow
- Countess of Chester NHS Foundation Trust, Liverpool Road, Chester CH2 1UL, UK
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Affiliation(s)
- Sandra Flynn
- Orthopaedics, Countess of Chester NHS Foundation Trust, United Kingdom; Faculty of Health & Social Care, University of Chester, United Kingdom.
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Abstract
BACKGROUND Observations in psychiatric in-patient settings are used to reduce suicide, self-harm, violence and absconding risk. The study aims were to describe the characteristics of in-patients who died by suicide under observation and examine their service-related antecedents. METHOD A national consecutive case series in England and Wales (2006-2012) was examined. RESULTS There were 113 suicides by in-patients under observation, an average of 16 per year. Most were under intermittent observation. Five deaths occurred while patients were under constant observation. Patient deaths were linked with the use of less experienced staff or staff unfamiliar with the patient, deviation from procedures and absconding. CONCLUSIONS We identified key elements of observation that could improve safety, including only using experienced and skilled staff for the intervention and using observation levels determined by clinical need not resources.
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Affiliation(s)
- S Flynn
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - T Nyathi
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - S-G Tham
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - A Williams
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - K Windfuhr
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - N Kapur
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - L Appleby
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - J Shaw
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
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Walker B, Flynn S, Johnson R. RELIABILITY AND VALIDITY OF HEALTH IN MOTION© FALLS SCREENING TOOL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B. Walker
- University of Indianapolis, Indianapolis, Indiana
| | - S. Flynn
- Blue Marble Game Company, Los Angeles, California,
| | - R. Johnson
- Blue Marble Game Company, Los Angeles, California,
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Bourke M, Fitzgerald T, Donlon N, Flynn S, Creedon S, Sparrow P, Brady A, McEneaney P, O'Brien G, McGreal G. Complications Arising Following Endovascular Repair of Aorto-iliac Aneurysms that Require Open Management: Ten Years’ Experience at a Single Centre. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kowanetz M, Zou W, Shames D, Cummings C, Rizvi N, Spira A, Frampton G, Leveque V, Flynn S, Mocci S, Shankar G, Funke R, Ballinger M, Waterkamp D, Sandler A, Hampton G, Amler L, Hegde P, Hellmann M. Tumor mutation load assessed by FoundationOne (FM1) is associated with improved efficacy of atezolizumab (atezo) in patients with advanced NSCLC. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.25] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kelly C, Smith M, Flynn S, Reyes A, Higgins M, McCaffrey J, Kelly C. Accrual to Cancer Clinical Trial. Ir Med J 2016; 109:436. [PMID: 27834087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Accrual to cancer clinical trials (CCT) is imperative to safeguard continued improvement in cancer outcomes. A retrospective chart review was performed of patients (n=140) starting a new anti-cancer agent in a north Dublin cancer centre. This review was performed over a four-month period, beginning in November 2015. Only 29% (n=41) had a CCT option. The overall accrual rate to CCT was 5% (n=7), which is comparable to internationally reported figures. The main reasons for failure to recruit to CCT included the lack of a CCT option for cancer type (n=30, 23%), stage (n=25, 19%), and line of treatment (n=23, 17%). Over the last decade, the rate of accrual to CCTs has in fact doubled and the number of trials open to recruitment has tripled. Ongoing governmental and philanthropic support is necessary to continue this trend to further expand CCT patient options with a target accrual rate of 10%.
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Affiliation(s)
- C Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - M Smith
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - S Flynn
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - A Reyes
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - M Higgins
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - J McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - C Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
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Abstract
Aims and method To explore the portrayal of homicide-suicide in newspaper articles, particularly how mental illness was reported. We carried out a qualitative study in England and Wales (2006-2008). Data from newspaper articles obtained via the LexisNexis database were used to examine a consecutive series of 60 cases. Results A fascination with extreme violence, vulnerable victims and having someone to blame made homicide-suicides newsworthy. Some offenders were portrayed in a stereotypical manner and pejorative language was used to describe mental illness. The findings showed evidence of inaccurate and speculative reference to mental disorder in newspaper reports. Clinical implications The media should avoid speculation on people's mental state. Accurate reporting is essential to reduce stigma of mental illness, which may in turn encourage people to seek help if they experience similar emotional distress.
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Flynn S. "Obtaining feedback is a great way to keep people engaged". Nurs Times 2015; 111:11. [PMID: 26665380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Wellington B, Flynn S, Duperouzel W, Treloar S. Assessment of chronic pain: A practice update. Int J Orthop Trauma Nurs 2015; 19:155-61. [DOI: 10.1016/j.ijotn.2015.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wellington B, Flynn S, Duperouzel W. Anti-embolic stockings for the prevention of VTE in orthopaedic patients: A practice update. Int J Orthop Trauma Nurs 2015; 19:45-9. [DOI: 10.1016/j.ijotn.2014.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rodway C, Flynn S, While D, Rahman MS, Kapur N, Appleby L, Shaw J. Patients with mental illness as victims of homicide: a national consecutive case series. Lancet Psychiatry 2014; 1:129-34. [PMID: 26360576 DOI: 10.1016/s2215-0366(14)70221-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The media attention received by homicides committed by patients with mental illness is thought to increase stigma. However, people with mental illness can also be victims of violence. We aimed to assess how often victims of homicide are current mental health patients and their relationship to the perpetrators. METHODS In a national consecutive case-series study, we obtained data for victims and perpetrators of all confirmed homicides between Jan 1, 2003, and Dec 31, 2005, in England and Wales. We requested information about contact with mental health services in the 12 months before the homicide for all victims and perpetrators. For victims and perpetrators who had contact with mental health services in the 12 months before homicide, we sent questionnaires to the clinician responsible for the patient's care. FINDINGS 1496 victims of confirmed homicide died between Jan 1, 2003, and Dec 31, 2005, in England and Wales. Patients with mental illness were more likely to die by homicide than were people in the general population (incidence rate ratio 2·6, 95% CI 1·9-3·4). 90 homicide victims (6%) had contact with mental health services in the 12 months before their death. 213 patients with mental illness were convicted of homicide in the same 3 year period. 29 of 90 patient victims were killed by another patient with mental illness. In 23 of these 29 cases, the victim and perpetrator were known to each other, and in 21 of these cases, the victims and perpetrators were undergoing treatment at the same National Health Service Trust. In these 29 cases in which patient victims were killed by another patient with mental illness, alcohol and drug misuse (19 victims [66%], 27 perpetrators [93%]) and previous violence (7 victims [24%], 7 perpetrators [24%]) were common in both victims and, particularly, perpetrators. In seven of the 29 cases in which the victim was killed by another patient with mental illness, both victim and perpetrator were diagnosed with schizophrenia. INTERPRETATION The high risk of patients with mental illness being victims of homicide is an important antistigma message, although this risk partly comes from other patients with mental illness; overall, the risk of patients committing homicide is greater than the risk of being a victim of homicide. Identification and safeguarding of patients at risk of violence should be prominent in clinical risk assessment. FUNDING Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Cathryn Rodway
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK.
| | - Sandra Flynn
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - David While
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Mohammed S Rahman
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Louis Appleby
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Jenny Shaw
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
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Abstract
This study aimed to estimate the prevalence of mental disorder in offenders convicted of serious violence, examine their social and clinical characteristics, and compare them with patients convicted of homicide. We examined a national clinical survey of all people convicted of serious violence in England and Wales in 2004. Mental disorder was measured by contact with mental health services within 12 months of the offense. Of the 5,966 serious violent offenders, 293 (5%) had been in recent contact with mental health services. Personality disorder (63, 22%) and schizophrenia (55, 19%) were the most common diagnoses. Most had previous convictions for violence (168, 61%). Seventy-two (25%) patients were at high risk of violence and 34 (49%) were not subject to the Care Programme Approach. Compared with serious violence offenders, homicide offenders were more likely to have been patients (293, 5% vs. 65, 10%; p < .01). We conclude that patients were responsible for a small proportion of serious violent offenses; however, high-risk patients require closer supervision, and regular inquiry about changing delusional beliefs, thoughts of violence, and weapon carriage.
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Flynn S, Ellery S, Mason L. LIVING WITH CHRONIC HEART FAILURE. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Flynn S. A day in the life of orthopaedic and trauma practitioners: Trauma clinical nurse specialist. Int J Orthop Trauma Nurs 2014. [DOI: 10.1016/j.ijotn.2013.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lange B, Flynn S, Rizzo A. Initial usability assessment of off-the-shelf video game consoles for clinical game-based motor rehabilitation. Physical Therapy Reviews 2013. [DOI: 10.1179/108331909x12488667117258] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Overshott R, Rodway C, Roscoe A, Flynn S, Hunt IM, Swinson N, Appleby L, Shaw J. Homicide perpetrated by older people. Int J Geriatr Psychiatry 2012; 27:1099-105. [PMID: 22912344 DOI: 10.1002/gps.2739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 03/23/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aims to describe the circumstances in which older people commit homicide, the form of assessment they undergo and to examine the proportion of those who suffer from mental illness. METHODS The study was carried out as part of the England and Wales National Confidential Inquiry into Suicide and Homicide by People with Mental Illness based on a five-year sample. The Inquiry was notified of the names of those over the age of 60 years convicted of homicide and also the details of the offence, sentencing and outcome in court by the Home Office. The Inquiry collected clinical data of those known to have had contact with mental health services from the responsible service and also retrieved psychiatric reports of those convicted. RESULTS Homicide incidents perpetrated by older people typically involve a man killing his partner in an impulsive manner. The most common method was by using a sharp instrument (34%), followed by the use of a blunt instrument (26%). The use of firearms was rare (11%). Perpetrators aged 65 years and older were significantly more likely to kill a current or former spouse/partner and less likely to kill an acquaintance. Forty-four per cent of perpetrators over 65 years old suffered from depression at the time of the offence, whereas rates of schizophrenia and alcohol dependence were low. CONCLUSIONS The information used in the study was extracted from a unique national database of homicide perpetrators. The characteristics and the circumstances of homicides perpetrated by older people are different to other age groups. An older-people homicide may be preventable if depression is identified early in older people.
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Affiliation(s)
- Ross Overshott
- Liaison Psychiatry, Greater Manchester West NHS Foundation Trust, Salford, UK.
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40
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Chalwin RP, Moran JL, Peake SI, Flynn S, Pieterse J, Williams P. Assessing the performance of a continuous infusion for potassium supplementation in the critically ill. Anaesth Intensive Care 2012; 40:433-41. [PMID: 22577908 DOI: 10.1177/0310057x1204000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypokalaemia is a common problem in critically ill patients, which if untreated, can result in dysrhythmia or another adverse outcome. We assessed the safety and efficacy of a continuous infusion of potassium chloride versus an existing intermittent infusion regimen. In this open-label randomised parallel-arm active-controlled pilot study, critically ill adults with plasma potassium concentration between 2.5 and 3.8 mmol/l were randomised to receive either a continuous infusion or intermittent infusions of potassium chloride for establishment and maintenance of normokalaemia. The primary outcome was the mean difference in plasma potassium concentration over time between the two study arms as assessed by a linear mixed-effects model. Although a statistically significant difference was observed (0.22 mmol/l; 95% confidence interval 0.17, 0.27; P <0.0001), this did not reach the pre-determined level indicative of a treatment effect (0.5 mmol/l). The continuous group demonstrated less variance in (mean) plasma potassium as reflected in narrower confidence intervals in a prediction-by-time model. The incidence rate ratio of dysrhythmia, assessed by a mixed-effects Poisson model, was similar in each group (0.62; 95% confidence interval 0.32, 1.21; P=0.16). We recorded no adverse events directly attributable to infusion of potassium chloride in either study arm. Although titrated continuous infusion did not demonstrate a clinically important difference by comparison with intermittent infusions for the maintenance of normokalaemia, there was more consistent control of plasma potassium with no observed complications or adverse events. Therefore, this trial showed an acceptable efficacy and safety profile for the continuous infusion regimen, suggesting scope for further study.
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Affiliation(s)
- R P Chalwin
- The Department of Intensive Care, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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41
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Windfuhr K, Turnbull P, While D, Swinson N, Mehta H, Hadfield K, Hiroeh U, Watkinson H, Dixon C, Flynn S, Thomas S, Lewis G, Ferrier IN, Amos T, Skapinakis P, Shaw J, Kapur N, Appleby L. The incidence and associated risk factors for sudden unexplained death in psychiatric in-patients in England and Wales. J Psychopharmacol 2011; 25:1533-42. [PMID: 20952453 DOI: 10.1177/0269881110379288] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Clinical characteristics and risk factors associated with sudden unexplained death (SUD) in the psychiatric population are unclear. Psychiatric in-patients (England, Wales) who met criteria for SUD were identified (1 March 1999-31 December 2005). Cases were matched with controls (in-patients alive on the day a SUD occurred). Data were collected via questionnaires. Some 283 cases of SUD were identified (41 annually), with a rate of 2.33/10,000 mental health admissions (in England). Electrocardiograms were not routine, cardiopulmonary resuscitation equipment was sometimes unavailable, attempts to resuscitate patients were carried out on one-half of all patients and post mortems/inquiries were not routine. Restraint and seclusion were uncommon. Risk factors included: benzodiazepines (odds ratio (OR): 1.83); ≥ 2 antipsychotics (OR: 2.35); promazine (OR: 4.02); diazepam (OR: 1.71); clozapine (OR: 2.10); cardiovascular disease (OR: 2.00); respiratory disease (OR: 1.98); diagnosis of dementia (OR: 2.08). Venlafaxine and a diagnosis of affective disorder were associated with reduced ORs (OR: 0.42; OR: 0.65). SUD is relatively rare, although it is more common in older patients and males. Prevention measures may include safer prescribing of antipsychotics and improved physical health care. The contribution of restraint or seclusion to SUD in individual cases is unclear. A uniform definition of SUD may help to identify contributing factors.
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Affiliation(s)
- Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University of Manchester, Manchester, UK.
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42
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Flynn S, Parker G, Gamble R. A survey of the pre-entry occupational health assessment process for undergraduate medical, nursing and midwifery students in England, Scotland and Wales. Occup Environ Med 2011. [DOI: 10.1136/oemed-2011-100382.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kalucy M, Rodway C, Finn J, Pearson A, Flynn S, Swinson N, Roscoe A, Da Cruz D, Appleby L, Shaw J. Comparison of British national newspaper coverage of homicide committed by perpetrators with and without mental illness. Aust N Z J Psychiatry 2011; 45:539-48. [PMID: 21718123 DOI: 10.3109/00048674.2011.585605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Adverse newspaper reporting of mental illness and in particular, violence committed by a mentally ill person, is thought to contribute to stigma. However, violent events are also considered highly newsworthy by journalists. The aim of this study was to compare the likelihood of newspaper reporting for convicted perpetrators of homicide with and without a history of contact with mental health services. METHOD A 12 month (April 2000-March 2001) cohort of 577 homicide perpetrators with and without a history of contact with mental health services in England and Wales was examined. These cases were identified by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. By examining 12 national newspapers, we compared the likelihood of reporting homicide perpetrators with and without mental illness. RESULTS Under half (228 cases, 40%) of the homicide perpetrators were reported in at least one of the study newspapers. Under a fifth (94 cases, 16%) of perpetrators had a history of contact with mental health services and such previous contact did not increase the likelihood of newspaper reporting (odds ratio 1.0 (0.6-1.6)). CONCLUSIONS Previous contact with mental health services did not influence the newsworthiness of a homicide perpetrator. The stigmatizing effect of reporting homicide by perpetrators with mental illness may relate more to the quality of reporting rather than selective over-reporting.
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Affiliation(s)
- Megan Kalucy
- School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
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Flynn S, Abel KM, While D, Mehta H, Shaw J. Mental illness, gender and homicide: a population-based descriptive study. Psychiatry Res 2011; 185:368-75. [PMID: 20724002 DOI: 10.1016/j.psychres.2010.07.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 06/25/2010] [Accepted: 07/28/2010] [Indexed: 11/30/2022]
Abstract
In England and Wales, a lifetime history of mental disorder is recorded in almost a third of homicides but mental illness as a defence in homicide cases has recently come under review. In this study, we aimed to compare the social, criminological and clinical characteristics of women and men convicted of homicide and secondly, to understand how pathways through the judicial system differ by gender of the perpetrator, characteristics of the offence and mental illness. A cross sectional study of 4572 convicted homicide perpetrators in England and Wales 1997-2004 was performed. Significantly more women who had committed homicide had a lifetime history of mental illness and were more likely to be mentally ill at the time of offence compared to men. Women more often received non-custodial sentences, whether or not they had mental illness. If the victim were a child or other relative, the courts were more lenient with women. Gender and the presence of mental illness both influence the characteristics of homicide and outcome of the legal process in the UK. Our findings suggest that all perpetrators of homicide should have a psychiatric assessment pre-trial. Psychiatrists need to rate risk objectively in a gender blind way when providing psychiatric reports to be used as evidence in court.
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Affiliation(s)
- Sandra Flynn
- Centre for Suicide Prevention, Community Based Medicine, University of Manchester, Manchester, UK.
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Ragupathy S, Flynn S, Duncan K. 16. Axillary ultrasound accuracy in assessing nodal metastases in a breast screening service. Cancer Imaging 2011. [DOI: 10.1102/1470-7330.2011.9079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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46
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Ragupathy SKA, Gagliardi T, Redpath TW, Flynn S, Jagpal B, Begley JKP, Gilbert FJ. Comparison of 1.5T and 3T in assessment of suspicious breast lesions. Breast Cancer Res 2010. [PMCID: PMC2978835 DOI: 10.1186/bcr2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Balshaw R, Khorasheh S, Barbeau M, Kelly S, Flynn S, Heisel O, McBurney CR. Longitudinal Outcomes of GastroIntestinal symptoms in Canada (LOGIC): key factors for an effective patient retention in observational studies. Can J Clin Pharmacol 2009; 16:e140-e150. [PMID: 19182307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Longitudinal Outcomes of GastroIntestinal symptoms in Canada (LOGIC) is an ongoing study on irritable bowel syndrome (IBS) treatment patterns and health outcomes in routine Canadian clinical practice. Advancements in understanding IBS, a chronic multifaceted GI disorder, may be possible through methodical observational studies. The objective of this paper is to describe site recruitment techniques and extensive subject follow-up methodology used to facilitate a high return rate of questionnaires from this population-based study of subjects with IBS. METHODS Invitation letters along with protocol synopses and preliminary site assessment questionnaires were faxed to potential sites across Canada. There were 1,556 subjects enrolled in this study from general practitioner sites (GP) and specialist sites (SP) in Canada. Subjects were compensated for the return of questionnaires reporting symptoms, quality of life, productivity, healthcare and resource utilization at baseline, Month 1, 3, 6, 9, and 12. Upon the return of questionnaires, subjects received thank you cards which included a reminder of the next questionnaire's due date. If subject questionnaires were not received within 2 weeks after the due date, the subjects received a reminder letter in the mail. RESULTS The methodology in the LOGIC study allowed for a high patient questionnaire return rate (89%) through extensive subject reminders and follow-up. Subject participation throughout the study was not found to be linked to study site size or type (GP or SP). CONCLUSION Questionnaire based observational studies may benefit from focusing resources on increasing questionnaire return rates to effectively maintain data reliability and also reduce non-response bias.
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Affiliation(s)
- R Balshaw
- Syreon Corporation, Vancouver, Canada
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Meehan J, Flynn S, Hunt IM, Robinson J, Bickley H, Parsons R, Amos T, Kapur N, Appleby L, Shaw J. Perpetrators of homicide with schizophrenia: a national clinical survey in England and Wales. Psychiatr Serv 2006; 57:1648-51. [PMID: 17085616 DOI: 10.1176/ps.2006.57.11.1648] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Few studies have described rates of schizophrenia in a national sample of homicide perpetrators. This study aimed to describe this group's social and clinical characteristics, mental state features, offense details, and outcome in court. METHOD Analyses used a national clinical survey that collected data on people convicted of homicide in England and Wales (1996-1999). Data were collected for those with schizophrenia or other delusional disorders from psychiatric reports and questionnaires. RESULTS Of the 1,594 people convicted of homicide, 85 (5 percent) had schizophrenia. Of the 57 people with schizophrenia for whom data were available, 32 (56 percent) had been ill for less than 12 months, and in the month before the offense, 32 (56 percent) had shown a change in the quality, intensity, or conviction of or emotional response to their delusional beliefs. Twenty-four (28 percent) had no previous contact with psychiatric services. CONCLUSIONS Regular assessment of delusions may help to detect an increased risk of violence, including homicide. More intensive care should be available for patients with a history of schizophrenia and previous violence.
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Affiliation(s)
- Janet Meehan
- Department of Psychiatry, University of Manchester, Williamson Building, Oxford Road, Manchester, Lancashire, United Kingdom M13 9PL
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Smith GN, Boydell J, Murray RM, Flynn S, McKay K, Sherwood M, Honer WG. The incidence of schizophrenia in European immigrants to Canada. Schizophr Res 2006; 87:205-11. [PMID: 16905294 DOI: 10.1016/j.schres.2006.06.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 06/08/2006] [Accepted: 06/14/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The risk for schizophrenia in immigrants to Europe is approximately three times that of native-born populations. Discrimination and marginalization may influence the risk for schizophrenia within migrant populations. The primary objective of the present study was to determine whether the risk associated with migration was also evident 100 years ago. A second objective was to determine whether changing social stresses are associated with changes to the incidence of schizophrenia. METHOD During the first two decades of the twentieth century, the Provincial Mental Hospital was the sole provider of psychiatric services in British Columbia, Canada. Detailed clinical records have been preserved for 99.5% of 2477 patients who had a psychiatric admission between 1902 and 1913. Diagnoses were made after a detailed file review and 807 patients met DSM-IV criteria for first-episode schizophrenia, schizophreniform disorder, schizoaffective disorder, or psychosis not otherwise specified. Diagnoses had high inter-rater reliability. The incidence of schizophrenia in migrants from Britain or Continental Europe was compared with that in the Canadian-born population using indirect standardization and Poisson models. RESULTS Migration from Britain or Continental Europe to Canada in the early twentieth century was associated with an increased rate of schizophrenia; IRR=1.54, (95% CI=1.33-1.78). Incidence increased over time in immigrants but not in the native-born population and this increase occurred during a period of economic recession. CONCLUSIONS Migration was a risk factor for schizophrenia a century ago as it is today. This risk occurred in white migrants from Europe and increased during a period of increased social stress.
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Affiliation(s)
- G N Smith
- Department of Psychiatry, University of British Columbia, 828 West 10th Ave, Vancouver, BC, Canada V5Z 1L8.
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Bickley H, Kapur N, Hunt IM, Robinson J, Meehan J, Parsons R, McCann K, Flynn S, Burns J, Amos T, Shaw J, Appleby L. Suicide in the homeless within 12 months of contact with mental health services : a national clinical survey in the UK. Soc Psychiatry Psychiatr Epidemiol 2006; 41:686-91. [PMID: 16779501 DOI: 10.1007/s00127-006-0087-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2005] [Indexed: 02/01/2023]
Abstract
BACKGROUND Suicide prevention is a health service priority. Homeless mental health patients present a challenge to services because of their complex health and social needs. AIMS To establish the numbers of homeless patients in contact with services who die by suicide; to describe their suicide methods and their social and clinical characteristics including aspects of clinical care. METHOD A national clinical survey based on a 4-year (1996-2000) sample of people in England and Wales who died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. RESULTS A total of 131 individuals who died by suicide were reported to have been homeless at the time of death--3% of all suicides by psychiatric patients, over 30 per year. Hanging was the most common cause of death. The most frequent diagnosis was schizophrenia. Around half were in-patients at the time of death. Social and clinical risk factors for suicide were common, including drug and alcohol misuse, and recent suicidal ideas and behaviour. Despite this, their clinical care was characterised by disengagement from services as a result of missed contacts, self-discharge, lack of follow-up and lack of key worker. CONCLUSIONS In order to reduce the number of deaths by suicide in those who are homeless and mentally ill, improvements in in-patient safety and engagement in the community are needed. This may be achieved through assertive community treatment, dual diagnosis services, and dedicated community mental health teams.
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Affiliation(s)
- Harriet Bickley
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University of Manchester, Oxford Road, Williamson Building, Manchester, M13 9PL, UK.
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