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Happell B, Warner T, Waks S, O'Donovan A, Manning F, Doody R, Greaney S, Goodwin J, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, van der Vaart KJ, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Something special, something unique: Perspectives of experts by experience in mental health nursing education on their contribution. J Psychiatr Ment Health Nurs 2022; 29:346-358. [PMID: 34032356 DOI: 10.1111/jpm.12773] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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] [Received: 09/27/2020] [Revised: 02/01/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal. ●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking. ●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues. ●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. ABSTRACT Introduction Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods Qualitative exploratory research methods were employed. In-depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, Hunter Institute of Medical Research, Priority Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,ACT Mental Health Consumer Network, Canberra, ACT, Australia
| | - Shifra Waks
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, ACT, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Annaliina Vatula
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | | | - Jerry Allon
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Happell B, Warner T, Waks S, O'Donovan A, Manning F, Doody R, Greaney S, Goodwin J, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, der Vaart KJV, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Becoming an Expert by Experience: Benefits and Challenges of Educating Mental Health Nursing Students. Issues Ment Health Nurs 2021; 42:1095-1103. [PMID: 34156892 DOI: 10.1080/01612840.2021.1931583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 02/05/2023]
Abstract
Expert by Experience involvement in mental health nursing education is increasing in popularity as a teaching technique. The emerging literature attests to its benefits in enriching the educational experience for students. Much less attention has been devoted to the experience from the perspective of the Experts themselves. To address this gap and ensure this important perspective is captured and considered, the aim of this paper is to present the perceptions and experiences of Experts by Experience in delivering an educational module to mental health nursing students. A qualitative exploratory approach was adopted, involving in-depth individual interviews with Experts by Experience who delivered a learning module to nursing students in Australia and Europe. Data were analysed thematically. Analysis produced two overarching themes: Empowerment, and Challenges. Challenges included six sub-themes: Being constructive, not just critical; Time to unpack and reflect; Need for co-production and support from nursing academics; Emotional and practical support; maintaining personal boundaries; and adapting to the audience. These findings make a significant contribution to a broader understanding of Expert by Experience involvement in mental health education. The use of standards to maintain integrity and avoid tokenism is recommended.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Terri Warner
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Shifra Waks
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Aine O'Donovan
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Fionnuala Manning
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Rory Doody
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Sonya Greaney
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - John Goodwin
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Chris Platania-Phung
- Department of Counselling, Australian College of Applied Psychology, Sydney, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Mari Lahti
- Faculty of Health and Social Sciences, Turku University of Applied Sciences, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Horgan A, O Donovan M, Manning F, Doody R, Savage E, Dorrity C, O'Sullivan H, Goodwin J, Greaney S, Biering P, Bjornsson E, Bocking J, Russell S, Griffin M, MacGabhann L, van der Vaart KJ, Allon J, Granerud A, Hals E, Pulli J, Vatula A, Ellilä H, Lahti M, Happell B. 'Meet Me Where I Am': Mental health service users' perspectives on the desirable qualities of a mental health nurse. Int J Ment Health Nurs 2021; 30:136-147. [PMID: 32808438 DOI: 10.1111/inm.12768] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 12/15/2022]
Abstract
Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users' perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co-produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub-themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery-oriented practice. These findings were utilized to directly inform development of a co-produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.
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Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Moira O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claire Dorrity
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Pall Biering
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Jarmo Pulli
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Brenda Happell
- School of Nursing and Midwifery, Faculty of Health and Medicine, Health and Medical Research Institute, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
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Horgan A, Donovan MO, Doody R, Savage E, Dorrity C, O'Sullivan H, Goodwin J, Greaney S, Biering P, Bjornsson E, Bocking J, MacGabhann L, Russell S, Griffin M, Jan van der Vaart K, Allon J, Granerud A, Hals E, Pulli J, Vatula A, Ellilä H, Lahti M, Happell B. Improving Service User Involvement in Mental Health Nursing Education: Suggestions from Those with Lived Experience. Issues Ment Health Nurs 2021; 42:119-127. [PMID: 32717160 DOI: 10.1080/01612840.2020.1780529] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/11/2023]
Abstract
Service user involvement in mental health nursing education is increasing and a developing evidence base is demonstrating more positive attitudes towards people labelled with a mental illness. To date, most research on this approach has focussed on the perspectives of nursing students, with very limited research drawing on the expertise and opinions of service users. The aim of this study was to explore potential improvements in mental health nursing education, and ways service user involvement can be enhanced as defined by service users themselves. An international qualitative research project was undertaken involving focus groups with service users (n = 50) from Australia and five European countries. The research was coproduced between Experts by Experience (service users) and mental health nurse academics. Data were analysed thematically. Findings reflected two broad themes: (1) improvements to content, including: further emphasis on developing emotional intelligence, understanding mental distress and broader context of care; (2) Improvements to service user involvement, including: support, format, and teaching and learning techniques. These findings provide direction for maximising the benefits of service user involvement and show the value of the expertise of service users.
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Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Moira O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claire Dorrity
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden Canberra, Australia
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Norway
| | - Jarmo Pulli
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Brenda Happell
- School of Nursing and Midwifery, Hunter Medical Research Centre, and Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
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Nicoletti P, Devarbhavi H, Goel A, Venkatesan R, Eapen CE, Grove JI, Zafer S, Bjornsson E, Lucena MI, Andrade RJ, Pirmohamed M, Wadelius M, Larrey D, Maitland-van der Zee AH, Ibanez L, Watkins PB, Daly AK, Aithal GP. Genetic Risk Factors in Drug-Induced Liver Injury Due to Isoniazid-Containing Antituberculosis Drug Regimens. Clin Pharmacol Ther 2020; 109:1125-1135. [PMID: 33135175 DOI: 10.1002/cpt.2100] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
Drug-induced liver injury (DILI) is a complication of treatment with antituberculosis (TB) drugs, especially in isoniazid (INH)-containing regimens. To investigate genetic risk factors, we performed a genomewide association study (GWAS) involving anti-TB DILI cases (55 Indian and 70 European) and controls (1,199 Indian and 10,397 European). Most cases were treated with a standard anti-TB drug regimen; all received INH. We imputed single nucleotide polymorphism and HLA genotypes and performed trans-ethnic meta-analysis on GWAS and candidate gene genotypes. GWAS found one significant association (rs117491755) in Europeans only. For HLA, HLA-B*52:01 was significant (meta-analysis odds ratio (OR) 2.67, 95% confidence interval (CI) 1.63-4.37, P = 9.4 × 10-5 ). For N-acetyltransferase 2 (NAT2), NAT2*5 frequency was lower in cases (OR 0.69, 95% CI 0.57-0.83, P = 0.01). NAT2*6 and NAT2*7 were more common, with homozygotes for NAT2*6 and/or NAT2*7 enriched among cases (OR 1.89, 95% CI 0.84-4.22, P = 0.004). We conclude HLA genotype makes a small contribution to TB drug-related DILI and that the NAT2 contribution is complex, but consistent with previous reports when differences in the metabolic effect of NAT2*5 compared with those of NAT2*6 and NAT2*7 are considered.
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Affiliation(s)
- Paola Nicoletti
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Harshad Devarbhavi
- Department of Gastroenterology, St John's Medical College Hospital, Bangalore, India
| | | | - Radha Venkatesan
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
| | | | - Jane I Grove
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Samreen Zafer
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Einar Bjornsson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - M Isabel Lucena
- UGC Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Raul J Andrade
- UGC Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, Liverpool University Hospitals and Liverpool Health Partners, University of Liverpool, Liverpool, UK
| | - Mia Wadelius
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Anke-Hilse Maitland-van der Zee
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Luisa Ibanez
- Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paul B Watkins
- Eshelman School of Pharmacy, University of North Carolina Institute for Drug Safety Sciences, Chapel Hill, North Carolina, USA
| | - Ann K Daly
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
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6
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Happell B, Horgan A, Manning F, Doody R, Greaney S, Goodwin J, Bocking J, Waks S, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, van der Vaart KJ, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Experts by experience in mental health nursing education: What have we learned from the commune project? J Psychiatr Ment Health Nurs 2020; 27:675-677. [PMID: 32285986 DOI: 10.1111/jpm.12635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, Faculty of Health and Medicine, Hunter Institute of Medical Research, Priority Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Shifra Waks
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia.,Australian College of Applied Psychology, Sydney, NSW, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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7
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Horgan A, Manning F, Donovan MO, Doody R, Savage E, Bradley SK, Dorrity C, O'Sullivan H, Goodwin J, Greaney S, Biering P, Bjornsson E, Bocking J, Russell S, MacGabhann L, Griffin M, van der Vaart KJ, Allon J, Granerud A, Hals E, Pulli J, Vatula A, Ellilä H, Lahti M, Happell B. Expert by experience involvement in mental health nursing education: The co-production of standards between Experts by Experience and academics in mental health nursing. J Psychiatr Ment Health Nurs 2020; 27:553-562. [PMID: 31989758 DOI: 10.1111/jpm.12605] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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] [Received: 12/04/2019] [Revised: 01/13/2020] [Accepted: 01/23/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Expert by Experience (EBE) involvement in mental health nursing education has demonstrated benefits, including enhancing understanding of holistic and recovery-focused practice and enhanced application of interpersonal skills. Structure and support for EBE involvement is lacking; often resulting in inadequate preparation and debriefing and tokenistic involvement. Service user involvement in mental health nursing education should be underpinned by lived experience perspectives. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE An exploration of EBE involvement in nursing education from the perspective of those with lived experience. The development of standards designed to provide structure to better support future EBEs involved in higher education. An exemplar for co-production of standards between EBE and nurse academics which has applicability for other contexts. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The standards could potentially strengthen EBE involvement in mental health nursing education, enhance their confidence and increase the retention of EBEs by creating an inclusive working culture. By increasing support for EBEs, the benefits to mental health nursing practice are likely to be maximized. ABSTRACT Introduction Involving people with lived experience of mental distress in mental health nursing education has gained considerable traction yet broader implementation remains ad hoc and tokenistic. Effective involvement requires curricula be informed by lived experience of service use. Aim To develop standards to underpin expert by experience involvement in mental health nursing education based on lived experience of service use. Methods Phase one used qualitative descriptive methods, involving focus groups with service users (n = 50) from six countries to explore perceptions of service user involvement in mental health nursing education. Phase two utilized these findings through consensus building to co-produce standards to support Experts by Experience involvement in mental health nursing education. Results Three themes emerged in Phase one: enablers and barriers, practical and informational support, and emotional and appraisal support. These themes underpinned development of the standards, which reflect nine processes: induction and orientation, external supervision, supportive teamwork, preparation for teaching and assessing, "intervision," mutual mentorship, pre- and post-debriefing, role clarity and equitable payment. Conclusions These standards form the framework entitled; Standards for Co-production of Education (Mental Health Nursing) (SCo-PE [MHN]). Implications for Practice The standards aim to support implementation of Expert by Experience roles in mental health nursing education.
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Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Moira O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Claire Dorrity
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Jarmo Pulli
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku University of Applied Sciences, Turku, Finland
| | - Annaliina Vatula
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku University of Applied Sciences, Turku, Finland
| | - Heikki Ellilä
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku University of Applied Sciences, Turku, Finland
| | - Mari Lahti
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku University of Applied Sciences, Turku, Finland
| | - Brenda Happell
- School of Nursing and Midwifery, Health and Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
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Happell B, Waks S, Horgan A, Greaney S, Manning F, Goodwin J, Bocking J, Scholz B, Hals E, Granerud A, Doody R, Platania-Phung C, Griffin M, Russell S, MacGabhann L, Pulli J, Vatula A, Browne G, van der Vaart KJ, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. "It is much more real when it comes from them": The role of experts by experience in the integration of mental health nursing theory and practice. Perspect Psychiatr Care 2020; 56:811-819. [PMID: 32166758 DOI: 10.1111/ppc.12496] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Received: 12/18/2019] [Revised: 01/28/2020] [Accepted: 02/25/2020] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To examine nursing students' perceptions of Experts by Experience impact on theoretical and practical learning. DESIGN AND METHODS Qualitative exploratory study involving focus groups with undergraduate nursing students from five European countries and Australia. Data were analyzed thematically. FINDINGS Participants described positive impacts as: bridging the theory and practice gap through first-hand experience, including sub-themes: bringing theory to life; can't be taught any other way, and innovative teaching methods fueling curiosity. RELEVANCE TO CLINICAL PRACTICE Integrating theory and practice is key for quality mental health nursing practice. Experts by experience can potentially contribute to reducing this enduring gap.
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Affiliation(s)
- Brenda Happell
- Faculty of Health and Medicine, School of Nursing and Midwifery, Hunter Institute of Medical Research, University of Newcastle University Drive, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, Expert by Experience lecturer, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland.,Area Lead for Mental Health Engagement, Southern Area Health Service Executive, Cork, Ireland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Annaliina Vatula
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Graeme Browne
- Coordinator Port Macquarie Campus, Program Convenor, Masters Mental Health Nursing, School of Nursing & Midwifery, Port Macquarie, New South Wales, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Bocking J, Happell B, Scholz B, Horgan A, Goodwin J, Lahti M, Platania-Phung C, MacGabhann L, Greaney S, Granerud A, Griffin M, Russell S, Bjornsson E, van der Vaart KJ, Ellilä H, Hals E, Doody R, Vatula A, Pulli J, Manning F, Allon J, Biering P. 'It is meant to be heart rather than head'; International perspectives of teaching from lived experience in mental health nursing programs. Int J Ment Health Nurs 2019; 28:1288-1295. [PMID: 31353779 DOI: 10.1111/inm.12635] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Accepted: 06/16/2019] [Indexed: 01/10/2023]
Abstract
Consumer participation is a clear expectation of contemporary mental health policy. Most activity has concentrated in direct service delivery, and academic roles for mental health consumers have been slow to establish. An international project was undertaken to implement and evaluate meaningful consumer involvement in mental health nursing education. A learning module was co-produced between 'Experts by Experience' (drawing on experience of mental distress and service use) and Mental Health Nurse Academics. This qualitative exploratory study aimed to capture how Experts by Experience perceive their contribution. Interviews were undertaken with Experts by Experience who delivered the learning module. Data were analysed thematically and subsequently interpreted with Critical Social Theory. Two main themes emerged from the findings: 'there wasn't a barrier' described how personal narratives enhanced relationships between Experts by Experience and students; and 'made the human being visible', described their experiences of allowing students to see the person behind a diagnosis. These findings suggest Experts by Experience teaching is valuable and potentially a tool in redressing stigma. Addressing poor public perceptions could attract higher numbers of quality practitioners to mental health and meet identified workforce shortages. The findings presented here strengthen the evidence base for Expert by Experience roles in mental health professional education. These findings can be considered in international curricula reviews and aid progress towards a more socio-political, humanistic focus in mental health nursing, congruent with rights-based reform agendas.
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Affiliation(s)
- Julia Bocking
- ANU Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia.,Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Brett Scholz
- ANU Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mari Lahti
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | | | - Heikki Ellilä
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Annaliina Vatula
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Jarmo Pulli
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Happell B, Waks S, Horgan A, Greaney S, Bocking J, Manning F, Goodwin J, Scholz B, Jan van der Vaart K, Allon J, Hals E, Granerud A, Doody R, Wai-Chi Chan S, Platania-Phung C, Griffin M, Russell S, MacGabhann L, Pulli J, Vatula A, Lahti M, Ellilä H, Browne G, Bjornsson E, Biering P. Expert by Experience Involvement in Mental Health Nursing Education: Nursing Students' Perspectives on Potential Improvements. Issues Ment Health Nurs 2019; 40:1026-1033. [PMID: 31498007 DOI: 10.1080/01612840.2019.1631417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/26/2022]
Abstract
Expert by experience involvement in mental health education for health professional programmes has increased in recent decades. The related literature has articulated the benefits, and changes in attitudes have been measured in some studies. Less attention has been devoted to ways this learning approach could be improved. The aim of this paper is to present the nursing students perspectives on how Expert by Experience input into nursing curricula could be enhanced. Qualitative exploratory research was undertaken, involving focus groups with students who had completed a mental health learning module co-produced by Experts by Experience and nurse academics. Results show two main themes: getting the structure right, and changes to content and approach. Some student responses could directly influence changes to the learning module. In other instances, responses indicate the need to better prepare students of the value of lived experience knowledge in its own right, rather than adjunct to more traditional methods of education. These findings are important in encouraging reflection on how future learning modules co-produced by Experts by Experience and Mental Health Nursing academics can be refined and better articulated.
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Affiliation(s)
- Brenda Happell
- University of Newcastle, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Julia Bocking
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sally Wai-Chi Chan
- University of Newcastle Singapore Operation, Singapore.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Graeme Browne
- School of Nursing & Midwifery, University of Newcastle, Port Macquarie, Australia
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Happell B, Waks S, Bocking J, Horgan A, Manning F, Greaney S, Goodwin J, Scholz B, van der Vaart KJ, Allon J, Hals E, Granerud A, Doody R, Chan SWC, Lahti M, Ellilä H, Pulli J, Vatula A, Platania-Phung C, Browne G, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. “But I’m not going to be a mental health nurse”: nursing students’ perceptions of the influence of experts by experience on their attitudes to mental health nursing. J Ment Health 2019; 30:556-563. [DOI: 10.1080/09638237.2019.1677872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Brenda Happell
- Professor of Nursing and Equally Well Ambassador, School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, Australia
| | - Shifra Waks
- Consumer Academic, the University of Melbourne, Parkville, Ireland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, the Australian National University, Woden, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, Expert by Experience Lecturer, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, the Australian National University, Woden, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- Area Lead for Mental Health Engagement, Southern Area Health Service Executive, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Graeme Browne
- Masters Mental Health Nursing, School of Nursing & Midwifery, Coordinator Port Macquarie Campus
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Happell B, Platania-Phung C, Scholz B, Bocking J, Horgan A, Manning F, Doody R, Hals E, Granerud A, Jan van der Vaart K, Allon J, Lahti M, Pulli J, Vatula A, Ellilä H, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. Assessment of the Opening Minds Scale for use with nursing students. Perspect Psychiatr Care 2019; 55:661-666. [PMID: 31169305 DOI: 10.1111/ppc.12393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 03/11/2019] [Accepted: 04/21/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Evaluate the validity of the Opening Minds Scale (OMS) for nursing students via Rasch models and confirmatory factor analysis (CFA). DESIGN AND METHODS Undergraduate nursing student responses to OMS (n = 423). Validity was evaluated via CFA and Rasch analysis. FINDINGS CFA results were strongest for a three-factor 13-item version of OMS. Rasch modeling supported sound properties for two of three scales. Internal reliabilities ranged between 0.6 and 0.7. PRACTICE IMPLICATIONS OMS has potential as a valid measure for stigma research and antistigma program evaluation. Rasch analysis suggest it is inappropriate to use a total OMS score for nursing student populations.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | - Julia Bocking
- School of Health Sciences, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Happell B, Waks S, Bocking J, Horgan A, Manning F, Greaney S, Goodwin J, Scholz B, van der Vaart KJ, Allon J, Hals E, Granerud A, Doody R, MacGabhann L, Russell S, Griffin M, Lahti M, Ellilä H, Pulli J, Vatula A, Platania-Phung C, Bjornsson E, Biering P. "I felt some prejudice in the back of my head": Nursing students' perspectives on learning about mental health from "Experts by Experience". J Psychiatr Ment Health Nurs 2019; 26:233-243. [PMID: 31220380 DOI: 10.1111/jpm.12540] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Received: 01/29/2019] [Revised: 05/26/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Consumer participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal Involving mental health "Experts by Experience" in the education of nursing students demonstrates positive attitudinal change WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: More detailed understanding of nursing students' experiences and perspectives about being taught mental health nursing by "Experts by Experience" An international focus, extending understandings about how Experts by Experience might be perceived in a broader range of countries WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Positive attitudes towards people labelled with mental illness are essential for quality nursing practice Nurses have an important leadership role in facilitating consumer participation within health services. It is critical that their attitudes are professional and optimistic. ABSTRACT: Introduction Consumer participation is central to mental health policy. Negative attitudes of health professionals are barriers to realizing policy goals. Evidence suggests consumers (Experts by Experience) can influence positive attitudes in nursing students. Research in this area to date is limited and primarily from Australia and New Zealand. Aim To enhance understanding of nursing students' perspectives and experiences of being taught mental health by an Expert by Experience. Method A qualitative exploratory approach was used. Focus groups were conducted with nursing students from seven universities in Australia and Europe. Data were analysed thematically. Results Student participants described how exposure to Experts by Experience challenged their views and attitudes and provided a mechanism for reflection, critique and change. The main theme "changing mindset" includes two subthemes: exposing stereotypes and reflection. Discussion This unique international study demonstrates the capacity for Experts by Experience to contribute to positive attitudinal change towards mental illness in nursing students. This changed mindset must occur for policy goals to be realized. Implications for practice Nurses in all areas of practice will work with people labelled with mental illness and experiencing mental distress. Overcoming stereotypes and adopting more positive attitudes is essential to deliver quality mental health care.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Melbourne, Parkville, Victoria, Australia
| | - Julia Bocking
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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14
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Happell B, Waks S, Bocking J, Horgan A, Manning F, Greaney S, Goodwin J, Scholz B, van der Vaart KJ, Allon J, Granerud A, Hals E, Doody R, Russell S, Griffin M, MacGabhann L, Lahti M, Ellilä H, Pulli J, Vatula A, Platania-Phung C, Bjornsson E, Biering P. 'There's more to a person than what's in front of you': Nursing students' experiences of consumer taught mental health education. Int J Ment Health Nurs 2019; 28:950-959. [PMID: 30953420 DOI: 10.1111/inm.12596] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Abstract
Holistic and person-centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery-oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience-led teaching as part of a co-produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person-centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person-centred care and recovery-oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students' approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery-oriented practice in mental health and holistic and person-centred practice in all areas of health care.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Bocking
- Medical School, Australian National University, Acton, Canberra, Australian Capital Territory, Australia.,Faculty of Health, University of Canberra, University Drive, Bruce, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- Area Lead for Mental Health Engagement, Southern Area Health Service Executive, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- Mental Health Practice, Healthy Living Centre, Dublin City University, Dublin, Ireland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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15
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Happell B, Platania-Phung C, Scholz B, Bocking J, Horgan A, Manning F, Doody R, Hals E, Granerud A, Lahti M, Pullo J, Vatula A, Ellilä H, van der Vaart KJ, Allon J, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. Nursing student attitudes to people labelled with 'mental illness' and consumer participation: A survey-based analysis of findings and psychometric properties. Nurse Educ Today 2019; 76:89-95. [PMID: 30776534 DOI: 10.1016/j.nedt.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 09/09/2018] [Revised: 01/15/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Understanding student attitudes towards people diagnosed with mental illness is central to realising evidence-based nursing education and policy at an international level. Redressing stigmatised views can assist in preparing nursing students to work in mental health settings and support the active involvement of consumers in all aspects of mental health service delivery (known as: consumer participation) at individual and systemic levels. Accurate research on nursing student attitudes is dependent on the availability of valid and reliable measures. OBJECTIVES Using data from and international study, this research sought to: (1) evaluate two measures of nurse student attitudes, and (2) explore whether attitudes to people labelled with a diagnosis of mental illness and who use mental health services is associated with more positive attitudes to consumer participation in mental health services. DESIGN Self-report quantitative data gained via the Consumer Participation Questionnaire (CPQ) and Mental Health Nurse Education Survey (MHNES). SETTING AND PARTICIPANTS University nursing students in Australia and Western Europe. DATA Pooled CPQ and MHNES data from Australia, Ireland, Finland, Norway and the Netherlands. METHODS The MHNES and CPQ were evaluated via exploratory factor analysis and Rasch modelling. Hierarchical regression was applied to see whether attitudes to mental illness and mental health practice relate to attitudes to consumer participation after addressing demographic differences. RESULTS Refined MHNES scales demonstrated overall fit on Rasch models. Reliabilities for MHNES ranged from 0.82 to 0.73. Perceived value of mental health nursing to consumers and lower negative stereotypes were associated with positive attitudes to consumer participation independent of age, gender and country [F (9, 381) = 15.78, p < .001]. Students who considered mental health nursing made a valuable contribution represented the strongest association with a positive attitude towards consumer participation. CONCLUSIONS Differences in openness to consumer participation are partly attributable to views about people diagnosed with mental illness and the perception that mental health practice makes a positive difference to these people within health service contexts.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia.
| | - Julia Bocking
- School of Health Sciences, University of Canberra, Faculty of Health, Australia.
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway.
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway.
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland; Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland.
| | - Jarmo Pullo
- Turku University of Applied Sciences, Turku, Finland; Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland; Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland; Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland.
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland.
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland.
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland.
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland.
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland.
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16
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Happell B, Platania-Phung C, Scholz B, Bocking J, Horgan A, Manning F, Doody R, Hals E, Granerud A, Lahti M, Pullo J, Vatula A, Koski J, van der Vaart KJ, Allon J, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. Changing attitudes: The impact of Expert by Experience involvement in Mental Health Nursing Education: An international survey study. Int J Ment Health Nurs 2019; 28:480-491. [PMID: 30390371 DOI: 10.1111/inm.12551] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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] [Accepted: 10/07/2018] [Indexed: 11/27/2022]
Abstract
Reform to nursing education is essential to ensure future generations of nurses are strongly positioned to value, know, and deliver strength-based, recovery-oriented mental health practice. A promising pathway to effectively drive reform is the coproduction of curricula by nursing academics and people with lived experience of recovery from mental distress referred to as Experts by Experience. The Co-production in Mental Health Nursing Education (COMMUNE) project is an international collaboration for development and implementation of consumer coproduced curricula. This study evaluated the inclusion of Expert by Experience-led mental health nursing education on nursing students' attitudes to people labelled with mental illness, mental health nursing, and consumer participation. A repeated self-report measures design was implemented in Australia, Ireland, and Finland to ascertain level of generalizability of consumer involvement within undergraduate nursing programmes. Data were collected from nursing students (n = 194) immediately before and after the education module, using three self-report instruments on attitudes (Mental Health Nurse Education Survey, Consumer Participation Questionnaire, and Opening Minds Scale). Data were analysed using descriptive and inferential statistics. Eighty-nine per cent of the 27 points of change reflected more favourable and accepting attitudinal change. Of these, 41% were significant at Bonferroni adjusted alpha of 0.0025. There was a statistically significant increase in preparedness for practice in the mental health field in each of the three countries. The most pronounced change is related to the social and systemic inclusion of people with a diagnostic label and recovery-oriented care more broadly.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australian Capital Territory, Australia
| | - Julia Bocking
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Building 6, Level 3, Canberra Hospital, Woden Canberra, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Jarmo Pullo
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Johanna Koski
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Martha Griffin
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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17
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Nicoletti P, Aithal GP, Chamberlain TC, Coulthard S, Alshabeeb M, Grove JI, Andrade RJ, Bjornsson E, Dillon JF, Hallberg P, Lucena MI, Maitland‐van der Zee AH, Martin JH, Molokhia M, Pirmohamed M, Wadelius M, Shen Y, Nelson MR, Daly AK. Drug‐Induced Liver Injury due to Flucloxacillin: Relevance of Multiple Human Leukocyte Antigen Alleles. Clin Pharmacol Ther 2019; 106:245-253. [DOI: 10.1002/cpt.1375] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/13/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Paola Nicoletti
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount Sinai New York New York USA
- Sema4, a Mount Sinai Venture Stamford Connecticut USA
| | - Guruprasad P. Aithal
- National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospital NHS Trust and University of Nottingham Nottingham UK
| | - Thomas C. Chamberlain
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne UK
- University of British ColumbiaVancouver British Columbia Canada
| | - Sally Coulthard
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne UK
| | - Mohammad Alshabeeb
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne UK
- Developmental Medicine DepartmentKing Abdullah International Medical Research Center Riyadh Kingdom of Saudi Arabia
| | - Jane I. Grove
- National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospital NHS Trust and University of Nottingham Nottingham UK
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of Nottingham Nottingham UK
| | - Raul J. Andrade
- UGC Digestivo y Servicio de Farmacología ClínicaInstituto de Investigación Biomédica de Málaga (IBIMA)Hospital Universitario Virgen de la VictoriaUniversidad de MálagaMálagaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)MadridSpain
| | - Einar Bjornsson
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineThe National University Hospital of Iceland Reykjavik Iceland
| | - John F. Dillon
- Medical Research InstituteUniversity of DundeeNinewells Hospital Dundee UK
| | - Par Hallberg
- Department of Medical Sciences and Science for Life LaboratoryUppsala University Uppsala Sweden
| | - M. Isabel Lucena
- UGC Digestivo y Servicio de Farmacología ClínicaInstituto de Investigación Biomédica de Málaga (IBIMA)Hospital Universitario Virgen de la VictoriaUniversidad de MálagaMálagaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)MadridSpain
| | - Anke H. Maitland‐van der Zee
- Department of Respiratory MedicineAcademic Medical Center (AMC)University of Amsterdam Amsterdam The Netherlands
| | - Jennifer H. Martin
- School of Medicine and Public HealthUniversity of Newcastle Callaghan New South Wales Australia
| | - Mariam Molokhia
- School of Population Health and Environmental SciencesFaculty of Life Sciences and MedicineKing's College London UK
| | - Munir Pirmohamed
- Department of Molecular and Clinical PharmacologyUniversity of Liverpool Liverpool UK
| | - Mia Wadelius
- Department of Medical Sciences and Science for Life LaboratoryUppsala University Uppsala Sweden
| | - Yufeng Shen
- The Herbert Irving Comprehensive Cancer CenterColumbia University New York New York USA
- Department of Biomedical InformaticsColumbia University New York New York USA
| | | | - Ann K. Daly
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne UK
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18
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Happell B, Platania-Phung C, Bocking J, Scholz B, Horgan A, Manning F, Doody R, Hals E, Granerud A, Lahti M, Pullo J, Ellilä H, Annaliina V, van der Vaart KJ, Allon J, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. Nursing Students' Attitudes Towards People Diagnosed with Mental Illness and Mental Health Nursing: An International Project from Europe and Australia. Issues Ment Health Nurs 2018; 39:829-839. [PMID: 30346220 DOI: 10.1080/01612840.2018.1489921] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 01/19/2023]
Abstract
The stigma associated with a diagnosis of mental illness is well known yet has not reduced significantly in recent years. Health professionals, including nurses, have been found to share similar negative attitudes towards people with labelled with mental illness as the general public. The low uptake of mental health nursing as a career option reflects these stigmatised views and is generally regarded as one of the least popular areas of in which to establish a nursing career. The aim of the current project was to examine nursing students' attitudes towards the concept of mental illness and mental health nursing across four European countries (Ireland, Finland, Norway and the Netherlands), and Australia, using the Opening Minds Scale and the Mental Health Nurse Education survey. The surveys were distributed to students prior to the commencement of the mental health theory component. Attitudes towards mental health nursing were generally favourable. Differences in opinion were evident in attitudes towards mental illness as a construct; with students from Australia and Ireland tending to have more positive attitudes than students from Finland, Norway and the Netherlands. The future quality of mental health services is dependent on attracting sufficient nurses with the desire, knowledge and attitudes to work in mental health settings. Understanding attitudes towards mental illness and mental health nursing is essential to achieving this aim.
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Affiliation(s)
- Brenda Happell
- a School of Nursing and Midwifery , the University of Newcastle, Callaghan , New South Wales , Australia
| | - Chris Platania-Phung
- b Synergy: Nursing and Midwifery Research Centre , University of Canberra, Faculty of Health, and ACT Health , WODEN , Australia
| | - Julia Bocking
- b Synergy: Nursing and Midwifery Research Centre , University of Canberra, Faculty of Health, and ACT Health , WODEN , Australia
| | - Brett Scholz
- b Synergy: Nursing and Midwifery Research Centre , University of Canberra, Faculty of Health, and ACT Health , WODEN , Australia
| | - Aine Horgan
- c School of Nursing and Midwifery , University College Cork , Cork , Ireland
| | - Fionnuala Manning
- c School of Nursing and Midwifery , University College Cork , Cork , Ireland
| | - Rory Doody
- c School of Nursing and Midwifery , University College Cork , Cork , Ireland
| | - Elisabeth Hals
- d Faculty of Health and Social Sciences , Inland Norway University of Applied Sciences , Hedmark , Norway
| | - Arild Granerud
- d Faculty of Health and Social Sciences , Inland Norway University of Applied Sciences , Hedmark , Norway
| | - Mari Lahti
- e Turku University of Applied Sciences, Turku, Finland, Faculty of Medicine, Department of Nursing Science , Turku University , Turku , Finland
| | - Jarmo Pullo
- e Turku University of Applied Sciences, Turku, Finland, Faculty of Medicine, Department of Nursing Science , Turku University , Turku , Finland
| | - Heikki Ellilä
- e Turku University of Applied Sciences, Turku, Finland, Faculty of Medicine, Department of Nursing Science , Turku University , Turku , Finland
| | - Vatula Annaliina
- e Turku University of Applied Sciences, Turku, Finland, Faculty of Medicine, Department of Nursing Science , Turku University , Turku , Finland
| | | | - Jerry Allon
- f Institute for Nursing Studies, University of Applied Sciences Utrecht , Utrecht , the Netherlands
| | - Martha Griffin
- g School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Siobhan Russell
- g School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Liam MacGabhann
- g School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Einar Bjornsson
- h Department of Nursing , University of Iceland , Reykjavik , Iceland
| | - Pall Biering
- h Department of Nursing , University of Iceland , Reykjavik , Iceland
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19
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Horgan A, Manning F, Bocking J, Happell B, Lahti M, Doody R, Griffin M, Bradley SK, Russell S, Bjornsson E, O'Donovan M, MacGabhann L, Savage E, Pulli J, Goodwin J, van der Vaart KJ, O'Sullivan H, Dorrity C, Ellila H, Allon J, Hals E, Sitvast J, Granerud A, Biering P. 'To be treated as a human': Using co-production to explore experts by experience involvement in mental health nursing education - The COMMUNE project. Int J Ment Health Nurs 2018; 27:1282-1291. [PMID: 29377483 DOI: 10.1111/inm.12435] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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] [Received: 10/30/2017] [Accepted: 12/17/2017] [Indexed: 12/30/2022]
Abstract
Increasingly, experts as deemed by personal experience or mental health service use, are involved in the education of nurses; however, accompanying research is limited and focuses primarily on opinions of nurse educators and students. The aim of this study was to develop an understanding of the potential contribution to mental health nursing education by those with experience of mental health service use. The research was part of the international COMMUNE (Co-production of Mental Health Nursing Education) project, established to develop and evaluate co-produced mental health content for undergraduate nursing students. A qualitative descriptive design was adopted with data collected through focus group interviews in seven sites across Europe and Australia. Experts by experience (people with experience of distress, service use, and recovery) co-produced the project in partnership with nursing academics. Co-production enriched the process of data collection and facilitated the analysis of data from multiple perspectives. Two themes are presented in this paper. The first focuses on how experts by experience can enhance students' understanding of recovery by seeing the strengths inherent in the 'human' behind the diagnostic label. The second highlights the importance of communication and self-reflection on personal values, where students can explore their own thoughts and feelings about mental distress alongside those with lived experience. Interacting with experts by experience in the classroom can assist in challenging stigmatizing attitudes prior to nursing placements. These findings can be used to inform international nursing curricula by increasing the focus on nursing skills valued by those who use the services.
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Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Julia Bocking
- SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australian Capital Territory, Australia
| | - Brenda Happell
- SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australian Capital Territory, Australia
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Martha Griffin
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Stephen K Bradley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Siobhan Russell
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Moira O'Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Liam MacGabhann
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claire Dorrity
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Heikki Ellila
- Turku University of Applied Sciences, Turku, Finland
| | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Jan Sitvast
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Vidarsdottir JB, Johannsdottir SE, Thorsdottir I, Bjornsson E, Ramel A. A cross-sectional study on nutrient intake and -status in inflammatory bowel disease patients. Nutr J 2016; 15:61. [PMID: 27268004 PMCID: PMC4897945 DOI: 10.1186/s12937-016-0178-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 05/28/2016] [Indexed: 12/11/2022] Open
Abstract
Background and aims Inflammatory bowel disease (IBD) can be associated with nutritional problems. The aim of this study was to investigate diet and nutritional status of IBD patients. Methods A total of 78 participants (35 men and 43 women aged 18–74 years) were included in this cross-sectional study. The majority (80 %) of the participant received infliximab treatment. Participants filled out disease related questionnaires and 31 participants also a 3-day food record. Body composition was measured and blood samples analysed in order to estimate nutritional status. Results The majority (87 %) claimed that diet affects digestive tract symptoms and 72 % had changed diet accordingly. The most common foods restricted were dairy products (60 %), processed meat (55 %), soft drinks (46 %), alcohol (45 %) and fast food (44 %). Body mass index was mostly in the overweight range but 46 % of the participants had been diagnosed with some nutritional deficiency since IBD diagnosis (most common was iron deficiency: 39 %). Patients who restricted meat products had lower ferritin values (48 ± 39 vs. 95 ± 74 μg/L, P = 0.011). Intake of vitamin D and calcium were not adequate (65 % below recommeded intake for both) and 60 % had poor vitamin D status. Conclusion IBD patients often change their dietary intake in order to affect digestive tract symptoms. Many patients have a history of nutrient deficiency. Restriction of dairy and meat consumption is common and is negatively associated with intake or status of micronutrients like calcium and iron. Dietary advice by a dietitian and use of potentially helpful dietary supplements is indicated.
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Affiliation(s)
- Jona B Vidarsdottir
- Unit for Nutrition Research, Landspitali, The National University Hospital of Iceland and Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Sigridur E Johannsdottir
- Department of Gastrointestinal Diseases, Landspitali, The National University Hospital of Iceland and Faculty of Medicine, School of Health Sciences, Reykjavik, Iceland
| | - Inga Thorsdottir
- Unit for Nutrition Research, Landspitali, The National University Hospital of Iceland and Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Einar Bjornsson
- Department of Gastrointestinal Diseases, Landspitali, The National University Hospital of Iceland and Faculty of Medicine, School of Health Sciences, Reykjavik, Iceland
| | - Alfons Ramel
- Unit for Nutrition Research, Landspitali, The National University Hospital of Iceland and Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
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Bjarnason I, Hayee B, Pavlidis P, Kvasnovsky C, Scalori A, Sisson G, Charlesworth A, Shaikh H, Bjornsson E, Heneghan MA. Contrasting Pattern of Chronic Inflammatory Bowel Disease in Primary and Autoimmune Sclerosing Cholangitis. EBioMedicine 2015; 2:1523-7. [PMID: 26629548 PMCID: PMC4634318 DOI: 10.1016/j.ebiom.2015.08.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/29/2015] [Accepted: 08/29/2015] [Indexed: 12/22/2022] Open
Abstract
Background Primary sclerosing cholangitis (PSC) and autoimmune sclerosing cholangitis (AISC) are related, but distinct chronic liver diseases. PSC is associated with a high prevalence of ulcerative colitis while the intestinal inflammation associated with AISC is less well characterised. Aims To assess and contrast aspects of intestinal inflammation in patients with AISC and PSC and compare the clinical features with those of patients with ulcerative colitis and Crohn's disease. Methods 23 and 22 patients with AISC and PSC, respectively, underwent review of colonoscopy and biopsy findings, capsule enteroscopy and assessment of clinical and inflammatory (faecal calprotectin) disease activity, which was compared with that of patients with ulcerative colitis and Crohn's disease (n = 55 each). Findings Five and 6 patients with AISC and PSC, respectively, had normal colonoscopy and faecal calprotectin levels of 34.4 ± 8.3 and 39.7 ± 8.4 μg/g, respectively (normal < 50 μg/g), whereas 18 and 16, respectively, had identical variably severe, right sided colitis with frequent rectal sparing, consistent with ulcerative colitis. Mean (± SD) faecal calprotectin levels did not differ significantly (p > 0.05) between patients with intestinal inflammation in AISC (588 ± 549 μg/g), PSC (421 ± 351 μg/g), ulcerative colitis (501 ± 656 μg/g) or Crohn's disease (476 ± 571 μg/g). Capsule enteroscopy showed that 7 of 18 (39%) (p < 0.03) of those with AISC had small bowel mucosal breaks whereas no patient with PSC had these findings. Interpretation Collectively these findings lend support to the suggestion that the chronic inflammatory bowel disease associated with PSC and in particular AISC may represent a distinct nosologic entity different from classic ulcerative colitis and Crohn's disease. The ulcerative colitis (UC) associated with autoimmune and primary sclerosing cholangitis behaves differently to classic UC. Patients with autoimmune and primary sclerosing cholangitis have similar pattern of colitis, resembling ulcerative colitis. 39% of those with autoimmune sclerosing cholangitis had small intestinal mucosal breaks resembling Crohn’s disease. The colitis associated with these chronic liver diseases differs distinctively from classic inflammatory bowel disease.
Most patients with the chronic liver disease primary sclerosing cholangitis have a colitis, which is classified as ulcerative colitis. Here we show that patients with a related liver disease, namely autoimmune sclerosing cholangitis, have an identical colitis, but 39% also have small bowel erosions or ulcers which is more suggestive of Crohn's disease. Intestinal inflammatory activity was similar in these patients as compared with patients with ulcerative colitis and Crohn's disease. Collectively these findings and the contrasting natural history of the colitis of chronic liver suggests that this represents a separate nosologic entity from classic inflammatory bowel disease.
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Affiliation(s)
- Ingvar Bjarnason
- Department of Gastroenterology, King's College Hospital, Denmark Hill, London, UK ; Department of Minimally Invasive Colorectal Surgery, King's College Hospital, Denmark Hill, London, UK
| | - Bu Hayee
- Department of Gastroenterology, King's College Hospital, Denmark Hill, London, UK
| | - Polychronis Pavlidis
- Department of Gastroenterology, King's College Hospital, Denmark Hill, London, UK
| | - Charlotte Kvasnovsky
- Department of Minimally Invasive Colorectal Surgery, King's College Hospital, Denmark Hill, London, UK
| | - Astrid Scalori
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK
| | - Guy Sisson
- Department of Gastroenterology, King's College Hospital, Denmark Hill, London, UK
| | - Annika Charlesworth
- Department of Gastroenterology, King's College Hospital, Denmark Hill, London, UK
| | - Hizbullah Shaikh
- Department of Histopathology, King's College Hospital, Denmark Hill, London, UK
| | - Einar Bjornsson
- Department of Gastroenterology, Landspitali University Hospital, Reykjavik, Iceland
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK
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Lindfors P, Ljótsson B, Bjornsson E, Abrahamsson H, Simrén M. Patient satisfaction after gut-directed hypnotherapy in irritable bowel syndrome. Neurogastroenterol Motil 2013; 25:169-e86. [PMID: 23051178 DOI: 10.1111/nmo.12022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 02/07/2023]
Abstract
BACKGROUND Gut-directed hypnotherapy is an effective treatment option for irritable bowel syndrome (IBS). However, clinical observations suggest that patient satisfaction with hypnotherapy is not always associated with improvement in IBS symptoms. METHODS We evaluated 83 patients with IBS treated with gut-directed hypnotherapy (1 h week(-1), 12 weeks). After the treatment period, patients reported their satisfaction with the treatment (ranging from 1 = not at all satisfied, to 5 = very satisfied) and completed questionnaires to assess IBS symptom severity, quality of life, cognitive function, sense of coherence, depression, and anxiety before and after treatment. KEY RESULTS After hypnotherapy improved IBS symptom severity, quality of life, cognitive function, and anxiety were seen. Thirty patients (36%) were very satisfied with the treatment and 57 (69%) patients scored 4 or 5 on the patient satisfaction scale. Patient satisfaction was associated with less severe IBS symptoms and better quality of life after the treatment. In a multiple linear regression analysis, only the quality of life domain sexual relations was independently associated with patient satisfaction after hypnotherapy, explaining 22% of the variance. Using 25% reduction of IBS symptom severity to define an IBS symptom responder, 52% of the responders were very satisfied with hypnotherapy, but this was also true for 31% in the non-responder group. CONCLUSIONS & INFERENCES Patient satisfaction with gut-directed hypnotherapy in IBS is associated with improvement of quality of life and gastrointestinal (GI) symptoms. However, other factors unrelated to GI symptoms also seems to be of importance for patient satisfaction, as a substantial proportion of patients without GI symptom improvement were also very satisfied with this treatment option.
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Affiliation(s)
- P Lindfors
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Olafsdottir LB, Gudjonsson H, Jonsdottir HH, Jonsson JS, Bjornsson E, Thjodleifsson B. Irritable bowel syndrome: Physicians' awareness and patients' experience. World J Gastroenterol 2012; 18:3715-20. [PMID: 22851864 PMCID: PMC3406424 DOI: 10.3748/wjg.v18.i28.3715] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 05/11/2012] [Accepted: 06/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To study if and how physicians use the irritable bowel syndrome (IBS) diagnostic criteria and to assess treatment strategies in IBS patients.
METHODS: A questionnaire was sent to 191 physicians regarding IBS criteria, diagnostic methods and treatment. Furthermore, 94 patients who were diagnosed with IBS underwent telephone interview.
RESULTS: A total of 80/191 (41.9%) physicians responded to the survey. Overall, 13 patients were diagnosed monthly with IBS by specialists in gastroenterology (SGs) and 2.5 patients by general practitioners (GPs). All the SGs knew of the criteria to diagnose IBS, as did 46/70 (65.7%) GPs. Seventy-nine percent used the patient’s history, 38% used a physical examination, and 38% exclusion of other diseases to diagnose IBS. Only 18/80 (22.5%) physicians used specific IBS criteria. Of the patients interviewed, 59/94 (62.8%) knew they had experienced IBS. Two out of five patients knew IBS and had seen a physician because of IBS symptoms. Half of those received a diagnosis of IBS. A total of 13% were satisfied with treatment. IBS affected daily activities in 43% of cases.
CONCLUSION: Half of the patients with IBS who consulted a physician received a diagnosis. Awareness and knowledge of diagnostic criteria for IBS differ between SGs and GPs.
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Olafsdottir LB, Gudjonsson H, Jonsdottir HH, Bjornsson E, Thjodleifsson B. Natural history of functional gastrointestinal disorders: comparison of two longitudinal population-based studies. Dig Liver Dis 2012; 44:211-7. [PMID: 22137573 DOI: 10.1016/j.dld.2011.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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] [Received: 04/06/2011] [Revised: 10/05/2011] [Accepted: 10/14/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders are common but information on their natural history is limited. AIMS To document the natural history of functional gastrointestinal disorders in a population based study and to compare with the Olmsted County study. METHOD A questionnaire was mailed to the same age- and gender-stratified random sample of the Icelandic population aged 18-75 in 1996 and 2006. Results were compared to the Olmsted County study. RESULTS Prevalence of functional gastrointestinal disorder symptoms was stable between these periods in time: 16.9% and 17.2% for irritable bowel syndrome, and 4.8% and 6.1% for functional dyspepsia. Onset of each disorder was more often higher in the Olmsted County study than in Iceland. Disappearance rates were similar for both studies. Transition probabilities varied across the different subgroups and were different between studies. The same proportion had the same symptoms in the initial and final studies. More subjects had no symptoms in Iceland (52% vs. 40%) and different symptoms at follow up (38% vs. 23%). CONCLUSION Prevalence of functional gastrointestinal disorder symptoms was stable over time but the turnover in symptoms was high. A higher number of subjects had no symptoms in Iceland than in Olmsted County and there was a greater variation in subjects having different symptoms at follow up.
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Janse M, Lamberts LE, Franke L, Raychaudhuri S, Ellinghaus E, MuriBoberg K, Melum E, Folseraas T, Schrumpf E, Bergquist A, Bjornsson E, Fu J, Westra HJ, Groen HJM, Fehrmann RSN, Smolonska J, van den Berg LH, Ophoff RA, Porte RJ, Weismuller TJ, Wedemeyer J, Schramm C, Sterneck M, Gunther R, Braun F, Vermeire S, Henckaerts L, Wijmenga C, Ponsioen CY, Schreiber S, HKarlsen T, Franke A, Weersma RK. Three ulcerative colitis susceptibility loci are associated with primary sclerosing cholangitis and indicate a role for IL2, REL, and CARD9. Hepatology 2011; 53:1977-85. [PMID: 21425313 PMCID: PMC3121050 DOI: 10.1002/hep.24307] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [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] [Received: 11/19/2010] [Accepted: 03/09/2011] [Indexed: 12/13/2022]
Abstract
UNLABELLED Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the bile ducts. Both environmental and genetic factors contribute to its pathogenesis. To further clarify its genetic background, we investigated susceptibility loci recently identified for ulcerative colitis (UC) in a large cohort of 1,186 PSC patients and 1,748 controls. Single nucleotide polymorphisms (SNPs) tagging 13 UC susceptibility loci were initially genotyped in 854 PSC patients and 1,491 controls from Benelux (331 cases, 735 controls), Germany (265 cases, 368 controls), and Scandinavia (258 cases, 388 controls). Subsequently, a joint analysis was performed with an independent second Scandinavian cohort (332 cases, 257 controls). SNPs at chromosomes 2p16 (P-value 4.12 × 10(-4) ), 4q27 (P-value 4.10 × 10(-5) ), and 9q34 (P-value 8.41 × 10(-4) ) were associated with PSC in the joint analysis after correcting for multiple testing. In PSC patients without inflammatory bowel disease (IBD), SNPs at 4q27 and 9q34 were nominally associated (P < 0.05). We applied additional in silico analyses to identify likely candidate genes at PSC susceptibility loci. To identify nonrandom, evidence-based links we used GRAIL (Gene Relationships Across Implicated Loci) analysis showing interconnectivity between genes in six out of in total nine PSC-associated regions. Expression quantitative trait analysis from 1,469 Dutch and UK individuals demonstrated that five out of nine SNPs had an effect on cis-gene expression. These analyses prioritized IL2, CARD9, and REL as novel candidates. CONCLUSION We have identified three UC susceptibility loci to be associated with PSC, harboring the putative candidate genes REL, IL2, and CARD9. These results add to the scarce knowledge on the genetic background of PSC and imply an important role for both innate and adaptive immunological factors.
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Affiliation(s)
- Marcel Janse
- Department of Gastroenterology and Hepatology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Laetitia E Lamberts
- Department of Gastroenterology and Hepatology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Lude Franke
- Department of Genetics, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Soumya Raychaudhuri
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts, 02115, USA, Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts, 02115, USA, Broad Institute, Cambridge, Massachusetts, 02142 USA
| | - Eva Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Kirsten MuriBoberg
- Norwegian PSC Research Center, Clinic for Specialized Surgery and Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Espen Melum
- Norwegian PSC Research Center, Clinic for Specialized Surgery and Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Trine Folseraas
- Norwegian PSC Research Center, Clinic for Specialized Surgery and Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Schrumpf
- Norwegian PSC Research Center, Clinic for Specialized Surgery and Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Annika Bergquist
- Department of Gastroenterology and Hepatology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Einar Bjornsson
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jingyuan Fu
- Department of Genetics, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Harm Jan Westra
- Department of Genetics, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Harry JM Groen
- Department of Pulmonology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Rudolf SN Fehrmann
- Department of Genetics, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Joanna Smolonska
- Department of Genetics, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roel A Ophoff
- Department of Medical Genetics and Rolf Magnus Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert J Porte
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Tobias J Weismuller
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Jochen Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Christoph Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Sterneck
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Gunther
- 1st Department of Medicine, University Medical Centre Schleswig-Holstein (UK S-H), Campus Kiel, Germany
| | - Felix Braun
- Department of General and Thoracic Surgery, University Medical Centre Schleswig-Holstein (UK S-H), Campus Kiel, Germany
| | - Severine Vermeire
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Liesbet Henckaerts
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Cisca Wijmenga
- Department of Genetics, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Cyriel Y. Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Tom HKarlsen
- Norwegian PSC Research Center, Clinic for Specialized Surgery and Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
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Bjornsson E. It is difficult to discontinue PPI treatment in patients with GERD. Am J Gastroenterol 2011; 106:367-8; author reply 368. [PMID: 21301460 DOI: 10.1038/ajg.2010.402] [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: 12/11/2022]
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Angulo P, Grandison GA, Fong DG, Keach JC, Lindor KD, Bjornsson E, Koch A. Bone disease in patients with primary sclerosing cholangitis. Gastroenterology 2011; 140:180-8. [PMID: 20955707 PMCID: PMC3043598 DOI: 10.1053/j.gastro.2010.10.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [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] [Received: 08/18/2010] [Revised: 09/30/2010] [Accepted: 10/07/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Osteopenic bone disease occurs frequently among patients with chronic liver disease but has not been well studied in those with primary sclerosing cholangitis (PSC). We investigated the prevalence, rate of progression, and independent predictors of bone disease in a large number of patients with all stages of PSC. METHODS Bone mineral density of the lumbar spine, hip, and total body was measured yearly for 10 years in 237 patients with PSC. RESULTS Osteoporosis (T-score less than -2.5) was found in 15% of patients and occurred 23.8-fold (95% confidence interval [CI], 4.6-122.8) more frequently in those with PSC than expected from a matched population. By multivariate analysis, age 54 years or older (odds ratio [OR], 7.8; 95% CI, 3.3-18.3), body mass index ≤ 24 kg/m(2) (OR, 4.9; 95% CI, 1.9-12.6), and inflammatory bowel disease for ≥ 19 years (OR, 3.6; 95% CI, 1.5-8.4) correlated with the presence of osteoporosis. Osteoporosis was present in 75% of patients with all 3 risk factors but in only 3.1% of those without all of them. Patients with PSC lost 1% of bone mass per year; this rate of bone loss was significantly associated with duration of inflammatory bowel disease. CONCLUSIONS Osteoporosis occurs frequently among patients with PSC. Old age, low body mass index, and long duration of inflammatory bowel disease can be used to identify patients with PSC who might derive the most benefit from measurements of bone density and treatments for bone diseases.
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Affiliation(s)
- Paul Angulo
- Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.
| | | | - Derek G. Fong
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, Kaiser Permanente South Bay Med Center, Harbor City, CA
| | - Jill C. Keach
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN
| | - Keith D. Lindor
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN
| | - Einar Bjornsson
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, Landspitali University Hospital, Reykjavik Iceland
| | - Alvaro Koch
- Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center
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Suzuki A, Andrade RJ, Bjornsson E, Lucena MI, Lee WM, Yuen NA, Hunt CM, Freston JW. Drugs associated with hepatotoxicity and their reporting frequency of liver adverse events in VigiBase: unified list based on international collaborative work. Drug Saf 2010; 33:503-22. [PMID: 20486732 DOI: 10.2165/11535340-000000000-00000] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Challenges exist in the clinical diagnosis of drug-induced liver injury (DILI) and in obtaining information on hepatotoxicity in humans. OBJECTIVE (i) To develop a unified list that combines drugs incriminated in well vetted or adjudicated DILI cases from many recognized sources and drugs that have been subjected to serious regulatory actions due to hepatotoxicity; and (ii) to supplement the drug list with data on reporting frequencies of liver events in the WHO individual case safety report database (VigiBase). DATA SOURCES AND EXTRACTION (i) Drugs identified as causes of DILI at three major DILI registries; (ii) drugs identified as causes of drug-induced acute liver failure (ALF) in six different data sources, including major ALF registries and previously published ALF studies; and (iii) drugs identified as being subjected to serious governmental regulatory actions due to their hepatotoxicity in Europe or the US were collected. The reporting frequency of adverse events was determined using VigiBase, computed as Empirical Bayes Geometric Mean (EBGM) with 90% confidence interval for two customized terms, 'overall liver injury' and 'ALF'. EBGM of >or=2 was considered a disproportional increase in reporting frequency. The identified drugs were then characterized in terms of regional divergence, published case reports, serious regulatory actions, and reporting frequency of 'overall liver injury' and 'ALF' calculated from VigiBase. DATA SYNTHESIS After excluding herbs, supplements and alternative medicines, a total of 385 individual drugs were identified; 319 drugs were identified in the three DILI registries, 107 from the six ALF registries (or studies) and 47 drugs that were subjected to suspension or withdrawal in the US or Europe due to their hepatotoxicity. The identified drugs varied significantly between Spain, the US and Sweden. Of the 319 drugs identified in the DILI registries of adjudicated cases, 93.4% were found in published case reports, 1.9% were suspended or withdrawn due to hepatotoxicity and 25.7% were also identified in the ALF registries/studies. In VigiBase, 30.4% of the 319 drugs were associated with disproportionally higher reporting frequency of 'overall liver injury' and 83.1% were associated with at least one reported case of ALF. CONCLUSIONS This newly developed list of drugs associated with hepatotoxicity and the multifaceted analysis on hepatotoxicity will aid in causality assessment and clinical diagnosis of DILI and will provide a basis for further characterization of hepatotoxicity.
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Affiliation(s)
- Ayako Suzuki
- Division of Gastroenterology, Duke University, Durham, North Carolina 27710, USA.
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Abstract
UNLABELLED Reactive metabolites generated by hepatic metabolism are thought to play an important role in the pathogenesis of drug-induced liver injury (DILI), but supporting data are limited. If this is true, then compounds with significant hepatic metabolism should cause more DILI than those without it. We conducted a study to examine the relationship between hepatic metabolism and DILI of prescription medications. We systematically extracted the metabolism characteristics of 207 of the most widely prescribed oral medications in the United States. Compounds with >50% hepatic metabolism were characterized as those with significant hepatic metabolism (n = 149). Hepatic adverse events of interest were alanine aminotransferase >3 times the upper limit of normal, jaundice, liver failure, liver transplantation, or fatal DILI. Compared with compounds with lesser hepatic metabolism, compounds belonging to the significant hepatic metabolism group had significantly higher frequency of alanine aminotransferase >3 times the upper limit of normal (35% versus 11%, P = 0.001), liver failure (28% versus 9%, P = 0.004), and fatal DILI (23% versus 4%, P = 0.001), but not jaundice (46% versus 35%, P = 0.2) or liver transplantation (9% versus 2%, P = 0.11). Twelve compounds with no hepatic metabolism had no reports of liver failure, liver transplantation, or fatal DILI. When the relationship between hepatic adverse events and combination of hepatic metabolism and daily dose was examined, compounds with both significant hepatic metabolism and daily dose >50 mg (n = 50) were significantly more hepatotoxic than compounds belonging to other groups. Compared with medications without biliary excretion, compounds with biliary excretion (n = 50) had significantly higher frequency of jaundice (74% versus 40%, P = 0.0001). CONCLUSION Our study finds an important relationship between a compound's metabolism profile and reports of hepatic adverse events.
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Affiliation(s)
- Craig Lammert
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Bangarulingam SY, Bjornsson E, Enders F, Barr Fritcher EG, Gores G, Halling KC, Lindor KD. Long-term outcomes of positive fluorescence in situ hybridization tests in primary sclerosing cholangitis. Hepatology 2010; 51:174-80. [PMID: 19877179 DOI: 10.1002/hep.23277] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [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] [Indexed: 12/17/2022]
Abstract
UNLABELLED Patients with primary sclerosing cholangitis (PSC) are at increased risk for developing cholangiocarcinoma (CCA). Fluorescence in situ hybridization (FISH) is a cytological test designed to enhance early CCA diagnosis. The long-term outcome of PSC patients with a positive FISH test (polysomy, trisomy/tetrasomy) are unclear. All PSC patients with at least one FISH test were identified and defined to have CCA if they had a positive tissue biopsy, positive cytology, or evidence of cancer in the explant after liver transplantation. A total of 235 PSC patients had at least one FISH test performed, and 56 patients had CCA on histopathology (n = 35) or cytology (n = 21). Overall, 120 of 235 (51%) of PSC patients tested for FISH were positive, but only one third of these positive patients had CCA. Sensitivity and specificity for FISH polysomy were 46% and 88%, and for trisomy/tetrasomy they were 25% and 67%, respectively. Survival analysis showed that patients with FISH polysomy had an outcome similar to patients with CCA; whereas FISH trisomy/tetrasomy patients had an outcome similar to patients with negative FISH tests. The FISH polysomy patients without cancer compared with those with CCA had lower serum bilirubin, lower carbohydrate antigen 19-9 (CA 19-9), lower Mayo risk score, and lower occurrence of dominant strictures. CONCLUSION In PSC patients, the presence of a dominant stricture plus FISH polysomy has a specificity of 88% for CCA. Patients with FISH showing trisomy or tetrasomy have a similar outcome to patients with negative FISH. FISH testing should be used selectively in patients with other signs indicating CCA and not as a screening tool in all PSC patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).
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Abstract
BACKGROUND The important role of nuclear receptors and their contribution to liver function in both physiological and pathological conditions has come to attention in recent years and has advanced our understanding of several liver diseases. These findings led to the introduction of targeting nuclear receptors as treatment strategies for various liver diseases. AIMS To review the new insights brought by the study of nuclear receptors to our understanding of the molecular basis of various liver diseases, and to summarize some of the recent studies that evaluated the efficacy of targeting nuclear receptor as a new approach in treating liver diseases. METHODS Review of articles, using PubMed and article references. RESULTS Nuclear receptor ligands in patients with liver diseases have been associated with a variety of toxicities. Some clinical results have not met the expectations predicted from animal experiments. Mechanistic explanations at the molecular level are needed for preventing toxicity and improving outcomes from nuclear receptor ligands. CONCLUSION The use of various nuclear receptor ligands in liver diseases is a promising approach that can benefit many patients suffering from these devastating diseases. However, we are far from a full understanding of the molecular mechanisms by which these receptors work.
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Affiliation(s)
- D A H Elfaki
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55901, USA
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Lammert C, Einarsson S, Saha C, Niklasson A, Bjornsson E, Chalasani N. Relationship between daily dose of oral medications and idiosyncratic drug-induced liver injury: search for signals. Hepatology 2008; 47:2003-9. [PMID: 18454504 DOI: 10.1002/hep.22272] [Citation(s) in RCA: 306] [Impact Index Per Article: 19.1] [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: 12/14/2022]
Abstract
UNLABELLED Idiosyncratic drug-induced liver injury (DILI) is traditionally thought not to be dose-related. However, it has been pointed out that most medicines that were withdrawn from marketing or received a black-box warning because of hepatotoxicity were prescribed at daily doses greater than 50 mg/day. To examine the relationship between daily dose of medications and idiosyncratic DILI, we conducted a study with two aims. First, using two pharmaceutical databases, we examined the relationship between daily dose of commonly prescribed medicines in the United States and reported frequency of their selected hepatic adverse events. Second, we examined serious DILI cases reported to the Swedish Adverse Drug Reactions Advisory Committee (1970-2004) for any signals supporting the relationship between daily dose and idiosyncratic DILI. Medications were categorized into < or =10 mg/day, 11-49 mg/day, and > or =50 mg/day groups. Among US prescription medicines, a statistically significant relationship was observed between daily dose of oral medicines and reports of liver failure (P = 0.009), liver transplantation (P < 0.001), and death caused by DILI (P = 0.004) but not alanine aminotransferase (ALT) > 3 x upper limit of normal (P = 0.10) or jaundice (P = 0.16). Of 598 eligible Swedish DILI cases, 9% belonged to the < or =10 mg/day group, 14.2% to the 11-49 mg/day group, and 77% of cases were caused by medications given at dose > or =50 mg/day. A statistically significant relationship was noted between daily dose and poor outcome (death or liver transplantation) of Swedish DILI cases (2%, 9.4%, and 13.2% in < or =10, 11-49, and > or =50 mg/day groups, respectively, P = 0.03). CONCLUSION These data suggest a relationship between daily doses of oral prescription medications and idiosyncratic DILI. More studies are needed to validate these observations and to explore their implications.
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Affiliation(s)
- Craig Lammert
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Dalgard O, Bjøro K, Ring-Larsen H, Bjornsson E, Holberg-Petersen M, Skovlund E, Reichard O, Myrvang B, Sundelöf B, Ritland S, Hellum K, Frydén A, Florholmen J, Verbaan H. Pegylated interferon alfa and ribavirin for 14 versus 24 weeks in patients with hepatitis C virus genotype 2 or 3 and rapid virological response. Hepatology 2008; 47:35-42. [PMID: 17975791 DOI: 10.1002/hep.21975] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [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: 12/11/2022]
Abstract
UNLABELLED A recent nonrandomized pilot trial showed that hepatitis C virus (HCV) patients with genotype 2/3 and rapid virological response (RVR) had a 90% sustained virological response (SVR) rate after 14 weeks of treatment. We aimed to assess this concept in a randomized controlled trial. In the trial, 428 treatment-naïve HCV RNA-positive patients with genotype 2 or 3 were enrolled. Patients with RVR were randomized to 14 (group A) or 24 (group B) weeks of treatment. Patients were treated with pegylated interferon alpha-2b (1.5 microg/kg) subcutaneously weekly and ribavirin (800-1400 mg) orally daily. The noninferiority margin was set to be 10% between the two groups with a one-sided 2.5% significance level. RVR was obtained in 302 of 428 (71%), and 298 of these were randomized to group A (n = 148) or group B (n = 150). In the intention-to-treat analysis, SVR rates were 120 of 148 (81.1%) in group A and 136 of 150 (90.7%) in group B (difference, 9.6%; 95% confidence interval, 1.7-17.7). Among patients with an HCV RNA test 24 weeks after the end of treatment, 120 of 139 (86.3%) patients in group A achieved SVR compared with 136 of 146 (93.2%) in group B (difference, 6.9%; 95% confidence interval, -0.1 to +13.9). CONCLUSION We cannot formally claim that 14 weeks of treatment is noninferior to 24 weeks of treatment. However, the SVR rate after 14 weeks of treatment is high, and although longer treatment may give slightly better SVR, we believe economical savings and fewer side effects make it rational to treat patients with genotype 2 or 3 and RVR for only 14 weeks.
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Affiliation(s)
- Olav Dalgard
- Infectious Disease Department, Ullevål University Hospital, Oslo, Norway.
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Takeuchi K, Smale S, Premchand P, Maiden L, Sherwood R, Thjodleifsson B, Bjornsson E, Bjarnason I. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2006; 4:196-202. [PMID: 16469680 DOI: 10.1016/s1542-3565(05)00980-8] [Citation(s) in RCA: 188] [Impact Index Per Article: 10.4] [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: 02/07/2023]
Abstract
BACKGROUND & AIMS It has been variably suggested that nonselective NSAIDs and cyclooxygenase (COX)-2 selective inhibitors aggravate or ameliorate clinical disease activity in patients with inflammatory bowel disease. We assessed the effect of these drugs in patients with inflammatory bowel disease (n = 209) and the possible mechanisms. METHODS First, patients with quiescent Crohn's disease and ulcerative colitis received the non-NSAID analgesic acetaminophen (n = 26) and the conventional NSAIDs naproxen (n = 32), diclofenac (n = 29), and indomethacin (n = 22) for 4 weeks. The Harvey-Bradshaw index was used to define relapse. Second, to assess the mechanism of relapse, intestinal inflammation was quantitated (fecal calprotectin) before and during treatment (20 patients/group) with acetaminophen, naproxen (topical effect, COX-1 and -2 inhibitor), nabumetone (COX-1 and -2 inhibitor), nimesulide (selective COX-2 inhibitor), and low-dose aspirin (selective COX-1 inhibition). RESULTS Nonselective NSAIDs were associated with a 17%-28% relapse rate within 9 days of ingestion. No patient had an early relapse on acetaminophen, nimesulide, or aspirin, whereas those on naproxen and nabumetone (20%) experienced relapse. These clinical relapses were associated with escalating intestinal inflammatory activity. CONCLUSIONS NSAID ingestion is associated with frequent and early clinical relapse of quiescent inflammatory bowel disease, and the mechanism appears to be due to dual inhibition of the COX enzymes. Selective COX-2 inhibition with nimesulide and COX-1 inhibition with low-dose aspirin appear to be well-tolerated in the short-term.
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Affiliation(s)
- Ken Takeuchi
- Department of Internal Medicine, Guy's, King's, St Thomas' Medical School, London, United Kingdom
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Bjornsson E, Castedal M, Abrahamsson H. Interlaboratory differences in method for analysis of manometry explain discrepancies in studies of duodenal phase III peristalsis. Neurogastroenterol Motil 2003; 15:331-3; author reply 335. [PMID: 12787343 DOI: 10.1046/j.1365-2982.2003.00407.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Bjornsson E, Hjelm E, Janson C, Fridell E, Boman G. Serology of chlamydia in relation to asthma and bronchial hyperresponsiveness. Scand J Infect Dis 1996; 28:63-9. [PMID: 9122636 DOI: 10.3109/00365549609027152] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Antibodies to the 3 strains of chlamydia were measured in the sera of 197 subjects; 122 with asthma-related symptoms and 75 from the general population. The subjects underwent a structured interview, spirometry, a methacholine provocation test and skin-prick tests. For chlamydia antibodies, IgG titer values of > or = 1:512 and/or IgM > or = 1:16 were regarded as evidence of a current or recent infection while IgG levels < 1:512 and > 1:32 were regarded as indicative of a previous infection. For Chlamydia pneumoniae, a relationship was found between current or recent infection and wheezing (odds ratio (OR) 6.0, confidence intervals (CI) 1.3-28) and also between IgA antibodies and bronchial hyperresponsiveness (BHR) (OR 3.3, CI 1.3-8.3). For Chlamydia trachomatis, serological signs of a previous infection were found significantly more often in subjects who reported having had asthma at some time: (OR 3.2, CI 1.4-7.1), asthma during the last year (OR 3.2, CI 1.4-7.1), wheezing during the last year (OR 4.2, CI 1.6-6.6) and in those who had BHR (OR 2.7, CI 1.2-6.1). We conclude that a relationship may exist between Chlamydia pneumoniae and Chlamydia trachomatis infections and asthma-related symptoms and BHR.
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Affiliation(s)
- E Bjornsson
- Departments of Lung Medicine and Asthma Research Centre, Karolinska Institute, Stockholm, Sweden
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Abstract
Do markers of eosinophil activation differ in their ability to detect subjects with atopy or bronchial hyper-responsiveness (BHR)? Comparisons of serum levels of eosinophil peroxidase (S-EPO), of eosinophil cationic protein (S-ECP) and the blood eosinophil count (B-Eos) have been made between 154 subjects aged 20-44 years, participating in the European Community Respiratory Health Survey in Uppsala, Sweden. Subjects with atopy had significantly higher levels of S-EPO and S-ECP than those without atopy (P <0 center dot 001). Subjects with BHR had significantly higher levels of S-EPO (P <0 center dot 001) and B-Eos (P <0 center dot 01) than subjects without BHR. Persons reporting asthma-related symptoms had significantly higher levels of S-EPO and B-Eos than subjects without such symptoms (P <0 center dot 001 and P <0 center dot 01, respectively). Asthma symptom score correlated significantly to S-EPO (r = 0 center dot 26, P <0 center dot 01), S-ECP (r = 0 center dot 20, P <0 center dot 05) and B-Eos (r = 0 center dot 18, P <0 center dot 05). Finally, S-EPO was significantly more sensitive than S-ECP for detecting subjects with BHR (P <0 center dot 05) and significantly more sensitive than B-Eos for detecting both subjects with BHR and subjects with a combination of atopy and BHR (P <0 center dot 05). It is concluded that S-EPO is a promising marker with a higher sensitivity for BHR than S-ECP or B-Eos. Further studies are needed to define the value of S-EPO when following disease activity.
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Affiliation(s)
- E Bjornsson
- Departments of Lung Medicine, Asthma Research Centre, Uppsala University, Sweden
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