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Edinburgh, United Kingdom

Therapists working with people who have complex problems associated with psychosis may find it difficult to apply currently available cognitive behavioural therapy (CBT) manuals to client's presenting problems. This can lead to activation of negative therapist beliefs about themselves, the client or the therapy and subsequent problems maintaining the therapeutic relationship. This paper describes the integration of a range of models and concepts derived from CBT which were used to assist one such client with complex problems associated with psychosis. As such, it is proposed that taking a flexible, formulation driven approach to therapy can assist therapists to remain client centred and work effectively. The therapy described draws on a number of concepts including those taken from schema focussed therapy, mindfulness and compassionate mind training. Therapist and client summary letters were used as part of the described intervention, but in addition, the client's summary is reproduced in the paper aiming to address the issue of the under reporting in the literature of the client's perspective on therapy. Copyright © 2011 John Wiley and Sons, Ltd. Copyright © 2013 John Wiley and Sons, Ltd. 20 1 January/February 2013 10.1002/cpp.771 Practitioner Report Practitioner Reports Copyright © 2011 John Wiley and Sons, Ltd.. Source

Hemoglobin thresholds and triggers for blood transfusions have changed over the years moving from a higher to a lower level. This review article summarizes the current evidence of transfusion thresholds in the hospitalized as well as in the outpatient setting and particularly in myelodysplasia. Fatigue is the main reported symptom in this group of patients and current clinical trials are looking for a more liberal approach of red cell transfusion and the effect on quality of life as opposed to the restrictive strategy used in the critical care setting. Practical considerations, the cost effectiveness of this strategy in addition to the possible complications, and the use of quality of life questionnaires have also been reviewed. © 2016 Ioannis Koutsavlis. Source

Yeo J.M.,University of Edinburgh | Lim X.,University of Edinburgh | Khan Z.,NHS Lothian | Pal S.,University of Edinburgh
European Archives of Psychiatry and Clinical Neuroscience

Single-photon emission-computed tomography (SPECT) may potentially contribute to the diagnostic work up of patients with neurodegenerative dementia. This systematic review aims to establish the diagnostic utility of 99mTc-hexamethylpropyleneamine (99mTc-HMPAO) and 99mTc-ethylcysteine dimer SPECT in distinguishing between Alzheimer's disease (AD) and frontotemporal dementia (FTD), AD and vascular dementia (VD), AD and dementia with Lewy bodies (DLB), and AD and normal controls (NC). We searched MEDLINE and Embase databases via OVID for articles from January 1985 to May 2012 and identified additional studies from reviews and references. Of 755 studies, 49 studies met the inclusion and exclusion criteria for this systematic review; AD versus FTD (n = 13), AD versus VD (n = 18), AD versus DLB (n = 5), and AD versus NC (n = 18). We compiled relevant data and graded the studies with an internal and external validity criteria checklist. We pooled the studies with a clinical diagnosis and those using 99mTc-HMPAO SPECT in a meta-analysis, calculating the pooled weighted sensitivity, specificity, likelihood ratios, and diagnostic odds ratios using DerSimonian-Laird random-effects model. The pooled weighted sensitivity and specificity of 99mTc-HMPAO-SPECT in distinguishing clinically diagnosed AD from FTD are 79.7 and 79.9 %, respectively, AD from VD are 74.5 and 72.4 %, AD from DLB are 70.2 and 76.2 %, and AD from NC are 76.1 and 85.4 %. SPECT does have diagnostic value, particularly in differentiating Alzheimer's disease from frontotemporal dementia and normal controls; however, it should not be used in isolation, rather as an adjunct, and interpreted in the context of clinical information and paraclinical test results. © 2013 Springer-Verlag Berlin Heidelberg. Source

Farooq S.,Wolverhampton City Primary Care Trust | Taylor M.,NHS Lothian
British Journal of Psychiatry

Evidence concerning the superior efficacy and effectiveness of clozapine has not fully informed routine clinical practice. This is possibly because of the perception that clozapine is a dangerous therapeutic agent. Clozapine use may actually promote longevity, and earlier use of clozapine in adequate dosages represents a neglected therapeutic opportunity in this age of stagnated antipsychotic innovation. © 2011 The Royal College of Psychiatrists. Source

Dobie J.,NHS Lothian
British Journal of Community Nursing

There is a paucity of research in relation to district nurses' (DNs) experiences of palliative care provision in adult care homes (CHs) despite their substantial involvement. The aim of this study was to demonstrate the current involvement of DNs in CHs and identify the potential implications for future practice in providing palliative care in this setting. The findings suggested that even experienced DNs, wanted support and education about when to commence palliative care. They also wanted earlier involvement with CH residents who have a life-limiting condition and CH managers were seen as being essential contributors towards planning care. There was concern among DNs as to how the Liverpool Care Pathway could be introduced into CHs with untrained carers and finally, DN alignment to CHs was shown to improve continuity of care for residents and produce more effective partnership working between DNs, general practitioners and CH staff. Source

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