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9. SIRT Compared with DEB-TACE for Hepatocellular Carcinoma: a Real-world Study (the SITAR Study).

Author

Mishra G., Nicoll A.J., Gow P., Roberts S.K., Lubel J., Kemp W., Dev A., Hirsch R.D., Mills C., Sawhney R., Sood S., Bird V., Mishra G., Nicoll A.J., Gow P., Roberts S.K., Lubel J., Kemp W., Dev A., Hirsch R.D., Mills C., Sawhney R., Sood S., and Bird V.

Abstract

Background: Hepatocellular carcinoma (HCC) is responsible for 1% of deaths worldwide, and the incidence continues to increase. Despite surveillance programs, 70% of HCC patients are not suitable for curative options at diagnosis, and therefore, non-curative treatments are essential to modern clinical practice. There are many novel treatments, though their roles are not well defined. This study aimed to contrast Selective Internal Radiation Therapy (SIRT) and Drug Eluting Bead Transarterial Chemoembolisation (DEB-TACE) to further define their roles. Method(s): This was a retrospective multicentre cohort study. Factors included for analysis were type of HCC treatment, number of lesions, lesion size, multiple disease severity scores, cirrhosis and vascular invasion. The primary endpoint was transplant-free survival. Result(s): Transplant-free survival was similar between the two cohorts (p = 0.654), despite a variation in median lesion size, SIRT: 54.5 mm, DEB-TACE: 34 mm (p <= 0.001). A univariate Cox proportional hazard model utilising treatment modality as the covariate showed no significant difference in survival (DEB-TACE HR 1.4 (95%CI 0.85-2.15 p = 0.207). The size of the largest lesion was the best predictor of 3-year survival (p = 0.035). Lesion size was inversely associated with survival (HR 1.01 (95%CI 1-1.02, p = 0.025)) on multivariate analysis. Conclusion(s): This study is the first to catalogue the experience of using SIRT in HCC in a real-world Australian population. It has demonstrated no difference in survival outcomes between DEB-TACE and SIRT. Further, it has shown SIRT to be a reasonable alternative to DEB-TACE especially in larger lesions and has demonstrated that DEB-TACE has a role in select patients with advanced disease.Copyright © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Published
2020

13. REFOCUS: developing a recovery focus in mental health services in England

Author

Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., and Leamy, M.

Abstract

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed.\ud Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery.\ud Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated.\ud Setting: Six mental health Trusts in England.\ud Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders.\ud Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery.\ud Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ).\ud Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and applicable to current service users. The recovery practice framework identified four domains of recovery support. INSPIRE, SAFE and IOM were developed and evaluated. The national survey identified differences between team managers (n=22), workers (n=120) and service users (n=108), and found higher recovery orientation was associated with improved recovery. The REFOCUS intervention has two elements: recovery promoting relationships and working practices. Phase 2: the 27-team trial involving 403 service users (297 at follow-up) showed no differences on primary outcomes of QPR (adjusted difference 0.63, 95%CI: -1.4 to 2.3, p=.55), but secondary outcomes of functioning (adjusted difference 5.90, 95%CI 2.6 to 9.2, p

Published
2017

14. What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of non-specific components.

Author

Priebe, S., Conneely, M., McCabe, R., and Bird, V.

Subjects
PSYCHIATRIC treatment, MENTAL health services, PATIENT compliance, NONVERBAL communication, PSYCHOTHERAPY
Abstract

Aims: Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research. Methods: We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them. Results: The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication – focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns – non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures – i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes – i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes. Conclusions: Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice. [ABSTRACT FROM AUTHOR]

Published
2020
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15. The SITAR study: SIRT versus DEB-TACE in identifying good prognostic indicators.

Author

Kemp W., Mishra G., Dev A., Gow P., Roberts S.K., Nicoll A.J., Ryan M., Hirsch R.D., Sawhney R., Bird V., Sood S., Kemp W., Mishra G., Dev A., Gow P., Roberts S.K., Nicoll A.J., Ryan M., Hirsch R.D., Sawhney R., Bird V., and Sood S.

Abstract

Introduction: Treatment decisions for patients with hepatocellular carci-noma (HCC) are largely guided by the Barcelona Clinic Liver Cancer (BCLC) staging system; patients with BCLC-B stage HCC are typically treated with transarterial chemoembolization (TACE), and those with BCLC-C with sorafenib. There is, however, a select subgroup of patients in BCLC-B or-C stages who are treated with selective internal radiation therapy (SIRT). SIRT has theoretical advantages over TACE, but as its use in HCC is not funded, there are limited data guiding which patients are the best candidates. Anecdotally, there is a subgroup of SIRT patients who have excellent outcomes. Our aims were to catalogue the clinical features and outcomes of patients with HCC who have received SIRT over the past 10 years at six institutions and to use a propensity matched comparator group of patients who have received drug-eluting bead (DEB)-TACE to identify those better suited to SIRT. Method(s): Participants were identified by a search of each site's hepatoma database. Inclusion criteria were (i) age >18 years, (ii) diagnosis of HCC made as per EASL-EORTIC and AASLD guidelines, (iii) received at least one session of either DEB-TACE or SIRT, and (iv) have had at least 6 months' follow-up after the treatment session. The endpoints used were overall survival from the time of treatment, time to progression, and radiological response. Complications were documented from patient files. Base-line characteristics were assessed using Cox regression. Statistical and P values were assessed using ANOVA univariate and multivariate analysis. Survival curves and response curves were made using the Kaplan-Meier method. Achieved power was also assessed to aid future prospective studies. Result(s): Interim results of the first 10 (of more than 50) SIRT patients show that all patients were male, with a median age at time of treatment of 66.3 years (range, 54.7-86.5). SIRT patients had a mean tumor size of 65.8 +/- 39.6 m

Published
2018

16. 690 Multi-centre evaluation and comparison of stone scoring systems in predicting outcomes after percutaneous nephrolithotomy

Author

Okhunov, Z., primary, Tailly, T., additional, Nadeau, B., additional, Huynh, M., additional, Olvera-Posada, D., additional, Akhavein, A., additional, Labadie, K., additional, Violette, P., additional, Alenezi, H., additional, Bird, V., additional, Razve, H., additional, Denstedt, J., additional, and Landman, J., additional

Published
2015
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17. Measures of the recovery orientation of mental health services: systematic review

Author

Williams, J. Patrick, Leamy, M, Bird, V, Harding, Carol A, Larsen, Joshua, Le Boutillier, C, Oades, Lindsay G, Slade, Mike, Williams, J. Patrick, Leamy, M, Bird, V, Harding, Carol A, Larsen, Joshua, Le Boutillier, C, Oades, Lindsay G, and Slade, Mike

Abstract

The review aimed to (1) identify measures that assess the recovery orientation of services; (2) discuss how these measures have conceptualised recovery, and (3) characterise their psychometric properties.

Published
2012

28. Case identification of depression in patients with chronic physical health problems: a diagnostic accuracy meta-analysis of 113 studies.

Author

Meader N, Mitchell AJ, Chew-Graham C, Goldberg D, Rizzo M, Bird V, Kessler D, Packham J, Haddad M, Pilling S, Meader, Nicholas, Mitchell, Alex J, Chew-Graham, Carolyn, Goldberg, David, Rizzo, Maria, Bird, Victoria, Kessler, David, Packham, Jon, Haddad, Mark, and Pilling, Stephen

Abstract

Background: Depression is more likely in patients with chronic physical illness, and is associated with increased rates of disability and mortality. Effective treatment of depression may reduce morbidity and mortality. The use of two stem questions for case finding in diabetes and coronary heart disease is advocated in the Quality and Outcomes Framework, and has become normalised into primary care.Aim: To define the most effective tool for use in consultations to detect depression in people with chronic physical illness.Design: Meta-analysis.Method: The following data sources were searched: CENTRAL, CINAHL, Embase, HMIC, MEDLINE, PsycINFO, Web of Knowledge, from inception to July 2009. Three authors selected studies that examined identification tools and used an interview-based ICD (International Classification of Diseases) or DSM (Diagnostic and statistical Manual of Mental Disorders) diagnosis of depression as reference standard. At least two authors independently extracted study characteristics and outcome data and assessed methodological quality.Results: A total of 113 studies met the eligibility criteria, providing data on 20,826 participants. It was found that two stem questions, PHQ-9 (Patient Health Questionnaire), the Zung, and GHQ-28 (General Health Questionnaire) were the optimal measures for case identification, but no method was sufficiently accurate to recommend as a definitive case-finding tool. Limitations were the moderate-to-high heterogeneity for most scales and the facts that few studies used ICD diagnoses as the reference standard, and that a variety of methods were used to determine DSM diagnoses.Conclusion: Assessing both validity and ease of use, the two stem questions are the preferred method. However, clinicians should not rely on the two-questions approach alone, but should be confident to engage in a more detailed clinical assessment of patients who score positively. [ABSTRACT FROM AUTHOR]

Published
2011
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30. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review.

Author

Bird, V., Premkumar, P., Kendall, T., Whittington, C., Mitchell, J., and Kuipers, E.

Subjects
EARLY medical intervention, PSYCHOSES, BEHAVIOR therapy, COGNITION, FAMILY services, PSYCHOTHERAPY
Abstract

Background Early intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments. Aims To evaluate the effectiveness of early intervention services, cognitive-behavioural therapy (CBT) and family intervention in early psychosis. Method Systematic review and meta-analysis of randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis. Results Early intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission. Conclusions For people with early psychosis, early intervention services appear to have clinically important benefits over standard care. Including CBT and family intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its component treatments for people with early and established psychosis need further research. [ABSTRACT FROM AUTHOR]

Published
2010
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32. Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury.

Author

Bird, V G, Brackett, N L, Lynne, C M, Aballa, T C, and Ferrell, S M

Subjects
*EJACULATION, *SPINAL cord injuries, *INFERTILITY, *PARAPLEGIA, *VIBRATORS (Massage)
Abstract

STUDY DESIGN:: Retrospective chart review. OBJECTIVE:: To identify factors in addition to level of injury (LOI) that may predict ejaculation by penile vibratory stimulation (PVS) in spinal cord injured males. SETTING:: Major urban medical school and teaching hospital. MATERIALS AND METHODS:: Presence of a bulbocavernosus response (BCR) and a hip flexor response (HR) before PVS (n=123 patients), and somatic responses during PVS (n=204 trials performed on a subset of 44 patients) were evaluated for their frequency of occurrence on trials with and without ejaculation. RESULTS:: Overall ejaculation success rates for cervical, T1–T6, and T7–T12 LOI were 71%, 73%, and 35%, respectively. Eighty per cent of patients who were positive for both BCR and HR ejaculated with PVS, while only 8% of patients who were negative for both BCR and HR ejaculated with PVS. For cervical injuries, BCR and HR were no more predictive of ejaculation by PVS than LOI alone. T1–T6 patients were more likely to ejaculate when at least one reflex was present. T7–T12 patients with no BCR were unlikely to ejaculate by PVS. Except for abdominal contractions, somatic responses were not present in the majority of PVS trials. When they were present, however, they occurred in a high percentage of ejaculation trials: withdrawal response (hip flexion, knee flexion and thigh adduction) (90%), piloerection (84%), extremity spasms (83%), thigh abduction (80%), and thigh adduction (72%). CONCLUSION:: We recommend that patients with cervical injuries initially undergo PVS. Patients with T1–T6 LOI with at least one reflex present, and patients with T7–T12 LOI with both reflexes, or only BCR present, may undergo PVS. Certain somatic/autonomic responses, when seen, may help in deciding whether to continue with a given trial, or give a repeat trial, of PVS. SPONSORSHIP:: The Miami Project to Cure Paralysis and the State of Florida Specific Appropriations.Spinal Cord... [ABSTRACT FROM AUTHOR]

Published
2001
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33. A conceptual framework for improving well-being in people with a diagnosis of psychosis

Author

Schrank, B., Riches, S., Bird, V., Murray, J., Tylee, A., and Slade, M.

Abstract

Background.Well-being is important for people with severe mental illness, such as psychosis. So far, no clear concept of well-being exists for this client group. A recent systematic review and narrative synthesis developed a static framework of well-being components. The present study aims to validate the static framework and to illuminate the processes by which well-being is experienced by people with psychosis.Methods.Semi-structured interviews were conducted with 23 service users with psychosis exploring their experience of well-being. Thematic analysis was used to analyse the data employing techniques taken from grounded theory to enhance the rigour of the analysis. Respondent validation was undertaken with 13 of the 23 participants.Results.Three superordinate categories of well-being were identified: current sense of self; transition to enhanced sense of self and enhanced sense of self. In the dynamic process of improving well-being the current sense of self undergoes a transition to an enhanced sense of self. The four factors influencing the transition are consistent with the static framework of well-being, hence validating the static framework. In addition, we identified three determinants of current sense of self and seven indicators of enhanced sense of self, which represent the achievement of improved well-being.Conclusions.This study provides an empirically defensible framework for understanding well-being in terms of determinants, influences and indicators. The influences are targets for interventions to improve well-being, and the indicators are outcome domains to assess the effectiveness of services in supporting well-being.

Published
2014
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34. Substrate specificities of the insulin and insulin-like growth factor 1 receptor tyrosine kinase catalytic domains.

Author

Xu, B, Bird, V G, and Miller, W T

Abstract

To compare the substrate specificities of the insulin and insulin-like growth factor 1 (IGF-1) receptor tyrosine kinases, the catalytic domains of the enzymes have been expressed in Escherichia coli as fusion proteins. The purified proteins have kinase activity, demonstrating that the catalytic domain of IGF-1 receptor, like that of insulin receptor, is active independent of its ligand-binding and transmembrane domains. The specificities of the two enzymes for the divalent cations Mg2+ and Mn2+ are indistinguishable. A series of peptides has been prepared that reproduces the major phosphorylation sites of insulin receptor substrate-1, a common substrate for the two receptor tyrosine kinases in vivo. Insulin and IGF-1 receptors show distinct preferences for these peptides; whereas insulin receptor prefers peptides based on Tyr-987 or Tyr-727 of insulin receptor substrate-1, the IGF-1 receptor preferentially recognizes the Tyr-895 site. The latter site, when phosphorylated, is a binding site for the SH2 domain-containing adapter protein Grb2. The ability of the two receptor tyrosine kinases to be phosphorylated and activated by v-Src has also been examined. The catalytic activity of IGF-1 receptor is stimulated approximately 3.4-fold by treatment with purified v-Src, while insulin receptor shows very little effect of Src phosphorylation under these conditions. This observation is relevant to recent findings of IGF-1 receptor activation in Src-transformed cells, and may represent one method by which Src amplifies its mitogenic signal. Collectively the data suggest that the catalytic domains of the two receptor kinases possess inherently different substrate specificities and signaling potentials.

Published
1995

37. REFOCUS: developing a recovery focus in mental health services in England

Author

Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., Leamy, M., Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., and Leamy, M.

Abstract

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed. Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery. Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated. Setting: Six mental health Trusts in England. Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders. Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery. Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ). Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and

38. REFOCUS: developing a recovery focus in mental health services in England

Author

Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., Leamy, M., Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., and Leamy, M.

Abstract

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed. Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery. Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated. Setting: Six mental health Trusts in England. Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders. Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery. Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ). Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and

39. REFOCUS: developing a recovery focus in mental health services in England

Author

Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., Leamy, M., Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., and Leamy, M.

Abstract

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed. Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery. Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated. Setting: Six mental health Trusts in England. Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders. Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery. Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ). Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and

40. REFOCUS: developing a recovery focus in mental health services in England

Author

Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., Leamy, M., Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., and Leamy, M.

Abstract

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed. Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery. Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated. Setting: Six mental health Trusts in England. Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders. Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery. Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ). Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and

41. REFOCUS: developing a recovery focus in mental health services in England

Author

Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., Leamy, M., Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., and Leamy, M.

Abstract

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed. Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery. Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated. Setting: Six mental health Trusts in England. Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders. Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery. Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ). Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and

42. REFOCUS: developing a recovery focus in mental health services in England

Author

Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., Leamy, M., Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., and Leamy, M.

Abstract

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed. Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery. Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated. Setting: Six mental health Trusts in England. Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders. Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery. Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ). Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and

43. REFOCUS: developing a recovery focus in mental health services in England

Author

Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., Leamy, M., Slade, Mike, Bird, V., Chandler, R., Clarke, E., Craig, T., Larsen, J., Lawrence, V., Le Boutillier, C., Macpherson, R., McCrone, P., Pesola, F., Riley, G., Shepherd, G., Tew, J., Thornicroft, G., Wallace, G., Williams, J., and Leamy, M.

Abstract

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed. Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recovery. Design: A two phase, mixed methods study. Phase 1 (theory) involved seven systematic reviews (develop a conceptual framework for recovery; establish its cross-cultural validity; develop a recovery practice framework; review measures of recovery measures; recovery support measures; strengths measures; staff understanding of recovery), development and evaluation of three new measures (INSPIRE for recovery support; IOM for individualised measurement of recovery; SAFE for feasibility assessment), evaluation of existing recovery measure (QPR), national survey, three qualitative studies (conceptual framework validation, staff recoveryoriented practice, black service users), and development of a new manualised REFOCUS intervention. Phase 2 involved a two-site cluster randomised controlled trial of the REFOCUS intervention, with a nested secondary outcome study, process and economic evaluation, interrupted time series analysis, sub-group analysis of black service users, and outcomes comparison. The impact of PPI on the programme was also empirically evaluated. Setting: Six mental health Trusts in England. Participants: 741 community mental health service users, 1,169 mental health staff and 54 expert stakeholders. Interventions: The manualised team-level REFOCUS intervention to increase support for personal recovery. Main outcome measures: Survey: Recovery Self Assessment (RSA). Trial: Questionnaire about the Process of Recovery (QPR), Client Satisfaction Questionnaire (CSQ). Results: Phase 1: the conceptual framework for recovery identified characteristics, stages and processes of recovery. It was cross-culturally valid and

47. Re: Multicenter External Validation and Comparison of Stone Scoring Systems in Predicting Outcomes after Percutaneous Nephrolithotomy.

Author

Tailly, T. O., Okhunov, Z., Nadeau, B. R., Huynh, M. J., Labadie, K., Akhavein, A., Violette, P. D., Olvera-Posada, D., Alenezi, H., Amann, J., Bird, V. G., Landman, J., Smith, A. D., Denstedt, J. D., and Razvi, H.

Abstract

The article comments on the study "Multicenter External Validation and Comparison of Stone Scoring Systems in Predicting Outcomes after Percutaneous Nephrolithotomy" by T.O. Tailly and others.

Published
2016
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48. REFOCUS Trial: protocol for a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams

Author

Slade Mike, Bird Victoria, Le Boutillier Clair, Williams Julie, McCrone Paul, and Leamy Mary

Subjects
Psychiatry, RC435-571
Abstract

Abstract Background There is a consensus about the importance of 'recovery' in mental health services, but the evidence base is limited. Methods/Design A two centre, cluster randomised controlled trial. Participants are community-based mental health teams, and service users aged 18-65 years with a primary clinical diagnosis of psychosis. In relation to the REFOCUS Manual researchintorecovery.com/refocus, which describes a 12-month, pro-recovery intervention based on the REFOCUS Model, the objectives are: (1) To establish the effectiveness of the intervention described in the REFOCUS Manual; (2) To validate the REFOCUS Model; (3) To establish and optimise trial parameters for the REFOCUS Manual; and (4) To understand the relationship between clinical outcomes and recovery outcomes. The hypothesis for the main study is that service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) compared to service users receiving care from control teams. The hypothesis for the secondary study is that black service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) and client satisfaction (as measured by the CSQ) compared to Black service users receiving care from control teams. The intervention comprises treatment as usual plus two components: recovery-promoting relationships and working practices. The control condition is treatment as usual. The primary outcme is the Process of Recovery Questionnaire (QPR). Secondary outcomes are satisfaction, Goal setting - Personal Primary Outcome, hope, well-being, empowerment, and quality of life. Primary outcomes for the secondary study will be QPR and satisfaction. Cost data will be estimated, and clinical outcomes will also be reported (symptomatology, need, social disability, functioning). 29 teams (15 intervention and 14 control) will be randomised. Within each team, 15 services users will be randomly chosen, giving a total sample of 435 service users (225 in intervention and 210 in control). Power for the main study: 336 service users will give power to detect a medium effect size of 0.4 (alpha 0.05, power = 0.8) on both QPR sub-scales. Power for the secondary study: 89 participants will give power to detect an effect size of 0.67 on both QPR sub-scales and on CSQ. A range of approaches are used to minimise bias, although service users and clinicians cannot be blinded. Discussion This cluster-RCT will evaluate a pro-recovery intervention in community mental health teams. Trial registration ISRCTN: ISRCTN02507940

Published
2011
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49. The contribution of advisory committees and public involvement to large studies: case study

Author

Tew Jerry, Larsen John, Fox Jo, Chandler Ruth, Bird Victoria, Slade Mike, and Leamy Mary

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Many large studies have complex advisory committee structures, yet there is no empirical evidence regarding their optimal composition, scope and contribution. The aim of this study was to inform the committee and advice infrastructure for future research studies. Methods In the context of a five-year study funded by the UK National Institute for Health Research, three advisory committees were formed. In addition, advice was obtained from individual experts. All recommendations received in the start-up phase (first seven months) of the study were recorded, along with the decision about implementation of the recommendation. A particular focus was on the impact of public involvement. Results A total of 172 recommendations were made, including 70 from 20 individual experts. The recommendations were grouped into five emergent themes: Scientific, Pragmatic, Resources, Committee and Collaboration. Most recommendations related to strengthening existing components or adding new components to the study protocol. Very few recommendations either proposed removing study components or contradicted other recommendations. Three 'implementation criteria' were identified: scientific value, pragmatic feasibility, and paradigmatic consistency. 103 (60%) of recommendations were implemented and 25 (15%) were not implemented. The benefits identified by the research team were improved quality and confidence, and the costs were increased cognitive demands, protocol revision time, and slower progress. Conclusions The findings are discussed in the context of the wider literature on public involvement in research. Six recommendations are identified. First, have a clear rationale for each advisory committee expressed as terms of reference, and consider the best balance between committees and individual consultation with experts. Second, an early concern of committees is inter-committee communication, so consider cross-representation and copying minutes between committees. Third, match the scope of advisory committees to the study, with a less complex advisory structure for studies with more finalised designs. Fourth, public involvement has a mixed impact, and relies on relationships of trust, which take time to develop. Fifth, carefully consider the match between the scientific paradigm applied in the study and the contribution of different types of knowledge and expertise, and how this will impact on possibilities for taking on advice. Finally, responding to recommendations uses up research team resources, and the costs can be reduced by using the three implementation criteria.

Published
2010
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