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The model of shared decision making with mental health patients and clinicians (doctors and pharmacists) harnesses the benefits of patients becoming partners in their own recovery through improved communication and greater self-advocacy. Shared decision making in mental health services is an emerging model of care which has not been well investigated, however it is seen as the way forward to achieving improved health outcomes for non-pharmacological and pharmacological therapy. Successful implementation of this model requires supporting the process through provision of information and training, use of decision aids, coaching in communication skills and inclusion of family and carers in the decision making process. This summary examines the application of the shared decision making model for psychiatric medication management, including barriers and facilitators.

The aim of this study was to determine the behaviour of vanadium in molten slag and carbon saturated iron alloys using a metal-slag-gas equilibration technique under controlled CO atmospher...

New phase equilibria data on complex slags containing CaO–Al2O3–SiO2FeO x –MgO–Na2O–NaF were obtained from high-temperature experiments using the drop–quench technique followed by characterization of the quench phases using optical and scanning electron microscopy. The results obtained show that addition of Na2O to slags of the CaO–SiO2–10% Fe2O3–20% Al2O3 system enlarged the liquid region at 1300 °C to higher MgO contents and to higher CaO/SiO2 ratios compared with the soda-free system. At 5–10% Na2O, the primary phase was melilite. At lower soda contents and lower CaO/SiO2 ratios, the primary phase was anorthite at low MgO contents and spinel at high MgO contents. In general, the addition of Na2O to the slag decreased the liquidus at all MgO contents and CaO/SiO2 ratios. The addition of NaF to the CaO–SiO2–10% Fe2O3–20% Al2O3 system extended the liquid region at 1200 °C to higher CaO/SiO2 ratios. The effect was the greatest at CaO/SiO2 ratio of 0.6 and at low MgO contents of slag (2%). Overall, this study showed that the Na and F from the spent pot lining (SPL) would enable the smelting process to operate at temperatures below 1200 °C, which would have significant benefit, including reduced heat losses from the furnace and longer refractory life.

The primary aim was to assess usability of the My Medicines and Me Questionnaire (M3Q) as a self-reported questionnaire for mental health patients to subjectively express side effects experienced with their psychotropic medications. The secondary aim was to evaluate patients' attitudes towards treatment and psychotropic medications following dialogue with their clinicians about side effects. Questionnaires were administered at six adult mental health facilities. A total of 205 participants were divided into intervention (facilitated dialogue) and non-intervention groups (no facilitated dialogue). The mean completion time for the M3Q was 15min (SD=6.5) with only 11 (5%) patients requiring assistance. The most commonly reported side effect was sedation (77%) and weight gain was ranked as the most bothersome (23%). The previously validated M3Q provided patients with the opportunity to express the impact these effects had on their lives. Side effects were the most common reason given for non-adherence. There were no significant changes in patient attitudes towards treatment and medications in the intervention group, mainly due to the logistical challenges in the clinicians' ability to view the questionnaire for the subsequent meeting with the patient. The M3Q demonstrated its usability in allowing patients to easily express their subjective experiences with side effects.

Objective: The objective of this study was to assess the acceptability, content validity and usability of the My Medicines and Me (M3Q) self-report side effect questionnaire. Methods: Eight focus groups consisting of mental health patients, carers, general practitioners, psychiatrists, mental health nurses and pharmacists were conducted, involving 78 participants. Two researchers independently examined the transcriptions and analysed the data thematically using an inductive method. Results: The findings supported changes to the formatting, length and phrasing of questions in the original version of the questionnaire. Although the groups provided differing views on the usability of the M3Q in clinical practice, the patient and carer groups were unconditionally in favour of such a tool to be used systematically to describe patients’ subjective experiences with side effects. Conclusion: The differing contribution made by all groups involved in the administration and completion of the M3Q assisted with content validity of the questionnaire. The acceptability and usability of this novel side effect questionnaire was also explored, with many participants agreeing it was a necessary tool for a patient centred approach to treatment. Following implementation of the changes to the current format of the questionnaire, investigation into the uptake and use in clinical practice should be carried out.

Objective: To assess the applicability, interpretability and potential limitations of an adverse event screening questionnaire (the Enhancing Quality Use of Medication Self-Reported Questionnaire [EQUIM-SRQ]) in an Australian mental health outpatient population. Method: Questionnaires were distributed amongst two Australian adult mental health clinics for completion either at the clinic (onsite), or externally (postal option), during March – May 2011. Assistance was offered to participants completing the questionnaire onsite. Clients who were visited in their homes by clinic staff were invited to participate as external participants. Results: Of 160 questionnaires distributed, 29 (18%) were completed. Of those, 22 were completed onsite, and seven were completed externally. Of the questionnaires completed onsite, 11 were fully completed, with 4 participants requiring assistance. A further 11 questionnaires were partially completed, with 2 participants requiring assistance. Of the questionnaires completed externally, 5 were fully completed. Conclusion: Although the response rate was low, the EQUIM-SRQ was applicable, interpretable and acceptable when completed or partially completed questionnaires were assessed. The potential exists to apply the EQUIM-SRQ in further research, and thereafter, clinical practice.

Optimum fluxing, smelting and leaching practices have been determined for maximising the recovery of alumina and soda, but not iron, from a slag produced by oxidative smelting of bauxite residue at 1400°C. The rate and extent of dissolution of alumina and soda increased in a water leach as the CaO/SiO2 ratio in the slag was increased from 0·1 to 2 by the addition of calcium carbonate to the dried bauxite residue. A water leach at 60°C, extracted 55% of the Al and 90% of the Na at 20 wt-% solids and 50 and 75% respectively, at 50 wt-% solids. Liquors containing ∼43 g L–1 Al and Na were obtained from leaches at 50 wt-% solids. By recycling this liquor in two further leaches on fresh slag at 50 wt-% solids, levels of 130 g L–1 Al and 125 g L–1 Na in solution were achieved. At these concentrations of alumina and soda, it is expected that the leach liquor should be suitable for recycling to the Bayer process. The dissolution of the alumina and soda from the slag was shown to be due to the leaching of a...

The human and legal rights under the Western Australian Mental Health Act (1996) of involuntary patients on community treatment orders (CTOs) include being provided with information by clinicians about the treatment expectations of the order, the procedure for review of status by the Mental Health Review Board, access to the Council of Official Visitors, and the opportunity for a second opinion about their psychiatric condition. To date, there has been no specific research in this area. This paper presents the findings of a study conducted in Western Australia where consumers on CTOs were asked to provide feedback as to whether they were informed of these legal rights. A questionnaire was distributed which asked eight questions related to being informed of these rights. The results indicated that from the consumer's perspective, the process of providing them with information about their rights was only partially met. Most consumers were informed about first appointments, their right to a review by the Mental Health Review Board, and provided with the appropriate legal form. However, in relation to what it means to be on a CTO, access to the Council of Official Visitors and the right to a second opinion, information was not being provided to the majority of consumers. The findings suggest that mental health clinicians need to make significant improvements in providing information to consumers. This level of consumer engagement could have beneficial results for the development of therapeutic relationships which in turn may lead to improved compliance with the CTO and better health outcomes for the consumer.

We aimed to construct and assess the psychometric properties of the My Medicines and Me Questionnaire (M3Q), a self-report side-effect questionnaire for mental health patients. Thirty individuals taking a psychotropic medication completed the M3Q side-effect checklist along with the Liverpool University Neuroleptic Side Effect Rating Scale. Thirty healthy comparison individuals also completed the M3Q checklist. Data were analyzed using factorial analysis. Psychometric evaluations including validity and reliability testing were carried out on the questionnaire's checklist. The original 54-item checklist of the M3Q was shortened to include only those items found to be significant in the factorial analysis. The revised 32-item checklist of the M3Q was found to be valid and reliable. The M3Q is a simple, valid and reliable questionnaire that can be used routinely in clinical practice for detecting bothersome side effects of a range of psychotropic medications. This will provide a platform for improved communication between the clinician and the patient.

The human and legal rights under the Western Australian Mental Health Act (1996) of involuntary patients on community treatment orders (CTOs) include being provided with information by clinicians about the treatment expectations of the order, the procedure for review of status by the Mental Health Review Board, access to the Council of Official Visitors, and the opportunity for a second opinion about their psychiatric condition. To date, there has been no specific research in this area. This paper presents the findings of a study conducted in Western Australia where consumers on CTOs were asked to provide feedback as to whether they were informed of these legal rights. A questionnaire was distributed which asked eight questions related to being informed of these rights. The results indicated that from the consumer's perspective, the process of providing them with information about their rights was only partially met. Most consumers were informed about first appointments, their right to a review by the Mental Health Review Board, and provided with the appropriate legal form. However, in relation to what it means to be on a CTO, access to the Council of Official Visitors and the right to a second opinion, information was not being provided to the majority of consumers. The findings suggest that mental health clinicians need to make significant improvements in providing information to consumers. This level of consumer engagement could have beneficial results for the development of therapeutic relationships which in turn may lead to improved compliance with the CTO and better health outcomes for the consumer.

PUBLIC HEALTH SYSTEMS in Australia and internationally are faced with the need to implement significant reforms. These reforms are driven by the need to balance the delivery of best practice clinical care with rapidly spiralling cost pressures. With much of the agenda for reform driven by managerial, administrative and even political priorities, clinicians have often felt sidelined from the reform process. Indeed, there is some evidence that clinicians have had decreased enthusiasm for their work in recent years, coinciding with a greater role of nonmedical managers and more restrictions on resources.1 There is a wealth of experience and intelligence within the clinical workforce that can contribute to finding solutions to the many complex issues facing the health system.2 This experience and intelligence is expressed in advice on the clinician?s specific areas of expertise and often within their own environment. This may work against the clinician having an effective impact on the reform agenda at the macro level. In that context, the establishment of a Clinical Senate in Western Australia to inform the health reform process by debating major issues that impact across the system is innovative. The Clinical Senate requires that Senators adopt a broad view, set aside their particular clinical allegiances and debate the issues in the best interests of the community. The Clinical Senate is a forum that allows clinicians to influence statewide-level processes through formally recognised channels. This article examines the rationale, processes and operation of the Clinical Senate in WA as a mechanism for effective clinician input into health reform.

Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients' subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20 min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.