Background: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, typically though not exclusively, considered a disorder of childhood. It is characterised by the core symptoms of inattention, hyperactivity, and impulsivity. Deficits in emotional regulation, executive function and motivation are also characteristics of ADHD. Cognitive Behaviour Therapy (CBT) is a common behavioural intervention in several child and adolescent psychopathologies as reported by Ramsay (2010), Solanto et al. (2010) Ramsay (2012) and Lopez et al. 2018). It is recommended as a non-pharmacological intervention alongside parent training, in school-aged children with a moderate severity of ADHD symptoms (NICE 2018b). Research Design: The aim of this systematic review is to evaluate the effects of CBT as an intervention for ADHD in school-aged children. The research objective is to assess the effects of CBT in reducing the core symptoms of ADHD. A search strategy was developed and our databases (CINAHL, Medline, PsychInfo and Scopus) were searched yielding 1100 results. The search was limited to randomised controlled trials which evaluated the efficacy of CBT compared with treatment as usual, no treatment, and waitlist, in school-aged children. Studies selected were limited to papers with a full text published in English within the last 10 years. Inclusion criteria included participants who were diagnosed by a medical professional, and participants under the age of 18 in full-time, mainstream education. Those with co-morbid autism or tic disorder were excluded, as were those with an intellectual disability. The standard procedure for systematic reviews as suggested by Cochrane was followed for the data collection and analysis. Six randomised controlled trials met the inclusion criteria. The age range of participants was from 8-18 years. The medication status of participants varied across the included studies. Findings: A narrative synthesis of the results includes the assessment of methodological quality and risk of bias. The studies all included different modalities of CBT intervention and a variety of measurement tools. There was insufficient inclusion of younger children to be able to draw any conclusions in this age group. The findings support the use of CBT as a non-pharmacological intervention to reduce the severity of ADHD symptoms in adolescents. However
Full mindfulness-teacher training pathway and courses on pain management programmes: why it mayall be worth it
provide full 8-week mindfulness courses within a multidisciplinary secondary outpatient pain management and rehabilitation service. We will also reflect on how we have grown to align to these high standards of training for There is a growing appetite for the provision of mindfulness training in order for staff to deliver mindfulness teaching on Pain Management Programmes (PMPs). With this, there is also a debate around what should be the minimum required standards for training pain management staff to teach mindfulness. In addition, the recent guidance on chronic primary pain made recommendations for more research into both the clinical effectiveness and cost-effectiveness of mindfulness. In this article, we will share our experience from our ongoing audit of clinical outcomes of having various members of our multidisciplinary team (MDT) trained in the necessary competences to provide full 8-week mindfulness courses within a multidisciplinary secondary outpatient pain management and rehabilitation service. We will also reflect on how we have grown to align to these high standards of training for PMP staff wishing to teach mindfulness, bearing in mind that they are believed to be the good practice standards required by most registered mindfulness teachers and supervisors.
The evolving classifications and epidemiological challenges surrounding chronic migraine and medication overuse headache: a review
Changes in diagnostic criteria, for example, the various International Classification of Headache Disorders criteria, would lead to changes in the outcomes of epidemiological studies. International Classification of Headache Disorders-1 was based mainly on expert opinion, yet most of the diagnostic criteria were reliable and valid, but it did not include chronic migraine. In its second version, the classification introduced chronic migraine, but this diagnosis resembled more a high-frequency migraine rather than the actual migraine Transformation process. It also introduced medication overuse headache, but it necessitated analgesic withdrawal and sub sequent headache improvement to be diagnosed as such. Hence patients having medication overuse headache could only be diagnosed in Retrospect, which was an awkward situation. Such restrictive criteria for chronic migraine and medication overuse headache omitted a high proportion of patients. International Classification of Headache Disorders-3 allows a diagnosis of medication overuse headache due to combination analgesics if taken for at least 10 days per month for more than three months. Hence the prevalence rate of medication overuse headache and chronic migraine can increase compared to the previous version of the headache classification. Different
criteria have been used across studies to identify chronic migraine and medication overuse headache, and therefore the information acquired from previous studies using earlier criteria becomes uncertain. Hence much epidemiological research would need to be interpreted cautiously or repeated with the most updated criteria, since the subjects in studies that apply the latest criteria may be phenotypically different from those in older studies.
Exploration of the Lived Experiences of Rectal Cancer Patients
Aim: To explore the lived experiences of rectal cancer patients following diagnosis, treatment and surgery. Background Patients diagnosed with rectal cancer can have a complex treatment trajectory involving a combination of radiotherapy, chemotherapy and surgery. Patients can now undergo sphincter saving surgery and avoid a permanent colostomy; however more often than not a temporary defunctioning ileostomy is formed to prevent anastomotic dehiscence. Sample and Setting A purposive sample of seven individuals were
recruited and consented to participate within this study: four females and three males, aged 44 – 71 years old. Five of the participants had a temporary defunctioning ileostomy, one had a temporary colostomy, and one had a permanent colostomy. Data Collection and Analysis Semi-structured interviews were utilised, and transcriptions were transcribed verbatim and analysed using interpretative phenomenological analysis. Findings Four major themes emerged from the data analysis: consequences of diagnosis, the effects of treatment, communication and outlook on life. Participants reported the shock of their diagnosis and the major challenges they experienced as a consequence of their stoma. Five out of the seven participants stated they would never have chemotherapy again due to the
severe nature of the side effects of the treatment. Surviving cancer changed their outlook on life and many discussed how it changed their lives for the better. Conclusion This study highlighted the complex trajectory rectal cancer patients endure. Participants reported that stoma formation and living with its unpredictability caused a detrimental effect on their physical and psychological wellbeing more than any other part of the treatment plan. However, the findings highlighted the resilience that colorectal cancer patients possess in order to complete their treatments and survive.
Disciplinary Power and Nurse Identity: A Foucauldian Analysis of Student Nurse Education in Jersey from 1924-2016
The purpose of this study is to explore how students’ nurse identity has developed over the years and the particular role that disciplinary power has had in shaping it. The research focus was the School of Nursing in Jersey from 1924-2016. The study site included the wider Social space where nurse education occurred at the School of Nursing; that is the classroom, the practice area and the nurses’ home. The study attempts to fill a gap in local nursing history by creating a unique record while also considering the wider social influences on how students develop a nurse identity. The primary data comprises interviews with fifteen (n=15) participants who provide a historical account of their experiences as students. Interview transcripts and diary narratives with a further four (n=4) former nursing students from the earlier period are also included. These are supplemented with documentary archive material in the form of hospital student nurse records, newspaper archives, Société Jèrriais archives, personal correspondence, and photographs. Foucault’s (1979) concept of panopticism was used to explore how the functioning of disciplinary power promoted the notion of docility and shaped the developing nurse identity of students. The Foucauldian framework provided a sociological analysis of disciplinary power and how the unconscious conditioning of students reated the “docile body”. The main themes identified relate to freedom (or not) of choice in choosing a career, shifting modes of control, control through the use of time, knowing your place, sister’s “gaze” as a panoptical figure, living and working by the rules, fear of punishment, the gendered nature of nursing as an occupation, medical dominance, and the support from fellow students. The technologies of surveillance, normalising judgement and examination were employed to understand how, as student nurses, the participants internalised the values, beliefs and behaviours experienced in the School of Nursing. Tracing these technologies of discipline from the beginnings of the School of Nursing to its present-day amounts to what in Foucauldian terms is a history of the objectification of the present. Findings indicate that discipline was a means of constructing experience and served to shape the identity of the participants as student nurses. It was easier to recognise Foucault’s (1979, 1995) concept of panopticism in the
traditional nurses’ accounts; how this applied to the contemporary setting was less obvious but nonetheless apparent. While there has been more discreet monitoring of students in recent years, the methods of surveillance remain rooted in Foucault’s (1979, 1995)
representation of panopticism and the construction of the “docile body”. Control was exerted over their lives in the classroom and on the wards. As students the participants began to regulate their own behaviour and discipline themselves. The historical perceptions of what it means to be a “good nurse” impacted on their developing identity across the years. The unconscious conditioning of the students served to create the “docile body” of the student nurse, and this impacted on the development of an identity. Having identified the importance of the influence of disciplinary power, further research exploring this among student nurses in the contemporary university setting could make a positive contribution to understanding how this moulds a nurse identity.
Self-Selection all the Way: Improving Patients’ Pain Experience and Outcomes on a Pilot Breathworks Mindfulness for Health Programme
This review explores adverse surgical outcomes for patients who experience hypothermia in the peri-operative period. Findings of the literature review highlight the need to establish a standard definition of hypothermia. Furthermore, the literature supports the full implementation of the National Institute for Health and Care Excellence guidance on ‘The Management of Inadvertent Perioperative Hypothermia in Adults’. A total of 18 studies were critically appraised to determine their rigour, reliability and validity. A discussion of the findings from the studies has taken into account the inferences drawn from the appraisal. Evaluation of the quality of the evidence has been used to evaluate which findings could apply to clinical practice. While there were variations in study quality, the evidence supports
developing an effective strategy for preventing hypothermia in the peri- operative period.