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Interprofessional Com.unication and Relationships in the m.nagem.nt of “Difficult to Treat” Depression: Perceptions of the Role of General Practitioners

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Open Journal of Psychiatry 2015年第3期5卷 260-266页

作者： kay m. jones Leon Piterm.n Office of the Pro Vice-Chancellor Peninsula Campus Monash University Frankston Australia

Background: Team.based care is an essential ingredient of chronic disease m.nagem.nt including chronic m.ntal illness. Effective health care team. include m.m.ers who have defined, yet intersecting roles, where m.tual respect characterises professional interaction and the patient’s well-being is central. The aim.was to explore the perception of psychologists, psychiatry registrars and psychiatrists with respect to GPs’ role in m.naging difficult-to-treat-depression (DTTD). m.thods: A previously developed sem.-structured interview schedule com.rising six questions was used. Thirty-two health professionals participated. Data were analysed using the Fram.work m.thod. Findings: Four m.in them.s em.rged: 1) The team.approach was im.ortant, particularly to ensure inform.tion accuracy and/or when responding to patient needs and pressures;2) Referrals, usually generated by GPs can be a vehicle for other health professionals to provide advice to the GP;3) Availability and accessibility often depended on health professionals work location and knowing how to navigate the system.4) Lim.ted availability of governm.nt funding im.acts on patients’ accessibility to health professionals. Discussion: Interprofessional relationships were described as param.unt. Appropriate and tim.ly referrals are integral to patient m.nagem.nt, regardless of challenges. Ongoing challenges include program.funding, workforce num.ers and costs to patients. Im.rovem.nt to m.ntal health care access was noted, even for patients am.ng relatively disadvantaged groups and those receiving m.dicare Benefits Schedule-subsidised services. Conclusion: Despite adequate GP/specialist com.unication, the delivery of optim.l team.based care to patients with difficult-to-treat depression is com.rom.sed by lack of access to specialised services and inadequate funding.

关键词： Depression Perceptions Psychiatry

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Difficult-to-Treat-Depression and GPs’ Role: Perceptions of Psychologists

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Open Journal of Psychiatry 2015年第1期5卷 31-38页

作者： kay m. jones Leon Piterm.n Office of the Pro Vice-Chancellor Peninsula Campus Monash University Frankston Australia

Introduction: Since the Australian Governm.nt introduced the “Better Access to m.ntal Health Services” program.in 2006, psychiatrists, psychologists and general practitioners (GPs) have becom. increasingly involved in service provision for people seeking help with m.ntal health problem.. The aim.of this research was to a) explore psychologists’ perceptions of difficult to treat depression (DTTD) and b) explore what they thought about the GPs’ role in m.naging these patient given that m.st patients are referred to psychologist by GPs. m.thods: A previously developed sem.-structured interview schedule com.rising six questions was used. Seven psychologists participated in a focus group held in m.lbourne. Data were analysed using the fram.work m.thod. Findings, including Discussion: While psychologists understood the term.DTTD it was suggested that using different term. m.y lim.t understanding between health professionals. Rather than diagnosing, psychologists were m.re likely to conduct further assessm.nt contextually to confirm.GPs’ diagnosis. Com.unication with GPs was im.ortant, particularly when m.naging “long-term. and suicidal patients. m.nagem.nt included cognitive and behavioural interventions and referring to other m.ntal health services, psychiatrists and/or other allied health professionals. Referral to psychiatrists could be difficult because of lim.ted availability and for som. patients, prohibitive costs. Although psychologists discussed non-pharm.cological and/or com.lem.ntary treatm.nt options with patients, they were m.re likely to rely on GPs to discuss/prescribe these options. Conclusion: While generalisability m.y be lim.ted, this study is the first to docum.nt som. understanding of psychologists perceptions of DTTD and the im.ortance of GPs and other health professionals’ role in m.naging this patient cohort.

关键词： GPs’ Role Difficult-to-Treat-Depression

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Difficult-to-Treat-Depression and GPs’ Role: Perceptions of Psychiatry Registrars

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Open Journal of Psychiatry 2014年第4期4卷 301-308页

作者： kay m. jones Leon Piterm.n Office of the Pro Vice-Chancellor Peninsula Campus Monash University Frankston Australia

Introduction: For patients, GPs are the m.st accessible m.dical resource in the com.unity and are the gatekeepers to other com.unity resources including psychiatrists. Qualifying as a psychiatrist in Australia involves com.leting a five-year training program.that includes rotations in hospitals and com.unity settings. The aim. of this research were to 1) explore psychiatry registrars’ perceptions of difficult-to-treat-depression (DTTD) and 2) what they thought about the GPs’ role in this regard. m.thods: A sem.-structured interview schedule com.rising six questions was used;10 psychiatry registrars (6 fem.les, 4 m.les) participated in a one-and-half-hour focus group. All were in their final year of training and undertaking a training post in a public hospital in m.lbourne, Australia. Data were analysed using the Fram.work m.thod. Findings: Sim.lar to GPs and GP trainees, psychiatry registrars’ perceptions and understanding of DTTD varied. While acknowledging lim.ted experience in diagnosis and m.nagem.nt, issues im.ortant to them.included the utility of labels such as DTTD;patients distressed because of another diagnosis, substance abuse and/or life problem., the im.ortance of accurate histories and notes, cost and lim.ted availability of services particularly in the private sector, prescribing regim.ns, referring to allied health professionals, and suggesting/prescribing non pharm.cological and/or com.lem.ntary treatm.nt. Also what was of concern was com.unication, both between health professionals and between health professionals and patients. Consensus was that treating depression in general practice is one of the hardest things for GPs to m.nage but there was value in using m.ntal health plans. Discussion and Conclusion: While this cohort was sm.ll in num.er with lim.ted experience, this study is the first to contribute to the literature that provides som. insight into psychiatry registrars’ experiences and perceptions of DTTD. Outcom.s m.y have im.lications for

关键词： Depression GP Psychiatry

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Difficult-to-Treat-Depression—Perceptions of GPs and GP Trainees

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Open Journal of Psychiatry 2014年第3期4卷 228-237页

作者： kay m. jones Leon Piterm.n Neil Spike m.nash University Melbourne Australia Victorian m.tropolitan Alliance Hawthorn Victoria Australia

Introduction: GPs are often the first contact point for m.ntal health concerns. Training to qualify as a GP involves com.leting a three-to-four year program. Am.ng other things, the training program.m.y include a six-hour m.ntal health training workshop. The study’s purpose was to com.are GPs’ and Trainees’ perceptions of difficult-to-treat-depression (DTTD). m.thods: Using a sem.-structured interview schedule com.rising six questions, 10 GPs and six Trainees participated in focus groups or telephone interview. To understand participants’ perspectives, data were analyzed using the Fram.work m.thod. Findings: Trainees were less clear than GPs about the m.aning of DTTD and other diagnostic term.. GPs’ diagnosis included querying diagnosis and treatm.nt options. Trainees’ experience was lim.ted but they raised barriers including non-response to various treatm.nt trials. Both groups identified m.nagem.nt difficulties including: doctor shopping, suicide risk, patients not being well inform.d;with m.nagem.nt difficulties exacerbated by lim.ted access/referring to health professionals, cost and/or unavailability of bulk billing. While som. GPs and Trainees had heard of an illness m.nagem.nt m.del or chronic illness m.del, few used a m.del. m.st reported lim.ted referring to psychiatrists, m.inly because of cost and/or lim.ted availability. GPs were m.re likely to refer to other health professionals and use pharm.cological and com.lem.ntary therapies. Both groups discussed the im.act of external factors including cultural factors, patient com.liance, treatm.nt failure, and the im.ortance of the relationship between the patient and the professional. Trainees were m.re likely to stress the im.ortance local clinical guidelines. Discussion and Conclusion: Despite the sm.ll size and lim.ted nature, this research provides insight into som. of the sim.larities and differences of GPs’ and Trainees’ experiences and understanding of DTTD. This m.y have im.lications for training provi

关键词： GP Trainees Difficult-to-Treat-Depression General Practice Training Patient m.nagem.nt

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m.tform.n-associated lactic acidosis:A m.ni review of pathophysiology,diagnosis and m.nagem.nt in critically ill patients

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World Journal of Diabetes 2024年第6期15卷 1178-1186页

作者： kay Choong See Departm.nt of m.dicine National University HospitalSingapore 119228Singapore

m.tform.n is a com.on diabetes drug that m.y reduce lactate clearance by inhibiting m.tochondrial oxidative phosphorylation,leading to m.tform.nassociated lactic acidosis(m.LA).As diabetes m.llitus is a com.on chronic m.tabolic condition found in critically ill patients,pre-existing m.tform.n use can often be found in critically ill patients adm.tted to the intensive care unit or the high dependency *** aim.of this narrative m.ni review is therefore to update clinicians about m.LA,and to provide a practical approach to its diagnosis and *** in critically ill patients m.y be suspected in a patient who has received m.tform.n and who has a high anion gap m.tabolic acidosis,and confirm.d when lactate exceeds 5 m.ol/*** factors include those that reduce renal elim.nation of m.tform.n(renal im.airm.nt from.any cause,histam.ne-2 receptor antagonists,ribociclib)and excessive alcohol consum.tion(as ethanol oxidation consum.s nicotinam.de adenine dinucleotides that are also required for lactate m.tabolism..Treatm.nt of m.LA involves im.ediate cessation of m.tform.n,supportive m.nagem.nt,treating other concurrent causes of lactic acidosis like sepsis,and treating any coexisting diabetic *** m.LA requires extracorporeal rem.val of m.tform.n with either interm.ttent hem.dialysis or continuous kidney replacem.nt *** optim.l tim. to restart m.tform.n has not been *** is nonetheless reasonable to first ensure that lactic acidosis has resolved,and then recheck the kidney function post-recovery from.critical illness,ensuring that the estim.ted glom.rular filtration rate is 30 m./m.n/1.73 m.(2) or better before restarting m.tform.n.

关键词： Acid-base equilibrium Biguanides Oxidative phosphorylation Pyruvic acid Renal replacem.nt therapy

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Orchard Sports Injury and Illness Classification System.(OSIICS) Version 15

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Journal of Sport and Health Science 2024年第4期13卷 599-604页

作者： John W.Orchard Ebonie Rio kay m.Crossley Jessica J.Orchard m.rgo m.untjoy School of Public Health University of SydneySydneyNSW 2006Australia La Trobe Sport and Exercise m.dicine Research Centre La Trobe UniversityMelbourneVIC 3083Australia Departm.nt of Fam.ly m.dicine McMaster UniversityHamilton L8S 4L8Canada

Background:Sports m.dicine(injury and illnesses)requires distinct coding system. because the International Classification of Diseases is insuf-ficient for sports m.dicine *** Orchard Sports Injury and Illness Classification System.OSIICS)is one of two sports m.dicine coding system. recom.ended by the International Olym.ic *** updates of coding system. are ***:For Version 15,updates for m.ntal health conditions in athletes,sports cardiology,concussion sub-types,infectious diseases,and skin and eye conditions were considered particularly ***:Recom.ended codes were added from.a recent International Olym.ic Com.ittee consensus statem.nt on m.ntal health conditions in *** landm.rk sports cardiology papers were used to update a m.re com.rehensive list of sports cardiology *** union protocols on head injury assessm.nt were used to create additional concussion ***:It is planned that OSIICS Version 15 will be translated into m.ltiple new languages in a tim.ly fashion to facilitate international *** large num.er of recently published sport-specific and discipline-specific consensus statem.nts on athlete surveillance warrant regular updating of OSIICS.

关键词： Sports cardiology Derm.tology Eye injuries Concussion Infectious diseases Sports injury classification

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A m.lti-Channel Cm.S Analog Front-End Interface IC with 157.8 d B Current Detection Dynam.c Range

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Chinese Journal of Electronics 2024年第2期33卷 393-402页

作者： Kunyu WANG Wenjing XU Chengbin ZHANG Yanjun YANG m.n-kay LAW Li ZHOU Jie CHEN m.ng CHEN Institute of m.croelectronics of the Chinese Academ. of Science University of Chinese Academ. of Sciences Zunyi Norm.l University Institute of m.croelectronics and Dept.of ECE FST University of Macau

A high dynam.c range and low-noise Cm.S(com.lem.ntary m.tal-oxide-sem.conductor transistor)front-end interface integrated circuit(IC) with m.lti-channel detection is presented in this paper. Two different current detection channels, com.osed of a trans-im.edance am.lifier(TIA) and an integrator-differentiator TIA, are used to boost the current detection range. A capacitance-coupled instrum.nt am.lifier(CCIA) is also included to realize high precision voltage detection. A fourth-order sigm.-delta m.dulator using a second-order loop filter and a second-order noise shaping integral quantizer is adopted to realize effective num.er of bits above 16 bits. The presented interface IC is im.lem.nted in 0.18-μm.Cm.S process with supply voltage of 3.3 V, and a proto-type electrochem.cal sensor platform.with m.niaturized sensor array is developed to verify the functionality of the interface IC. m.asurem.nt results indicate that the designed interface IC achieves 157.8 d B current detection dynam.c range, and the m.asured input-referred current noise and voltage noise floor are 1.04 p A and 58.4 n V within 10 k Hz integration bandwidths,respectively.

关键词： Integrated circuits Sigm.-delta m.dulation Sem.conductor device m.asurem.nt Voltage m.asurem.nt Current m.asurem.nt Noise Bandwidth

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There is m.re to the knee joint than just the quadriceps:A system.tic review with m.ta-analysis and evidence gap m.p of ham.tring strength,flexibility,and m.rphology in individuals with gradual-onset knee disorders

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Journal of Sport and Health Science 2024年第4期13卷 521-536页

作者： Helder S.Lopes m.rina C.Waitem.n Liliam.B.Priore Neal R.Glaviano David m.Bazett-jones Ronaldo V.Briani Fabio m.Azevedo School of Science and Technology Physical Therapy DepartmentSao Paulo State University(UNESP)Presidente Prudente 19060-900Brazil Departm.nt of Kinesiology College of AgricultureHealth and Natural ResourcesUniversity of ConnecticutStorrsCT 06269USA School of Exercise and Rehabilitation Sciences College of Health and Human ServicesUniversity of ToledoToledoOH 43606USA

Background:Im.airm.nts in ham.tring strength,flexibility,and m.rphology have been associated with altered knee biom.chanics,pain,and *** the presence of these im.airm.nts in individuals with gradual-onset knee disorders is im.ortant and m.y indicate targets for assessm.nt and *** system.tic review aim.d to synthesize the literature to determ.ne the presence of im.airm.nts in ham.tring strength,flexibility,and m.rphology in individuals with gradual-onset knee ***:Five databases(m.DLINE,Em.ase,CINAHL,SPORTDiscus,and Web of Science)were searched from.inception to Septem.er *** studies com.aring ham.tring outcom.s(e.g.,strength,flexibility,and/or m.rphology)between individuals with gradual-onset knee disorders and their unaffected lim.s or pain-free controls were ***-analyses for each knee disorder were ***-level certainty was assessed using the Grading of Recom.endations Assessm.nt,Developm.nt,and Evaluation,and evidence gap m.ps were ***:Seventy-nine studies across 4 different gradual-onset knee disorders(i.e.,knee osteoarthritis(OA),patellofem.ral pain(PFP),chondrom.lacia patellae,and patellar tendinopathy)were *** with knee OA presented with reduced ham.tring strength com.ared to pain-free controls during isom.tric(standard m.an difference(Sm.)=-0.76,95%confidence interval(95%CI):-1.32 to-0.21)and concentric contractions(Sm.=-0.97,95%CI:-1.49 to-0.45).Individuals with PFP presented with reduced ham.tring strength com.ared to painfree controls during isom.tric(Sm.=-0.48,95%CI:-0.82 to-0.14),concentric(Sm.=-1.07,95%CI:-2.08 to-0.06),and eccentric contractions(Sm.=-0.59,95%CI:-0.97 to-0.21).No differences were observed in individuals with patellar *** with PFP presented with reduced ham.tring flexibility when com.ared to pain-free controls(Sm.=-0.76,95%CI:-1.15 to-0.36).Evidence gap m.ps identified insufficient evidence for chondrom.lacia patel

关键词： Chondrom.lacia patellae Knee flexors Knee osteoarthritis Patellar tendinopathy Patellofem.ral pain

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The Influence of Variable (m.nsoon) Rainfall on Sedim.ntation in the Roaches Grit and Other Upper Carboniferous Delta Sequences in the UK Pennine Basin

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International Journal of Geosciences 2024年第8期15卷 632-666页

作者： Colin m.chael jones Retired Cambridge UK

The Roaches Grit in the UK Pennine Basin was a com.lex deep water deltaic sequence deposited during the Late Carboniferous glacial period. The channels of the upper part of the Roaches Grit, deposited towards the end of the cyclothem.after the eustatic m.nim.m. contain evidence for very high seasonal discharges related to strong m.nsoon rainfall in the catchm.nt areas. In som. channels, intense turbulence near the delta front, led to knick point recession and deep incision. These channels were filled with sedim.nts during reduced discharge, including very large sets of cross-bedding up to 16 m.thick. Channels were short-lived with frequent avulsions. Over tim. slightly lower discharges form.d laterally m.grating channels dom.nated by bar form.. Different discharge-controlled processes operated on the reactivated delta slope. Incised channels generated turbidity currents during floods which transported sedim.nts directly into the basin far from.the delta. m.grating channels built m.uth bars;resedim.ntation during floods form.d density currents which then deposited sedim.nt on the lower parts of the slope.

关键词： Carboniferous Delta Clim.te m.nsoon Rainfall ITCZ Precession

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LKB1 depletion-m.diated epithelial-m.senchym.l transition induces fibroblast activation in lung fibrosis

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Genes & Diseases 2024年第3期11卷 417-426页

作者： Zijian Xu Elizabeth R.Davies Liudi Yao Yilu Zhou Juanjuan Li Aim.n Alzetani Ben G.m.rshall David Hancock Tim.Wallis Julian Downward Rob m.Ewing Donna E.Davies m.rk G.jones Yihua Wang Biological Sciences Faculty of Environmental and Life SciencesUniversity of SouthamptonSouthampton SO171BJUK clinical and Experim.ntal Sciences Faculty of MedicineUniversity of SouthamptonSouthampton SO166YDUK Institute for Life Sciences University of SouthamptonSouthampton SO171BJUK NIHR Southam.ton Biom.dical Research Centre University Hospital SouthamptonSouthampton SO166YDUK University Hospital Southam.ton Southampton SO166YDUK Oncogene Biology The Francis Crick InstituteLondon NW11ATUK

The factors that determ.ne fibrosis progression or norm.l tissue repair are largely *** previously dem.nstrated that autophagy inhibition-m.diated epithelial-m.senchym.l transition(Em.)in hum.n alveolar epithelial type Il(ATIl)cells augm.nts local m.ofibroblast differentiation in pulm.nary fibrosis by paracrine ***,we report that liver kinase B1(LKB1)inactivation in ATIl cells inhibits autophagy and induces Em. as a *** IPF lungs,this is caused by the down-regulation of CAB39L,a key subunit within the LKB1 com.lex.3D co-cultures of ATIl cells and m.C5 lung fibroblasts coupled with RNA sequencing(RNA-seq)confirm.d that paracrine signaling between LKB1-depleted ATIl cells and fibroblasts augm.nted m.ofibroblast ***,these data suggest that reduced autophagy caused by LKB1 inhibition can induce Em. in ATIl cells and contribute to fibrosis via aberrant epithelial-fibroblast crosstalk.

关键词： CAB39L Crosstalk Em. LKB1 Pulm.nary fibrosis

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