2021 |
Hollier TM, Frost BG, Michie PT, Lewin TJ, Sly KA, 'Improvements in Hope, Engagement and Functioning Following a Recovery-Focused Sub-Acute Inpatient Intervention: a Six-Month Evaluation', Psychiatric Quarterly, 92 1611-1634 (2021) [C1]
Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study ... [more]
Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study was to evaluate the medium-term outcomes of a 6-week sub-acute inpatient intervention program for 27 service users with a diagnosis of serious mental illness (mean age = 33.22¿years, 70.4% with a psychosis diagnosis). Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up (with mean z-change ranging from 0.72 to 1.35), as did the self-reported social connection measure (Mental Health Recovery Star, MHRS; mean z-change: 1.05). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. Change scores based on self-reported and clinician-rated measures tended to be uncorrelated. An exploration of client-level outcomes revealed three recovery trajectory subgroups: transient (21.7%), gradual (34.8%), or sustained (43.5%) improvement; with members of the latter group tending to have longer illness durations. The study¿s findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery. However, they also suggest that recovery perspectives differ between clients and clinicians, and that far more work is required to understand the psychological factors that generate and sustain the hope that recovery is possible.
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Nova |
2020 |
Sly KA, Lewin TJ, Frost BG, Tirupati S, Turrell M, Conrad AM, 'Care pathways, engagement and outcomes associated with a recovery-oriented intermediate stay mental health program', PSYCHIATRY RESEARCH, 286 (2020) [C1]
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Nova |
2019 |
Clark V, Conrad AM, Lewin TJ, Baker AL, Halpin SA, Sly KA, Todd J, 'Addiction Vulnerability: Exploring Relationships Among Cigarette Smoking, Substance Misuse, and Early Psychosis', Journal of Dual Diagnosis, 14 78-88 (2019) [C1]
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Nova |
2017 |
Frost BG, Turrell M, Sly KA, Lewin TJ, Conrad AM, Johnston S, et al., 'Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)', BMC Health Services Research, 17 1-12 (2017) [C1]
Background: An ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU).... [more]
Background: An ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU). This paper: provides an overview of the targeted 6-week program, operating within an Integrated Recovery-oriented Model (IRM); characterises the clients admitted during the first 16 months; and documents their recovery needs and any changes. Methods: A brief description of the unit¿s establishment and programs is initially provided. Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS) and addressed through a range of in-situ, individual and group interventions. Extracted client and service data were analysed using descriptive statistics, paired t-tests examining change from admission to discharge, and selected correlations. Results: The initial 154 clients (165 admissions, average stay = 47.86 days) were predominately male (72.1%), transferred from acute care (75.3%), with schizophrenia or related disorders (74.0%). Readmission rates within 6-months were 16.2% for acute and 3.2% for sub-acute care. Three MHRS subscales were derived, together with stage-of-change categories. Marked improvements in MHRS Symptom management and functioning were identified (z-change = -1.15), followed by Social-connection (z-change = -0.82) and Self-belief (z-change = -0.76). This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge (z-change = 0.98). Clinician-rated Health of the Nation Outcome Scales (HoNOS) improvements were smaller (z-change = 0.41), indicative of illness chronicity. Staff valued the elements of client choice, the holistic and team approach, program quality, review processes and opportunities for client change. Addressing high-levels of need in the 6-week timeframe was raised as a concern. Conclusions: This paper demonstrates that a recovery-oriented model can be successfully implemented at the intermediate level of care. It is hoped that ongoing evaluations support the enthusiasm, commitment and feedback evident from staff, clients and carers.
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Nova |
2017 |
Frost BG, Tirupati S, Johnston S, Turrell M, Lewin TJ, Sly KA, Conrad AM, 'An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges', BMC PSYCHIATRY, 17 (2017) [C1]
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Nova |
2017 |
Conrad AM, Lewin TJ, Sly KA, Schall U, Halpin SA, Hunter M, Carr VJ, 'Utility of risk-status for predicting psychosis and related outcomes: evaluation of a 10-year cohort of presenters to a specialised early psychosis community mental health service', Psychiatry Research, 247 336-344 (2017) [C1]
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Nova |
2014 |
Conrad AM, Lewin TJ, Sly KA, Schall U, Halpin SA, Hunter M, Carr VJ, 'Ten-year audit of clients presenting to a specialised service for young people experiencing or at increased risk for psychosis', BMC PSYCHIATRY, 14 (2014) [C1]
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Nova |
2012 |
Lewin TJ, Carr VJ, Conrad A, Sly K, Tirupati S, Cohen M, et al., 'Shift climate profiles and correlates in acute psychiatric inpatient units', Social Psychiatry and Psychiatric Epidemiology, 47 1429-1440 (2012) [C1]
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Nova |
2009 |
Sly K, Sharples J, Lewin TJ, Bench CJ, 'Court outcomes for clients referred to a community mental health court liaison service', International Journal of Law and Psychiatry, 32 92-100 (2009) [C1]
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Nova |
2009 |
Sly K, Lewin TJ, Carr VJ, Conrad A, Cohen M, Tirupati S, et al., 'Measuring observed mental state in acute psychiatric inpatients', Social Psychiatry and Psychiatric Epidemiology, 44 151-161 (2009) [C1]
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Nova |
2008 |
Carr VJ, Lewin TJ, Sly K, Conrad A, Tirupati S, Cohen M, et al., 'Adverse incidents in acute psychiatric inpatient units: Rates, correlates and pressures', Australian and New Zealand Journal of Psychiatry, 42 267-282 (2008) [C1]
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Nova |
2005 |
Hazell P, Lewin TJ, Sly K, 'What is a clinically important level of improvement in symptoms of attention-deficit/hyperactivity disorder', Australian and New Zealand Journal of Psychiatry, 39 354-358 (2005) [C1]
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2004 |
Carless PA, Stokes BJ, Moxey AJ, Henry DA, 'Desmopressin for minimising perioperative allogenic blood transfusion', Cochrane Database of Systematic Reviews, - CD001884 (2004) [C1]
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Nova |
2003 |
Hazell P, Carr VJ, Lewin TJ, Sly K, 'Manic Symptoms in Young Males With ADHD Predict Functioning But Not Diagnosis After 6 Years', Journal of the American Academy of Child & Adolescent Psychiatry, 42 552-560 (2003) [C1]
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2003 |
Sharples J, Lewin TJ, Hinton RJ, Sly KA, Coles GW, Johnston PJ, Carr VJ, 'Offending behaviour and mental illness: Characteristics of a mental health court liaison service', Psychiatry, Psychology and Law, 10 300-315 (2003)
This paper begins with a brief review of recent literature about relationships between offending behaviour and mental illness, classifying studies by the settings within which the... [more]
This paper begins with a brief review of recent literature about relationships between offending behaviour and mental illness, classifying studies by the settings within which they occurred. The establishment and role of a mental health court liaison (MHCL) service is then described, together with findings from a 3-year service audit, including an examination of relationships between clients¿ characteristics and offence profiles, and comparisons with regional offence data. During the audit period, 971 clients (767 males, 204 females) were referred to the service, comprising 1139 service episodes, 35.5% of which involved a comorbid substance use diagnosis. The pattern of offences for MHCL clients was reasonably similar to the regional offence data, except that among MHCL clients there were proportionately more offences against justice procedures (e.g., breaches of apprehended violence orders [AVOs]) and fewer driving offences and ¿other offences¿. Additionally, male MHCL clients had proportionately more malicious damage and robbery offences and lower rates of offensive behaviour and drug offences. A range of service and research issues is also discussed. Overall, the new service appears to have forged more effective links between the mental health and criminal justice systems. © 2003 Taylor & Francis Group, LLC.
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2002 |
Baker AL, Lewin TJ, Reichler HM, Clancy R, Carr VJ, Garrett R, et al., 'Evaluation of a motivational interview for substance use within psychiatric in-patient services', Addiction, 97(10) 1329-1337 (2002) [C1]
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2002 |
Henry DA, Moxey AJ, Carless PA, O'Connell D, McClelland B, Henderson KM, et al., 'Desmopressin for minimising perioperative allogeneic blood transfusion', Praxis, 91 1504 (2002)
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2002 |
Baker AL, Lewin TJ, Reichler HM, Clancy R, Carr VJ, Garrett R, et al., 'Motivational interviewing among psychiatric in-patients with substance use disorders', ACTA Psychiatrica Scandinavica, 106 233-240 (2002) [C1]
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2001 |
Henry DA, Moxey AJ, Carless PA, O'Connell D, McClelland B, Henderson KM, et al., 'Desmopressin for minimising perioperative allogeneic blood transfusion.', Cochrane database of systematic reviews (Online), (2001)
BACKGROUND: Public concerns regarding the safety of transfused blood have prompted re-consideration of the use of allogeneic (from an unrelated donor) red blood cell (RBC) transfu... [more]
BACKGROUND: Public concerns regarding the safety of transfused blood have prompted re-consideration of the use of allogeneic (from an unrelated donor) red blood cell (RBC) transfusion, and a range of techniques designed to minimise transfusion requirements. OBJECTIVES: To examine the evidence for the efficacy of desmopressin (1-deamino-8-D-arginine-vasopressin), in reducing perioperative blood loss and the need for red cell transfusion in patients who do not have congenital bleeding disorders. SEARCH STRATEGY: Articles were identified by: computer searches of OVID MEDLINE, EMBASE, and Current Contents (to August 2000) and web sites of international health technology assessment agencies (to May 1998). References in the identified trials and review articles were checked and authors contacted to identify additional studies. SELECTION CRITERIA: Randomised controlled parallel group trials in which adult patients, scheduled for non-urgent surgery, were randomised to DDAVP, or to a control group, who did not receive the intervention. DATA COLLECTION AND ANALYSIS: Trial quality was assessed using criteria proposed by Schulz et al. (1995) and Jadad et al. (1996). The principal outcomes were: the number of patients exposed to red cells, and the amount of blood transfused. Other clinical outcomes are detailed in the review. MAIN RESULTS: Fourteen trials of DDAVP (N=1034) reported data on the proportion of patients exposed to allogeneic RBC transfusion. In subjects treated with DDAVP the relative risk of exposure to peri-operative allogeneic blood transfusion was 0.98 (95%CI: 0.88 to 1.10) compared with control. In DDAVP-treated patients the relative risk of requiring re-operation due to bleeding was 0.56 (95%CI: 0.18 to 1.73). There was no statistically significant effect overall for mortality and non-fatal myocardial infarction in DDAVP-treated patients compared with control (RR=1.53: 95%CI: 0.58 to 4.05) and (RR=1.52: 95%CI: 0.67 to 3.49) respectively. REVIEWER'S CONCLUSIONS: There is no convincing evidence that desmopressin minimises perioperative allogeneic RBC transfusion in patients who do not have congenital bleeding disorders. These data suggest that there is no benefit of using DDAVP as a means of minimising perioperative allogeneic RBC transfusion. This meta-analysis had 90% power to detect a relative risk reduction of at least 17% for receiving a red cell transfusion at alpha = 0.05 (two-sided).
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2001 |
Henry DA, Moxey AJ, Carless PA, O'Connell D, McClelland B, Henderson KM, et al., 'Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion.', Cochrane database of systematic reviews (Online), (2001)
BACKGROUND: Concerns regarding the safety of transfused blood have prompted re-consideration of the use of allogeneic (blood from an unrelated donor) blood transfusion. OBJECTIVES... [more]
BACKGROUND: Concerns regarding the safety of transfused blood have prompted re-consideration of the use of allogeneic (blood from an unrelated donor) blood transfusion. OBJECTIVES: To assess the effects of the anti-fibrinolytic drugs aprotinin, tranexamic acid, and epsilon aminocaproic acid, on peri-operative red blood cell (RBC) transfusion. SEARCH STRATEGY: We searched MEDLINE (to May 1998), EMBASE (to December 1997), web sites of international health technology assessment agencies (to May 1998). References in identified trials and review articles were checked and authors contacted to identify any additional studies. SELECTION CRITERIA: Randomised controlled trials of anti-fibrinolytic drugs in adults scheduled for non-urgent surgery. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: We found 61 trials of aprotinin (7027 participants). Aprotinin reduced the rate of RBC transfusion by a relative 30% (RR=0.70: 95%CI: 0.64 to 0.76). The average absolute risk reduction (ARR) was 20.4% (95%CI: 15.6% to 25.3%). On average, aprotinin use saved 1.1 units of RBC (95%CI: 0.69 to 1.47) in those requiring transfusion. Aprotinin also significantly reduced the need for re-operation due to bleeding (RR=0.40: 95%CI: 0.25 to 0.66). We found 18 trials of tranexamic acid (TXA) (1,342 participants). TXA reduced the rate of RBC transfusion by a relative 34% (RR=0.66: 95%CI: 0.54 to 0.81). This represented an ARR of 17.2% (95%CI: 8.7% to 25.7%). TXA use resulted in a saving of 1.03 units of RBC (95%CI: 0.67 to 1.39) in those requiring transfusion. We found four trials of epsilon aminocaproic acid (EACA) (208 participants). EACA use resulted in a statistically non-significant reduction in RBC transfusion (RR=0.48: 95%CI: 0.19 to 1.19). Comparisons between agents Eight trials made 'head-to-head' comparisons between TXA and aprotinin. There was no significant difference between the two drugs in the rate of RBC transfusion: RR=1.21 (95%CI: 0.83 to 1.76) for TXA compared to aprotinin. Adverse Effects Aprotinin did not seem to be associated with an excess risk of adverse effects, including thrombo-embolic events (thrombosis RR=0.64: 95%CI: 0.31 to 1.31) and renal failure (RR=1.19: 95%CI: 0.79 to 1.79). Fewer data were available for TXA and EACA. REVIEWER'S CONCLUSIONS: From this review it appears that aprotinin reduces the need for red cell transfusion, and the need for re-operation due to bleeding, without serious adverse effects. However, there was significant heterogeneity in trial outcomes, and some evidence of publication bias. Similar trends were seen with TXA and EACA, although the data were rather sparse. The poor evaluation of these latter drugs is unfortunate as results suggest they may be equally as effective as aprotinin, but are significantly cheaper. The evidence reviewed here supports the use of aprotinin in cardiac surgery. Further small trials of this drug are not warranted. Future trials should be large enough to compare the efficacy and cost-effectiveness of aprotinin with that of TXA and EACA.
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2001 |
Henry DA, Moxey AJ, Carless PA, O'Connell D, McClelland B, Henderson KM, et al., 'Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion.', The Cochrane database of systematic reviews, CD001886 (2001)
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2000 |
Hazell P, Talay-Ongan A, Hutchins P, Foreman P, Keatinge DR, Dunne A, et al., 'Best practice in diagnosis and treatment for attention deficit hyperactivity disorder: Research and guidelines', Australian Journal of Early Childhood, 25, No 4 34-40 (2000) [C1]
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1999 |
Hazell P, Hazell T, Waring T, Sly K, 'A survey of suicide prevention curricula taught in Australian univesities', Australian & New Zealand Journal of Psychiatry, 33 253-259 (1999) [C1]
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1999 |
McGettigan PG, Sly K, O'Connell DL, Hill SR, Henry DA, 'The Effects of Information Framing on the Practices of Physicians', Journal of General Internal Medicine, 14 633-642 (1999) [C1]
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