Morpeth Cottage Hospital

Aims and Method To investigate the effects of a standard National Health Service early intervention in psychosis service on bed days and engagement with services. We conducted a naturalistic before-and-after study comparing outcomes of individuals who received treatment from the service ( n =75) with outcomes of individuals who presented to mental health services before the early intervention service was established and received treatment as usual ( n =114). Results People treated by the early intervention in psychosis service had significantly fewer admissions ( P < 0.001), readmissions ( P < 0.001), total bed days ( P < 0.01) and better engagement with services ( P < 0.05). Clinical Implications An early intervention in psychosis service compliant with current British mental health policy led to reduced use of psychiatric bed days confirming recent findings elsewhere. This leads to major financial savings, easily justifying the initial cost of investment in the service.

New self-help material for anxiety and depression, together with a companion manual for general practitioners were developed and evaluated over three months. The self-help manual was evaluated in a randomised controlled trial. Nine hypotheses were advanced but few significant results were noted. The manual for general practitioners was evaluated in a before-and-after design with general practitioners acting as their own baseline. Six hypotheses were advanced but again few significant results were noted. These outcomes are believed to be consequences of the short duration of the trials and the small numbers recruited. In spite of these difficulties, a trend was noted toward greater improvements in general health and reduced medication among users of the self-help material. A second trend towards reduced prescribing and increased counselling was detected among general practitioners using the practitioner's manual. Both manuals were well received, by general practitioners and their patients.

Although optimal clinical supervision has long been thought to include a supportive, pastoral or restorative element (Kadushin, 1992), it has tended to be marginalized by the more business-like components of “normative” and especially “formative” supervision (the managerial and development elements). Within the nursing profession in the UK, supervision was first formally highlighted in 1993 and has continued to gather policy momentum, with a recommendation that it should be part of the working life of every nurse (The Scottish Government, 2009). Subsequently, a national review noted that: “There is an urgent need to develop interventions that address the high levels of stress, burnout and dissatisfaction among mental health nurses (The Scottish Executive, 2006, p.57)”. Supervision is a key intervention in this area. Continuing this emphasis on supervision, the UK's new Health and Social Care Secretary informed hospital staff that his first priority is a healthy workforce (Hancock, 2018). Specifically, he recognized that the nation's health was determined by the health of the workforce. To improve staff health, he promised to counter workplace pressures by improving funding, tackling high workloads, improving managerial leadership and by providing high-quality training and support. Such measures would allow staff to achieve their full potential, providing safe, high-quality care. As acknowledged by Hancock (2018), health and social care workers face a variety of exceptionally challenging job-related stressors. If they are not helped to cope with such stressors their work performance and personal wellbeing may suffer, leading to occupational “burnout”. The original goals of supportive supervision addressed just these problems, by improving morale and job satisfaction through protecting the worker from excessive stress, by boosting personal coping strategies of staff, and by offering validation and support (Kadushin, 1992). By contrast, “formative” supervision fosters the professional development of staff, while “normative” supervision addresses workplace issues (Winstanley & White, 2014). Ideally, all three components are combined within each supervision session. As we will detail, supportive supervision is exceptionally well placed to foster a healthy workforce. An evidence-based definition enjoying expert consensus is that supportive supervision “deals with the supervisee's morale and job satisfaction, boosting personal coping strategies and offering empathy and validation. The emotional demands of work (including supervision) should be processed jointly, through debriefing, encouragement and other kinds of social support. Supportive supervision should also encourage personal growth” (e.g. resilience: Milne & Reiser, 2017, p;.191). This definition is consistent with a popular questionnaire, the Manchester Clinical Supervision Scale, used for measuring supervision quality (Winstanley & White, 2014). Questionnaire items tap supervisees’ perceptions, the supervisors’ ability to discuss sensitive issues, to offer support, and to offer advice and guidance. The context may be changing towards greater supportive supervision, but does it work? A seminal study (Butterworth et al., 1997) reported an overwhelmingly positive response to supervision from community psychiatric nurses. While those that received supervision suffered less psychological distress arising from their work, those who did not receive supervision showed clear detrimental effects arising from their workplace. More recently, Cutcliffe and McFeely (2001, p.317) conducted focus groups with 17 practice nurses, finding that clinical supervision was perceived as synonymous with receiving support, which in turn enabled successful operation of the formative and normative components. For these nurses, providing support was therefore seen as essential to effective supervision. Cleary and Freeman (2006) examined specific ways in which supportive supervision operated with mental health nurses. These mechanisms included receiving peer support; exchanging ideas; reflecting on daily practice; expressing concerns about patients; increasing self-awareness; taking time out; and debriefing. Steel, Macdonald, Schroder, and Mellor-Clark (2015) surveyed 116 multi-disciplinary therapists, finding evidence that most experienced work-related anxiety and high levels of emotional exhaustion. However, these researchers also reported that these therapists had coped effectively with their anxiety, drawing on their training and emphasizing their professional accomplishments. A correlational study with 823 counsellors analysed emotional exhaustion and staff turnover (Knudsen, Ducharme, & Roman, 2008), reporting that supervision empowered them with decision-making and encouraged a more balanced perception of the workplace. Similarly, supervision that either provides social support or assists supervisees in accessing social support can foster workplace adjustments. For example, a systematic review of stress-management interventions with mental health professionals indicated that social support and related supervision were frequently and successfully employed (Edwards et al., 2003). In recent years, clinical supervision has come a long way, especially in nursing, and the changing organizational culture encourages further progress. The UK government's recent commitment to supporting health and social care staff highlights the most neglected and least understood aspect, supportive supervision. However, there is good evidence for at least five complementary strategies of implementing supportive supervision, together with illustrative studies, practical examples, training materials and supervisor training demonstration projects to guide their application (e.g. Wallbank & Woods, 2012). These resources can enhance supervision, an especially promising intervention for countering pressures faced by nurses in their challenging workplaces. This can contribute to fulfilling the goal of improving staff health and clinical care.

The use of microwaves for imaging applications is currently of much research interest particularly in the areas of security imaging and medical imaging. Microwaves have been shown to be able to image objects concealed beneath clothing and recent research work has indicated that microwaves could offer a new low cost non-ionising technique for the detection and imaging of breast cancer tumours. Traditional intensity only measurements have only been able to provide 2D images of objects. This work will describe how our indirect holographic approach can be used to reconstruct 3D images of objects from a single scalar 2D holographic intensity pattern.

Neurodiversity is an umbrella term for a range of neurodevelopmental conditions such as autism, attention deficit hyperactivity disorder (ADHD), dyslexia, dyspraxia, dyscalculia and Tourette's syndrome (Doyle, 2020). Other terms used to describe neurodevelopmental conditions include neurodivergent, neurodistinct or neuroatypical. Why is this discussion important? Because between 15% and 20% of the general population may identify as being neurodivergent (Doyle, 2020) and, by extension, similar figures are anticipated to reflect healthcare practitioners. The topic of neurodiversity is not new. In fact, the Journal of Clinical Nursing has published papers exploring topics such as the experiences of having tics (Lee et al., 2019) or autism (Brown et al., 2021). Consequently, nurses will either interact clinically with persons who are neurodivergent, conduct research with or about them or work professionally with them. Thus, the need for nurses to be well informed about neurodiversity is becoming increasingly important. Terminology matters and nurses will be well served by engaging with an evolving lexicon. We offer three areas where nurses can obtain a more comprehensive perspective of the challenges people who are neurodivergent may experience: appreciating the societal context by moving from a non-normative to normative perspective; clarifying the relevance of neurodiversity to nursing; and furthering equality and diversity in the profession. The experience of being neurodivergent differs from person to person; however, people who are neurodivergent can encounter challenges when accessing and engaging with healthcare services, availing of employment opportunities or during more general interactions across society (Milton, 2012). The societal context can confer disadvantage considering that much of society's expectations are based on the neurotypical person. The neurodiversity movement seeks equality and acceptance. Increasingly, representative organisations such as the United Kingdom-based Institute of Neurodiversity seek to challenge narratives which pathologise those who are neurodivergent. The neurodiversity paradigm is built on the social model of disability which changes the narrative around neurodivergence as well as broader disabilities (Doyle, 2020). This paradigm challenges healthcare professionals who are more accustomed to models of care that emphasise diagnosis and treatment as responses to presenting needs. Neurodiversity then embraces a strength-based model focusing on the need for societal adaptation. However, it is far more common for the experiences of persons who are neurodivergent such as for autism (as an example of neurodivergence) to be defined in terms of deficits relative to non-autistic people, for example, deficits in social cognition and communication. Moreover, it is possible that non-autistic and autistic persons may have difficulty interacting and empathising with each other, a situation Milton (2012) calls the ‘double empathy problem’. Consequently, any perceived deficit can work both ways. Deficit models usually focus primarily on perceived deficiencies and/or limitations of individuals and groups, generally advocate for ‘correcting’ differences and are the antithesis of strength-based models. An example of the strength-based model is reflected through self-advocacy actions. Self-advocates have played an important role, as seen in journalism (The Washington Post being a good example) acknowledging the expertise of autistic adults and in educating the general public about the neurodiversity movement. Such visible advocacy has enabled autistic people to see themselves as having their own culture akin to deaf culture and different to the majority culture (Friedner & Block, 2017). The work of advocates such as Jim Sinclair, one of the first advocates to articulate an anti-cure perspective, is highly relevant in this context wherein they ask parents to love their children for who they are. Self-advocacy has helped neurodivergent people to connect and create a sense of community based on shared struggles. The rise of the internet and social media has played an important role in this. Society, and by extension, healthcare providers are being asked to re-imagine autism and other neurodivergence as an acceptable form of difference. Sienna Castellon, advocate and founder of Neurodiversity Celebration Week, makes clear that neurodivergent people should not be viewed through a deficits lens (Summers, 2020). In fact, differences in thinking and being in the world can be significant strengths in particular contexts. Changing the societal context means neurodivergent people should also not be viewed as those to ‘fix’ or ‘cure’ but rather they are a naturally occurring variance of the human experience. Nursing as a profession has often positioned itself as an advocate for seldom heard voices therefore it seems important that we engage with and are cognisant of the impact of the neurodiversity movement. There are compelling reasons to enhance neurodiversity awareness within nursing. From a clinical perspective, Benson (2023) asserts that the hegemony of neuro-normativity (neuro-normativity that focuses on the neurotypical experience to the exclusion of neurodivergence) can perpetuate the marginalisation of those who are neurodivergent. Neurodivergent people may engage with healthcare differently. How they interact, talk, experience senses and interpret information can differ from those who are not neurodivergent. These differences can be emphasised in interactions with healthcare professionals. For example, there is the risk of either missed physical health diagnoses or misdiagnosis of neurodivergence. Missing a diagnosis in a person who is neurodivergent has the potential for a significant impact on physical health outcomes generally and more especially on outcomes of mental health illness (where there is an increased co-occurrence with neurodivergence). A missed physical diagnosis due to insufficient communication, or diagnostic overshadowing, may contribute to increased morbidity and early mortality. Nurses understanding of neurodivergence can be reflected in care plans and treatment contexts—one size does not fit all. The individuality of each person is key. In our experience in Ireland, a majority of neurodivergent people prefer identity first as opposed to person first language. Such a preference is contrary to many diversity efforts being undertaken globally. A prudent practice is to ask a person their preference. Nurses must therefore take account of such individual difference and terminology preference in care-planning. Training is important with respect to improving understanding. A growing number of advocates and organisations are calling for mandatory repeated training in neurodiversity for all public facing professionals as part of continuing professional development. This training should be co-delivered by neurodivergent professionals to ensure better outcomes. Another equally important reason to engage with neurodiversity is to further equality and diversity in the nursing profession itself. Significant strides towards a more inclusive workplace have been made, including over the last decade, in areas such as gender, ethnicity and sexual expression. We assert that neurodiversity may well be a remaining bastion of exclusion. Sweetmore (2022), a mental health nurse, offers an insightful if sobering account of gaps and missed opportunities of her own experience as an autistic woman availing of and working within services. Her work, in particular, illustrates issues of underdiagnosis and masking in women, and the potentially serious attendant mental health implications. It is unlikely that her experience is isolated. Organisations such as Untapped, based in Australia, seek to increase the participation of neurodivergent people in the workforce, and there is more work to be done in this regard. In fact, the Institute of Neurodiversity estimates that the numbers of neurodivergent professionals in all industries are significantly higher than currently estimated. Many neurodivergent professionals are not disclosing for fear of discrimination. However, this does not mean they are not there and all workplaces have a duty of care to their employees to create a psychologically safe environment where everyone can bring their whole self to work. When this is not present and neurodivergent people have to mask, a risk to the individual's emotional and psychological wellbeing may arise. Masking involves a neurodivergent person hiding their true self and acting as though they are neurotypical. There is no reason to believe that healthcare is any different to other employment sectors. In fact, were it to be demonstrated that healthcare or nursing is an outlier and that neurodivergent people are significantly underrepresented or forced to mask, a worrying picture of exclusion would be painted. As the largest of all healthcare professions, nurses work in remarkably diverse contexts. Surely, we should seek to ensure that diversity is celebrated in the make-up of our profession itself. Addressing the three areas highlighted in this editorial is one step to increasing awareness within the profession of an important issue—the needs and presence of persons who are neurodivergent. However, much remains to be done. As a profession that embraces diversity, nurses can lead the way.

Clinical supervision (CS) works best when based on a collaborative working alliance between the supervisor and the supervisee, leading to a range of benefits to patients, health organizations and health professionals (Martin, Copley, & Tyack, 2014). However, the optimal approach to collaboration is far from clear, as sometimes a firm and even “disagreeable” hierarchical style of leadership has proved most effective in CS (Rieck, Callahan, & Watkins, 2015). The value of leadership in enhancing healthcare delivery and outcomes is being increasingly acknowledged. A global independent commission on educating health professionals for the 21st century cited weak leadership as a systemic problem (Frenk et al., 2010). Similarly, a scoping review of 114 papers on leadership in interprofessional education highlighted the move away from traditional hierarchical, individualistic leadership styles to more contemporary, reciprocal and collaborative leadership approaches (Brewer, Flavell, Trede, & Smith, 2016). In these contemporary leadership approaches, the leader's and followers’ roles change, dependent on the situation (The King's Fund, 2011). Is this also the best way forward for CS? If anything, CS has lacked sufficiently firm leadership, with peer supervision a worrying illustration (Martin, Milne, & Reiser, 2017). Very few supervision models even mention leadership, shying away from notions like responsibility, accountability and inter-personal power. A rare exception is the tandem model of CS, which explicitly positions the supervisor as leader, also embedding this perspective in the leadership literature. This model, first proposed by Milne and James (2005), views supervisors and supervisees as two cyclists on a tandem. According to this analogy, the supervisor occupies the front seat and so takes control (steering the tandem, applying the brakes, changing the gears, etc.), assuming responsibility for ensuring that good progress is made down the developmental pathway. In the back seat of this metaphorical tandem, the supervisee is therefore equally clearly depicted as a follower. A recent study examining workplace-based supervision endorsed such leadership as crucial in driving CS outcomes (Dorsey et al., 2018). Firm leadership does not mean that the supervisee is disempowered. The tandem model does not say that supervisees should not lead, but rather it urges strong leadership. Supervisees can empower their supervisors by collaborating actively (e.g. negotiating objectives; sharing planning; furnishing materials; self-evaluating). Of special significance, supervisees can also provide leadership by applying their “learning expertise” (Bransford & Schwartz, 2009). This refers to the way that learners actively refine their capacity for learning, drawing on their most effective learning strategies. As a result, they come to supervision well-prepared to benefit, having thought carefully about the problem that they propose for discussion, reflected critically on what they already know about the problem, studied the literature for possible solutions and perhaps also sought guidance from colleagues. Evidence for such a “reciprocal” approach to leadership comes from Green, Barkham, Kellett, and Saxon (2014), who found that the best therapists were also the best supervisees: they were more proactive, better prepared, more organised and more motivated to use an experiential approach (e.g. requesting role-plays; seeking procedural knowledge about how to apply therapy techniques). Supervisors should rejoice in such collaboration, reinforcing and in turn reciprocating their supervisees’ contribution. We close with some suggestions. In addition to empowering the supervisee as a collaborator, supervisors should seek continued training in supervision, studying guidelines and demonstrations of effective leadership (e.g. Milne & Reiser, 2017). Feedback is another powerful aid, so helping their supervisees to become better at offering feedback on supervision holds promise. A related option is to objectively rate supervision, using an observational instrument like the SAGE tool (Supervision: Adherence and Guidance Evaluation, Milne, Reiser, Cliffe, & Raine, 2011), which can profile and rate leadership competencies (e.g. managing the session, agenda-setting, teaching), relating these to linked ratings of the effect such behaviours have on the supervisee. Similarly, coding what is said in supervision (content evaluation) also appears promising as a methodology to evaluate feedback practices and leadership within CS (Dorsey et al., 2018). Leadership has become topical in healthcare and professional education, heightening the sense that leadership should belatedly be strengthened in the much-neglected sphere of CS. Modern emphases on collaboration, empowerment, and situational leadership fit with some important findings and methods within CS, especially the idea of strong but reciprocal leadership. This is a timely moment to give leadership more explicit attention in CS practice, training and research.

Abstract Although retinal photography is established in hospital diabetes clinics there has been little evaluation of it in general practice. This study examines the outcome of non‐mydriatic retinal photography (NMRP) performed on‐site within general practice in NE England. The three participating practices already had a structured diabetes care system and the results from the NMRP were compared with previously recorded information. From the 200 photographs assessed there was a 22% reporting failure rate because of technical problems. No statistically significant difference was found in the numbers of abnormalities noted by NMRP and conventional screening, although two eyes with proliferative retinopathy were discovered. Patient attendance for NMRP was 75% but the operational efforts and costs apart from equipment, technical operation and consultant reporting had to be borne by the practices. The study does not establish the value of NMRP for screening in general practices where structured diabetes care already exists, but this may be more valuable where structured care does not already exist.

Diphasiastrum ×issleri (Rouy) Holub has been much misunderstood and greatly confused in the British Isles, the consequence of both nomenclatural and practical identification issues. Following the clarification of its hybridogenous origin(s) and the parent taxa involved (which had been the source of dispute between European and American authors) the taxonomic treatment of this plant has seen various approaches adopted, some of which have regrettably led to mis-recording and a lack of clarity. In parallel to the taxonomic and nomenclatural issues are the very real difficulties posed by the differentiation of this taxon from its progenitors, a task made difficult by their morphological plasticity, the possibilities of introgression and the formation of triploid as well as diploid primary hybrids. Here we consider the appropriate treatment of this taxon: nomenclaturally as species vs. hybrid and from a conservation viewpoint. We elaborate and re-assess all of its English and Welsh records. As a consequence of this review a revised conservation status is required. We conclude that all Welsh and most English records of this taxon are erroneous, including those for the Northumbrian sites and that therefore it is currently Regionally Extinct (RE) in England and not CR (D) as given in the Red-List for England (as D. complanatum). It, however, remains NT (D) at a GB level because of the presence of the taxon in Scotland. Guidance for the discrimination of D. ×issleri from atypical forms of D. alpinum is given.

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Fair Isle is a small island of 768 hectares located half way between Orkney and Shetland. In the previous publication of Quinteros Peñafiel et al. (2017), we provided a complete flora for the island. This note updates the status of the Fair Isle flora subsequent to the survey by including corrections, new finds and other notable records.

Continuing professional development matters even if you’re on a career break. Louise Freeman explains how to continue learning without spending too much money

1. Beretninger om den Kjöbenhavnske, den Nörrejyske, Ostifternes og den Viborgske Sindssygeanstalt i 1880.

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What the author sets himself to demonstrate is, that although hallucination is psycho-sensorial, the functional anomaly which gives rise to it belongs to the sensorial system alone. He believes that this theory expresses the method nature employs in the production of this phenomenon.

From the obscurity of this but recently described, although probably not at all uncommon, disease, it may be allowable to enter somewhat fully into the history and description of this case, for it is impossible to say where one, perhaps unconsciously, may be unearthing a fact or trimming a torch that in the hands of others may give light.

The leadership shown by UK cardiac surgeons through the Society for Cardiothoracic Surgery in Great Britain and Ireland offers the best way to ensure good clinical practice for all patients in the future.1 To understand why, it is worth highlighting the essentials of their achievement.

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Pergamon comprehensive mathematics, by P. Bridgewater, C. B. Carrington and H. Smith. Books 1-4. Pp 1032. £1·25 each. 1970-1975. SBN 0 08 008923 2/008925 9/008927 5/008929 1 (Wheaton) - Volume 60 Issue 414

Journal Article Sir Christopher Hatton's dog Get access H. A. Dillon H. A. Dillon 1Morpeth Terrace Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume s5-I, Issue 11, 14 March 1874, Page 209, https://doi.org/10.1093/nq/s5-I.11.209c Published: 14 March 1874

Mathematics for general education, by the Mathematics Appreciation Project Group., Sets A-F. £45, £45, £45, £55, £55, £59·95. Advanced number skills. Teacher’s book. £4·95. Pupil’s book. 95p. SBN 0 333 19326 1/19328 8 1976-7 (Macmillan Education) - Volume 63 Issue 423