Enhancing patient engagement and positive step-down discharges through co-production: a quality improvement initiative in an in-patient rehabilitation psychiatric unit [Abstract]

Introduction This Quality Improvement (QI) programme aimed to integrate co-production principles into rehabilitation psychiatry to enhance patient-centred care and facilitate positive step-down discharges. The initiative was developed in response to suboptimal audit results, revealing low patient attendance and limited positive discharges within an in-patient psychiatric unit. Recognising the critical role of rehabilitation psychiatry in supporting recovery and reintegration, the programme sought to transform patient engagement through equitable partnerships between patients and healthcare professionals. Objectives The programme’s primary objectives were to: 1. Implement and evaluate co-production within the Care Programme Approach (CPA). 2. Increase patient attendance at CPA meetings and improve positive step-down discharges. 3. Enhance engagement, communication, and shared decision-making to achieve better patient outcomes, including reduced anxiety. Methods A phased approach was employed, encompassing diagnostic, problem-solving, and evaluation stages. Root cause analyses were conducted using fishbone cause-and-effect diagrams and the 5-Why Technique. The Model of Improvement guided the programme, with change ideas developed and refined through Plan-Do-Study-Act (PDSA) cycles. Interventions included distributing patient information leaflets, staff training sessions, and introducing a structured CPA agenda template. Quantitative analysis using paired t-tests evaluated changes in attendance, discharge rates, and Hamilton Anxiety Rating Scale (HAM-A) scores. Qualitative data were gathered from a co-produced CPA questionnaire, with emerging themes integrated into the project’s evolution through narrative synthesis. Results The implementation of co-production yielded significant improvements in patient engagement and discharge outcomes, resulting in a 50% increase in CPA meeting attendance and a 70% positive step-down discharge rate. Interventions were associated with reduced anxiety levels, evidenced by improvements in HAM-A scores. Qualitative analysis highlighted key themes, including challenges during community transitions, empowerment through shared decision-making, and enhanced communication with healthcare professionals. The structured CPA agenda template further improved patient-centred communication and care experiences. Conclusions The integration of co-production within rehabilitation psychiatry fosters transformative partnerships that enhance patient engagement and clinical outcomes. This QI programme demonstrates the efficacy of patient-centred interventions, supported by structured communication tools, in empowering individuals, reducing anxiety, and improving transitions to community care. Co-production provides a robust framework for advancing rehabilitation psychiatry and optimising patient care pathways

Recognition of dance-like actions: memory for static posture or dynamic movement?

Dance-like actions are complex visual stimuli involving multiple changes in body posture across time and space. Visual perception research has demonstrated a difference between the processing of dynamic body movement and the processing of static body posture. Yet, it is unclear whether this processing dissociation continues during the retention of body movement and body form in visual working memory (VWM). When observing a dance-like action, it is likely that static snapshot images of body posture will be retained alongside dynamic images of the complete motion. Therefore, we hypothesized that, as in perception, posture and movement would differ in VWM. Additionally, if body posture and body movement are separable in VWM, as form- and motion-based items, respectively, then differential interference from intervening form and motion tasks should occur during recognition. In two experiments, we examined these hypotheses. In Experiment 1, the recognition of postures and movements was tested in conditions in which the formats of the study and test stimuli matched (movement-study to movement-test, posture-study to posture-test) or mismatched (movement-study to posture-test, posture-study to movement-test). In Experiment 2, the recognition of postures and movements was compared after intervening form and motion tasks. These results indicated that (1) the recognition of body movement based only on posture is possible, but it is significantly poorer than recognition based on the entire movement stimulus, and (2) form-based interference does not impair memory for movements, although motion-based interference does. We concluded that, whereas static posture information is encoded during the observation of dance-like actions, body movement and body posture differ in VWM

The Novel Object and Unusual Name (NOUN) database: a collection of novel images for use in experimental research

Many experimental research designs require images of novel objects. Here we introduce the Novel Object and Unusual Name (NOUN) Database. This database contains 64 primary novel object images and additional novel exemplars for ten basic- and nine global-level object categories. The objects’ novelty was confirmed by both self-report and a lack of consensus on questions that required participants to name and identify the objects. We also found that object novelty correlated with qualifying naming responses pertaining to the objects’ colors. Results from a similarity sorting task (and subsequent multidimensional scaling analysis on the similarity ratings) demonstrated that the objects are complex and distinct entities that vary along several featural dimensions beyond simply shape and color. A final experiment confirmed that additional item exemplars comprise both sub- and superordinate categories. These images may be useful in a variety of settings, particularly for developmental psychology and other research in language, categorization, perception, visual memory and related domains

Neural Correlates of Visual Motion Prediction

Predicting the trajectories of moving objects in our surroundings is important for many life scenarios, such as driving, walking, reaching, hunting and combat. We determined human subjects’ performance and task-related brain activity in a motion trajectory prediction task. The task required spatial and motion working memory as well as the ability to extrapolate motion information in time to predict future object locations. We showed that the neural circuits associated with motion prediction included frontal, parietal and insular cortex, as well as the thalamus and the visual cortex. Interestingly, deactivation of many of these regions seemed to be more closely related to task performance. The differential activity during motion prediction vs. direct observation was also correlated with task performance. The neural networks involved in our visual motion prediction task are significantly different from those that underlie visual motion memory and imagery. Our results set the stage for the examination of the effects of deficiencies in these networks, such as those caused by aging and mental disorders, on visual motion prediction and its consequences on mobility related daily activities

Cultural differences in sensitivity to the relationship between objects and contexts: evidence from P3

Cross-cultural differences in Easterners and Westerners have been observed in different cognitive domains. Differential sensitivity to the relationship between objects and contexts might be an underlying cognitive mechanism for these differences. Twenty-one Chinese and 22 Germans participated in a three-stimulus event-related potential oddball task. They were instructed to monitor geometrical forms filled in black (targets) that were presented among a series of blank geometrical forms (standards). Novel stimuli were colored images of common objects. Robust novelty P3 and target P3 over the entire scalp were observed in both groups. As compared with the German group, Chinese participants showed larger amplitudes of novelty P3 and target P3 over frontal regions and earlier peak latency for target P3. This indicates a higher sensitivity to the relationship between contexts and objects in the Chinese as compared with the German group, which might be an underlying mechanism for cross-cultural differences reported in many cognitive domains. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Evidence against altered excitatory/inhibitory balance in the posteromedial cortex of young adult APOE E4 carriers: a resting state ¹H-MRS study

AbstractA strategy to gain insight into early changes that may predispose people to Alzheimer’s disease is to study the brains of younger cognitively healthy people that are at increased genetic risk of AD. The Apolipoprotein (APOE) E4 allele is the strongest genetic risk factor for AD, and several neuroimaging studies comparing APOE E4 carriers with non-carriers at age ~20-30 have detected hyperactivity (or reduced deactivation) in posteromedial cortex (PMC), a key hub of the default network (DN) which has a high susceptibility to early amyloid deposition in AD. Transgenic mouse models suggest such early network activity alterations may result from altered excitatory/inhibitory (E/I) balance, but this is yet to be examined in humans. Here we test the hypothesis that PMC fMRI hyperactivity could be underpinned by altered levels of excitatory (glutamate) and/or inhibitory (GABA) neurotransmitters in this brain region. Forty-seven participants (20 APOE E4 carriers and 27 non-carriers) aged 18-25 underwent resting-state proton magnetic resonance spectroscopy (1H-MRS), a non-invasive neuroimaging technique to measure glutamate and GABA in vivo. Metabolites were measured in a PMC voxel of interest and in a comparison voxel in the occipital cortex (OCC). There was no difference in either glutamate or GABA between the E4 carriers and non-carriers in either MRS voxel, nor in the ratio of glutamate to GABA, a measure of E/I balance. Default Bayesian t-tests revealed evidence in support of this null finding. Results suggest that PMC hyperactivity in APOE E4 carriers is unlikely to be associated with, or indeed may precede, alterations in local resting-state PMC neurotransmitters, thus informing the spatio-temporal order and the cause/effect dynamic of neuroimaging differences in APOE E4 carriers.HighlightsHyperactivity in posteromedial (PM) network in people at AD genetic risk (APOE E4)Such PM network hyperactivity may initiate pathogenic cascade that triggers ADAPOE mouse models suggest hyperactivity driven by excitatory/inhibitory imbalanceUsing 1H-MRS at 3T we studied PMC E/I balance in young adult APOE E4 carriersFound evidence against altered E/I balance in young adult APOE E4 carriers</jats:sec