Objective. To assess the performance characteristics of the Institute for Healthcare Improvement Global Trigger Tool (GTT) to determine its reliability for tracking local and national adverse event rates. Data Sources. Primary data from 2008 chart reviews. Study Design. A retrospective study in a stratified random sample of 10 North Carolina hospitals. Hospital-based (internal) and contract research organization-hired (external) reviewers used the GTT to identify adverse events in the same 10 randomly selected medical records per hospital in each quarter from January 2002 through December 2007. Data Collection/Extraction. Interrater and intrarater reliability was assessed using k statistics on 10 percent and 5 percent, respectively, of selected medical records. Additionally, experienced GTT users reviewed 10 percent of records to calculate internal and external teams' sensitivity and specificity. Principal Findings. Eighty-eight to 98 percent of the targeted 2,400 medical records were reviewed. The reliability of the GTT to detect the presence, number, and severity of adverse events varied from k 5 0.40 to 0.60. When compared with a team of experienced reviewers, the internal teams' sensitivity (49 percent) and specificity (94 percent) exceeded the external teams' (34 and 93 percent), as did their performance on all other metrics. Conclusions. The high specificity, moderate sensitivity, and favorable interrater and intrarater reliability of the GTT make it appropriate for tracking local and national adverse event rates. The strong performance of hospital-based reviewers supports their use in future studies.

Background: Cognitive dysfunction occurs in depression and can persist into remission. It impacts on patient functioning but remains largely unrecognised, unmonitored and untreated. We explored understanding of cognitive dysfunction in depression among UK clinicians.Methods: A multi-step consultation process.Step 1: a multi-stakeholder steering committee identified key themes of burden, detection and management of cognitive dysfunction in depression, and developed statements on each to explore understanding and degree of agreement among clinicians.Step 2: 100 general practitioners (GPs) and 100 psychiatrists indicated their level of agreement with these statements.Step 3: the steering committee reviewed responses and highlighted priority areas for future education and research.Results: There was agreement that clinicians are not fully aware of cognitive dysfunction in depression. Views of the relationship between cognitive dysfunction and other depressive symptom severities was not consistent with the literature. In particular, there was a lack of recognition that some cognitive dysfunction can persist into remission. There was understandable uncertainty around treatment options, given the current limited evidence base. However, it was recognised that cognitive dysfunction is an area of unmet need and that there is a lack of objective tests of cognition appropriate for depressed patients that can be easily implemented in the clinic.Limitations: Respondents are likely to be 'led' by the direction of the statements they reviewed. The study did not involve patients and carers. Conclusions: UK clinicians should undergo training regarding cognitive dysfunction in depression, and further research is needed into its assessment, treatment and monitoring.

Purpose -This paper's aim is to explore the added value of occupational therapy in supported employment, demonstrated by a case study in Sussex Partnership NHS Foundation Trust.Design/methodology/approach -The paper sets out the unique contribution of occupational therapy to the evidence based individual placement with support (IPS) model, through a case study of implementation in Sussex.Findings -Occupational therapists are well placed to play a central role in embedding IPS into clinical teams, as well as supporting the work of employment specialists. They also have a wider role in championing person centred practice, and challenging negative assumptions about the work abilities of people with mental health problems.Practical implications -Clarity of role design is crucial, with methods for assessing and monitoring competence built into supervision structures. Clinicians need to be motivated and enthusiastic about the role as well as having allocated time to carry out the discrete employment support function. The partnership between the employment service and clinical team is central to good implementation of the model.Originality/value -This paper adds clarity to the role of occupational therapy in supporting people with severe and enduring mental health problems to gain and maintain mainstream employment. There is a need for the development of a more formal evidence base for occupational therapy interventions in the field of supported employment; this paper is a starting point outlining key issues.

IntroductionCognitive dysfunction is an important aspect of depression that includes problems with thinking, concentration and memory. Research suggests that the cognitive aspect of depression is highly prevalent and has a significant impact on patient functioning. Currently, cognitive dysfunction in depression is largely unrecognised, unmonitored and untreated.AimsWe aim to define cognitive dysfunction in clinical depression (major depressive disorder) and explore its detection and management in the UK, highlighting priority areas to be addressed.MethodsA modified Delphi method was used as the process to gain consensus. A multi-stakeholder steering committee of depression experts (including psychiatrists, psychologists, primary care physicians, and representatives from occupational therapy and a depression charity) provided the key themes and, through round-table discussion, developed draft statements. The main areas of focus were burden, detection and management of cognitive dysfunction in depression. These statements formed a questionnaire to be reviewed by 150–200 health-care professionals with an involvement in the management of depression, with level of agreement noted as ‘strongly disagree’, ‘disagree’, ‘don’t know/uncertain’, ‘agree’ or ‘strongly agree’. Responses to the questionnaire will be analysed (very high agreement [> 66%] or very low agreement [< 33%]) and the steering committee will revise and finalise the consensus statements, and identify priority areas for future consideration. The steering committee was initiated and supported by the pharmaceutical company Lundbeck Ltd, through an educational grant. Lundbeck Ltd did not influence content.ResultsResults of the questionnaire and the evolution of the final consensus statements will be presented.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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