No / We co-designed and piloted ‘Festival in a Box’, an outreach programme to enable socially isolated people with dementia to engage with and enjoy cultural activities in their homes. It comprised 3–4 weekly home visits, each led by a professional artist to create art works using materials brought in ‘the box’. Activities included music, poetry, pottery, crafts and photography. We qualitatively interviewed 13 participants (6 people with dementia, 4 artists, 3 befrienders). Six participants with dementia completed, enjoyed and engaged with the planned visits. Main themes were: engagement, reflection on value of previous cultural activities, precariousness and isolation in current neighbourhood and the importance of a voice and being heard. Befrienders reported their preconceptions of what participants could do were challenged. Artists reported shifts in their preconceptions about dementia and the influence of the project on their professional practice. We propose that the ‘Festival in a Box’ pilot study suggests a means through which community arts festivals could work with socially isolated people with dementia to contribute to the creation of ‘Dementia Friendly Communities’. A larger-scale pilot study is now needed to develop this hypothesis.

Introduction: Thromboprophylaxis recommendations for hospitalized cancer are based on trials done for the general medically patients, as there are no randomized clinical trials(RCTs) looking at thromboprophylaxis in medically ill patients with cancer. Methods: To determine if thromboprophylaxis is safe and effective to prevent VTE these patients, a Systematic Review(SR) was done. A survey was performed to assess: clinical equipoise, trial design and minimally clinically important difference(MCID) for a potential trial. Lastly, a pilot study for an RCT was designed. Results: The pooled RR of VTE was 0.91 (95%CI:0.21 to 4.0;I2:68%) among hospitalized cancer patients receiving thromboprophylaxis compared to placebo. 63.9% believe there is clinical equipoise and 58.3% would consider participating in a RCT comparing different agents/dosing. The MCID for absolute reduction in symptomatic VTE between two arms was 2% and for “acceptable” increase in major bleeding events was 1%. Conclusion: The risk-benefit ratio of current doses of thromboprophylaxis administered to hospitalized cancer patients is unclear and additional RCTs are necessary.

Introduction: Thromboprophylaxis recommendations for hospitalized cancer are based on trials done for the general medically patients, as there are no randomized clinical trials(RCTs) looking at thromboprophylaxis in medically ill patients with cancer. Methods: To determine if thromboprophylaxis is safe and effective to prevent VTE these patients, a Systematic Review(SR) was done. A survey was performed to assess: clinical equipoise, trial design and minimally clinically important difference(MCID) for a potential trial. Lastly, a pilot study for an RCT was designed. Results: The pooled RR of VTE was 0.91 (95%CI:0.21 to 4.0;I2:68%) among hospitalized cancer patients receiving thromboprophylaxis compared to placebo. 63.9% believe there is clinical equipoise and 58.3% would consider participating in a RCT comparing different agents/dosing. The MCID for absolute reduction in symptomatic VTE between two arms was 2% and for “acceptable” increase in major bleeding events was 1%. Conclusion: The risk-benefit ratio of current doses of thromboprophylaxis administered to hospitalized cancer patients is unclear and additional RCTs are necessary.

Background. Depression and anxiety are common and debilitating disorders, and at least one third of patients do not respond to available interventions. Morita Therapy, a Japanese psychological therapy which contrasts with established Western approaches, is currently untested in the UK and may represent a potentially effective alternative approach. Aim. To optimise and investigate the feasibility and acceptability of Morita Therapy as a treatment for depression and anxiety in the UK. Design. Three studies were undertaken in line with the MRC framework (2008) for complex interventions. Study One: scoping and systematic review to describe the extent, range and nature of Morita Therapy research activity reported in English. Study Two: intervention optimisation study, integrating literature synthesis with qualitative research, to develop the UK Morita Therapy outpatient protocol. Study Three: mixed methods feasibility study encompassing a pilot randomised controlled trial (RCT) and embedded qualitative interviews to prepare for a fully-powered RCT of Morita Therapy versus treatment as usual (TAU). Results. Study One: 66 papers meeting the inclusion criteria highlighted heterogeneity in the implementation of Morita Therapy, and an absence of both UK-based research and relevant unbiased RCTs. Study Two: a potentially deliverable and acceptable therapy protocol and tailored therapist training programme were developed for a UK population. Study Three: 68 participants were recruited and 94% retained at four month follow-up; 70.6% of Morita Therapy participants adhered to the minimum treatment dose, and 66.7% achieved remission in depressive symptoms (compared to 30.0% in TAU). Qualitative and mixed methods findings indicated that Morita Therapy was broadly acceptable to therapists and participants, and highlighted potential moderators of acceptability, treatment adherence and outcomes. Conclusions. Patients in the UK can accept the premise of Morita Therapy and find the approach beneficial. It is feasible to conduct a large-scale UK-based trial of Morita Therapy with minor modifications to the pilot trial protocols.

Background: In young people with a first episode of psychosis (FEP), cannabis use is widespread and associated with a significantly worsened prognosis. Few cannabis-specific interventions for this population have been evaluated; most have focused on ceasing or reducing cannabis use, and none are considered highly effective in addressing cannabis use. For many young people with FEP who use cannabis, abstinence-focused approaches may be unappealing or unrealistic options potentially impacting intervention engagement or outcomes. Harm reduction interventions, which seek to reduce cannabis use-related harms rather than requiring abstinence, may present an appealing alternative to young people with FEP who continue using cannabis; few interventions have implemented this approach. Further, there is a scarcity of studies documenting preferences of young people with FEP for cannabis harm reduction interventions or evaluating cannabis harm reduction interventions in this population. Aims: This thesis aims to (a) synthesize the evidence on efficacy of preventive interventions focusing on cannabis use for people with psychosis (review); (b) determine the preferences of young people with FEP using cannabis in relation to key characteristics of cannabis harm reduction interventions (survey); and (c) describe the development of a technology-based harm reduction intervention for young people with FEP who use cannabis, and its associated pilot trial (protocol). Methods: Three studies were conducted. Review: Six databases were searched for randomized controlled trials (RCTs) of interventions aiming to reduce cannabis use-related harms or prevent cannabis use disorder in people with psychosis. Two independent reviewers assessed eligible studies for effectiveness and reporting quality. Intervention effectiveness was described by assessing cannabis-related harms and use outcomes. Survey: A survey, combining two discrete choice experiments (DCE) and conventional survey methodology, was developed to document preferences for cannabis harm reduction interventions. This survey was administered to 89 youth in Canada having FEP and using cannabis. One DCE focused on core attributes of harm reduction interventions (DCE 1) and the second on attributes of boosters (DCE 2). We analyzed these using mixed ranked-ordered logistic regression models. Conventional survey questions on preferences were analyzed using summary statistics. Protocol: A brief, technology-based cannabis harm reduction intervention for young people with FEP using cannabis, called the Cannabis Harm- reducing App to Manage Practices Safely (CHAMPS), was developed to complement FEP standard care. A pilot RCT aiming to recruit 100 young people with FEP and using cannabis was designed to assess the intervention acceptability and the feasibility of conducting a full-scale trial in this population and with this intervention. Results: Review: Five studies were assessed, none of which measured cannabis use-related harms or demonstrated clear efficacy in reducing cannabis use in young people with psychosis. All studies had high risk of bias. Survey: Preferred characteristics for cannabis-focused harm reduction interventions (DCE 1) were: shorter sessions; less frequent sessions; shorter interventions; and technology-based interventions. Preferences for post-intervention boosters (DCE 2) included opting into boosters and having shorter boosters. Protocol: The protocol describing the development of CHAMPS and its pilot RCT was published; the pilot RCT is currently underway. Significance: Few cannabis-specific interventions for young people with FEP have been conducted, none demonstrating clear efficacy or focusing on harm reduction outcomes. Survey findings suggest an interest in cannabis harm reduction interventions and highlight preferred characteristics of young people with FEP for cannabis harm reduction interventions. These findings can guide the design of cannabis harm reductions interventions, as with CHAMPS. CHAMPS represents a novel cannabis harm reduction intervention for young people with FEP who use cannabis, and its associated pilot RCT has the potential to advance knowledge for scientists regarding acceptability and feasibility of implementing cannabis harm reduction interventions in the cannabis and early psychosis fields. / Contexte: Chez les jeunes ayant un premier épisode de psychose (PEP), la consommation de cannabis est très répandue et associée à une détérioration significative du diagnostic. Peu d'interventions spécifiques au cannabis pour cette population ont été évaluées; la plupart se sont concentrées sur l'arrêt ou la réduction de la consommation de cannabis, et aucune n'est considérée comme très efficace pour traiter la consommation de cannabis. Pour de nombreux jeunes ayant un PEP et consommant du cannabis, les approches axées sur l'abstinence peuvent être peu attrayant ou irréaliste, ce qui peut avoir un impact sur l'engagement ou les résultats de l'intervention. Les interventions de réduction des méfaits, qui cherchent à réduire les méfaits liés à la consommation de cannabis plutôt que d'exiger l'abstinence, peuvent constituer une alternative attrayante pour les jeunes ayant un PEP qui continuent à consommer du cannabis; peu d'interventions ont mis en œuvre cette approche. En outre, il existe peu d'études documentant les préférences des jeunes ayant un PEP pour les interventions de réduction des méfaits du cannabis ou évaluant les interventions de réduction des méfaits du cannabis dans cette population. Objectifs : Cette thèse vise à (a) synthétiser les preuves de l'efficacité des interventions préventives axées sur la consommation de cannabis pour les personnes ayant un PEP (revue); (b) déterminer les préférences des jeunes ayant un PEP qui consomment du cannabis par rapport aux caractéristiques clés des interventions de réduction des méfaits du cannabis (sondage); et (c) décrire le développement d'une intervention de réduction des méfaits basée sur la technologie pour les jeunes ayant un PEP qui consomment du cannabis, ainsi que l'essai pilote associé (protocole). Méthodes: Trois études ont été réalisées. Revue: Six bases de données ont été consultées à la recherche d'essais contrôlés randomisés (ECR) portant sur des interventions visant à réduire les méfaits liés à la consommation de cannabis ou à prévenir les troubles liés à la consommation de cannabis chez les personnes ayant un PEP. Deux chercheurs indépendants ont évalué les études éligibles en termes d'efficacité et de qualité des résultats. L'efficacité des interventions a été décrite en évaluant les effets sur les méfaits liés au cannabis et les résultats de la consommation. Sondage: Un sondage, combinant deux expériences de choix discret (ECD) et une méthodologie d'enquête conventionnelle, a été élaboré pour documenter les préférences en matière d'interventions de réduction des méfaits du cannabis. Cette enquête a été menée auprès de 89 jeunes Canadiens ayant un PEP et consommant du cannabis. Une ECD mettait l’accent sur les caractéristiques principales des interventions de réduction des méfaits (ECD 1) et l'autre sur les caractéristiques des sessions de rappel (ECD 2). Nous les avons analysés à l'aide de modèles de régression logistique mixtes et ordonnés. Les questions conventionnelles de sondage sur les préférences ont été analysées à l'aide de statistiques sommaires. Protocole: Une brève intervention de réduction des méfaits du cannabis basée sur la technologie et destinée aux jeunes ayant un PEP et consommant du cannabis, appelée Cannabis Harm-reducing App to Manage Practices Safely (CHAMPS), a été développée pour accompagner les soins standards du PEP. Un ECR pilote visant à recruter 100 jeunes ayant un PEP et consommant du cannabis a été conçu pour évaluer l'acceptabilité de l'intervention et la faisabilité d'un essai à grande échelle au sein de cette population et avec cette intervention. Résultats: Revue: Cinq études ont été évaluées, dont aucune n'a mesuré les méfaits liés à la consommation de cannabis ou n'a démontré une efficacité claire dans la réduction de la consommation de cannabis chez les jeunes ayant un PEP. Toutes les études présentaient un risque élevé de biais. Sondage: Les caractéristiques préférées pour les interventions de réduction des méfaits du cannabis (ECD 1) étaient: des sessions plus courtes, des sessions moins fréquentes, des interventions plus courtes et des interventions basées sur la technologie. Les préférences pour les séances de rappel après l'intervention (ECD 2) comprenaient le choix de participer à des séances de rappel et des séances de rappel plus courtes. Protocole: Le protocole décrivant le développement de CHAMPS et son essai pilote a été publié; l'essai pilote est actuellement en cours. Impact: Peu d'interventions spécifiques au cannabis ont été menées auprès des jeunes ayant un PEP, aucune n'ayant démontré une efficacité évidente ou n'ayant mis l'accent sur la réduction des méfaits. Les résultats de l'enquête suggèrent un intérêt pour les interventions de réduction des risques liés au cannabis et mettent en évidence les caractéristiques préférées des jeunes ayant un PEP pour les interventions de réduction des risques liés au cannabis. Ces résultats peuvent guider la conception d'interventions de réduction des méfaits du cannabis, comme c'est le cas avec CHAMPS. CHAMPS représente une nouvelle intervention de réduction des méfaits du cannabis pour les jeunes ayant un PEP qui consomment du cannabis, et l'ECR pilote qui lui est associé a le potentiel de faire progresser les connaissances des scientifiques concernant l'acceptabilité et la faisabilité de la mise en œuvre d'interventions de réduction des méfaits du cannabis dans les domaines du cannabis et des psychoses précoces.