Specialist services and transitional care in paediatric endocrinology in the UK and Ireland

Background: Independent peer review of healthcare services can complement existing internal-, institutional-, and national-level regulatory mechanisms aimed at improving quality of healthcare. However, this has not been reported for paediatric endocrinology services in the UK. We aimed to test feasibility and acceptability through a first cycle of a national peer review of paediatric endocrine services. Methods: Tertiary centres in paediatric endocrinology across the UK were assessed against 54 quality standards, developed by the British Society for Paediatric Endocrinology and Diabetes (BSPED) in five domains of healthcare by a team comprising paediatric endocrinologists and specialist nurses. The evaluation was supported by a self-assessment. A post-peer-review questionnaire was used as feedback. Results: All 22 centres in the UK underwent independent peer review between 2011 and 2017. Each served a median population of 2.6 million (range 1–8 million) and offered 1,872 (range 779–6,738) outpatient consultations annually. A total of 43 (range 30–49) standards were met in combined evaluation of all centres. Variance of adherence for essential standards ranged from 52 to 97% at individual centres with 90% adherence demonstrated by 32% of centres. Post-review feedback showed 20/22 (95%) validating the utility of the peer review. Conclusions: The BSPED peer review of all UK centres providing paediatric endocrine services is shown to be feasible and provides a quality benchmark for replication by national services.

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Clinic, courtroom or (specialist) committee: in the best interests of the critically Ill child?

Journal of Medical Ethics ◽

10.1136/medethics-2017-104706 ◽

2018 ◽

Vol 44 (7) ◽

pp. 471-475 ◽

Cited By ~ 3

Author(s):

Richard Huxtable

Keyword(s):

Critically Ill ◽

Support Services ◽

Best Interests ◽

Ethics Support ◽

Specialist Services ◽

Critically Ill Child ◽

The Uk ◽

Promising Development ◽

Specialist Committee

Law’s processes are likely always to be needed when particularly intractable conflicts arise in relation to the care of a critically ill child like Charlie Gard. Recourse to law has its merits, but it also imposes costs, and the courts’ decisions about the best interests of such children appear to suffer from uncertainty, unpredictability and insufficiency. The insufficiency arises from the courts’ apparent reluctance to enter into the ethical dimensions of such cases. Presuming that such reflection is warranted, this article explores alternatives to the courts, and in particular the merits of specialist ethics support services, which appear to be on the rise in the UK. Such specialist services show promise, as they are less formal and adversarial than the courts and they appear capable of offering expert ethical advice. However, further research is needed into such services – and into generalist ethics support services – in order to gauge whether this is indeed a promising development.

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Distribution and characteristics of in-patient child and adolescent mental health services in England and Wales

The British Journal of Psychiatry ◽

10.1192/02-620 ◽

2003 ◽

Vol 183 (6) ◽

pp. 547-551 ◽

Cited By ~ 2

Author(s):

Anne O'Herlihy ◽

Adrian Worrall ◽

Paul Lelliott ◽

Tony Jaffa ◽

Peter Hill ◽

...

Keyword(s):

Mental Health ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Specialist Service ◽

England And Wales ◽

Current State ◽

Specialist Services ◽

Adolescent Mental Health Service ◽

Independent Sector ◽

The Uk

BackgroundLittle is known about the current state of provision of child and adolescent mental health service in-patient units in the UK.AimsTo describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales.MethodFollowing identification of units, data were collected by a postal general survey with telephone follow-up.ResultsEighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions.ConclusionsA national approach is needed to the planning and commissioning of this specialist service.

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Dentists’ preferences for diagnosis, management and referral of chronic oro-facial pain: Results from a national survey

Health Education Journal ◽

10.1177/0017896911419350 ◽

2011 ◽

Vol 71 (6) ◽

pp. 662-669 ◽

Cited By ~ 10

Author(s):

Vishal R Aggarwal ◽

Amy Joughin ◽

Joanna Zakrzewska ◽

Priscilla Appelbe ◽

Martin Tickle

Keyword(s):

Primary Care ◽

Facial Pain ◽

Temporomandibular Disorder ◽

Postal Questionnaire ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Specialist Services ◽

Primary Care Practitioners ◽

Pain Symptoms ◽

The Uk

Aim: To explore the diagnosis, treatment and referral patterns of chronic oro-facial pain patients by generalist primary care dentists (GDPs) in the UK. Methods: A cross-sectional survey was conducted using a non-stratified random sample of 500 GDPs who were selected from the General Dental Council register. A self-complete postal questionnaire with four hypothetical clinical case scenarios describing sub-types of chronic oro-facial pain (COFP) was used to investigate diagnosis, treatment and referral options of GDPs. Results: Two hundred and twenty (44%) GDPs responded. The majority correctly diagnosed temporomandibular disorder (TMD; 88%) and burning mouth syndrome (BMS; 92%). There was more variation in the diagnosis of the other cases related to persistent oro-facial pain. For TMD there was a clear preference for treatment with occlusal splint therapy, and referral to a temporomandibular joint (TMJ) specialist. The BMS scenario showed drug therapy and referral to an oral medicine specialist to be most popular. The chronic oro-facial pain cases had greater variation in management and choice of psychotherapy was related to duration of pain symptoms. Conclusions: The greater variation in responses to scenarios based on patients with chronic oro-facial pain may reflect the difficulty clinicians face in diagnosing and treating this condition. Management appears to follow a biomedical model and most clinicians chose to refer patients for treatment. There are few specialist services to cater for such referrals, indicating a need to train primary care practitioners in management of chronic COFP, along with the establishment of evidence-based guidelines.

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Dental Management of Patients With Acquired and Congenital Bleeding Disorders

Primary Dental Journal ◽

10.1177/2050168420923866 ◽

2020 ◽

Vol 9 (2) ◽

pp. 47-55

Author(s):

Sukina Moosajee ◽

Sobia Rafique

Keyword(s):

Primary Care ◽

Dental Treatment ◽

Care Patient ◽

Bleeding Disorders ◽

Medical Interventions ◽

National Priority ◽

Dental Management ◽

Specialist Services ◽

Dental Setting ◽

The Uk

In an age when people are living longer and medical interventions are continually becoming more advanced, clinicians will need to be aware of systemic disorders and treatments that may cause complications in the dental setting. The Office for National Statistics’ projections state that 26% of the UK population will be aged over 65 years by 2041.1 Therefore, clinicians may often encounter patients who complain of prolonged bleeding following certain procedures, most commonly dental extractions. In the majority of cases, the cause is often a local one, which can be managed using simple local measures. However, poor management can lead to potentially fatal consequences. The aim of this paper is to update clinicians on the dental management of patients with acquired or congenital bleeding disorders, and on how to decide the most appropriate setting for safe dental care. Patient safety in the NHS is a national priority with ever greater measures being put into place to avoid patient harm. Whilst most patients can be successfully treated in primary care, for the provision of safe dental treatment, the clinician may need to make a decision regarding referral to specialist services for all dental treatment, or share care between primary care and specialist services for selected procedures.

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British art librarianship today and tomorrow

Art Libraries Journal ◽

10.1017/s0307472200008919 ◽

1994 ◽

Vol 19 (3) ◽

pp. 20-26

Author(s):

Jan van der Wateren

Keyword(s):

Visual Arts ◽

British Library ◽

Present Position ◽

25Th Anniversary ◽

British Art ◽

Active Player ◽

Specialist Services ◽

The Uk ◽

The Relationship ◽

Subject Specialist

The National Art Library (NAL) has moved from its former isolation, through the developments of the last decade, to its present position as a focus for and active player in the art library and information community of the UK. The NAL has worked with ARLIS on some of the major co-operative ventures currently preoccupying the art library field. However, there is still a need for further clarification of, and support for, subject specialist services in the national arena, not least the relationship with the British Library. The potential of the proposed Library Commission and Visual Arts Library and Information Plan is still to be realised. Art librarians must work with their users in formulating a more radical and visionary view of their objectives, as they face the challenges of the future.This article is a revised version of a paper delivered to the 25th Anniversary Conference of ARLIS/UK & Ireland, London, 7th-10th April 1994.

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Mental health services for black and minority ethnic elders in the United Kingdom: a systematic review of innovative practice with service provision and policy implications

International Psychogeriatrics ◽

10.1017/s1041610212001858 ◽

2012 ◽

Vol 25 (3) ◽

pp. 359-373 ◽

Cited By ~ 12

Author(s):

Sarmishtha Bhattacharyya ◽

Susan Mary Benbow

Keyword(s):

Mental Health ◽

United Kingdom ◽

Mental Health Problems ◽

Policy Implications ◽

The United Kingdom ◽

Specialist Services ◽

The Uk ◽

Socially Excluded ◽

Minority Ethnic ◽

Learning Points

ABSTRACTBackground: The proportion of older people from black and minority ethnic (BME) groups in the United Kingdom (UK) is increasing steadily as the population ages. The numbers with dementia, depression, and other mental health problems are predicted to increase. Government policy documents have highlighted gaps in services for BME elders and/or the need to develop culturally appropriate services, in order to prevent people from BME communities from becoming socially excluded and finding services hard to access. This paper reviews published examples of innovative services and key learning points from them.Method: A search was carried out on Pubmed, Medline, and Google Scholar for service developments aimed at BME elders in the UK. Sixteen relevant papers and reports were identified and were analysed to identify learning points and implications for clinical practice and policy.Results: Commissioning issues included were forward planning for continuing funding and mainstreaming versus specialist services. Provider management issues included were employing staff from the communities of interest, partnership, and removing language barriers. Provider service issues included were education for service provider staff on the needs of BME elders, making available information in relevant languages, building on carers’ and users’ experiences, and addressing the needs of both groups.Conclusion: A model for structuring understanding of the underutilisation of services by BME elders is suggested. The main emphasis in future should be to ensure that learning is shared, disseminated, and applied to the benefit of all communities across the whole of the UK and elsewhere. Person-centred care is beneficial to all service users.

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ASD and offending: reflections of practice in from a New Zealand perspective

Journal of Intellectual Disabilities and Offending Behaviour ◽

10.1108/jidob-07-2016-0012 ◽

2017 ◽

Vol 8 (2) ◽

pp. 90-98 ◽

Cited By ~ 3

Author(s):

David Bathgate

Keyword(s):

New Zealand ◽

Rare Condition ◽

Background Information ◽

Content Type ◽

The United Kingdom ◽

Specialist Services ◽

Secure Unit ◽

The Uk ◽

Training Position ◽

The Impact

Purpose There is growing awareness in New Zealand (NZ) of the impact that Autistic Spectrum Disorder (ASD) has on individuals and their families and the ability to engage in health services. Although it is a relatively rare condition, approximately 1 per cent of the population will have ASD, directly affecting approximately 40,000 individuals in NZ. The purpose of this paper is to provide some reflections and questions on what we can learn from a NZ perspective. This is based on an overview of the limited literature around ASD and offending and the author’s experience in the UK working in a medium secure unit. Design/methodology/approach Through a past site visit as part of the annual international conference on the Care and Treatment of Offenders with an Intellectual and/or Developmental Disability in the United Kingdom (UK), the author became aware of the medium secure forensic unit for male patients with ASD at the Roseberry Park Hospital (UK’s Tees, Esk and Wear Valleys NHS Foundation Trust). During the author’s advanced training in forensic psychiatry with the Royal Australian and New Zealand College of Psychiatrists the author was privileged to be able to apply and be accepted for a four-month sabbatical training position at this hospital. Findings Outlined is background information about ASD and review findings from the limited literature on ASD and offending. Also outlined is the author’s learning as a trainee working in medium secure unit for people with ASD who have offended, and finally how this experience may help in the development of services in NZ, given that at this stage such services are under-developed. Originality/value To be able to share the valuable experience and learning opportunity the author was able to have, as well as raise the awareness of ASD generally, and specifically the need for specialist services for the small number of people with ASD who come into contact with Justice Services.

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Local Authority and Voluntary Adoption Agencies' Arrangements for Supporting Adoptive Families: A Survey of UK Practice

Adoption & Fostering ◽

10.1177/030857590302700309 ◽

2003 ◽

Vol 27 (3) ◽

pp. 51-60 ◽

Cited By ~ 4

Author(s):

Alan Rushton

Keyword(s):

Support Services ◽

Service Provision ◽

Local Authority ◽

Adoptive Families ◽

Looked After Children ◽

Specialist Services ◽

Timely Access ◽

Adoption Agencies ◽

The Uk ◽

Voluntary Adoption

This paper presents the main messages from a survey of adoption support services in local authority and voluntary adoption agencies throughout the UK. The survey examined developments in service provision and delivery resulting from the Government's drive to increase the use of adoption as an option to secure permanence for looked after children. Alan Rushton reports that substantial changes are taking place in many agencies, but that there is further to go to achieve equitable and timely access to specialist services when they are needed.

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The short Synacthen test: a questionnaire survey of current usage

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-301713 ◽

2012 ◽

Vol 97 (10) ◽

pp. 870-873 ◽

Cited By ~ 8

Author(s):

Charlotte Jane Elder ◽

Pooja Sachdev ◽

Neil Peter Wright

Keyword(s):

Low Dose ◽

Inhaled Corticosteroids ◽

British Society ◽

High Dose ◽

Paediatric Endocrinology ◽

Children With Asthma ◽

Synacthen Test ◽

The Uk ◽

Meta Analyses ◽

Short Synacthen Test

BackgroundSupported by meta-analyses, the low-dose Synacthen test (LDST) has gained in popularity, with many believing it to be more sensitive than the supraphysiological standard (250 µg) short ST (SSST), particularly when assessing children prescribed high-dose inhaled corticosteroids (HDICS). However, consensus is lacking about its specific clinical application, what is considered ‘low dose’ and how that dose is made up.MethodsTo ascertain current use of the short Synacthen test (SST), a questionnaire was emailed to members of the British Society of Paediatric Endocrinology and Diabetes in the UK and Ireland (N=257), requesting a response from each department (N=92). A reminder was sent a month later to members of departments which had not responded.ResultsThe authors received 39 replies, giving a response rate of 42%. All departments use the SST: 82% use an LDST, 87% use the SSST and 69% use both. The 1 µg dose was used by 44% of hospitals, with the other 56% using seven different doses based on age, weight and body surface area. There were 14 different methods of preparing the low dose test. Additionally, variations in the timings of cortisol sampling and the diagnostic cut-offs for adrenal insufficiency were found. Increased requests for SSTs in children with asthma prescribed HDICS were noted by 44% of respondents, with 67% reporting the detection of adrenal suppression in this group.ConclusionStandardisation of the SST is required to address the considerable variation in the methodology and application of this test in the UK and Ireland.

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