scholarly journals Could social prescribing contribute to type 2 diabetes prevention in people at high risk? Protocol for a realist, multilevel, mixed methods review and evaluation

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042303
Author(s):  
Sara Calderón Larrañaga ◽  
Megan Clinch ◽  
Trisha Greenhalgh ◽  
Sarah Finer
Keyword(s):  
Type 2 Diabetes ◽  
National Health Service ◽  
High Risk ◽  
Health Service ◽  
National Health ◽  
Stakeholder Group ◽  
Long Term Conditions ◽  
Social Prescribing

IntroductionSocial prescribing is an innovation being widely adopted within the UK National Health Service policy as a way of improving the management of people with long-term conditions, such as type 2 diabetes (T2D). It generally involves linking patients in primary care with non-medical community-based interventions. Despite widespread national support, evidence for the effectiveness of social prescribing is both insufficient and contested. In this study, we will investigate whether social prescribing can contribute to T2D prevention and, if so, when, how and in what circumstances it might best be introduced.Methods and analysisWe will draw on realist evaluation to investigate the complex interpersonal, organisational, social and policy contexts in which social prescribing relevant to T2D prevention is implemented. We will set up a stakeholder group to advise us throughout the study, which will be conducted over three interconnected stages. In stage 1, we will undertake a realist review to synthesise the current evidence base for social prescribing. In stage 2, we will investigate how social prescribing relevant to people at high risk of T2D ‘works’ in a multiethnic, socioeconomically diverse community and any interactions with existing T2D prevention services using qualitative, quantitative and realist methods. In stage 3 and building on previous stages, we will synthesise a ‘transferable framework’ that will guide implementation and evaluation of social prescribing relevant to T2D prevention at scale.Ethics and disseminationNational Health Service ethics approval has been granted (reference 20/LO/0713). This project will potentially inform the adaptation of social prescribing services to better meet the needs of people at high risk of T2D in socioeconomically deprived areas. Findings may also be transferable to other long-term conditions. Dissemination will be undertaken as a continuous process, supported by the stakeholder group. Tailored outputs will target the following audiences: (1) service providers and commissioners; (2) people at high risk of T2D and community stakeholders; and (3) policy and strategic decision makers.PROSPERO registration numberCRD42020196259.

188-LB: Type 2 Diabetes Is Genetically Correlated with Multiple Long-Term Conditions but These Correlations Are Only Partly Explained by BMI

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 188-LB
Author(s):  
LUKE C. PILLING ◽  
FRANK DUDBRIDGE ◽  
DAVID MELZER ◽  
JACK BOWDEN ◽  
TIMOTHY M. FRAYLING
Keyword(s):  
Type 2 Diabetes ◽  
Long Term Conditions

scholarly journals Implementation of cell-free DNA-based non-invasive prenatal testing in a National Health Service Regional Genetics Laboratory

2019 ◽  
Vol 101 ◽  
Author(s):  
Fiona S. Togneri ◽  
Mark D. Kilby ◽  
Elizabeth Young ◽  
Samantha Court ◽  
Denise Williams ◽  
...  
Keyword(s):  
National Health Service ◽  
High Risk ◽  
Health Service ◽  
National Health ◽  
Prenatal Testing ◽  
Low Risk ◽  
Trisomy 13 ◽  
Cell Free Dna ◽  
Non Invasive ◽  
Free Dna

Abstract Background Non-invasive prenatal testing (NIPT) for the detection of foetal aneuploidy through analysis of cell-free DNA (cfDNA) in maternal blood is offered routinely by many healthcare providers across the developed world. This testing has recently been recommended for evaluative implementation in the UK National Health Service (NHS) foetal anomaly screening pathway as a contingent screen following an increased risk of trisomy 21, 18 or 13. In preparation for delivering a national service, we have implemented cfDNA-based NIPT in our Regional Genetics Laboratory. Here, we describe our validation and verification processes and initial experiences of the technology prior to rollout of a national screening service. Methods Data are presented from more than 1000 patients (215 retrospective and 840 prospective) from ‘high- and low-risk pregnancies’ with outcome data following birth or confirmatory invasive prenatal sampling. NIPT was by the Illumina Verifi® test. Results Our data confirm a high-fidelity service with a failure rate of ~0.24% and a high sensitivity and specificity for the detection of foetal trisomy 13, 18 and 21. Secondly, the data show that a significant proportion of patients continue their pregnancies without prenatal invasive testing or intervention after receiving a high-risk cfDNA-based result. A total of 46.5% of patients referred to date were referred for reasons other than high screen risk. Ten percent (76/840 clinical service referrals) of patients were referred with ultrasonographic finding of a foetal structural anomaly, and data analysis indicates high- and low-risk scan indications for NIPT. Conclusions NIPT can be successfully implemented into NHS regional genetics laboratories to provide high-quality services. NHS provision of NIPT in patients with high-risk screen results will allow for a reduction of invasive testing and partially improve equality of access to cfDNA-based NIPT in the pregnant population. Patients at low risk for a classic trisomy or with other clinical indications are likely to continue to access cfDNA-based NIPT as a private test.

scholarly journals Scottish rehabilitation services: eight year follow-up

1993 ◽  
Vol 17 (6) ◽  
pp. 341-344
Author(s):  
Robin G. McCreadie ◽  
Douglas J. Williamson ◽  
Lesley J. Robertson
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Mentally Ill ◽  
Support Services ◽  
Psychiatric Rehabilitation ◽  
Rehabilitation Services ◽  
Local Authorities

A survey of Scottish psychiatric rehabilitation and support services, carried out in 1983 (McCreadie et al, 1985), found that although there were wide between-hospital differences, the National Health Service in Scotland was making considerable efforts to provide services for the long-term mentally ill. However, services provided by local authorities were seriously deficient.

The lost worlds of royal commissions in the NHS: The unaccountable in pursuit of the unanswerable?

2019 ◽  
Vol 37 (2) ◽  
pp. 199-217
Author(s):  
Martin Powell
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Royal Commission ◽  
Select Committee ◽  
House Of Lords ◽  
The Impact ◽  
British National Health ◽  
Advisory Bodies

There have been recent calls for a royal commission (RC) on the British National Health Service (NHS). This article focuses on the impact of RCs and similar advisory bodies, particularly on finance recommendations, of three inquiries with broad remits across the whole of the NHS from very different periods: Guillebaud (1956); Royal Commission on the National Health Service (1979); and House of Lords Select Committee on the Long-term Sustainability of the NHS (2017). These inquiries appear to have had rather limited impacts, especially on NHS funding. First, there appears to be some hesitancy in suggesting precise figures for NHS expenditure. Second, the reports are advisory, and governments can ignore their conclusions. Third, governments have ignored their conclusions. In the 1950s and the 1980s, contrary to the recommendations of the inquiries, NHS expenditure subsequently grew only slowly, and charges were increased. In short, asking an independent RC to provide answers on NHS expenditure is perhaps the unaccountable in pursuit of the unanswerable.

scholarly journals Quantifying the impact of delayed delivery of cardiac rehabilitation on patients’ health

2020 ◽  
Vol 27 (16) ◽  
pp. 1775-1781
Author(s):  
Sebastian Hinde ◽  
Alexander Harrison ◽  
Laura Bojke ◽  
Patrick Doherty
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Life Expectancy ◽  
Cardiac Rehabilitation ◽  
National Health ◽  
Average Lifetime ◽  
National Guidelines ◽  
Patient Health ◽  
The Impact

Background Despite its role as an effective intervention to improve the long-term health of patients with cardiovascular disease and existence of national guidelines on timeliness, many health services still fail to offer cardiac rehabilitation in a timely manner after referral. The impact of this failure on patient health and the additional burden on healthcare providers in an English setting is quantified in this article. Methods Two logistic regressions are conducted, using the British Heart Foundation National Audit of Cardiac Rehabilitation dataset, to estimate the impact of delayed cardiac rehabilitation initiation on the level of uptake and completion. The results of these regressions are applied to a decision model to estimate the long-term implications of these factors on patient health and National Health Service expenditure. Results We demonstrate that the failure of 43.6% of patients in England to start cardiac rehabilitation within the recommended timeframe results in a 15.3% reduction in uptake, and 7.4% in completion. These combine to cause an average lifetime loss of 0.08 years of life expectancy per person. Scaled up to an annual cohort this implies 10,753 patients not taking up cardiac rehabilitation due to the delay, equating to a loss of 3936 years of life expectancy. We estimate that an additional £12.3 million of National Health Service funding could be invested to alleviate the current delay. Conclusions The current delay in many patients starting cardiac rehabilitation is causing quantifiable and avoidable harm to their long-term health; policy and research must now look at both supply and demand solutions in tackling this issue.

scholarly journals Tilting the balance: the first long-term medium secure unit in the NHS in England and Wales

2006 ◽  
Vol 30 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Niamh Power ◽  
Dawn Harwood ◽  
Akintunde Akinkunmi
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
The West ◽  
England And Wales ◽  
Future Developments ◽  
Secure Unit

Rollo May Ward, a long-term medium secure facility integrated within the West London Mental Health National Health Service (NHS) Trust, is the first dedicated long-term NHS medium secure unit to have opened in England. It caters for a group of men with complex clinical needs and risk assessment issues who had previously been inappropriately detained within high secure services owing to a lack of suitable, less secure placement facilities. We describe the background to the development of the long-term medium secure service, the referral and assessment processes, the structure of the ward and the therapeutic programmes available to patients. We also outline the characteristics of the first 21 patients to be admitted to the ward and offer advice for similar future developments.

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