scholarly journals Readmission after discharge from acute mental healthcare among 231 988 people in England: cohort study exploring predictors of readmission including availability of acute day units in local areas

BJPsych Open ◽  
2021 ◽  
Vol 7 (4) ◽  
Author(s):  
David P. J. Osborn ◽  
Graziella Favarato ◽  
Danielle Lamb ◽  
Terri Harper ◽  
Sonia Johnson ◽  
...  
Keyword(s):  
Logistic Models ◽  
Mental Healthcare ◽  
Clinical Predictors ◽  
Individual Patient Level ◽  
Trust Level ◽  
Crisis Resolution Teams ◽  
National Cohort ◽  
Early Readmission ◽  
The Uk ◽  
English National Health

Background In the UK, acute mental healthcare is provided by in-patient wards and crisis resolution teams. Readmission to acute care following discharge is common. Acute day units (ADUs) are also provided in some areas. Aims To assess predictors of readmission to acute mental healthcare following discharge in England, including availability of ADUs. Method We enrolled a national cohort of adults discharged from acute mental healthcare in the English National Health Service (NHS) between 2013 and 2015, determined the risk of readmission to either in-patient or crisis teams, and used multivariable, multilevel logistic models to evaluate predictors of readmission. Results Of a total of 231 998 eligible individuals discharged from acute mental healthcare, 49 547 (21.4%) were readmitted within 6 months, with a median time to readmission of 34 days (interquartile range 10–88 days). Most variation in readmission (98%) was attributable to individual patient-level rather than provider (trust)-level effects (2.0%). Risk of readmission was not associated with local availability of ADUs (adjusted odds ratio 0.96, 95% CI 0.80–1.15). Statistically significant elevated risks were identified for participants who were female, older, single, from Black or mixed ethnic groups, or from more deprived areas. Clinical predictors included shorter index admission, psychosis and being an in-patient at baseline. Conclusions Relapse and readmission to acute mental healthcare are common following discharge and occur early. Readmission was not influenced significantly by trust-level variables including availability of ADUs. More support for relapse prevention and symptom management may be required following discharge from acute mental healthcare.

scholarly journals Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Hasselberg ◽  
K. H. Holgersen ◽  
G. M. Uverud ◽  
J. Siqveland ◽  
B. Lloyd-Evans ◽  
...  
Keyword(s):  
Mental Health ◽  
Multidisciplinary Teams ◽  
Evidence Based ◽  
Crisis Resolution ◽  
Health Crisis ◽  
The Core ◽  
Crisis Resolution Teams ◽  
Fidelity Scale ◽  
The Uk ◽  
Evidence Based Model

Abstract Background Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. Methods We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. Results The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users’ choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. Conclusions The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

scholarly journals Convolutional Neural Network-Based Clinical Predictors of Oral Dysplasia: Class Activation Map Analysis of Deep Learning Results

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1291
Author(s):  
Seda Camalan ◽  
Hanya Mahmood ◽  
Hamidullah Binol ◽  
Anna Luiza Damaceno Araújo ◽  
Alan Roger Santos-Silva ◽  
...  
Keyword(s):  
Cross Validation ◽  
Clinical Predictors ◽  
Oral Dysplasia ◽  
Novel Technologies ◽  
Photographic Images ◽  
The Uk ◽  
Map Analysis ◽  
Development And Validation ◽  
Fold Cross Validation ◽  
Activation Map

Oral cancer/oral squamous cell carcinoma is among the top ten most common cancers globally, with over 500,000 new cases and 350,000 associated deaths every year worldwide. There is a critical need for objective, novel technologies that facilitate early, accurate diagnosis. For this purpose, we have developed a method to classify images as “suspicious” and “normal” by performing transfer learning on Inception-ResNet-V2 and generated automated heat maps to highlight the region of the images most likely to be involved in decision making. We have tested the developed method’s feasibility on two independent datasets of clinical photographic images of 30 and 24 patients from the UK and Brazil, respectively. Both 10-fold cross-validation and leave-one-patient-out validation methods were performed to test the system, achieving accuracies of 73.6% (±19%) and 90.9% (±12%), F1-scores of 97.9% and 87.2%, and precision values of 95.4% and 99.3% at recall values of 100.0% and 81.1% on these two respective cohorts. This study presents several novel findings and approaches, namely the development and validation of our methods on two datasets collected in different countries showing that using patches instead of the whole lesion image leads to better performance and analyzing which regions of the images are predictive of the classes using class activation map analysis.

scholarly journals Are efforts to attract graduate applicants to UK medical schools effective in increasing the participation of under-represented socioeconomic groups? A national cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018946 ◽  
Author(s):  
Ben Kumwenda ◽  
Jennifer Cleland ◽  
Rachel Greatrix ◽  
Rhoda Katharine MacKenzie ◽  
Gordon Prescott
Keyword(s):  
Medical Student ◽  
Medical School ◽  
Student Population ◽  
Multiple Logistic Regression ◽  
Sociodemographic Characteristic ◽  
Universities And Colleges ◽  
Graduate Entry ◽  
Socioeconomic Groups ◽  
National Cohort ◽  
The Uk

IntroductionAttracting graduates was recommended as a means of diversifying the UK medical student population. Graduates now make up nearly a quarter of the total medical student population. Research to date has focused on comparing the sociodemographic characteristics of applicants to and/or students on traditional and graduate entry programmes (GEMs), yet GEMs account for only 40% of the graduate medical student population. Thus, we aimed to compare the sociodemographic characteristic and outcomes of graduates and non-graduate applicants across a range of programmes.MethodsThis was an observational study of 117 214 applicants to medicine who took the UK Clinical Aptitude Test (UKCAT) from 2006 to 2014 and who applied to medical school through Universities and Colleges Admissions Service (UCAS). We included applicant demographics, UKCAT total score and offers in our analysis. Applicants were assigned as graduates or non-graduates on the basis of their highest qualification. Multiple logistic regression was used to predict the odds of receiving an offer, after adjusting for confounders.ResultsIrrespective of graduate or non-graduate status, most applicants were from the highest socioeconomic groups and were from a white ethnic background. Receiving an offer was related to gender and ethnicity in both graduates and non-graduates. After adjusting for UKCAT score, the OR of an offer for graduates versus non-graduates was approximately 0.5 (OR=0.48, 95% CI 0.46 to 0.49).DiscussionOur findings indicate that the aim of diversifying the medical student population on socioeconomic grounds by attracting graduates has been only marginally successful. Graduate applicants from widening access backgrounds are less likely than others to be offered a place at medical school. Different approaches must be considered if medicine is to attract and select more socially diverse applicants.

scholarly journals Two hearts and a loan? Mortgages, employment insecurity and earnings among young couples in six European countries

Urban Studies ◽  
2017 ◽  
Vol 55 (11) ◽  
pp. 2451-2469 ◽  
Author(s):  
Giulia M Dotti Sani ◽  
Claudia Acciai
Keyword(s):  
Social Inequalities ◽  
Logistic Models ◽  
European Countries ◽  
Earned Income ◽  
Employment Insecurity ◽  
National Differences ◽  
Nationally Representative ◽  
The Uk ◽  
The Relationship ◽  
Employment Instability

Homeownership is increasingly understood by policy makers and social scientists as a fundamental asset against poverty risks, especially in times of economic uncertainty. However, in several Western countries, homeownership among younger generations appears to be increasingly difficult to achieve, likely a result of growing employment instability and stringent criteria to access credit. This article uses multinomial logistic models and nationally representative EU-SILC data from six European countries to examine (a) to what extent precarious employment among young couples is linked to being a mortgage holder; (b) whether earned income can compensate for employment instability in being a mortgagee; (c) cross-national differences in the relationship between being a mortgage holder, earnings, and employment insecurity. Our results indicate that the higher the levels of employment insecurity, the lower the chances of being a mortgage holder in all countries. Moreover, we find that at a given level of employment insecurity, households with higher levels of earned income have higher chances of being mortgage holders than households with lower earned income. However, while earned income has a stronger effect in achieving a mortgage among couples who have secure employment in Italy, earnings are more important among couples with lower levels of employment security in France, the UK, Spain and Poland. These results suggest that the relationship between social inequalities and housing is partially mediated by the national context.

scholarly journals Mental healthcare in Hungary: contradictions and possibilities

2010 ◽  
Vol 7 (2) ◽  
pp. 36-38 ◽  
Author(s):  
Tamás Kurimay
Keyword(s):  
Health Spending ◽  
Mental Healthcare ◽  
World Health ◽  
Minority Population ◽  
Official Language ◽  
The European Union ◽  
Middle Income ◽  
The Republic ◽  
Health Organization ◽  
The Uk

The Republic of Hungary is a landlocked country of 93000 km2 in central Europe; it is bordered by Austria, Slovakia, Ukraine, Romania, Serbia, Croatia and Slovenia. Its official language is Hungarian. Hungary joined the European Union (EU) in 2004. About 90% of the population of c. 10 million is ethnically Hungarian, with Roma comprising the largest minority population (6–8%). Currently classified as a middle-income country with a gross domestic product (GDP) of $191.7 billion (2007 figure), Hungary's total health spending accounted for 7.4% of GDP in 2007, less than the average of 8.9% among member states of the Organisation for Economic Co-operation and Development (OECD, 2009). The proportion of the total health budget for mental health is 5.1%, which is low when compared with, for instance, the UK (England and Wales 13.8%, Scotland 9.5%) (World Health Organization, 2008, p. 118, Fig. 8.1).

scholarly journals It's time to talk: rekindling the relationship with primary care

2008 ◽  
Vol 14 (2) ◽  
pp. 84-85 ◽  
Author(s):  
Roger Banks ◽  
Linda Gask
Keyword(s):  
Mental Health Problems ◽  
Mental Healthcare ◽  
Strategy Training ◽  
Specialist Care ◽  
Healthcare Provision ◽  
Policy And Strategy ◽  
Working Together ◽  
Strategic Policy ◽  
The Uk ◽  
The Relationship

Healthcare provision in the UK is in a process of continual change. The structures and processes by which people with mental health problems and people with learning disabilities receive support from statutory services have been, and continue to be, subject to many and varied strategic, policy and professional influences. Integrated and collaborative ways of working between generalist (‘primary’) and specialist (‘secondary’) care have become eroded over time and yet they may be needed more than ever. In this editorial we encourage a collaborative approach between practitioners in generalist and specialist care in studying and developing three strands of work: policy and strategy; training; and professional behaviour. Above all, we advocate strongly for a renewed and dynamic dialogue between psychiatrists and general practitioners in working together to provide high-quality mental healthcare.

scholarly journals Intracranial haemorrhage in children with inherited bleeding disorders in the UK 2003-2015: A national cohort study

Haemophilia ◽  
2018 ◽  
Vol 24 (4) ◽  
pp. 641-647 ◽  
Author(s):  
E. A. Chalmers ◽  
J. Alamelu ◽  
P. W. Collins ◽  
M. Mathias ◽  
J. Payne ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intracranial Haemorrhage ◽  
Bleeding Disorders ◽  
National Cohort ◽  
The Uk

scholarly journals Evaluating the impact of cycle helmet use on severe traumatic brain injury and death in a national cohort of over 11000 pedal cyclists: a retrospective study from the NHS England Trauma Audit and Research Network dataset

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027845 ◽  
Author(s):  
Nick Dodds ◽  
Rowena Johnson ◽  
Benjamin Walton ◽  
Omar Bouamra ◽  
David Yates ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Research Network ◽  
Lower Limb Injury ◽  
Helmet Use ◽  
Mortality And Morbidity ◽  
National Cohort ◽  
The Uk ◽  
The Impact

ObjectivesIn the last 10 years there has been a significant increase in cycle traffic in the UK, with an associated increase in the overall number of cycling injuries. Despite this, and the significant media, political and public health debate into this issue, there remains an absence of studies from the UK assessing the impact of helmet use on rates of serious injury presenting to the National Health Service (NHS) in cyclists.SettingThe NHS England Trauma Audit and Research Network (TARN) Database was interrogated to identify all adult (≥16 years) patients presenting to hospital with cycling-related major injuries, during a period from 14 March 2012 to 30 September 2017 (the last date for which a validated dataset was available).Participants11 192 patients met inclusion criteria. Data on the use of cycling helmets were available in 6621 patients.Outcome measuresTARN injury descriptors were used to compare patterns of injury, care and mortality in helmeted versus non-helmeted cohorts.ResultsData on cycle helmet use were available for 6621 of the 11 192 cycle-related injuries entered onto the TARN Database in the 66 months of this study (93 excluded as not pedal cyclists). There was a significantly higher crude 30-day mortality in un-helmeted cyclists 5.6% (4.8%–6.6%) versus helmeted cyclists 1.8% (1.4%–2.2%) (p<0.001). Cycle helmet use was also associated with a reduction in severe traumatic brain injury (TBI) 19.1% (780, 18.0%–20.4%) versus 47.6% (1211, 45.6%–49.5%) (p<0.001), intensive care unit requirement 19.6% (797, 18.4%–20.8%) versus 27.1% (691, 25.4%–28.9%) (p<0.001) and neurosurgical intervention 2.5% (103, 2.1%–3.1%) versus 8.5% (217, 7.5%–9.7%) (p<0.001). There was a statistically significant increase in chest, spinal, upper and lower limb injury in the helmeted group in comparison to the un-helmeted group (all p<0.001), though in a subsequent analysis of these anatomical injury patterns, those cyclists wearing helmets were still found to have lower rates of TBI. In reviewing TARN injury codes for specific TBI and facial injuries, there was a highly significant decrease in rates of impact injury between cyclists wearing helmets and those not.ConclusionsThis study suggests that there is a significant correlation between use of cycle helmets and reduction in adjusted mortality and morbidity associated with TBI and facial injury.

scholarly journals Clinical outcomes and programming strategies of implantable cardioverter-defibrillator devices in paediatric hypertrophic cardiomyopathy: a UK National Cohort Study

EP Europace ◽  
2020 ◽  
Author(s):  
Gabrielle Norrish ◽  
Henry Chubb ◽  
Ella Field ◽  
Karen McLeod ◽  
Maria Ilina ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Implantable Cardioverter Defibrillator ◽  
Incidence Rate ◽  
Clinical Outcomes ◽  
Cardioverter Defibrillator ◽  
National Cohort ◽  
Icd Shock ◽  
The Uk ◽  
Device Complications

Abstract Aims Sudden cardiac death (SCD) is the most common mode of death in paediatric hypertrophic cardiomyopathy (HCM). This study describes the implant and programming strategies with clinical outcomes following implantable cardioverter-defibrillator (ICD) insertion in a well-characterized national paediatric HCM cohort. Methods and results Data from 90 patients undergoing ICD insertion at a median age 13 (±3.5) for primary (n = 67, 74%) or secondary prevention (n = 23, 26%) were collected from a retrospective, longitudinal multi-centre cohort of children (&lt;16 years) with HCM from the UK. Seventy-six (84%) had an endovascular system [14 (18%) dual coil], 3 (3%) epicardial, and 11 (12%) subcutaneous system. Defibrillation threshold (DFT) testing was performed at implant in 68 (76%). Inadequate DFT in four led to implant adjustment in three patients. Over a median follow-up of 54 months (interquartile range 28–111), 25 (28%) patients had 53 appropriate therapies [ICD shock n = 45, anti-tachycardia pacing (ATP) n = 8], incidence rate 4.7 per 100 patient years (95% CI 2.9–7.6). Eight inappropriate therapies occurred in 7 (8%) patients (ICD shock n = 4, ATP n = 4), incidence rate 1.1/100 patient years (95% CI 0.4–2.5). Three patients (3%) died following arrhythmic events, despite a functioning device. Other device complications were seen in 28 patients (31%), including lead-related complications (n = 15) and infection (n = 10). No clinical, device, or programming characteristics predicted time to inappropriate therapy or lead complication. Conclusion In a large national cohort of paediatric HCM patients with an ICD, device and programming strategies varied widely. No particular strategy was associated with inappropriate therapies, missed/delayed therapies, or lead complications.

Sign in / Sign up

Export Citation Format

Share Document