Crisis in Admission Beds

1995 ◽  
Vol 167 (6) ◽  
pp. 765-769 ◽  
Author(s):  
Robin B. Powell ◽  
Doris Hollander ◽  
Robert I. Tobiansky
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Corrective Action ◽  
Clear Correlation ◽  
Bed Occupancy ◽  
Careful Monitoring ◽  
Psychiatric Units ◽  
The Mean ◽  
Occupancy Rates

BackgroundThis study was carried out to measure bed occupancy in Greater London's psychiatric units, in response to the apparent shortage of admission beds.MethodThe bed occupancy of London's 54 National Health Service (NHS) acute psychiatric units within 29 districts was ascertained by telephone on 16 bank holidays covering the period 1990–93.ResultsThe mean occupancy level for all London over the 4 years was 97.54% (95% CI = ±0.94%). The number of beds occupied in inner London was significantly greater (99.79 ± 1.11%) than in outer London (95.1 ± 1.49%) (t = 3.85, d.f. = 462, P < 0.001). Bed occupancy for inner London units was ≥ 100% on over 49% of occasions. There has been a steady decline in the number of beds over the four-year period. There was a clear correlation between occupancy levels and the Jarman UPA8 Underprivilege Score (r = 0.504) and between bed provision and the UPA8 (r = 0.67).ConclusionOccupancy rates have become unacceptably high and require careful monitoring. Corrective action may be required in order to prevent a breakdown in services.

scholarly journals Instant lithium monitoring

1991 ◽  
Vol 15 (3) ◽  
pp. 138-139 ◽  
Author(s):  
J. R. King ◽  
J.D. Phillips ◽  
R. Judge ◽  
A. D. Armond ◽  
J. A. Corbett ◽  
...  
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Affective Disorders ◽  
Lithium Therapy ◽  
Careful Monitoring ◽  
Hospital Beds

Lithium therapy for affective disorders has been estimated to result in savings of hospital beds in the National Health Service of £23 million each year. In order to maintain and justify this saving we must invest to provide careful monitoring of serum lithium concentrations in patients living in the community. In recent years the advent of lithium clinics has done much to improve the compliance and safety of lithium therapy (Masterton et al, 1988), but we believe that there may be scope for further improvement both in the service to the patient and in encouragement of the patient to comply.

Cataract surgery refractive outcomes: representative standards in a National Health Service setting

2018 ◽  
Vol 103 (4) ◽  
pp. 539-543 ◽  
Author(s):  
Kerr Brogan ◽  
Charles J M Diaper ◽  
Alan P Rotchford
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Cataract Surgery ◽  
National Health ◽  
Postoperative Outcome ◽  
Absolute Error ◽  
European Guidelines ◽  
Refractive Outcomes ◽  
Service Setting ◽  
The Mean

Background/aimsTo report refractive outcomes from an National Health Service (NHS) cataract surgery service and assess if results meet suggested benchmark standard.MethodsDetails of all patients undergoing cataract surgery in the Southern General and New Victoria hospitals in Glasgow, UK, between November 2006 and December 2016 were prospectively entered into an electronic database. Patients were reviewed 4 weeks postoperatively in the eye clinic and underwent refraction at their local optometrist prior to this appointment. Surgically uncomplicated cases with in the bag’ non-toric intraocular lens implantation were included. Patients with previous laser refractive procedures or failing to achieve 6/12 acuity or better postoperatively were excluded. Proximity to targeted postoperative refraction was documented.ResultsOver this 10-year period, 11 083 eyes underwent cataract surgery. Of these, 8943 eyes of 6936 patients (80.69%) met the inclusion criteria and had both target and postoperative outcome refraction recorded. The mean difference between the targeted and outcome refraction was −0.07 D (SD 0.67). The mean absolute error was 0.50 D. Postoperative refraction was within 1 D of target refraction for 7938 eyes (88.76%) and within 0.50 D for 5577 eyes (62.36%).ConclusionRefractive outcomes following routine cataract surgery reported here are well within the targets recommended by the Royal College of Ophthalmologists and European guidelines, but suggest that higher cataract refractive outcome benchmark standards may not yet be a realistic expectation for all NHS units with current biometry practice.

scholarly journals Assessing the impact of England's National Health Service R&D Health Technology Assessment program using the “payback” approach

2009 ◽  
Vol 25 (01) ◽  
pp. 1-5 ◽  
Author(s):  
James Raftery ◽  
Stephen Hanney ◽  
Colin Green ◽  
Martin Buxton
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Health Technology Assessment ◽  
Case Studies ◽  
National Health ◽  
Technology Assessment ◽  
Clinical Excellence ◽  
Health Technology ◽  
The Mean ◽  
The Impact

Objectives:This study assesses the impact of the English National Health Service (NHS) Health Technology Assessment (HTA) program using the “payback” framework.Methods:A survey of lead investigators of all research projects funded by the HTA program 1993–2003 supplemented by more detailed case studies of sixteen projects.Results:Of 204 eligible projects, replies were received from 133 or 65 percent. The mean number of peer-reviewed publications per project was 2.9. Seventy-three percent of projects claimed to have had had an impact on policy and 42 percent on behavior. Technology Assessment Reports for the National Institute for Health and Clinical Excellence (NICE) had fewer than average publications but greater impact on policy. Half of all projects went on to secure further funding. The case studies confirmed the survey findings and indicated factors associated with impact.Conclusions:The HTA program performed relatively well in terms of “payback.” Facilitating factors included the program's emphasis on topics that matter to the NHS, rigorous methods and the existence of “policy customers” such as NICE.

scholarly journals Olanzapine in practice

1998 ◽  
Vol 22 (9) ◽  
pp. 552-554 ◽  
Author(s):  
David Taylor ◽  
Siobhan Drummond ◽  
Joanne Pendlebury
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Standard Dose ◽  
Relative Effectiveness ◽  
Substantial Proportion ◽  
Dose Titration ◽  
Anticholinergic Drugs ◽  
The Mean ◽  
Typical Antipsychotics

Prescription charts including a prescription for olanzapine were evaluated for 202 patients from 15 National Health Service trusts. In patients prescribed olanzapine for less than six weeks, the mean dose was found to be 12.4mg/day but 56% of patients were prescribed olanzapine as the sole antipsychotic. For patients prescribed olanzapine for longer than six weeks (when dose titration and drug crossovers were assumed to be complete) the mean dose of olanzapine was 15.8mg/day and 64% received olanzapine as the sole antipsychotic. A substantial proportion of patients were prescribed concurrent anticholinergic drugs (but relatively few when on olanzapine alone). Olanzapine was used in doses higher than the standard dose recommended by the manufacturers, often in combination with typical antipsychotics. Such practices increase costs and, at least in the latter case, very probably adversely affect outcome. Studies are needed to evaluate the relative effectiveness of commonly used antipsychotic regimens in naturalistic settings. In the absence of these, olanzapine should be used as the sole antipsychotic and patients should be property assessed on lower doses before dose increases are undertaken.

scholarly journals Management of psychiatric in-patient violence in the Anglia region

1999 ◽  
Vol 23 (8) ◽  
pp. 486-489 ◽  
Author(s):  
J. H. Dowson ◽  
J. Butler ◽  
O. Williams
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Learning Disability ◽  
National Health ◽  
Staff Training ◽  
Physical Restraint ◽  
Clinical Implications ◽  
Patient Violence ◽  
Victim Support ◽  
Psychiatric Units

Aims and methodA total of 384 incidents of violence against the person (six ‘serious' and 378 ‘mild’), by adult in-patients in general psychiatric units (GPUs) and learning disability units (LDUs) in 10 National Health Service trusts in the Anglia region, were evaluated by Interviews with staff and examination of records.ResultsThe findings, when compared with standards derived from previous recommendations, showed deficiencies in the documentation of incidents (there was no satisfactory written record of physical restraint for 97% of incidents in GPUs and 86% in LDUs), in the training of staff in ‘control and restraint’ procedures (If two or more staff were involved In physical restraint, for 3% of incidents in GPUs and 100% in LDUs, the staff had received no training within the previous 12 months) and in policies for victim support (there was no written policy that included procedures for victim support in relation to 84% of incidents in GPUs and 44% in LDUs).Clinical implicationsTrusts should consider reviewing their policies on the prevention and management of violence, particularly in relation to staff training.

scholarly journals Is the number of new trauma and orthopaedic consultant posts increasing or decreasing?

2017 ◽  
Vol 99 (8) ◽  
pp. 591-593
Author(s):  
S Wilson ◽  
NPM Jain ◽  
DS Johnson
Keyword(s):  
Medical Journal ◽  
British Medical Journal ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Surgical Specialty ◽  
The Mean ◽  
The Uk ◽  
Year 2000 ◽  
Registrar Training

Introduction Trauma and orthopaedics is a popular surgical specialty in the UK. Recent changes to the National Health Service have suggested an imbalance with fewer jobs yet more trainees. Furthermore, subspecialisation is emerging within all surgical disciplines. The aim of this study was to examine whether there were decreasing numbers of trauma and orthopaedic (T&O) consultant appointments in the UK, and to determine the frequency of subspecialisation. Methods All 51 issues of the British Medical Journal (BMJ) careers supplement from the year 2000 were reviewed as well as the 51 issues from 2010. The number of T&O posts, requested subspecialty interests and the number of posts in other surgical specialties were analysed. Results A total of 481 consultant posts in T&O were advertised in the 102 issues of the careers supplements reviewed. Of these, 281 were advertised in 2000 and 200 in 2010. The mean number of posts per issue was 5.5 in 2000 and 3.9 in 2010. In 2000 orthopaedic posts represented 30.5% of all surgical posts while in 2010 this was 37.8%. Under two-thirds (61.6%) of posts requested a specialty interest in 2000 but this increased to 93% in 2010. The greatest increase in named subspecialty was seen in ‘spine’ (from 4.1% to 19.0%.) while ‘general’ had the greatest decrease (from 38.4% to 7.0%). Conclusions UK consultant posts in T&O are decreasing in frequency. Most advertised posts request a subspecialty interest but registrar training focuses on producing ‘generally’ competent orthopaedic consultants. The onus is therefore on fellowships to develop subspecialty interest. As these are not all educationally approved, reconfiguration of fellowships is likely to be necessary.

scholarly journals Fluticasone furoate/Vilanterol 92/22 μg once-a-day vs Beclomethasone dipropionate/ Formoterol 100/6 μg b.i.d.: a 12-week cost analysis in mild-to-moderate asthma

2016 ◽  
Vol 11 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Chiara Distante ◽  
Luca Bonadiman ◽  
Paola Turco ◽  
Sergio Iannazzo
Keyword(s):  
National Health Service ◽  
Lung Function ◽  
Health Service ◽  
Cost Analysis ◽  
National Health ◽  
Beclomethasone Dipropionate ◽  
Fluticasone Furoate ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Asthma is a disease with high cost for the National Health Service. Two of the most recent LABA/ICS combinations for persistent bronchial asthma are Beclomethasone dipropionate/Formoterol (B/F) delivered via the Nexthaler device and Fluticasone furoate/Vilanterol (F/V) delivered via the Ellipta device. No comparison has been carried out yet in terms of cost analysis in asthma, to our knowledge. Aim of the present monocentric, observational, retrospective study was to calculate and compare the costs of mild-to-moderate asthma patients assuming B/F 100/6 μg b.i.d. to those of patients assuming F/V 92/22 μg once-a-day over a 12-week treatment period from the Italian National Health Service perspective. Methods: Data were obtained automatically and anonymously from the institutional database of the Lung Unit of the Specialist Medical Centre (CEMS), Verona, Italy, UNI EN ISO 9001-2008 validated. FEV1 values, number of relapses, healthcare resources as hospitalizations due to asthma relapses, days of hospitalization, general practitioner (GP), specialist visits, and days of inactivity, were recorded over the study period together with the use of extra medications (systemic steroids and antibiotics). In order to compare the outcomes achieved in both groups, the propensity score matching method was used in STATA, and statistical significance was accepted for p < 0.05. Results: Clinical data of 77 patients treated with B/F b.i.d (Group A) and of 40 patients treated with F/V 92/22 μg once-a-day (Group B) were selected. The PS-matching process, designed as matching on the baseline covariates, gender, age, FEV1 and comorbidities, returned a cohort of 40 group A patients of the entire cohort matched with 40 patients of group B, fully comparable for demographics and clinical characteristics. In the PS-matched cohort, the mean (±SE) number of relapses per patient during the follow-up was 0.53 (±0.12) in group A and 0.28 (±0.07) in group B. In group A, n = 25 (62.50 %), n = 9 (22.50 %), and n = 6 (15 %) patients had 0, 1, 2 relapses, respectively. In group B, n=29 (72.50 %), and n = 11 (27.50 %) had 0 and 1 relapse, respectively. Over the study period, the average number of hospitalizations per patient was 0.15 (±0.06), with 0.28 (±0.12) days of hospitalization in group A, and 0.08 (±0.04) with 0.08 (±0.04) days of hospitalization in group B, respectively. The difference between the two groups in terms of FEV1(L) improvement vs baseline was 0.11 in favour of group B (p = 0.007). When results were compared, the improvement in lung function obtained in group B proved significantly higher both in terms of absolute FEV1 and of FEV1 % predicted. The mean (±SE) cost of hospitalizations per patient was € 345.30 (±133.23) in group A and € 172.65 (±98.18) in group B, respectively, with a mean not significant difference of - € 172.65 in favour of group B (p = 0.9). In particular, the mean (±SE) cost for visits per patient was € 26.82 (±3.73) in group A and € 11.36 (±2.30) in group B (p = 0.002), and the mean cost for rescue medications per patient was € 35.24 (±6.93) in group A, and € 18.73 (±3.38) in group B, respectively (p = 0.05). Conclusions: Even if both ICS/LABA combinations were checked over a limited period of time, they seem characterized by a different profile in terms of effect on lung function and economic impact on mild-tomoderate asthma. The once-daily inhalation of combined Fluticasone furoate/Vilanterol 92/22 μg showed the potential for enhanced clinical outcomes and reduced costs when compared to Beclomethasone dipropionate/Formoterol 100/6 μg b.i.d.

scholarly journals Balance Disability After Stroke

2006 ◽  
Vol 86 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Sarah F Tyson ◽  
Marie Hanley ◽  
Jay Chillala ◽  
Andrea Selley ◽  
Raymond C Tallis
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Testing Session ◽  
Anterior Circulation ◽  
Cross Sectional ◽  
Visuospatial Neglect ◽  
The Mean ◽  
First Time ◽  
Different Levels

Abstract Background and Purpose. Balance disability is common after stroke, but there is little detailed information about it. The aims of this study were to investigate the frequency of balance disability; to characterize different levels of disability; and to identify demographics, stroke pathology factors, and impairments associated with balance disability. Subjects. The subjects studied were 75 people with a first-time anterior circulation stroke; 37 subjects were men, the mean age was 71.5 years (SD=12.2), and 46 subjects (61%) had left hemiplegia. Methods. Prospective hospital-based cross-sectional surveys were carried out in 2 British National Health Service trusts. The subjects’ stroke pathology, demographics, balance disability, function, and neurologic impairments were recorded in a single testing session 2 to 4 weeks after stroke. Results. A total of 83% of the subjects (n=62) had a balance disability; of these, 17 (27%) could sit but not stand, 25 (40%) could stand but not step, and 20 (33%) could step and walk but still had limited balance. Subjects with the most severe balance disability had more severe strokes, impairments, and disabilities. Weakness and sensation were associated with balance disability. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability. Discussion and Conclusion. Subjects with the most severe balance disability had the most severe strokes, impairments, and disabilities. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability. [Tyson SF, Hanley M, Chillala J, et al. Balance disability after stroke. Phys Ther. 2006;86:30–38.]

scholarly journals Initial impact of COVID-19 on paediatric spinal services in Scotland

2020 ◽  
Vol 4 (1) ◽  
pp. e000826
Author(s):  
Matthew Newman ◽  
Enrique Garrido ◽  
Athanasios I Tsirikos
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Waiting Time ◽  
National Health ◽  
Spine Deformity ◽  
Mean Waiting Time ◽  
The Mean ◽  
Clinical Appointment

COVID-19 has affected many National Health Service Scotland services. Our aim is to describe this impact on the Scottish National Spine Deformity Service (SNSDS). All referrals to the SNSDS from 1 January 2020 to 30 June 2020 were analysed and compared with the same period in 2019. There was a 64.3% decline in referrals during the pandemic to the SNSDS. The mean waiting time to be seen in first clinical appointment for a new referral was 6.5 weeks in 2020 compared with 10.9 in 2019. There were 60 patients still waiting to be seen at the end of the study period.

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