scholarly journals The National Stroke Strategy – Is it Achievable?

2009 ◽  
Vol 91 (8) ◽  
pp. 641-644 ◽  
Author(s):  
TD Reid ◽  
LJ Finney ◽  
AR Hedges
Keyword(s):  
Education Programme ◽  
Medical Emergency ◽  
Minor Stroke ◽  
Amaurosis Fugax ◽  
Symptomatic Carotid ◽  
Public Response ◽  
Department Of Health ◽  
Mean Waiting Time ◽  
Rapid Access Clinic ◽  
The Uk

INTRODUCTION Timing of intervention in symptomatic carotid disease is critical. The UK Department of Health's National Stroke Strategy published in December 2007 recommends urgent carotid intervention within 48 h, in appropriate patients, who have suffered a transient ischaemic attack (TIA), amaurosis fugax or minor stroke. Despite the running of a rapid-access clinic for patients with symptoms of TIA, the time from symptom to surgery is rarely less than 2 weeks. To date, there has been little published research on the UK public response to the symptoms of TIA, and no study at all of the response of primary care to such patients. The aim of this study was to ascertain both these responses to see whether a 48-h target is achievable. PATIENTS AND METHODS A total of 402 men attending our aortic aneurysm screening sessions were asked to complete a questionnaire requesting their most likely response to an episode of amaurosis fugax or TIA. All 45 GP practices in the hospital catchment area were asked how they would respond to patients requesting to be seen with the symptoms used in the questionnaire. RESULTS Nearly one in six patients would ignore the symptom unless it recurred, approximately half would request a GP appointment and a third would see an optician if they had amaurosis fugax. The mean waiting time to see a GP was 2 days for a routine appointment and within 24 h for an emergency appointment. CONCLUSIONS It is clear that a significant number of people would ignore the first symptom of carotid ischaemia; for those with amaurosis fugax, nearly a third would initially seek help from their optician. Those given a routine GP appointment would have to wait a minimum of 2 days. If the Department of Health is serious about reducing the incidence of stroke and introducing a target of 48 h from symptom to treatment, then there needs to be a wide-spread public and healthcare education programme, in particular alerting opticians and GP receptionists that these symptoms constitute a medical emergency.

scholarly journals New procedures to cut delays in transfer of mentally ill prisoners to hospital

2008 ◽  
Vol 32 (1) ◽  
pp. 20-22 ◽  
Author(s):  
Nigel McKenzie ◽  
Becky Sales
Keyword(s):  
Mentally Ill ◽  
Outcome Measure ◽  
Waiting Times ◽  
Home Office ◽  
Adherence To Medication ◽  
Department Of Health ◽  
Mean Waiting Time ◽  
Before And After ◽  
The Uk ◽  
New Procedures

Aims and MethodWe sought to determine whether new procedures recommended by the UK Department of Health in partnership with the Home Office reduced delays in transferring mentally ill prisoners to hospital. Our main outcome measure was time taken from identification of a prisoner's need for transfer to actual transfer to hospital. Waiting times for transfers that took place during 6-month periods before and after introduction of the new procedures were assessed. We also assessed adherence to medication while awaiting transfer.ResultsThere was a reduction in mean waiting time from 77 days to 53 days (24 days; 95% CI –2 to 50). Approximately 50% of patients offered medication while awaiting transfer were non-adherent.Clinical ImplicationsDespite the new procedures, many individuals with acute mental illness remain untreated in prison for several months while awaiting transfer to hospital. We recommend that time limits should be specified for hospital transfers from prison comparable to norms under civil sections.

scholarly journals Social Sensing of Heatwaves

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3717
Author(s):  
James C. Young ◽  
Rudy Arthur ◽  
Michelle Spruce ◽  
Hywel T. P. Williams
Keyword(s):  
New York ◽  
The United States ◽  
Measured Temperature ◽  
Social Sensing ◽  
Public Response ◽  
Environmental Consequences ◽  
The United Kingdom ◽  
Social Reaction ◽  
Twitter Activity ◽  
The Uk

Heatwaves cause thousands of deaths every year, yet the social impacts of heat are poorly measured. Temperature alone is not sufficient to measure impacts and “heatwaves” are defined differently in different cities/countries. This study used data from the microblogging platform Twitter to detect different scales of response and varying attitudes to heatwaves within the United Kingdom (UK), the United States of America (US) and Australia. At the country scale, the volume of heat-related Twitter activity increased exponentially as temperature increased. The initial social reaction differed between countries, with a larger response to heatwaves elicited from the UK than from Australia, despite the comparatively milder conditions in the UK. Language analysis reveals that the UK user population typically responds with concern for individual wellbeing and discomfort, whereas Australian and US users typically focus on the environmental consequences. At the city scale, differing responses are seen in London, Sydney and New York on governmentally defined heatwave days; sentiment changes predictably in London and New York over a 24-h period, while sentiment is more constant in Sydney. This study shows that social media data can provide robust observations of public response to heat, suggesting that social sensing of heatwaves might be useful for preparedness and mitigation.

scholarly journals Assessment of the quality, content and perceived utility of local maternity guidelines in hospitals in England implementing the saving babies’ lives care bundle to reduce stillbirth

2020 ◽  
Vol 9 (2) ◽  
pp. e000756
Author(s):  
Yu Zhen Lau ◽  
Kate Widdows ◽  
Stephen A Roberts ◽  
Sheher Khizar ◽  
Gillian L Stephen ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Stakeholder Involvement ◽  
Care Bundle ◽  
Intrapartum Care ◽  
National Guidelines ◽  
Department Of Health ◽  
The Uk

IntroductionThe UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies’ Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff.MethodsSeventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions toward and experiences of the use of clinical practice guidelines using a series of Likert scales.ResultsUnit guidelines showed considerable variation in quality with median scores of 50%–58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations.ConclusionTo successfully implement initiatives such as the SBLCB change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations . In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.

The NACPDE: new opportunities for dentists trained overseas

2009 ◽  
Vol 91 (8) ◽  
pp. 283-283 ◽  
Author(s):  
Margaret Wilson
Keyword(s):  
Royal College ◽  
Clinical Training ◽  
Dental Education ◽  
Postgraduate Education ◽  
Dental Surgery ◽  
Department Of Health ◽  
The World ◽  
The Uk

The National Advice Centre for Postgraduate Dental Education (NACPDE) was founded in 1978 and is based in the Faculty of Dental Surgery of The Royal College of Surgeons of England and funded by the Department of Health. The UK has traditionally played an important part in providing clinical training and postgraduate education for dentists from all parts of the world. But it is equally important to recognise the contribution oversea-strained dentists have made to the NHS.

scholarly journals The International Fellowship Scheme for consultant psychiatrists: trainees' perspective

2006 ◽  
Vol 30 (6) ◽  
pp. 229-231 ◽  
Author(s):  
Sanju George ◽  
Bill Calthorpe ◽  
Sudhir Khandelwal
Keyword(s):  
Royal College ◽  
Home Country ◽  
Department Of Health ◽  
Job Opportunities ◽  
International Fellowship ◽  
The Uk

The NHS International Fellowship Scheme for consultants offers overseas consultants, in specialties including psychiatry, an opportunity to work in the UK (Goldberg, 2003). This was launched by the Department of Health in 2002 and so far over 100 consultant psychiatrists have been recruited. However, there are several aspects of the project that are unclear. How long will this recruitment continue? Are there any arrangements in place to encourage overseas consultants to return to their home country at the end of their fellowship? Are they eligible to train senior house officers (SHOs) and specialist registrars (SpRs)? Will the recruitment under the scheme have an impact on job opportunities for SpRs currently training in the UK? Why is membership of the Royal College of Psychiatrists being granted to the newly recruited consultants without an examination? These and many more concerns have arisen in the wake of this scheme. In this article, we evaluate the scheme, discuss its implications and suggest possible ways forward.

A lack of foresight? Jurisdictional uncertainties in the regulatory interface between the HFEA, the UK Stem Cell Bank and beyond

Legal Studies ◽  
2007 ◽  
Vol 27 (3) ◽  
pp. 511-535 ◽  
Author(s):  
Ryan Morgan
Keyword(s):  
Embryonic Stem ◽  
Embryo Research ◽  
Es Cell ◽  
Statutory Interpretation ◽  
Cell Bank ◽  
Human Fertilisation ◽  
Department Of Health ◽  
Regulatory Architecture ◽  
Policy Objectives ◽  
The Uk

Much of the legal attention surrounding human embryonic stem (ES) cell research within the UK has, to date, focused on cloning techniques. Whilst this is both understandable and appropriate given litigation on this topic, there has been less focus on other areas. This paper identifies and analyses areas of incoherence and deficiency within the regulatory architecture governing human ES cell derivation and research within the UK. This is not merely a theoretical exercise, as there are indications that many of the policy objectives currently being pursued in this area have, at best, a shaky jurisdictional basis. It is all too easy to recall that lobby groups have challenged the Human Fertilisation and Embryology Act 1990, the legislative foundation for embryo research and most infertility treatment, on the basis of jurisdictional uncertainty and statutory interpretation. Whilst many pro-life campaigners are opposed to ES cell research on ethical grounds, the arguments utilised thus far in relation to litigation have been entirely legal, involving issues of statutory interpretation and whether the regulator, the Human Fertilisation and Embryology Authority (HFEA), or the Department of Health have acted ultra vires the 1990 Act. This paper will reveal that there are a number of further areas which might be open to attack on this basis.

Abstract 202: Cost-effectiveness Of Carotid Stenting In Canada

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mohammed Almekhlafi ◽  
Fiona Clement ◽  
Michael D Hill
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Carotid Stenting ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Minor Stroke ◽  
System Perspective ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Procedural Costs

BACKGROUND To estimate the cost-effectiveness of carotid stenting (CAS) compared to endarterectomy (CEA) in symptomatic patients. METHODS A cost-utility analysis from the Canadian health system perspective was performed using a Markov analytic model. Clinical estimates were based on a recent meta-analysis. Procedural costs for CAS and CEA were derived from a local cohort. The costs for hospitalization and rehabilitation for minor and major strokes were based on the Burden of Ischemic Stroke (BURST) study. Utility scores were based on SAPPHIRE trial. A Monte Carlo simulation using a hypothetical cohort of 10,000 and sensitivity analyses were performed to investigate the model assumptions and uncertainties. RESULTS CAS was more expensive (incremental cost of $6106.84) and had a lower effectiveness (- 0.12 QALYs). The model was sensitive to the risk of annual death. At a threshold odds ratio (OR) of 0.85, CAS was associated with an incremental cost-effectiveness ratio (ICER) of $32,839.04. Using estimates from SAPPHIRE trial, CAS dominated CEA. When estimates from CREST or EVA-3S trials were used, CEA dominated CAS. Only after simultaneously reducing CAS costs and risks of periprocedural and annual minor strokes, CAS had a favorable ICER. This was achieved at a threshold CAS procedural cost of $4350, a threshold OR of periprocedural minor stroke of 1, and a threshold OR of annual minor stroke of 1.15or less; resulting in an ICER of $577.5. The figure shows CAS cost-effectiveness plane. CONCLUSIONS In this analysis, CAS was associated with higher costs and lower effectiveness compared to CEA in symptomatic carotid stenosis patients. The results were driven by the costs of periprocedural major and minor stroke. The costs associated with MI did not impact the results. For CAS to be more effective, it needs to be performed in patients with longer survival, in patients at a high surgical-risk, or at a lower procedural costs plus lower rates of periprocedural and annual minor strokes.

scholarly journals The College: an analysis of members' views

1999 ◽  
Vol 23 (1) ◽  
pp. 11-15 ◽  
Author(s):  
R. E. Kendell ◽  
R. Duffett
Keyword(s):  
British Journal ◽  
Random Sample ◽  
Response Rate ◽  
Education And Training ◽  
Republic Of Ireland ◽  
Department Of Health ◽  
The Republic ◽  
Large Random Sample ◽  
The Uk ◽  
And Training

Aims and methodIn November 1997 a questionnaire was sent to a large random sample of members, fellows, affiliates and inceptors living in the UK or the Republic of Ireland.ResultsOne thousand four hundred and seventy-six completed questionnaires were available for analysis, a response rate of 63%. The College was complemented for raising standards of education and training in psychiatry and criticised for not trying hard enough, or failing, to influence the policies of the Department of Health. A high proportion of respondents highly valued the British Journal of Psychiatry and Psychiatric Bulletin but few made use of the library. A high percentage of Irish, Welsh and Scottish members, and of members of the five smaller faculties, participated in and expressed their appreciation of the activities of the College.ImplicationsWhatever its other failings the College is not dominated by general psychiatrists and their interests, or by London-based psychiatrists. It is surprisingly successful at involving Scottish, Welsh and Irish psychiatrists, and members of the smaller faculties, in its activities. To some extent, however, the faculties are thriving at the expense of the English divisions.

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