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Background: There is a limited amount of research assessing the effectiveness of group therapy on acute inpatient psychiatric wards, and mixed results from research assessing inpatient psychological therapies in general. Previous studies highlight challenges for conducting research on psychiatric inpatient hospitals, such as short admissions, high patient turnover, engagement challenges, acuteness of illness, overmedication and feelings of stigma and disempowerment. Aims: This service evaluation aims to assess whether weekly ward‐based interpersonal group therapy reduces short‐term psychological distress for women on an acute psychiatric inpatient ward in inner‐city London (Tower Hamlets), UK. Methods: This service evaluation compared psychological distress, as measured by the Clinical Outcomes in Routine Evaluation 10 (CORE‐10), pre‐ and post‐intervention for women attending a weekly ward‐based interpersonal therapy group between February 2023 and August 2023. Results: There were 46 participants included in the analysis. There was an 11.3% decrease in the mean CORE‐10 score post‐intervention. Four (9%) patients exhibited significant and reliable change (i.e. short‐term psychological distress reduced to a 'healthy' level). A further three (7%) patients exhibited no significant change. Short‐term psychological distress did not significantly deteriorate for any patients who attended the ward‐based interpersonal therapy group. Conclusion: It is feasible to collect pre‐ and post‐outcome data to assess psychological distress following a weekly ward‐based interpersonal therapy group over a 6‐month period, which meet acceptable a priori sample size calculations. The group appears to have an immediate positive impact for the majority (95%) of patients where short‐term psychological distress reduced or stayed the same; however, this was only significant for 16% of patients. It would be important to collect qualitative data, ideally using multiple methods or data sources for triangulation, in order to corroborate and strengthen the current findings. Practitioners cannot rely solely on the results of this study to demonstrate effectiveness of psychotherapeutic group interventions in acute inpatient settings. [ABSTRACT FROM AUTHOR]

Objective: In the West Midlands regional genetics service, cases of perinatal death with a possible genetic diagnosis are evaluated by the perinatal pathology genetic multidisciplinary team (MDT). The MDT assesses autopsy findings and suggests appropriate genomic assessment. The objective of this retrospective service evaluation was to determine the clinical utility of the MDT in assessing perinatal deaths associated with structural anomaly. This is the first evaluation since the introduction of whole‐genome and whole‐exome sequencing in routine clinical care. Methods: This was a retrospective service evaluation including all cases of perinatal death with an associated structural anomaly and suspected genetic etiology that underwent perinatal MDT assessment between January and December 2021. All cases received a full or partial postmortem examination and at least a chromosomal microarray analysis. Demographic characteristics, phenotype, genotype, MDT recommendations, diagnoses, outcomes and impact of postmortem analysis and genetic testing data were collected from patient case notes. Results: Overall, 123 cases were discussed at the MDT meetings in 2021. Genetic evaluation was recommended in 84 cases and accepted in 64 cases. A range of genetic tests were requested according to indication and availability. Thirty diagnoses were made in 29 cases from 26 unrelated families. The diagnostic yield was 24% (29/123) in all cases or 45% (29/64) in cases with a suspected genetic diagnosis who underwent genetic testing. Postmortem examination provided clinically actionable phenotypic data in 79% of cases. A genetic diagnosis enabled accurate recurrence risk counseling and provision of appropriate follow‐up, including prenatal testing and preimplantation diagnosis for patients with inherited conditions. Conclusions: Genomic testing was a clinically useful addition to (but not a substitute for) postmortem examination in cases of perinatal death associated with structural anomaly. The MDT approach helped assess cases and plan appropriate follow‐up. Expedited whole‐genome sequencing or panel‐agnostic analysis were most appropriate for heterogeneous presentations. This broad approach can also expand knowledge of prenatal phenotypes and detect novel disease genes, and should be a priority in future research. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is vital to improve the mental health (MH) of young people in Hong Kong, where the suicide rate has nearly doubled among those aged 15‐29 years since 2014. This multi‐method evaluation aimed to assess Coolminds, which promoted MH literacy by engaging students, parents, and educators in secondary schools in Hong Kong. METHODS: Students, parents, and teachers completed self‐report measures before and after attending workshops aimed at raising MH literacy. Pre‐ and post‐survey data were collected between November 2021 and August 2022. Qualitative data from participant feedback and a focus group interview with Coolminds staff were analyzed using descriptive content analysis. RESULTS: The final dataset included 2903 students, 395 parents, and 325 educators from 52 schools. Only 3 schools had engagement with all 3 key groups. Significant improvements in MH knowledge were observed after the Coolminds workshops for all 3 groups. Qualitative analysis identified a reactive approach to MH issues, and bureaucratic and logistical challenges as barriers to implementation. CONCLUSION: Findings support the effectiveness of the Coolminds curriculum in improving MH literacy for each group and the demand for MH promotions in school settings. The implementation challenges indicate the need for future initiatives to better align with local needs and practices. [ABSTRACT FROM AUTHOR]

Summary: Scaled interventions are required to address levels of overweight and obesity and reduce health inequalities. Little data is available on the effectiveness of community weight management programmes for participants self‐selecting to attend across different socio‐economic backgrounds. This analysis investigates 3, 6, and 12‐month outcomes of adults joining a real‐life community weight management programme. Weight, attendance and Indices of Multiple Deprivation (IMD) data from all fee‐paying adults joining Slimming World in 2016 were collated. Data were analysed using descriptive and inferential statistics to determine predictors of weight loss. Mean BMI of 1 094 676 adults (7.6% male) was 33.0 ± 6.4 kg/m2. Mean % weight change at 3, 6, and 12 months was −5.0% ± 3.6%, −5.9% ± 5.2%, and −6.0% ± 5.8%. Those attending 75% sessions achieved greater weight loss with mean weight losses at 3, 6, and 12‐months of 7.7% ± 3.3%, 11.3% ± 5.2%, and 14.1% ± 7.5%, respectively. Effect sizes from comparison of weight change between deprivation deciles were negligible, with similar outcomes in the most and least deprived deciles at 12‐months (−5.7% ± 5.9% vs. −6.2% ± 5.9%). This service evaluation of more than 1 million adults attending a community weight management programme found they were able to achieve and/or maintain an average 6% weight loss at 12 months, with high attenders achieving >14% loss. Men and those with higher levels of deprivation were accessing the support and achieving significant weight losses. Slimming World as a real‐life, scalable weight management programme is well placed to help adults manage their weight and address health inequalities. [ABSTRACT FROM AUTHOR]

Background: Critical illness survival rates have improved, but patients frequently face prolonged new or worsened physical, cognitive and psychosocial impairments. These difficulties associated with critical care admission are known as post-intensive care syndrome (PICS). Aims: The multidisciplinary Intensive care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme was developed to support patients in the recovery period from critical illness. During the COVID-19 pandemic, the psychology support offered by this service was adapted from an in-person group to individual remote review. This audit evaluated both the extent to which this input aligned with the recommended guidelines and the acceptability of this adapted delivery to this patient group, which could help guide post-pandemic psychology input to the service. Study Design: The records of 207 patients were analysed retrospectively. The nature of support offered to a sub-sample of 50 patients detailed in clinical summary letters was compared with the Faculty of Intensive Care Medicine (2019) guidelines. Telephone calls were made to gather feedback on the virtual psychology support from 10 patients. Results: Psychological difficulties were identified by 111 of the 207 patients who attended the virtual clinic. A total of 88 of these patients accepted referral for virtual psychology support and 67 (76%) of those patients attended. The virtual psychology support offered was found to be largely in accordance with ICU aftercare guidance and acceptable to patients. Patients found the summary letters of consultations accurate and helpful. Most patients expressed a preference for in-person support and the opportunity to meet other patients. Conclusions: The adaptations to the psychology support offered by InS:PIRE during the COVID-19 pandemic were found to be largely in line with ICU aftercare psychology guidelines and were acceptable to patients. Further research is needed on future methods of delivering psychology support for this patient group. Relevance to Clinical Practice: This audit highlights issues important to patients in the post-ICU period based on individual consultations not previously possible. Patient opinion was sought on the impact of changing the delivery of post-ICU psychological support, which will help guide future improvements in the service. [ABSTRACT FROM AUTHOR]

Aims: In 2018 the National Institute of Health and Care Research, United Kingdom, launched a 3‐year Senior Nurse and Midwife Research Leader Programme to support nurse and midwifery research leaders to develop research capacity and capability within NHS organisations. We report the results of a service evaluation of the programme strengths, areas for improvement and achievement of programme aims. Design: Partially mixed, concurrent mixed methods programme evaluation, including: (a) meeting evaluation (survey), (b) annual evaluation (survey) and (c) qualitative stakeholder interviews. Methods: Survey results were quantitatively analysed using descriptive statistics. Interviews were audio‐recorded, transcribed, deductively coded using elements within the logic model and analysed using the seven‐stage framework analysis method. Results: Satisfaction with the programme was high (75%). The main perceived benefit of the programme was being part of a network. Challenges included accessing learning resources, lack of opportunity to network and lack of clarity about the programme aims. Meetings were evaluated as relevant and helpful (mean 93%), thought‐provoking (92%), inspiring (91%), at the appropriate level (91%) and aligned with the programme aims (90%). All meetings were ranked as highly beneficial by attendees (92%). Stakeholder feedback on the programme success reflected the importance of leadership, the programme design and content, 'connection and community' and communication with and about the cohort. Overall, the anticipated programme aims were met, evaluating well from both the perspective of those on the programme and the wider stakeholder group. There has been a lack of investment in schemes to support research leadership development for nurses/midwives. A novel programme to support nursing/midwifery research leadership was positively evaluated. The programme is a useful model to support future capacity and capability building for nurses/midwives. The work is reported with reference to the SQUIRE 2 and SRQR checklists. No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: In England, court‐based mental health liaison and diversion (L&D) services work across courts and police stations to support those with severe mental illness and other vulnerabilities. However, the evidence around how such services support those with neurodevelopmental disorders (NDs) is limited. Aims: This study aimed to evaluate, through the lens of court and clinical staff, the introduction of a L&D service for defendants with NDs, designed to complement the existing L&D service. Methods: A realist evaluation was undertaken involving multiple agencies based within an inner‐city Magistrates' Court in London, England. We developed a logic model based on the initial programme theory focusing on component parts of the new enhanced service, specifically training, screening, signposting and interventions. We conducted semi‐structured interviews with the court staff, judiciary and clinicians from the L&D service. Results: The L&D service for defendants with NDs was successful in identifying and supporting the needs of those defendants. Benefits of this service included knowledge sharing, awareness raising and promoting good practice such as making reasonable adjustments. However, there were challenges for the court practitioners and clinicians in finding and accessing local specialist community services. Conclusion: A L&D service developed for defendants with NDs is feasible and beneficial to staff and clinicians who worked in the court setting leading to good practice being in place for the defendants. Going forward, a local care pathway would need to be agreed between commissioners and stakeholders including the judiciary to ensure timely and equitable access to local services by both defendants and practitioners working across diversion services for individuals with NDs. [ABSTRACT FROM AUTHOR]

Background: As a result of the complex nature of neurosurgical patients, nasogastric (NG) tube feeding is often implemented for patients who are unable to consume adequate oral intake. During recovery, patients on enteral nutrition (EN) are progressed to oral nutrition, which can result in NGT removal and discontinuation of supportive feeding plans. This is often before patients become established on sufficient oral intake to meet their nutritional requirements. Methods: We conducted an exploration of current NG removal practices in patients (n = 23) across five neurosurgical wards over a 3‐month period to assess practitioner review response times, NG feeding duration, decision making on NG removal, and the influence of dietary recommendations and differing EN protocols on patients' ability to meet their nutritional requirements. Our aim was to use this data to design and implement a protocol to improve consistency of these practices. Results: After oral intake was commenced, only those receiving supplementary EN achieved nutritional targets immediately. Conversely, no patient who had their NGT removed at this stage achieved these targets. Following NG removal, the likelihood of a patient meeting nutritional targets was influenced by the decision maker, supporting the practice of registered dietitian led cessation of NG feeding. These findings led us to develop an "NG Transition Feeding Protocol" to serve as a simple, clear pathway which treating teams can utilise to guide NG feeding decisions. Conclusions: NG feeding supports neurosurgical patients to meet nutritional requirements in the early stages following commencement of oral intake. The development of an "NG Transition Feeding Protocol" may help to improve consistency of transition feeding on neurosurgical wards, allowing time for nutrition assessment to support informed decisions around NG removal. The aim of this protocol is to improve the efficiency of transition feeding, improve dietetic workload efficiency, nursing staff confidence and avoid compromising nutritional status of patients as a result of the early cessation of EN. Key points: We found that once oral nutritional intake was commenced, only those receiving supplementary supplementary nasogastric (NG) feeding were able to meet their nutritional targets in the early stages of dietary reintroduction. Conversely, no patient who had their NG tube removed immediately after the commencement of oral intake met these targets; therefore, premature NG removal risks compromising nutritional status of patients unnecessarily.We observed that following NG removal, the likelihood of a patient meeting nutritional targets was influenced by the decision maker, supporting the practice of registered dietitian‐led cessation of NG feeding.In cases where this did not occur, we found that unclear decision making on who has designated responsibility for NG removal can result in inconsistencies in practice, potentially leading to confusion between multidisciplinary team members about these roles.Our findings have helped define a clear multidisciplinary pathway between speech and language therapist, registered dietitians and nursing colleagues to optimise nutrition support for patients in this setting. The development of an "NG Transition Feeding Protocol" might help to improve consistency of transition feeding on the neurosurgical wards, allowing adequate time for formal nutrition assessment to support informed decisions around NG removal.Our hope is that this protocol will improve the efficiency of transition, which in turn may improve dietetic workload efficiency, nursing staff confidence regarding decision making and avoid compromising nutritional status of patients as a result of the early cessation of enteral feeding. [ABSTRACT FROM AUTHOR]

This research investigates consumers' perceptions and evaluations of robot service agents compared with human service agents when service requests are rejected. Six studies were conducted. The results show that when consumers receive a rejection of their service request, they evaluate the service less negatively if the service is handled by a chatbot agent versus a human agent. The reason is that consumers have lower expectations that robots will be able to provide flexible services to them. Consequently, their dissatisfaction with the request rejection is lower when the service is handled by robots. However, the aforementioned effect is not observed (1) when consumers have not experienced the service yet, (2) when their service request has been accepted, or (3) when the service agent conveys emotions to apologize for request rejection. [ABSTRACT FROM AUTHOR]

Background: Mobilization is a key component in the recovery of those admitted to critical care. However, previous research has demonstrated challenges in the implementation of mobilization within critical care, including staff knowledge, attitudes, and behaviours. Aim: The aim of the current study was to explore the perceived barriers and limitations to mobilization from the perspective of nursing staff, and to compare these with physiotherapists. Study Design: Single‐site service evaluation utilizing the patient mobilizations attitudes and beliefs survey for ICU and locally developed barriers to rehabilitation questionnaire. Results: About 135 participants (126 nurses and 9 physiotherapists) were invited to anonymously complete the questionnaires (either paper or electronic), with a response rate of 73.0% (n = 92) for nursing staff and 100% for physiotherapists. Nursing staff reported significantly higher perceived barriers to rehabilitation on both questionnaires when compared with physiotherapy staff, which was not associated with years of experience within critical care. Behavioural barriers were most frequent in both professions which included items such as time availability and presence of perceived contra‐indications to mobilization. Conclusion: Nursing staff reported greater perceived barriers to rehabilitation when compared with physiotherapists. Further quality improvement projects are now required to reduce these barriers and assist the implementation of mobilization as part of the rehabilitation process. Relevance to Clinical Practice: Rehabilitation is an essential element of practice within critical care. Understanding the system, local and personal barriers will allow for improvement projects to enhance the delivery of care and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Aim: The management of dentoalveolar procedures under general anaesthetic has been a widespread challenge recently. The establishment and implementation of an advanced sedation service within the oral surgery department at Liverpool University Dental Hospital offered a potential alternative to managing those awaiting procedures. A comprehensive service evaluation aimed to demonstrate that patients previously considered for general anaesthetic could be safely and efficiently managed with an advanced sedation service. Materials and Methods: The service evaluation employed mixed methods; a data collection tool captured procedural demographics retrospectively whilst a patient‐reported outcome measure (PROM) was designed to engage patients regarding their experience. Results: The service evaluation highlighted that 27% of patients previously listed for general anaesthetic were managed with local anaesthetic or conscious sedation alone. The sedation outcomes demonstrated that all patients were co‐operative and achieved an optimal level of sedation. No adverse sedation outcomes were recorded. Patient‐reported outcomes were positive with 100% rating it as an excellent service. Conclusions: The use of an advanced sedation service has demonstrated successful outcomes and reduced reliance on theatre resources. The use of polypharmacy; midazolam and propofol, provides a safe, effective and efficient modality to perform complex procedures in an outpatient hospital setting. Advanced sedation techniques can be particularly effective in the management of complex procedures, dental anxiety and in adolescent and medically complex patients. Patient engagement supports the service as an effective option for delivering quality care. [ABSTRACT FROM AUTHOR]

Introduction: Centralisation of head and neck surgical services means that patients in regional and remote Australia need to travel long distances for treatment and follow‐up, imparting a significant financial burden on patients and the health system. Objective: To estimate costs of travel to local outreach clinics and determine potential cost savings to patients and the health system by avoiding patient travel to major cities for head and neck surgical care. Design: Retrospective audit of three head and neck surgery outreach clinics in New South Wales, Australia over 4 years (2017–2020). Direct costs of travel from a patient's residence to their local outreach clinic were estimated. Costs of travel and accommodation to Sydney for an appointment were calculated for different travel modes. Estimated reimbursements for travel through government support schemes were calculated based on published rates. Findings: Some 657 patients attended the three clinics, accounting for 1981 appointments. Depending on mode of travel, the estimated median cost of return travel (including accommodation) to Sydney was $379 to $739 per patient per trip and the median government reimbursement ranged from $182 to $279 per trip. In comparison, the cost of return travel by car to local outreach clinics ranged from $28 to $163 per appointment. Outreach clinics were estimated to save patients a median of $285 per trip and avoided government reimbursements of $215 per trip. Discussion: Despite uptake in telehealth, outreach medical services remain an important asset for people living in regional areas to address inequities in access. However, the cost benefits are likely to be underestimated as our approach did not account for indirect costs associated with travel. Conclusion: Outreach head and neck surgical services located in regional areas can reduce the financial burden on both patients and the healthcare system. Greater investment in outreach clinics could ensure sustainability of services to promote equitable access to specialised surgical services. [ABSTRACT FROM AUTHOR]

Objectives: (1) Generate emperical knowledge of a Musculoskeletal (MSK) Advanced Practice Physiotherapist (APP) Service in Scottish Primary Care; (2) Identify the incidence and baseline time to diagnosis of Axial Spondyloarthropathy (AxSpA); (3) Identify APP Rheumatology referral fulfilment of the NICE 2017 Guidelines and Spondylarthritis Diagnosis Evaluation (SPADE) Tool; (4) Calculate APP Rheumatology referral conversion rates for AxSpA diagnosis and further investigation; (5) Contribute towards the current body of literature for informing analysis of MSK APP services within Scottish Primary Care. Methods: An audit and evaluation approach was undertaken over a 3‐year period (May 2019–April 2022). Relevant clinical cases from the whole‐service data‐set were identified and analysed, using retrospective electronic healthcare record review and descriptive statistical techniques. Results: A total of 37,656 primary care MSK APP consultations took place, with N = 19 suspected AxSpA referrals made to Rheumatology. N = 6 cases of AxSpA were diagnosed by a Rheumatologist (31.6%). The mean age of individuals diagnosed with AxSpA was 39.6 ± 8.8, and 66.7% (4/6) were female. Mean time to diagnosis was 3.4 years, and incidence per‐10,000 person‐years was 1.6. Compliance of referrals with the NICE 2017 Guidelines and SPADE Tool Criteria was 78.9%. Of those diagnosed with AxSpA, 66.7% met both referral criterion sets. Conclusion: Those referred by an MSK APP from primary care had a 5.1 year shorter time to diagnosis than the previous reported UK average of 8.5 years. APPs identified relevant AxSpA features in referring to Rheumatology, and supported effective implementation of the local secondary care pathway. [ABSTRACT FROM AUTHOR]

Background: Post‐COVID Syndrome (also known as Long COVID) refers to the multi‐system condition affecting individuals following COVID‐19 infection. This can include speech and language therapy (SLT) needs, including voice, swallowing, communication and upper airway difficulties. There is limited published literature in this clinical area of practice, particularly for those receiving input from community SLT services. Aims: To describe and compare demand, typical SLT presentation and service delivery across two National Health Service (NHS) Long COVID multidisciplinary services. Independent retrospective service evaluation was completed for each service. Descriptive statistics were produced and compared across services. This service evaluation followed The Strengthening the Reporting of Observation Studies in Epidemiology guidelines for cohort studies. Outcomes & Results: The findings indicated similarities across the two services in SLT service need and demand, clinical presentations and intervention approaches provided within Long COVID services. There were specific differences in the service provision and delivery of intervention in cognitive communication and upper airways subspecialities. Conclusions & Implications: This study highlights the clinical complexities of SLT needs in individuals with Long COVID and the importance for an appropriately skilled and supported workforce within effective multidisciplinary teams. We call for consensus on SLT practices and a consistent and standardized approach to evaluation for SLT needs in Long COVID. WHAT THIS PAPER ADDS: What is already known on this subject: SLT needs, including voice, swallowing, communication and upper airway difficulties, are present in individuals presenting with Long COVID, both in those who were or were not hospitalized. SLTs are seeing such individuals in a variety of settings, including community services and Long COVID multidisciplinary teams. There is minimal evidence of the clinical presentations and interventions provided to individuals with SLT needs compared across Long COVID services. What this study adds to existing knowledge: This study compares two NHS Long COVID services providing a SLT service pathway. It highlights the similarities and differences in service demand and capacity, patient presentation, and SLT intervention to make suggestions for future practice consideration and priority evaluation. Expert consensus among SLT clinicians is a priority to ensure clinicians are delivering consistent and equitable care for patients, while new evidence and data emerge. A consistent and standardized approach to data collection and outcome measures is essential to ensure future research captures the impact and value of SLT input with individuals with Long COVID. What are the clinical implications of this work?: The complexities and multifactorial SLT needs of individual with Long COVID call for appropriate SLT staffing provision, skill and training to fulfil the needs of this population. Speech and language therapists should be integrated with multidisciplinary Long COVID services to provide holistic care for patients and to support the professionals working with individuals with post‐COVID voice, swallowing, communication and upper airway symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic resulted in a rapid shift to telehealth implementation across paediatric occupational therapy services. Although telehealth can be an appealing option, access is conditional, and the delivery of a telehealth service differs from face‐to‐face. If telehealth is to be a viable and equitable option for families, insight is needed into why the service might be declined. The purpose of our study was to explore barriers to paediatric occupational therapy telehealth services from client and therapist perspectives in a Greater Sydney local health district. Method: A mixed method approach was used, including (i) retrospective review of clinical records for 250 clients seeking occupational therapy who declined the service and (ii) a focus group with four therapists providing the service. Client demographic information was summarised using descriptive statistics. Open‐text responses about reasons for declining telehealth were analysed using qualitative content analysis, whereas thematic analysis was used to explore focus group data. Findings: Key findings from the mixed methods analysis identified barriers and issues to consider when working to ensure equitable access to telehealth for children and families. These issues included child engagement, family complexity, the nature of assessments, interventions, and overarching service characteristics as well as the family's digital inclusion. Digital inclusion comprises affordable access to the internet, data, and devices and the capacity of a child and/or family to engage online. Conclusion: Our findings suggest that telehealth is not a panacea when face‐to‐face services are not available. Multiple barriers confounded uptake of telehealth prompting a call to action to ensure equitable access to occupational therapy services for all children. [ABSTRACT FROM AUTHOR]

In this paper, we present and reflect upon the process of evaluating two residential mental health facilities in Thessaloniki, Greece, through the WHO QualityRights tool kit. The QualityRights tool kit is a structured process for assessing quality of care and human rights in mental health and social care facilities, in accordance with the United Nations Convention on the Rights of Persons with Disabilities (CRPD), introduced by the World Health Organization in 2012. We have piloted the use of the Toolkit in two supported accommodation facilities, a hostel and a service supervising independent living in apartments, for individuals with long‐term severe mental health problems in the region of Thessaloniki. In this paper, we present the methodology and process of evaluating the facilities, including the challenges posed to the evaluation process by restrictions due to the Covid‐19 pandemic. We showcase the outcome of this evaluation through presenting a summary of the results and the ensuing recommendations for improvement. Finally, we reflect on the usefulness, appropriateness and relevance of the Toolkit for evaluating mental health care facilities in the particular context of contemporary Greece. [ABSTRACT FROM AUTHOR]

Employment is frequently desired by persons who experience homelessness yet is often elusive. Little is known about the range and effectiveness of employment‐based interventions evaluated in existing literature on key psychosocial outcomes including employment participation, mental well‐being, housing tenure, community integration and substance use. To identify and synthesise existing studies, we conducted a systematic review of effectiveness using the methodology proposed by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Following the removal of duplicates, we screened 13,398 titles and abstracts, and reviewed 79 studies at the full‐text review stage using two independent raters. A total of 16 studies met criteria for inclusion in a narrative synthesis and were subjected to critical appraisal. The majority of studies were conducted in the US (n = 14; 87.5%) with other studies published in Canada (n = 1; 6.3%) and Australia (n = 1; 6.3%). Interventions evaluated in existing studies included combined substance use and vocational skills interventions (n = 7; 43.8%), supported employment (n = 6; 37.5%), and integrated supports including an employment component (n = 3; 18.8%). The effectiveness of these interventions on employment, mental well‐being, housing tenure, community integration, and substance use is presented. Findings suggest that research evaluating employment interventions for persons who experience homelessness is in an early stage of development. Researchers and practitioners may consider collaborating with persons with lived experiences of homelessness and practitioners in co‐designing and modifying existing approaches to target key outcomes more effectively. Policymakers may consider allocating resources to such initiatives to further the development of practice and research aimed at supporting persons who experience homelessness to secure and sustain employment during and following homelessness. [ABSTRACT FROM AUTHOR]

Rationale: This service evaluation details the process of introducing Single Session Therapy (SST) with families to a Child and Adolescent Mental Health Service in the United Kingdom. SST is a model of short-term psychotherapy intervention which can be applied to family contexts to provide timely mental health support., Aims and Objectives: This service evaluation had two objectives: (1) Review the existing evidence base and literature for SST. (2) Evaluate the implementation of a new SST treatment pathway in CAMHS, including patient experiences and satisfaction with the service., Method: SQUIRE Guidelines are used to report on this new knowledge of healthcare. This evaluation used qualitative methods to evaluate the impact of the new service. The team also used existing frameworks within the Trust, namely discharge data, which is collected routinely as part of service evaluation., Results: This evaluation suggests positive support for this model, and that many families appreciate and value the opportunity to build on strengths and work toward their goals as families. This project outcome appears to support some of Talmon's (1990) findings that the most commonly attended number of sessions is one, and that of those who attended only one session, many perceived the session as useful. Waiting times for our service are extremely long. The pace and structure around goals and solutions could feel both galvanising, as some reported, but others felt it was an insufficient response to the severity of their difficulties., Conclusion: More high-quality research is needed before judgments can be made around the cost-effectiveness or efficacy of SST over existing approaches in the United Kingdom. While implementing SST should not be used to justify reduction in existing interventions, it offers a positive additional service for young people experiencing mental health difficulties and their families., (© 2024 John Wiley & Sons Ltd.)

Objectives: The aim of this evaluation was to review service outcomes for a spinal advanced practitioner physiotherapy (APP) triage service during COVID‐19. The evaluation compares outcomes gathered against pre‐pandemic data and evaluates the impact of the pandemic on service delivery. Design: Service‐level data were extracted between 2019 and 2021 including: total referrals, new and follow‐up appointments, telehealth consultation rates, discharges at first appointment, magnetic resonance imaging and injection request rates. Multidisciplinary‐team (MDT) meeting notes with Spinal Surgeons were reviewed and surgical conversion calculated. Patient satisfaction data were collated using: Friends and Family test, specific questionnaires, individual and formal complaints and compliments, and telephone surveys. Analysis was performed by the lead author and results were compared between years using analysis of variance, as well as with previously reported data. Setting: 'Nottingham University Hospitals' National Health Services Trust is a secondary care spinal unit, using APPs to triage, assess and manage spinal conditions. Results: In 2020, 407 (22%; p = 0.02) less patients were referred to the service, however, there was a significant increase in the number of telehealth attendances (mean = 50% in 2020 from 2019, p = 0.005). Only 13% (n = 1342) patients were discussed at MDT, of which 8% (n = 808) were discussed for surgical consideration, and 36% (n = 268) were directly listed. High levels of patient satisfaction were reported by 89% (n = 1028 of 1160) patients. Conclusion: This service evaluation demonstrates a statistically significant change in numbers of patients referred and telehealth attendances in the year of the pandemic (2020). Surgical conversion declined during the pandemic, and did not recover post‐pandemic. [ABSTRACT FROM AUTHOR]

Attrition from clinical interventions targeting underserved populations is a substantive challenge to achieving optimal health outcomes. Our nationally recognised enriched medical home intervention (EMHI) utilised community health worker home visitation to improve health outcomes of children by engaging the entire family and removing barriers to care‐seeking. Families were enrolled into the program between 2013 and 2016, and, as part of the evaluation of the program's success, we identified predictors of program completion by conducting a secondary analysis of 304 families participating in the EMHI evaluation research. Program completers finished participation in the EMHI with mutual agreement that the family can independently follow recommended care. Program non‐completers were either lost to follow‐up or dropped out before reaching this milestone. Data were collected using electronic medical records and validated self‐report surveys to assess constructs such as social support, mental health difficulties and neighbourhood characteristics. The EMHI participants were primarily families with infants <24 months old, Medicaid‐insured and Latino. In the multivariable logistic regression model, EMHI program factors as well as community factors independently predicted program continuation and retention. Specifically, families learning about newborn care or with preferred spoken language Spanish were more likely to complete the program. Participants reporting neighbourhood distrust had a greater likelihood of non‐completion than others. Results underscore the importance of cultural competency and community involvement in program design and dissemination. Our findings are applicable to other home‐based interventions with the goal of supporting underserved families in following recommended clinical care. [ABSTRACT FROM AUTHOR]

Summary: Service evaluation model is an essential ingredient in service‐oriented Internet of things (IoT) architecture. Generally, traditional models allow each user to submit their comments with respect to IoT services individually. However, these kind of models are fragile to resist various attacks, like comment denial attacks, and Sybil attacks, which may decrease the comments submission rate. In this article, we propose a new aggregation digital signature scheme to resolve the problem of comments aggregation, which may aggregate different comments into one with high efficiency and security level. Based on the new aggregation digital signature scheme, we further put forward a new service evaluation model named Tesia allowing specific users to submit the comments as a group in IoT networks. More specifically, they aggregate comments and assign one user as a submitter to submit these comments. In addition, we introduce the synchronization token mechanism into the new service evaluation model, to assure that all users in the group may sign their comments one by one, and the last one who receives the token is assigned as the final submitter. Tesia has more acceptable robustness and can greatly improve the comments submission rate with rather lower submission delay time. [ABSTRACT FROM AUTHOR]

Background and purpose: This position paper makes recommendations following an audit of care provided to people presenting with a seizure to emergency departments (EDs) in Europe. Methods: Participating countries were asked to include five hospitals agreeing to identify 50 consecutive seizure patients presenting to their ED between 1 August 2016 and 31 August 2017. Anonymous data were collected to a web database. Where quoted, percentages are mean site values and ranges are the 10th–90th centile. Results: Data were collected on 2204 ED visits (47 sites, up to six per country, across 15 countries): 1270 (58%) known epilepsy, 299 (14%) previous blackouts but no epilepsy diagnosis, 634 (29%) with a first seizure. Wide variability was identified for most variables. Of those with known epilepsy, 41.2% (range 26.2%–59.6%) attended the ED in the previous 12 months, but only 64.7% (range 37.2%–79.8%) had seen an epilepsy specialist in the previous 12 months. 67.7% (range 34.0%–100%) were admitted, 53.1% to a neurology ward (range 0.0%–88.9%). Only 37.5% first seizure patients (range 0.0%–71.4%) were given advice about driving. Conclusions and recommendations: It is recommended that in Europe guidance is agreed on the management and onward referral of those presenting to the ED with a seizure; a referral process is created that can be easily implemented; it is ensured that the seizure services receive referrals and see the patients within a short time period; and a simple system is developed and implemented to allow continuous monitoring of key indices of epilepsy care. [ABSTRACT FROM AUTHOR]

Introduction: Parenting is a valued, common and challenging adult role. Many parents, including some living with disability or difficult social circumstances, experience barriers to fulfilling their parenting roles. Yet, occupational therapy involvement in parenting is rarely documented. Current understandings about 'doing' parenting lack cohesion and are dispersed in occupational therapy literature. This study aims to map and synthesise occupational therapy literature on 'doing' parenting to describe the state of the existing knowledge base, and develop a conceptual framework of parenting occupations as portrayed in occupational therapy literature. Methods: A scoping review was conducted. Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science were searched on 28 October 2019 and updated on 18 February 2021. Journal articles and book chapters were screened for eligibility. Included texts' publication characteristics, methodological characteristics, and areas of focus were summarised. Interpretive content analysis was conducted. Results: From 5945 unique records, 105 texts were included. These discussed general parenting, parents with disabilities, and parenting in challenging social situations. Most texts focussed on mothers caring for young children in Western cultural contexts. The analysis culminated in the development of a conceptual framework: the Parenting Occupations and Purposes (POP) Framework. This comprises 10 interrelated areas of parenting occupations, which are performed for the purposes of addressing the child's basic, developmental and social needs. Parenting occupations were also found to be influenced by additional, underlying occupations that build parenting capacity ‐ Continuous Parental Development (CPD) occupations. Conclusion: These findings provide an overview of current occupational therapy conceptualisations of parenting. Unlike most of the existing literature on parenting, the POP Framework is parent‐centric rather than child‐centric. More research on parenting occupations is needed, especially with more diverse representation (fathers, ages of children, parental disability and sociocultural background). Further research is required to examine the POP Framework's usefulness in guiding research and practice, particularly among parents with diverse characteristics. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences of women who had used an Early Pregnancy Assessment Unit (EPAU) service in the UK and make recommendations for their improvement. Design: Qualitative interview study. Setting: Early Pregnancy Assessment Units in the UK. Sample: A maximum variation sample of women who had consented to be interviewed having attended one of 26 EPAUs involved in the VESPA study in 2018. Methods: In‐depth telephone interviews with 38 women. A thematic framework analysis was conducted, with a focus on how experiences varied according to EPAU service configuration and clinical pathway. Main outcome measures: Women's experiences of EPAU services. Results: We found that EPAUs are highly valued, and women's experiences were generally positive. However, women reported a range of issues that negatively affected their experience. These included difficulties accessing the service, insensitive management of the investigation and treatment options of pregnancy loss, poor communication, insufficient information and a lack of support for their psychological health. These issues were not strongly associated with EPAU configuration or clinical pathway. Conclusions: Recommendations to improve women's experiences include the separation of EPAUs from general maternity services, and we make suggestions on how to remove barriers to access by reviewing opening hours, how to provide sensitive patient management, such as automatically cancelling appointments and scans following pregnancy loss, and how to improve communication, both with women and their partners as well as with other parts of the health service. Early Pregnancy Assessment Units are highly valued by women but aspects of their care experiences, particularly around sensitive management of pregnancy loss, could be improved. Early Pregnancy Assessment Units are highly valued by women but aspects of their care experiences, particularly around sensitive management of pregnancy loss, could be improved. [ABSTRACT FROM AUTHOR]

Background: How many patients should we be patch testing? A previous study suggested that the minimum proportion of a population to be patch tested for allergic contact dermatitis was 1:700 annually. Objectives: To evaluate if the current minimum rate for patch testing has changed over the 20 years since the previous study in order to maximize the value. Methods: In cooperation with the British Society for Cutaneous Allergy, a proforma for collation of retrospective data between January 2015 and December 2017 was sent to patch‐test centers in the United Kingdom (UK) and the Republic of Ireland (ROI). The number of positive tests was analyzed against the proportion of population tested to see what proportion of the population would yield the greatest number of positive results. Results: Responses from 11 centers showed that the minimum number needed to patch test had increased to 1:550 per head of population per year using the current criteria. Conclusions: In agreement with previous studies, we should be patch testing more people than we are. We could reduce the threshold for referral of patients we patch test to derive the most benefit from this investigation. [ABSTRACT FROM AUTHOR]

NAP7 will define peri-operative cardiac arrest as " I chest compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist i ", in line with other cardiac arrest audits [19]. Patients undergoing cardiac catheter laboratory procedures, endoscopic procedures and diagnostic and/or interventional radiological procedures will also be included if an anaesthetist is present, or is asked to attend to provide anaesthesia care during a case but before cardiac arrest. A specific challenge for NAP7 is identifying which antecedent causes and events predict peri-operative cardiac arrest, which interventions are associated with preventing cardiac arrest and which interventions work best when cardiac arrest occurs. The challenges of defining, studying and learning from peri-operative cardiac arrest. [Extracted from the article]

Background: Timeliness is viewed as a key feature of health‐care quality. Internationally, this is challenging. In England, cancer waiting time targets are currently not being met. For example, between 2015 and 2018 only 71% of patients with upper gastrointestinal (UGI) cancer started treatment within the recommended 62 days of referral. Objective: We explored patients' experiences to identify areas for service improvement. Design: Semi‐structured interviews were conducted. Setting and participants: Twenty patients who were referred through the urgent (two‐week) GP referral route and were within six months of receiving first treatment were recruited. Data analysis: Data from the interviews were analysed thematically. Results: Four themes were developed: organization of care; diagnosis; support; and views and expectations of the NHS. Patients described cross‐cutting issues such as complex and varied pathways and uncertainty about what would happen next. They felt daunted by the intensity and speed of investigations. They were presented with a recommended course of action rather than options and had little involvement in decision making. They were grateful for care, reluctant to complain and resigned to the status quo. Discussion and conclusions: In order to meet patient needs, the NHS needs to improve communication and streamline pathways. Future cancer pathways also need to be designed to support shared decision making, be truly person‐centred and informed by patient experience. [ABSTRACT FROM AUTHOR]

Rationale, Aims, and Objectives: The reorganization of acute major trauma pathways in England has increased survival following traumatic injury, resulting in an increased patient population with diverse and complex needs requiring specialist rehabilitation. However, national audit data indicate that only 5% of patients with traumatic injuries have access to specialist rehabilitation, and there are limited guidelines or standards to inform the delivery of rehabilitation interventions for individuals following major trauma. This group concept mapping project aimed to identify the clinical service needs of individuals accessing our major trauma rehabilitation service, prioritize these needs, determine whether each of these needs is currently being met, and plan targeted service enhancements. Methods: Participants contributed towards a statement generation exercise to identify the key components of rehabilitation following major trauma, and individually sorted these statements into themes. Each statement was rated based on importance and current success. Multi‐dimensional scaling and hierarchical cluster analysis were applied to the sorted data to produce themed clusters of ideas within concept maps. Priority values were applied to these maps to identify key areas for targeted service enhancement. Results: Fifty‐eight patients and health care professionals participated in the ideas generation activity, 34 in the sorting, and 49 in the rating activity. A 7‐item cluster map was agreed upon, containing the following named clusters: Communication and Coordination; Emotional and psychological wellbeing; Rehabilitation environment; Early rehabilitation; Structured therapy input; Planning for home; and Long‐term support. Areas for targeted service enhancement included access to timely and adequate information provision, collaborative goal setting, and specialist pain management across the rehabilitation pathway. Conclusion: The conceptual framework presented in this article illustrates the importance of a continuum of rehabilitation provision across the injury trajectory, and provides a platform to track future service changes and facilitate the codesign of new rehabilitation interventions for individuals following major trauma. [ABSTRACT FROM AUTHOR]

Objective: Replying to germ cell tumour patients' needs, we implemented "Shared Community Follow‐up"—a collaborative initiative, enabling remote delivery of specialist cancer care across large geographical areas. Blood, radiological investigations and patient‐reported outcome measures (PROMs) are completed remotely and integrated within the electronic patient records for specialist review without patients requiring appointments. We describe the service evaluation estimating the feasibility, safety and acceptability of this initiative versus traditional Standard Follow‐up. Methods: This cross‐sectional evaluation estimated feasibility (uptake, adherence) and safety (via missed appointments, timeliness, cancellations) using routinely collected service process data. An acceptability questionnaire, evaluating patient satisfaction, was administered to 91 patients. Results: The new service is feasible. Across 2 years (2014–2016), uptake increased 54% (N = 123 to N = 270) and only 4.8% (N = 13) of patients were non‐adherent. Fewer missed/cancelled investigations (N = 39, 5.9% vs. N = 566, 85.5%), timelier investigations (seven vs. 14 timely investigations) and equal relapse detection suggest its safety. PROMs replaced 3 appointments/patient. Patients were as satisfied with both services (3.4/4 vs. 3.6/4). Conclusion: New follow‐up services, with investigations completed remotely and shared between community providers and cancer centres, offer an alternative to traditional appointments with advantages for patients and the National Health Service. [ABSTRACT FROM AUTHOR]

Objective: A remote telemedical otology referral and advice service was introduced to interested general practices. General practitioners (GPs) were given a new device, "endoscope‐i" that combines an optimized smartphone high definition video app with an otoendoscope. They were specifically trained to examine and capture images of patients' eardrums, which were sent electronically with a summary of clinical information and an in‐app hearing testing (if required), for specialist advice to two ear, nose, and throat (ENT) consultants. We describe the findings from an evaluation of the first 6 months of this service to establish the feasibility and acceptability of an otology telemedical referral and advice service. Methods: The new service was advertised to GP practices in Northern Staffordshire. All interested GPs were provided with training and equipment to deliver the remote referral service. Data were collected from GPs at baseline, informal feedback in response to referral outcomes and end of service feedback. Referral data were collected routinely during the service delivery. Results: Fifteen GP leads from 15 practices received training and equipment. One quickly lost the equipment. Of the remaining 14 practices, eight sent a total of 53 remote referrals using this technology over 6 months. The most common reason for referral was an uncertainty of what could be seen in or around the eardrum. The primary barrier for implementation was lack of wireless internet connections within practices. GPs reported that they used this technology to share examination findings with patients. Conclusions: GPs were positive about the technology, from initial engagement with training and after advice were given. Some GPs expanded the role of the technology to a consultation aid. Referral volume was manageable. Commissioners should consider tariffs structures for such services; empirical cost‐effectiveness and workload‐impact evaluation would inform this. [ABSTRACT FROM AUTHOR]

Aim: Peer review is one component of the improvement of diabetes care delivered by the National Health Service (NHS) in England and Wales. Queensland has a decentralised model of service provision with an established state diabetes network.Methods: The NHS scheme was adapted for use in Australia, and seven trained reviewers were recruited to visit 14 'hub' centres, which in turn covered 29 'spoke' units delivering care to over 95% of all public patients <16 years old in the state. Details of control as measured by glycosylated haemoglobin (HbA1c), the rate of presentation of diabetic ketoacidosis (DKA), the use of state guidance and staffing levels were recorded. Thirteen minimum standards of care were used as a basis for assessment. A report for the use of each inspected unit was produced at the end of the process.Results: Most units had not previously collected outcome data; 45% of new cases presented with DKA. The centre mean HbA1c was 9.1%, and only 21% of patients achieved the Australian recommended level of <7.5%. Only three centres met some of the internationally recommended staffing levels. Only two centres provided transitional care to adult services. Of 13 NHS minimum standards of care, a mean of 5 were achieved (range 1-8), a mean of 4.6 partially achieved (range 3-6) and a mean of 3.9 not achieved (range 0-9). The care for 68 patients with type 2 diabetes was particularly poor.Conclusions: Paediatric diabetes care in Queensland is suboptimal. Recommended remedial actions are suggested that may be applicable to other states. [ABSTRACT FROM AUTHOR]

Objective: Physiotherapist‐led musculoskeletal triage clinics are an effective and efficient means of managing patients presenting with musculoskeletal disorders in primary and secondary care. Data regarding the activity and outcomes of physiotherapist‐led triage in hospital‐based outpatient rheumatology clinics are scarce. Thus, the aim of this study was to undertake a service evaluation of activity and outcomes of a physiotherapist‐led rheumatology‐based Musculoskeletal Assessment Clinic (MAC). The primary objective was to quantify the proportion of patients independently managed by the clinical specialist physiotherapists (CSPs). Methods: A retrospective service evaluation was undertaken of all patients who attended the Rheumatology MAC at St Vincent's University Hospital, Dublin (SVUH) between August 2012 and February 2014. The Clinical Audit Department of SVUH approved the study. Data were analyzed using descriptive statistics. Results: Five hundred and eight patients attended the MAC: 76% were female and the mean age was 55 years and ranged between 18‐91. Seventy‐five percent of patients were independently managed by the CSP without needing to see a consultant rheumatologist, whereas 17% were referred to the rheumatology team. Eighty‐seven percent of patients referred to the rheumatology team had rheumatological intervention (eg, injection, medical management, or multidisciplinary rehabilitation). A substantially higher proportion of patients with regional musculoskeletal pain and degenerative conditions were independently managed by the CSP compared with those who had rheumatological/inflammatory conditions. Conclusion: The majority of patients who attended the MAC were independently managed by the physiotherapists, suggesting that physiotherapist‐led triage may be a useful and efficient means of managing a proportion of patients referred for a specialist rheumatological consultation. [ABSTRACT FROM AUTHOR]

Objective: The quality of acute stroke care in a regional Victorian hospital (study hospital) was assessed by comparing with selected standard indicators of Acute Stroke Clinical Care. Design: A retrospective review of records of patients with stroke was performed manually and by reviewing electronic database. Setting: The study was carried out in Goulburn Valley Health, one of the five regional referral and teaching hospitals in Victoria, Australia. Participants: Patients with stroke who were discharged from the study hospital between October 2015 and March 2016. Main outcome measures: Timeliness of brain imaging, proportion of patients thrombolysed if arrived within 4.5 hours of stroke and timeliness of thrombolysis. Results: A total of 66 patients' records was found. Brain imaging was completed for 45%, compared to 25.8% nationally, if arrived to the study hospital within 1 hour of stroke and 100% imaging completed within 24 hours of arrival, compared to 75.6% nationally. When patients arrived to the emergency department within 4.5 hours of stroke, 37.5% (23.6% nationally and 18.6% in similar‐ sized hospitals) of them were thrombolysed, while none was thrombolysed within 60 minutes of arrival. Door‐to‐thrombolysis time was 85 minutes, 7 minutes longer than national standard. Symptoms onset to thrombolysis time was 225 minutes, 55 minutes longer than national standard. Conclusion: The timeliness of brain imaging and thrombolysis was comparable in the study hospital to that of the national standard, while other stroke management indicators still require improvement. Continuing efforts for improvement and revisiting possible areas of delay are warranted. [ABSTRACT FROM AUTHOR]

Aim: To measure the effectiveness of advanced nurse practitioners (ANPs) against national quality requirements for out‐of‐hours (OOH) care, to compare ANP effectiveness with that of doctors working in the same service, and to evaluate the impact of ANPs on the service. Background: There is little documented evidence of ANPs undertaking urgent home visits in the OOH setting. This study advances current knowledge of this aspect of the OOH service and makes recommendations for the management of the ANP urgent home visiting service. Methods: Analysis of 1,539 ANP home‐visit patient electronic case notes over a 12‐month period, a focus group of eight GPs, and interviews with six ANPs. Results: Advanced nurse practitioners are as effective as GPs in undertaking urgent home visits. Their documentation is more consistent and their refer‐on rate to secondary care is less than that of GP colleagues. Conclusion: Advanced nurse practitioners can provide equivalent clinical outcomes to GPs when undertaking urgent home visits. Implications for Nursing Management: This study adds to the body of evidence for the positive impact of ANPs on OOH service delivery and managers can be assured that they are practising at a level that makes them effective and safe to undertake this role. [ABSTRACT FROM AUTHOR]

We sought to examine the management and referral of nonhealing mouth ulcer presentations in Australian community pharmacies in the Greater Brisbane region. Trained simulated patients visited 220 randomly selected community pharmacies within the Greater Brisbane region in 2016. Simulated patients enacted two nonhealing (>1 month) mouth ulcer scenarios: A direct product request (DPR) (n = 110) and a symptom‐based request (SBR) (n = 110). Results were documented and evaluated against Australian national pharmacy practice standards. Referral rates for pharmacy staff (pharmacist, pharmacy assistant or mixed—pharmacist and assistant) were also assessed. Australian pharmacy practice standards recommend staff ask six key questions during SBR and DPR consultations to enable informed decision‐making. Two questions relating to identifying the patient and their symptoms were asked in the majority of interactions (76% and 69% respectively); the remaining four questions relating to symptom duration, treatments tried, other medications, and medical conditions were enquired in only 32%, 53%, 31%, and 27% of interactions, respectively. Simulated patients were referred to the doctor/dentist in only 11.8% of all interactions (both scenarios requiring referral). Overall, staff handling of nonhealing mouth ulcer consultations was suboptimal compared to national professional standards. In particular, duration of the nonhealing mouth ulcer was enquired in less than one‐third of consultations potentially resulting in low referral rates by staff. This study identifies the need for increased oral cancer awareness and education for community pharmacy staff and reinforcing the importance of practising according to professional standards to effectively screen for potentially cancerous nonhealing mouth lesions. [ABSTRACT FROM AUTHOR]

Although Northern Ireland has high levels of mental health problems, there has been a relative lack of systematic research on mental health services that can provide an evidence base for legal, policy, and service developments. This article aims to provide a review of the central issues relating to mental health service provision in Northern Ireland, and to gather the perceptions of different stakeholders of these services. The study utilised in‐depth qualitative interviews, focus groups, and an online survey to collect data from respondents throughout the region. This method involved the completion of semistructured interviews with significant mental health commissioners and senior managers, and with service‐users and their key workers. Focus groups sessions were also completed with mental health professionals, service‐users, and carers. Data collection occurred between December 2014 and June 2015. Thematic analysis was used to identify key issues. The findings identified that considerable progress had been made not only in the development of mental health services in the last decade, but also highlighted the significant limitations in current services. Most notably, strengths in provision included the transition from long‐stay hospital care to community‐based services and person‐centred approaches. The researchers identified the need to improve funding, address problems with fragmentation, and gaps in service provision. Based on these findings, the authors consider the implications for practice and policy relating to the human and organisational aspects of service development. In particular, services should be developed focusing on a recovery ethos and on person‐centred and relationship‐based approaches. The needs of carers should additionally be considered and programmes developed to tackle stigma. [ABSTRACT FROM AUTHOR]

Background/aim: The delivery of evidence‐based health care requires the routine adoption of outcome measures that are valid and reliable. The Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs‐OT) was developed in Australia to capture a global snapshot of status for any client, and has preliminary psychometric evidence to support use. Building on the psychometric evidence of the AusTOMs‐OT will provide therapists and researchers with further information as to how best to apply the AusTOMs‐OT in their field. This study reports on the reliability of the 12 AusTOMs‐OT scales, which are each scored on the four domains of Impairment, Activity Limitation, Participation Restriction and Distress/Wellbeing. Methods: A total of 31 occupational therapists rated 12 written case studies on two occasions, separated by two weeks. Test–retest reliability, inter‐rater reliability, intra‐rater reliability (using intra‐class correlation coefficients (ICCs)) and measurement error were calculated, in line with the COnsensus‐based guidelines for the Selection of health Measurement Instruments (COSMIN). Results: The ICCs for inter‐rater reliability for all domains for all scales ranged from 0.531 to 0.922 suggesting moderate to very high reliability. Therapist intra‐rater reliability ranged from ICC 0.675 to 1.000, suggesting moderate to high consistency. The stability of the scales was demonstrated with test–retest ICCs coefficients ranging from 0.616 to 0.960. The measurement error was found to be below 0.5 point for all scales and domains except for Scale 1, Impairment (just over at 0.604) and similarly the error range for each scale was also all below 1 point except Scale 1, Impairment. Conclusion: The AusTOMs‐OT scales possess moderate to very high reliability across the 12 scales. Occupational therapists can continue to use AusTOMs‐OT with confidence with all clients to establish global outcomes and to build evidence to underpin practice. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Appointment non‐attendance contributes added cost to the healthcare sector through wasted resource allocations. Medical imaging departments commonly schedule appointments for most modalities; however, no study has quantified patient attendance rates in the Australian regional setting. This is despite evidence that regional, rural and remote Australians tend to demonstrate poorer health than metropolitan counterparts. This study aims to identify the factors that influence appointment non‐attendance at a teaching hospital in regional Australia. Methods: Categories restricted to age, gender, indigenous status, distance from investigation site, referral source and imaging modality were collected for all appointments (N = 13,458) referred to the medical imaging department in 2015. The likelihood of each of these factors correlating with a patient not attending a scheduled appointment was calculated using the chi‐squared analysis and binary logistic regression. Results: Gender, indigenous status as well as specific imaging modalities, referral sources and age categories were significantly associated with non‐attendance. Overall, male patients were 1.57 (P < 0.001) times more likely to miss a scheduled appointment than female patients. Patients who identified as Aboriginal and Torres Strait Islander were 2.66 (P < 0.001) times more likely to miss a scheduled appointment than patients who did not identify as Aboriginal and Torres Strait Islander. Conclusions: Several key factors appear to affect medical imaging appointment non‐attendance. Key factors include indigenous status, gender, image modality, referral source and age. Further improvement is required to better meet the needs of underrepresented patient demographics. [ABSTRACT FROM AUTHOR]

Summary: Background: An initial study of patch testing practices across Wales, United Kingdom, showed wide variation in practice against a standardized set of guidelines and best practice recommendations. Objectives: To evaluate (i) current patch testing practice on a national level in the United Kingdom and Republic of Ireland (ROI), (ii) compliance with the current published guidelines, and (iii) the proportion of the catchment population tested by patch testing centres. Methods: In consultation with the British Association of Dermatologists and British Society for Cutaneous Allergy, proformas addressing clinical guidelines and best practice recommendations were sent to all dermatology units in the United Kingdom and ROI. Results: Ninety one of 325 centres (28%) performed patch testing. The optimum proportion of annual tests was not being achieved in the United Kingdom and ROI. The range tested varied between 1:1200 and 1:1600. Conclusions: Most centres achieved a high level of best practice outcomes. Shortcomings were found in the recording of minimum data, benchmarking, and attendance at meetings. We suggest that the findings of this study should be used as evidence to help improve services locally. [ABSTRACT FROM AUTHOR]

The perinatal period is a time of great vulnerability for many women, in particular those with a range of psychosocial vulnerabilities and mental health risk factors. This paper outlines the psychosocial and mental health profile of consumers and their partners of a perinatal and infant mental health ( PIMH) service in Australia. To establish the consumer profile, we analysed client vulnerabilities and demographical information maintained over a 6-year period for 406 consumers. Consumer information, including mental health problems, psychosocial vulnerabilities and demographical information, was entered into a standalone database by the allocated clinicians upon service allocation and throughout treatment. The women accepted by PIMH presented with an average of nine different vulnerabilities. Frequently endorsed risk factors included depression (72.66%), anxiety (71.43%), comorbid depression and anxiety (58.13%), self-harm (past, 7.88%, present, 16.26%), a history of family mental health issues (39.66%), childhood trauma (57.88%), limited support (68.84%), relationship conflict with partners (38.92%) and financial stress (47.29%). The women's partners also presented with a range of vulnerabilities, in particular childhood trauma (34.11%) and mental health issues (30.81%). This study contributes to our understanding of the profile of vulnerable women in the perinatal period, and in particular contributes to the literature by highlighting that in addition to depression, anxiety, self-harm and trauma are also significant in PIMH service delivery. [ABSTRACT FROM AUTHOR]

Aim To evaluate the clinical-effectiveness and resource use associated with Case Management Services in a UK private sector Design An observational cohort study based on prospective data collection of patient reported outcome measures and data collection from an existing administrative health database. Setting A United Kingdom (UK) private healthcare provider Participants Consecutive referrals into the Case Management Service over a three-month period. Interventions Participants were managed within the Case Management Service in accordance with usual pathways. Main Outcome Measures Outcome measures included EQ-5D-5L and PSFS. Measurements were taken at baseline, and repeated at the point at which the client's case was closed. The CARE measure examined patient reported experience. Cost Consequence analysis was completed using existing data for the same period of time in two separate years: 2014, two years after CMS implementation, and 2011, prior Case Management Service development Results There was a statistically significant improvement in quality of life (EQ-5D-5L p < 0.0001; EQ-VAS p < 0.001) and functional ability (p < 0.001) following the Physiotherapy Case Management. The CARE measure showed high levels of patient satisfaction with 96% of clients rating their individual case manager as good to excellent. The cost consequences analysis showed a cost reduction in therapy resource utilisation by £252 842 (from £10 772 875 to £10 520 034). Conclusions The Case Management Service showed the provision to be providing significant improvement in quality of life and functional outcomes within efficient use of resources, and service users are highly satisfied with their experience. [ABSTRACT FROM AUTHOR]

Accessible summary The government and other organisations say that improving health care is important for people with learning disabilities., We asked people with learning disabilities and the people who look after them what it was like for them when they went to the dentist., Those we asked said that when they went to the dentist, they knew that those they saw knew about looking after their teeth., Some of those we talked to though said that certain things needed to be better., Abstract Background The government alongside other health and social care organisation have identified the need to improve the care provided for people with learning disabilities. Materials and Methods This service evaluation aimed to explore the experiences of people with learning disabilities and their carers who accessed community dental services using a qualitative research design. Adults with learning disabilities ( n = 4) and their carers ( n = 6) took part in one to one, face to face semi structured interviews. Results and Discussion Generally, participants were satisfied with community dental services and in particular valued the skills and the competence of practitioners. However, when dissatisfaction was expressed this was generally as a result of poor communication and the transition from child to adult dental services. Conclusions A number of recommendations are identified and discussed in relation to engagement with adults with learning disabilities and their carers in the development and delivery of community dental services. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The Self-Management and Recovery Training (SMART Recovery) program provides facilitated mutual aid for people with addictions. To date, little research has examined SMART Recovery. This paper examined participant and facilitator perceptions of the helpfulness of cognitive behaviour therapy tools in SMART Recovery groups. SMART Recovery's strengths and areas for improvement were also explored, as well as overall participant satisfaction with SMART Recovery.Design and Methods: This exploratory study was conducted as part of the first national survey of SMART Recovery in Australia. Paper surveys were posted to all registered SMART Recovery groups for participants. SMART Recovery facilitators were emailed a link to an online survey.Results: Overall, satisfaction with SMART Recovery was moderate to strong. Participants and facilitators perceived the cognitive behaviour therapy tools incorporated within SMART Recovery to be helpful. Participants and facilitators nominated the group experience and the SMART Recovery tools and strategies as helpful aspects of SMART Recovery. Participants and facilitators were concerned with improving public knowledge about SMART Recovery groups, updating the structure and content of SMART Recovery groups, and increasing training for facilitators.Discussion and Conclusions: SMART Recovery displays strengths as communicated by those who utilise its services. However, there are opportunities to continue to improve SMART Recovery. Updating the training for facilitators and increasing communication between SMART Recovery Australia's head office and its facilitators may serve to improve service delivery. Future research should focus on examining the efficacy of SMART Recovery groups on participant outcomes.[Kelly PJ, Raftery D, Deane FP, Baker AL, Hunt D, Shakeshaft A. From both sides: Participant and facilitator perceptions of SMART Recovery groups. Drug Alcohol Rev 2017;36:325-332]. [ABSTRACT FROM AUTHOR]

Child abuse commonly occurs within the context of multiple risk factors, in particular parental mental health and/or drug and alcohol problems. As no one agency can address all these factors, inter‐agency collaboration is paramount to the protection of vulnerable children, especially in families with a complex array of problems. This paper outlines a range of recommendations to improve collaboration between child protection workers and mental health/drug & alcohol (MH/D&A) clinicians from the perspective of Keep Them Safe‐Whole Family Team (KTS‐WFT) clinicians. Taking referrals from child protection, the KTS‐WFT offers interventions to families with parental MH/D&A problems where there are child protection concerns. As part of a larger evaluation of a KTS‐WFT site, 10 KTS‐WFT clinicians participated in in‐depth interviews. Analysis of the interviews identified collaboration with child protection as a primary theme. Participants reported a number of barriers to effective collaboration; in particular, participants reported challenges with information sharing and confidentiality, inconsistency in terms of the level and style of collaboration, tensions between the different theoretical paradigms that underpin practice for MH/D&A clinicians vs. child protection workers, and insufficient clarity around processes and expectations. Consistent with the identified barriers, primary recommendations to improve collaboration were to improve information sharing, overcome silo ways of thinking, manage risk together more consistently, and develop consistent processes and expectations. [ABSTRACT FROM AUTHOR]

Some authors have called attention to the lack of service integration related to evaluation and treatment of parental substance abuse, an ongoing challenge for service providers. A cross-training project involving exchanges (immersion sessions) among clinical teams was established to improve the integration, effectiveness and coherence of interventions for pregnant women and mothers with problematic substance use, and to prevent negative impacts of substance abuse on parenting skills and on foetal and child development. The research goal was to understand, from the perspectives of care providers, how cross-training either fosters or fails to foster changes in the practices of care providers who work with young pregnant women and mothers whose use of psychotropic drugs puts them at risk of neglecting their children. The cross-training project was carried out between 2009 and 2013. During the last phase of the project, focus group data were collected from 14 different clinical teams ( N = 121) from the fields of substance abuse, child protection, perinatality and early childhood. The responses of each focus group yielded data for thematic analysis, performed using a mixed coding approach that included predefined and emerging themes. Points of convergence and divergence were identified by comparing what was said in different groups and types of clinical settings. At the conclusion of the project, the care providers said they knew their clinical partners better, communicated more with each other and made more referrals to those partners, and were better able to express themselves clearly about the effects of psychotropic drug use on the foetus, the child and the parenting role. In conclusion, the project helped create a culture of co-operation and partnership that has direct effects on services for pregnant women and young mothers who use substances. [ABSTRACT FROM AUTHOR]

Men's Sheds and similar community programmes are known to encourage help-seeking behaviour and thus improve the health and well-being outcomes for the men who attend. This paper investigates this issue through a community needs assessment of a Men's Shed programme in inner-regional Australia. The immediate purpose of this research was to help direct future funding initiatives, and provide recommendations for potential changes and improvements to the programme. A community-level needs assessment is a systematic process used to determine and address gaps or needs between current and desired conditions within a particular community. We sought to explore how particular formats and structures of Men's Sheds programmes contribute to improve social and medical well-being, and whether there are key programme characteristics that could be emulated. In total, 22 surveys and 20 interviews were conducted with the men who participated in the programme. The report finds 95% of men are satisfied with the current running of the programme. While there were areas that have been identified for improvement, most men reported that they are content with the current format and would not like to see major changes to its implementation. The results of this research confirm the known benefits of these types of programmes. This paper provides other community programmes with some insight into the key success factors for running a Men's Shed. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the number of patients attending a medical emergency department ( MED) with dental problems over a three-year period. This cross-sectional study was carried out as part of a service evaluation. Data were collected via a database search of patient attendances at the MED using free text and the 10th revision of the International Statistical Classification of Diseases and Related Health Problems ( ICD-10) for oral and dental diagnoses. Data were analysed using descriptive statistics, t-test and chi-squared tests. Over the three-year period, there were 2504 visits to the MED for dental-related complaints, accounting for 0·7% of all attendances. The majority of patients were male (53·9%), with a mean age of 29 (s.d. 19·4) years for men, and 32 (s.d. 19·7) years for females. The mean index of multiple deprivation per cent rank was 35·0%. The most common diagnosis was unspecified dental disorder. Ten per cent of dental attendances to MED were repeat attendances by the same patients. In conclusion, patient attendances at MED for dental problems account for 0.7% of all attendances. MED may not be the most appropriate place for these patients to attend, in terms of care pathways, and also for economic reasons. The reasons why patients attend MED for dental problems clearly warrant further research. [ABSTRACT FROM AUTHOR]

Background Morbid obesity is an ongoing concern worldwide. There is a paucity of research reporting primary care outcomes focussed on complex and morbidly obese populations. The National Institute for Health and Care Excellence (NICE) recommends a specialist, multidisciplinary weight management team for the successful management of such populations. This is the first service evaluation reporting both primary (weight change) and secondary [body mass index (BMI), waist circumference, physical activity levels, fruit and vegetable intake, Rosenberg self-esteem score] outcomes in these patients. Methods The present study comprised a prospective observational study of a cohort data set for patients ( n = 288) attending their 3-month and 6-month ( n = 115) assessment appointments at a specialist community weight management programme. Results Patients had a mean (SD) initial BMI of 45.5 (6.6) kg m-²; 66% were females. Over 80% of patients attending the service lost some weight by 3 months. Average absolute weight loss was 4.11 (4.95) kg at 3 months and 6.30 (8.41) kg at 6 months, equating to 3.28% (3.82%) and 4.90% (6.26%), respectively, demonstrating a statistically significant weight change at both time points ( P < 0.001). This meets NICE best practice guidelines for the commissioning of services leading to a minimum of 3% average weight loss, with at least 30% of patients losing at ≥5% of their initial weight. Waist measurement and BMI were reduced significantly at 3 months. Improvements were also seen in physical activity levels, fruit and vegetable consumption, and self-esteem levels ( P < 0.001). Conclusions This service was successful in aiding weight loss in morbidly obese populations. The findings of the present study support the view that weight-loss targets of 3% are realistic. [ABSTRACT FROM AUTHOR]

Objective: The routine use of intraoperative cholangiogram (IOC) in laparoscopic cholecystectomy (LC) remains a contentious issue. IOC helps to delineate biliary tree anatomy, prevent bile duct injury and image stones in the common bile duct (CBD). It may prove to be a valuable alternative to ERCP or MRCP, especially in the rural setting with limited resources. Design/Setting/Participants/Interventions/Main outcome measures: All patients undergoing laparoscopic cholecystectomy during a 12-month period were audited. For the first 6 months, patients were recruited for routine IOC and for the second 6 months, routine IOC was not performed. Cases were analysed with regard to patient demographics, operative details and clinical outcomes. Results: A total of 75 patients were analysed within the 12-month period. The majority were women aged 41-50. Ultrasound suggested common bile duct stones in 6.7% of cases. IOC was attempted in 50.7% of cases. Of these, 29 (76.3%) were successful. IOC added an average of 28 min to total theatre time. A total of 75% (n = 22) of IOCs showed normal flow of contrast into the intra- and extra-hepatic biliary systems. In 17% (n = 5) of patients, stones within the CBD were suspected, and these were referred for further management. ERCP/MRCP confirmed CBD stones in 60% (n = 3) of these patients. There was poor correlation between pre-operative suspicion and confirmed CBD stones (two patients only with preoperative suspected CBD stone confirmed on IOC and ERCP). There were no operative complications related to IOC. There were no post-operative complications in cases where no IOC was done. Conclusion: The majority of patients treated in our centre were women, middle-aged patients booked for elective laparoscopic cholecystectomy. Although only 6.7% cases were suspicious for CBD stones pre-operatively, a total of 17% of patients with routine IOC suggested CBD stones. IOC was found to be safe, taking only an additional 28 min of total theatre time. Routine rather than selective use of IOC could be considered to improve patient safety and long-term results. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The management of rheumatoid arthritis ( RA) usually entails regular hospital reviews with a specialist often when the patient is well rather than during a period of exacerbation. An alternative approach where patients initiate appointments when they need them can improve patient satisfaction and resource use whilst being safe. This service evaluation reports a system-wide implementation of a patient-initiated review appointment system called Direct Access ( DA) for people with RA. The aim was to establish the impact on patient satisfaction of the new system versus usual care as well as evaluate the implementation processes. Methods As all patients could not start on the new system at once, in order to manage the implementation, patients were randomly allocated to DA or to usual care. Instead of regular follow-up appointments, DA comprised an education session and access to a nurse-led telephone advice line where appointments could be accessed within two weeks. Usual care comprised routine follow-ups with the specialist. Data were collected on patient satisfaction, service use and outcomes of any contact to the advice line. Results Three hundred and eleven patients with RA were assessed as being suitable for DA. In terms of patient satisfaction, between-group differences were found in favour of DA for accessibility and convenience, ease of contacting the nurse and overall satisfaction with the service. Self-reported visits to the general practitioner were also significantly lower. DA resulted in a greater number of telephone contacts (incidence rate ratio = 1.69; 95% confidence interval 1.07 to 2.68). Hospital costs of the two different service models were similar. Mean waiting time for an appointment was 10.8 days Conclusion This service evaluation found that DA could be implemented and it demonstrated patient benefit in a real-world setting. Further research establishing the broader cost-consequences across the whole patient pathway would add to our findings. [ABSTRACT FROM AUTHOR]