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Background: There is growing evidence regarding the potential of closed incision negative pressure wound therapy (ci‐NPWT) to prevent surgical site infections (SSIs) in healing wounds by primary closure following a caesarean section (CS). Aim: To assess the cost‐effectiveness of ci‐NPWT compared to standard dressings for prevention of SSI in obese women giving birth by CS. Materials and Methods: Cost‐effectiveness and cost‐utility analyses from a health service perspective were undertaken alongside a multicentre pragmatic randomised controlled trial, which recruited women with a pre‐pregnancy body mass index ≥30 kg/m2 giving birth by elective/semi‐urgent CS who received ci‐NPWT (n = 1017) or standard dressings (n = 1018). Resource use and health‐related quality of life (SF‐12v2) collected during admission and for four weeks post‐discharge were used to derive costs and quality‐adjusted life years (QALYs). Results: ci‐NPWT was associated with AUD$162 (95%CI −$170 to $494) higher cost per person and an additional $12 849 (95%CI −$62 138 to $133 378) per SSI avoided. There was no detectable difference in QALYs between groups; however, there are high levels of uncertainty around both cost and QALY estimates. There is a 20% likelihood that ci‐NPWT would be considered cost‐effective at a willingness‐to‐pay threshold of $50 000 per QALY. Per protocol and complete case analyses gave similar results, suggesting that findings are robust to protocol deviators and adjustments for missing data. Conclusions: ci‐NPWT for the prevention of SSI in obese women undergoing CS is unlikely to be cost‐effective in terms of health service resources and is currently unjustified for routine use for this purpose. [ABSTRACT FROM AUTHOR]

Characterizing patterns of mental phenomena in epidemiological studies of adolescents can provide insight into the latent organization of psychiatric disorders. This avoids the biases of chronicity and selection inherent in clinical samples, guides models of shared aetiology within psychiatric disorders and informs the development and implementation of interventions. We applied Gaussian mixture modelling to measures of mental phenomena from two general population cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC, n = 3018) and the Neuroscience in Psychiatry Network (NSPN, n = 2023). We defined classes according to their patterns of both positive (e.g. wellbeing and self-esteem) and negative (e.g. depression, anxiety, and psychotic experiences) phenomena. Subsequently, we characterized classes by considering the distribution of diagnoses and sex split across classes. Four well-separated classes were identified within each cohort. Classes primarily differed by overall severity of transdiagnostic distress rather than particular patterns of phenomena akin to diagnoses. Further, as overall severity of distress increased, so did within-class variability, the proportion of individuals with operational psychiatric diagnoses. These results suggest that classes of mental phenomena in the general population of adolescents may not be the same as those found in clinical samples. Classes differentiated only by overall severity support the existence of a general, transdiagnostic mental distress factor and have important implications for intervention. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.Design/methodology/approach Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.Findings While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.Research limitations/implications There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.Practical implications While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.Originality/value Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs. [ABSTRACT FROM AUTHOR]