NHS Tayside Assurance and Advisory Group : third progress report

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Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers

Visionary mapping: cartography in William Blake’s networks, poetry, visual art, and reception

This thesis relates the visual-verbal art of William Blake (1757-1827) to the history and theory of mapping. From half-sketched London sites to expansive mappings of the entire cosmos, Blake exhibits a persistent, if agonistic, impulse to map the world around him. Although eccentric, Blake’s cartographic imagination was far from isolated in the culture of his day. In this study, I characterise Blake’s spatial thought as by turns cartographic and anti-cartographic, positioning him as both a participant in and a critic of eighteenth- century mapping practices. Perhaps owing to the idiosyncrasies of Blake’s mythography, neither Blake scholars nor map scholars have sought fully to understand his cartographic imagination. Blakean worldmaking is habitually othered, which has the effect of upholding Blake’s reputation as a Romantic isolationist existing somehow outside of time and space. Attempting to bring Blake back down to earth, I characterise him as a fundamentally networked figure, focusing on his demonstrable connections to the cartographic culture of his day. In doing so, I hope also to open up little-explored literary and artistic byways in the history of cartography. The cartographic aspects of Blake’s work have arguably survived and thrived to a greater and richer extent in the creative reception of his work than has been acknowledged in Blake scholarship to date. I turn to this reception in the final chapter of this thesis, tracing the afterlives of Blakean mapping within contemporary networks of small-press and independent publishers in London. These individuals and groups have often been highly attuned to the cartographic affordances of Blake’s work, carrying forward Blake’s “golden string” in ever-evolving mappings of an ever-evolving London

Developing data-driven innovation in creative industries

This White Paper reports on the findings of the Data-Driven Innovation (DDI) Programme Sector Development consultation (2018-20), which investigated the data capability and further potential for innovation across the creative industries in the Edinburgh and South East City Region of Scotland. It presents an overview of the findings with early models of delivery through The University of Edinburgh to stimulate greater awareness and support for data innovation ambition, as well as key themes to focus on for future development. Consultation was conducted with the creative industries community in the Edinburgh and South East City Region, including Scottish creative industries trade bodies and networks, leading creative companies and individual creative practitioners, and with staff in The University of Edinburgh. We are grateful to the industry for their feedback, and to colleagues within the Data-Driven Innovation Programme, Edinburgh Futures Institute, Creative Informatics Cluster and their partners Edinburgh Napier University, Codebase and Creative Edinburgh for their input, advice and support. The consultation that informs this White Paper was initiated and supported by the Data-Driven Innovation Programme of The University of Edinburgh within the Edinburgh and South East Region City Deal

Association between benzodiazepine co-prescription and mortality in people on opioid replacement therapy:a population-based cohort study

Objective: To investigate the association between Opioid Replacement Therapy (ORT) and benzodiazepine co-prescription and all-cause mortality compared to the prescription of ORT alone.Design: Population based cohort studySetting: Scotland, UK.Participants: Participants were people prescribed ORT between January 2010 and end of December 2020 aged 18 years or above.Main outcome measures: all-cause mortality, drug related deaths and non-drug related deaths. Secondary outcome: ORT continuous treatment duration.Analysis: Cox regression with time-varying covariates.Results: During follow up 5776 of 46899 participants died: 1398 while on co-prescription and 4378 while on Opioid Replacement Therapy only. The mortality per 100 person years was 3.11 during co-prescription and 2.34 on ORT only. The adjusted hazard ratio for all-cause mortality was 1.17 (1.10 to 1.24). The adjusted hazard ratio for drug related death was 1.14 (95% CI 1.04 to 1.24) and the hazard for death not classified as drug-related was 1.19 (95% CI 1.09 to 1.30).Conclusion: Co-prescription of benzodiazepines in opioid replacement therapy increased risk of all cause mortality, although less than the international literature. Co-prescribing was also associated with longer retention in treatment. Risk from benzodiazepine co-prescription needs to be balanced against the risk from illicit benzodiazepines and unplanned treatment discontinuation. A randomised controlled trial is urgently needed to provide clear clinical direction.<br/

Attitudes toward e-mental health services in a community sample of adults: online survey

Background: Despite evidence that e-mental health services are effective, consumer preferences still appear to be in favor of face-to-face services. However, the theory of planned behavior (TPB) suggests that cognitive intentions are more proximal to behavior and thus may have a more direct influence on service use. Investigating individual characteristics that influence both preferences and intentions to use e-mental health services is important for better understanding factors that might impede or facilitate the use of these services. Objective: This study explores predictors of preferences and intentions to access e-mental health services relative to face-to-face services. Five domains were investigated (demographics, technology factors, personality, psychopathology, and beliefs), identified from previous studies and informed by the Internet interventions model. We expected that more participants would report intentions to use e-mental health services relative to reported preferences for this type of support and that these 5 domains would be significantly associated with both intentions and preferences toward online services. Methods: A mixed sample of 308 community members and university students was recruited through social media and the host institution in Australia. Ages ranged between 17 and 68 years, and 82.5% (254/308) were female. Respondents completed an online survey. Chi-square analysis and t tests were used to explore group differences, and logistic regression models were employed to explore factors predicting preferences and intentions. Results: Most respondents (85.7%, 264/308) preferred face-to-face services over e-mental health services. Relative to preferences, a larger proportion of respondents (39.6%, 122/308) endorsed intentions to use e-mental health services if experiencing mental health difficulties in the future. In terms of the 5 predictor domains, 95% CIs of odds ratios (OR) derived from bootstrapped standard errors suggested that prior experience with online services significantly predicted intentions to use self-help (95% CI 2.08-16.24) and therapist-assisted (95% CI 1.71-11.90) online services in future. Being older predicted increased intentions to use therapist-assisted online services in future (95% CI 1.01-1.06), as did more confidence using computers and the Internet (95% CI 1.06-2.69). Technology confidence was also found to predict greater preference for online services versus face-to-face options (95% CI 1.24-4.82), whereas higher doctor-related locus of control, or LOC (95% CI 0.76-0.95), and extraversion (95% CI 0.88-1.00) were predictive of lower likelihood of preferring online services relative to face-to-face services. Conclusions: Despite generally low reported preferences toward e-mental health services, intentions to access these services are higher, raising the question of how to best encourage translation of intentions into behavior (ie, actual use of programs). Strategies designed to ease people into new Internet-based mental health programs (to enhance confidence and familiarity) may be important for increasing the likelihood that they will return to such programs later

Association between benzodiazepine coprescription and mortality in people on opioid replacement therapy:a population-based cohort study

Objective To investigate the association between opioid replacement therapy (ORT) and benzodiazepine (BZD) coprescription and all-cause mortality compared with the prescription of ORT alone.Design Population-based cohort study.Setting Scotland, UK.Participants Participants were people prescribed ORT between January 2010 and end of December 2020 aged 18 years or above.Main outcome measures All-cause mortality, drug-related deaths and non-drug related deaths.Secondary outcome ORT continuous treatment duration.Analysis Cox regression with time-varying covariates.Results During follow-up, 5776 of 46 899 participants died: 1398 while on coprescription and 4378 while on ORT only. The mortality per 100 person years was 3.11 during coprescription and 2.34 on ORT only. The adjusted HR for all-cause mortality was 1.17 (1.10 to 1.24). The adjusted HR for drug-related death was 1.14 (95% CI, 1.04 to 1.24) and the hazard for death not classified as drug-related was 1.19 (95% CI, 1.09 to 1.30).Conclusion Coprescription of BZDs in ORT was associated with an increased risk of all-cause mortality, although with a small effect size than the international literature. Coprescribing was also associated with longer retention in treatment. Risk from BZD coprescription needs to be balanced against the risk from illicit BZDs and unplanned treatment discontinuation. A randomised controlled trial is urgently needed to provide a clear clinical direction.Trial registration number NCT04622995.</p

How Can I Drink Safely?; Perception Versus the Reality of Alcohol Consumption

This article investigates differences between perception and actual consumption of alcohol in young adults within the UK, suggesting that inaccurate information in the public domain may hamper those seeking to drink safely plus the development of moderate drinking cultures. Results confirm that inaccurate information may be preventing the development of safe drinking behaviours among certain groups. In addition, they indicate that some groups choose to ignore safe consumption limits in particular circumstances. Results indicate that many government strategies aimed at reducing unsafe drinking behaviour are inaccurately targeted; changing male public consumption behaviour may trigger changes in female behaviour